Why Sacramento’s Western Health Advantage is further expanding Bay Area coverage

Charlotte Gibbs, an analyst with Sacramento-based Western Health Advantage, talks to a member on the phone.
Charlotte Gibbs, an analyst with Sacramento-based Western Health Advantage, talks to a member on the phone. lsterling@sacbee.com

Western Health Advantage, the managed-health plan founded by Sacramento and Solano County doctors in 1996, plans to further expand its coverage in the Bay Area and partner with providers in the UCSF medical system and John Muir Health to cover more populous counties, CEO Garry Maisel said Tuesday.

“The Sacramento region and the San Francisco region have now really become one mega-region,” Maisel said. “People commute from the bay to Sacramento for jobs. They commute from Sacramento to the bay for jobs. It makes sense to be able to cover people who live in both areas because that’s how the business world does business now in this area.”

Maisel noted that he expected the connectedness to only increase. The Greater Sacramento Economic Council and the Bay Area Council announced a few months ago that they would partner to attract businesses to a mega-region that stretches from the craggy cliffs of the Pacific to the foothills of the Sierra. Maisel sits on the board of the Sacramento economic council.

Western Health Advantage has been serving the North Bay Area – Marin, Sonoma and Napa counties – for about four years. About 20,250 individuals, or 15 percent of the health insurer’s roughly 135,000 members, live in those counties. The remainder are in the Sacramento region.

Those North Bay counties are home to roughly 911,132 residents, according to January 2017 population estimates by the California Department of Finance, compared with 4,429,303 in the counties now being added: San Francisco, San Mateo, Alameda and Contra Costa counties.

To serve members in the Bay Area, Western Health inked an agreement with a health care alliance known as Canopy Health. Formed in 2015, Canopy united UCSF Health and John Muir Health. It has more than 4,000 participating physicians and 13 hospitals and about a dozen urgent-care centers around the Bay Area. Western Health has sought state regulatory approval for the expansion.

“Our goal has always been to create the most accessible and transparent network in the Bay Area, and we feel this new relationship will allow us to exceed our goals in every way,” says Joel Criste, the chief executive of Canopy Health.

The Bay Area expansion comes as Western Health also integrates new members from the California Public Employees Retirement System. CaIPERS announced that it expects to spend an estimated $9.1 billion in 2018 to purchase health benefits for 1.4 million active and retired state, local and school employees and their families.

At the same time, UC Davis physicians will no longer offer primary-care services to Western Health’s business customers starting Jan. 1. However, the Sacramento-based insurer offers health insurance to employees of the University of California system, and UC Davis doctors will continue to serve those Western Health members. In total, Maisel said, about 20,000 Western Health Advantage members must find new primary-care doctors by Jan. 1.

“We’ve notified all of our members by letter, saying that, if you have a UC Davis primary-care doctor, you have to make a change by Jan. 1 of this year,” Maisel said. “We’ve provided them with lists of other doctors that are ready, willing and able to see them.”

Cathie Anderson: 916-321-1193, @CathieA_SacBee