Health Plans, APD in Talks For Coverage

All N.H. Hospitals Expected To Be in a Network in 2015

Lebanon — Talks underway with Anthem Blue Cross Blue Shield, New Hampshire’s largest health insurer, could result in the addition of Alice Peck Day Hospital to Pathway, the Anthem network available to residents who seek coverage in 2015 through the federally operated exchange created by the Affordable Care Act.

That inclusion, if consummated, along with other proposed expansions to the exchange, known as the New Hampshire Marketplace, would substantially add to the choices available to consumers who are required to have health insurance by the ACA but lack coverage through their employers, the Medicare program for the elderly or the Medicaid program for low-income individuals and families.

Anthem had already announced plans to add two other small hospitals in the Upper Valley to its proposed exchange network for 2015: Cottage Hospital in Woodsville and Valley Regional Hospital in Claremont.

And last week the state Insurance Department issued a summary of insurance company proposals currently being reviewed that shows residents shopping in the marketplace for 2015 coverage being able to choose from 50 plans from five insurance providers that among them offer coverage for care from all of the state’s 26 hospitals.

The final lineup of insurance plans and hospitals available through the marketplace in 2015 remains uncertain, as the public comment period lasts until July 8, New Hampshire regulators face an Aug. 10 deadline to recommend which companies and plans should be offered in the marketplace and federal review of the proposals extends into September.

Open season for consumers to shop for 2015 coverage through the Marketplace is scheduled to start Nov. 15.

The evolving and uncertain Marketplace reflects changing alliances, powerful economic forces and old-fashioned deal-making in the health care and insurance industries that will have big implications for the choices that will be available to New Hampshire residents who want or need to buy individual health insurance policies. Those factors will also affect the economic health and caregiving roles of the big and small hospitals that comprise the region’s health care resources.

In that context, Lebanon-based APD, a 72-year-old hospital with annual revenue of about $60 million that stands a mere four miles away from Dartmouth-Hitchcock Medical Center, where annual revenue exceeds $1.1 billion, might be viewed as a barometer to measure changes underway.

Chris Dugan, an Anthem spokesman, said that the insurer is “discussing our exchange network with (APD) hospital.” Those discussions began after Alice Peck Day’s representatives contacted Anthem “regarding (APD’s) affiliation discussions with Dartmouth-Hitchcock,” he said.

APD spokesman Peter Glenshaw confirmed that the hospital had begun talking to “Anthem Blue Cross Blue Shield in the hopes of being included in their network next year.”

He said he did not have enough information to comment on why his hospital’s pending affiliation with its bigger neighbor had been a factor in Anthem’s decision to begin talking. He did confirm that the process of formally affiliating APD with Dartmouth-Hitchcock remained on track and that it was “still our expectation” that the formal hook-up would be completed by the end of 2014.

Dugan said that Anthem was persuaded to include additional small hospitals in its network because it had learned more about their role in providing care for patients who initially receive high-level or intensive care at Dartmouth-Hitchcock, then receive less intensive care or rehabilitation services at smaller hospitals.

Rolf Olsen, a spokesman for Valley Regional, which got included in the Pathway network even though it is not currently moving toward affiliation with D-H, said that at least one other factor seemed to have prompted Anthem to add to the list of hospitals from which its policy holders could receive care on the most favorable terms: “There was considerable pressure placed through the legislative delegation by (Valley Regional CEO) Peter (Wright) and by other CEOs.”

Dugan declined to comment on how politics might have factored in Anthem’s change of course, other than to note that the insurer continued to work to “balance access and affordability.”

For whatever reasons, big changes are underway in the New Hampshire exchange where, this year, 38,000 New Hampshire residents purchased policies from Anthem, which was the only supplier of coverage and offered care in a network that excluded 10 of the state’s 26 hospitals.

APD, Cottage and Valley Regional hospital found themselves on the outside looking in.

For 2015, four other insurers are seeking regulatory approval to compete with Anthem and all of the state’s hospitals seem on track to be included in multiple networks .

Interviews with hospitals and insurers confirmed that under agreements in place, Harvard Pilgrim would include all five Upper Valley hospitals in its basic health maintenance organization network, while all but Valley Regional would be in the ElevateHealth HMO network. ElevateHealth is a partnership with Dartmouth-Hitchcock and Elliott Health System of Manchester that uses a coordinated care model and has premiums about 10 percent lower than Harvard Pilgrim’s other HMO, said Harvard Pilgrim spokeswoman Mary Wallin.

Minuteman Health Network has agreements to include APD, Cottage and Valley Regional in its network, while representatives at Mary Hitchcock and New London said they were talking with Minuteman. A Minuteman spokesman confirmed the hospitals in its network but was unable to immediately confirm the talks. Yet another insurer, Wisconsin-based Assurant Health, is talking about network inclusion with APD and New London, according to hospital representatives.

A year ago, Anthem’s decision to stick with a narrow hospital network sparked controversy. In the Upper Valley, Anthem’s Pathway network included only DHMC and New London Hospital, which in 2012 had affiliated with Dartmouth-Hitchcock in an agreement that gave the larger organization seats on New London’s board and control over some of its strategic decisions.

Dugan said that Anthem excluded some hospital to keep premiums in check. “The concept of a narrow network is not unique nationally” but was new to New Hampshire in 2014, he said.

The narrow network allowed “Anthem to offer health benefit plans on the (exchange) that are priced approximately 30 percent lower than a plan using a broad network,” the insurer said in a news release.

As the sole insurer available to consumers shopping for insurance in the Marketplace, Anthem had been in a position of strength in its dealings with hospitals.

“In exchange for a low rate, they will be part of our network,” Dugan said. “What the provider gets back is volume.”

Dugan was unable to say how the expansion of insurance company competition in the Marketplace would affect Anthem’s future leverage to extract price concessions from hospitals.

Rick Jurgens can be reached at or 603-727-3229


An earlier version of this story incorrectly attributed to Anthem spokesman Chris Dugan a statement about the way in which Anthem negotiated with hospitals for the current network.