Anthem rejoins health partnership fold

Anthem Blue Cross Blue Shield of New Hampshire has announced that it’s going back to the drawing board to help build a tiered health-care product with some of the state’s largest purchasers of health insurance.

“This cause is so worthy, we needed to be at the table,” said Douglas Wenners, vice president of health care management at Anthem in New Hampshire.

The decision marks a change of heart for the company, which on March 15 announced that it was declining an offer to from the New Hampshire Healthcare Purchaser Partnership to build a “tiered” health insurance network that would rank providers based on quality and cost-efficiency measures. The reason.

At the time, Anthem expressed frustration with the nearly two-year effort, pointing to what it saw as the provider community’s limited role in designing the new health-care product.

Wenners, who made the latest announcement at the June 8 meeting of the partnership, acknowledged that development and eventual rollout of a tiered product that expects high-quality services from providers at lower costs than traditional health plans “will not be easy.”

A human resources manager who attended the open purchaser meeting expressed her relief at the Anthem decision, saying that without a large provider like Anthem taking part, it was doubtful the program could have continued.

“It wouldn’t make sense to build a product nobody wanted to sell,” she said.

James Weiss, president of the partnership’s board of directors, said Anthem’s return to the fold “was huge. We now have a partner that will work with us to build a product.”

In October 2003, the partnership issued a request for proposal, asking interested providers to commit to developing and marketing the product. Two of New Hampshire’s three largest insurers, Anthem and CIGNA, expressed a desire to discuss the model. Harvard Pilgrim declined, stating its New Hampshire membership was not large enough to make such a tiered product viable in this state.

Eventually, CIGNA declined as well, saying it, too, was piloting a similar program in the West.

Anthem continued to work with the partnership, but found certain specifics in the RFP undoable.

“The partnership was demanding to have a product built by July 2004. We couldn’t do that,” said Wenners. “We proposed to work through it over time, but we were pushed.”

According to Weiss, talks held in late March with Marjorie Dorr, president of Anthem East, were instrumental in rebuilding the partnership’s relationship with Anthem.

“She thought they had to create a new network. We just wanted a tiered co-pay system. She said that Anthem would be able to do that.”

Wenners said the time constraints also have been relaxed, allowing for some retooling of the concept.

“There is no timetable now. We know this issue is very complex. We see a lot of challenges with this. The partnership is very passionate, and it’s understandable why. It will take time to develop a product.”

Apparently, quite a bit of retooling is taking place. Weiss stopped short of saying they were redesigning the concept from scratch, but he did say that both sides “continue to discuss in detail how to determine quality, tiering the co-pay and the data. We’ve done a lot, but we want to make sure we’re all on the same page. Hopefully, we will have something in place by July 2005.”

While the timetable may have been extended, the partnership still has not extended its hand to the physician community, something that still rankles Anthem.

“It is still an issue, I have to be frank,” said Wenners. “We’ve always worked together with physicians and hospitals, and that is something we strive to maintain. To not be asked to do this is a strange place for us. How that’s going to play out, I can’t say specifically. It is our experience that you get the strongest support when you work with the physicians and hospitals.”

One of the largest hurdles the partnership has been trying to overcome is New Hampshire’s relatively small population – and the number of providers in the state. According to the New Hampshire State Board of Medicine, there are about 5,200 physicians actively practicing in the state. Most experts agree tiered products work best if there is choice available.

To help address that concern, the partnership is in discussion with the Maine Healthcare Purchasing Collaborative, a group that advocates on behalf of employers in that state to the provider and managed care communities.

The Maine group developed a value-based purchasing model for pharmaceuticals that would reimburse quality providers at a higher rate, but the product became stalled in the Maine Legislature.

Weiss said that since Anthem Maine, like Anthem New Hampshire, also is part of the larger Anthem East group and already has a relationship with the Maine purchaser group, he is hoping the New Hampshire partnership will work with the Maine group.

Anthem Maine also has a relationship with several employers that have a presence in both states, such as Hannaford, whose vice president of human resources, Peter Hayes, sits on the New Hampshire partnership’s board of directors.

Anthem’s Wenners said, “We are now starting to look at this as a regional issue, instead of just a New Hampshire one.”