Limited provider networks could be the cost-cutting solution we’ve been looking for

Anthem’s and Harvard Pilgrim’s innovative new networks, involving leading health care providers throughout the state, should be applauded as cost-effective alternatives to the old way of doing things

While serving as president of the Business and Industry Association for nearly nine years, I’ve had the chance talk to people from all walks of life, all over the state, about their health insurance priorities.

I’ve talked to small business owners in Concord and Manchester who employ young mothers needing health insurance policies that provide access to quality care for their children, but don’t break the bank. I’ve talked to contractors on the Seacoast who work in dangerous jobs and need policies that cover the unexpected. I’ve talked to young professionals in Nashua and Salem who don’t expect to be sick but want coverage that gives them access to yearly check-ups and other preventive services.

All these people have different lives with different challenges. But the one thing they have in common is that cost is a primary driving factor as they figure out and select a health insurance policy that works best for them.

Starting this January, Granite Staters like these folks will have new options and benefits when the Affordable Care Act goes into effect. Whether or not you like the ACA, it is the law of the land. The ACA requires all Americans to buy health insurance or pay a tax penalty. To expand access to health insurance, each state is now required to set up an online health insurance marketplace so that individual customers and small businesses with 50 or fewer employees can shop for health insurance.

Online marketplace options are shaping up to offer good choices. For example, many people who already have a policy will see expanded benefits, including services like doctor visits and outpatient care, emergency medicine, maternity and newborn care and prescription drug coverage. Screenings, shots and exams will be offered for free, as well as plans with lower deductibles and subsidies for people who need them.

But here’s the catch. Expanded benefits and more people covered mean higher costs. So health insurers are faced with a choice: either pass those costs on to the insured – primarily businesses and their employees – or find ways to manage those costs so health insurance remains affordable.

It’s one thing to talk broadly about the concept of expanded health care coverage under the ACA, but quite another to put it into action. It requires that health insurers adapt and come up with creative solutions that work for those paying the bills, employers and employees.

In New Hampshire, we are witnessing health insurers do just that – developing creative solutions, in partnership with leading health care providers, to ensure everyone in New Hampshire has access to quality health care, while taking steps to mitigate steep and continuous premium increases.

Anthem Blue Cross and Blue Shield is the only carrier offering health insurance plans on New Hampshire’s online marketplace during the first year. (Northeast Delta Dental is offering dental plans in the online marketplace.) Anthem’s approach to managing costs across the state is to develop a health care network with 16 leading health care providers.

The network has a dual goal of reducing health care costs while continuing to offer businesses and their employees access to excellent care. In the individual market, where the majority of activity will occur, New Hampshire residents who choose Anthem’s products will see premiums that are more than 25 percent lower than the same products would be with a broader network.

Similarly, Harvard Pilgrim Health Care has partnered with Dartmouth-Hitchcock Medical Center and Elliot Health System to offer businesses a lower-priced health insurance product. They are employing similar cost-saving strategies, such as select provider networks and more efficient use of resources, and will offer this product for 10 percent less than similar products in the market.

As those familiar with the BIA know well, we invest significant time and energy each year to ensure we understand the key challenges facing our members. While some responses change from year to year, one constant is the concern over the affordability of health care and health insurance in our state.

Continually rising health care and health insurance costs are simply not sustainable for employers or employees. Innovation will be the single greatest factor in bringing health care costs under control. Anthem’s and Harvard Pilgrim’s innovative new networks, involving leading health care providers throughout the state, should be applauded as cost-effective alternatives to the old way of doing things. In the changing health care landscape, the old way hasn’t succeeded in bending the health care cost curve. These new innovations just might.

Jim Roche is president of the Business and Industry Association of New Hampshire.

Categories: Opinion