Transparency would improve health exchange

Competition will only resolve some of the flaws of the new system


Published:

This month, the door formally opens on the Affordable Care Act in New Hampshire and patients begin to use their plans on the state’s health exchange. It was good to read in this paper that help is on the way to offer alternatives to plans offered by Anthem Blue Cross and Blue Shield, currently the only insurer available on the exchange (“Third health insurer plans to enter N.H. market,” Dec. 27-Jan. 9 NHBR).

Minuteman Health Inc. and Harvard Pilgrim Health Care have both signaled a desire to join New Hampshire’s marketplace in 2015. That’s good, but help won’t arrive soon enough to prevent major damage to patients who wish to keep their doctor.

Because of the structure of New Hampshire’s health care exchange, Granite Staters are stuck under the shadow of a network that triggers more questions than answers. Anthem negotiated the terms of the deal, and then decided which providers would be included in this narrow network.

The new plan has federal government approval and a full endorsement by the state. Factors that reportedly went into the creation of Anthem’s network include cost, access for patients and the availability of services people needed to match the requirements of the ACA. Anthem alone decided which hospitals and providers would participate.

Unlike networks in Massachusetts, where cost and quality data must be included in the public process, New Hampshire’s plan was crafted in total secrecy.

The result is that in New Hampshire, a health insurance company has stepped into the middle of a doctor/patient relationship.

Look no further than Rochester, where Frisbie Memorial Hospital was frozen out of Anthem’s narrow network. There was no negotiation. Our hospital was given no chance to apply or compete for access into the plan. We were excluded, even though Frisbie Hospital has lower hospital charges than its closest competitors, as well as consistently high marks for quality care.

With Frisbie shut out, there are several thousand people in greater Rochester who, if they wish to obtain coverage on the exchange, will have to travel out of the city and find a new doctor. Take it or leave it. But individuals of moderate means who elect not to obtain coverage through the exchange will lose access to federal government tax subsidies to pay part of their premiums.

This is not what was promised to patients and their families.

Defenders of the status quo will argue the arrival of Minuteman and Harvard Pilgrim in 2015 offers the solution to our problem. But that argument ignores the biggest flaw in Anthem’s new health care network.

With the state and federal governments’ blessings, this narrow network was born outside of any public scrutiny. Unlike networks in Massachusetts, where cost and quality data must be included in the public process, New Hampshire’s plan was crafted in total secrecy.

Anthem claims it is cutting premiums 25 percent in the narrow network. Yet Minuteman’s CEO has publicly stated he can offer premiums 20 percent below Anthem’s new rate and offer a broader network. This is good news and is indicative of what real competition can do – lower premiums and offer more provider choices.

However, there is still a need for transparency for the public to know if this major public policy reform is the best we can get for New Hampshire. Other states allow the public to see the fine print of these contracts. We should have the same access.

The public has a right to know what is in the fine print of the government-approved narrow network. I’m sure Harvard Pilgrim and Minuteman would also like to know what deals have been struck to this point. Competition will resolve some of the flaws of this new system, but without the full light of disclosure of the fine print of every plan, New Hampshire’s narrow network will not be an improvement.

Al Felgar is president and CEO of Frisbie Memorial Hospital in Rochester.


 

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