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UPDATED: Dartmouth-Hitchcock and Elliot Health join forces to offer insurance plan 10% below Harvard Pilgrim

September 09. 2013 8:27PM

CONCORD — Two of the largest hospitals in New Hampshire, Dartmouth-Hitchcock and Elliot Health Systems, have joined forces with Harvard Pilgrim Health Care to create ElevateHealth, a health insurance plan that will be offered at first only through the workplace at rates 10 percent below identical plans Harvard Pilgrim offers employers through its existing statewide network.
The two hospitals and the health insurance company formed a business partnership and built a small network of providers in the hope of controlling costs, improving outcomes and coordinating care, according to a presentation by senior executives from all three organizations at a news conference Monday morning in Concord.
In addition to Elliot and Dartmouth-Hitchcock, providers in the network will include Cheshire Medical Center, New London Hospital, Southern New Hampshire Medical Center, Derry Medical Center and physicians or practices associated with those hospitals, with coverage beginning on Dec. 1.
A business partnership in which an insurance company and health care providers share both the risks and rewards of an insurance product is new to New Hampshire and not that common nationally. The Kaiser Permanente Plans in California and plans offered through the Mayo Clinic in Minnesota were cited as two examples.
Dr. James N. Weinstein, CEO and president of Dartmouth-Hitchcock, proposed the idea to Harvard Pilgrim and reached out to Elliot Hospital to begin the negotiations that led to the creation of ElevateHealth. Weinstein said the collaboration has the potential to "change the landscape of health care delivery in this state and serve as a model for the nation."
ElevateHealth will offer a variety of plans with varying costs and benefits that will be available only through employer-sponsored health insurance programs for now, although the hope is to expand the network over time and eventually add individual purchase options.
Eric H. Schultz, president and CEO of Harvard Pilgrim, said the company intends to offer coverage through the state's online health insurance exchange as part of the Affordable Care Act in 2015, and that ElevateHealth plans could be among the offerings.
Breaking old patterns
The collaboration is an effort to break the traditional relationship between insurers and providers, which often became adversarial and has contributed to escalating health care costs, said Schultz.
"Negotiations have fed the volume game," he said. "That's gotten the health care system in trouble, and we're all looking for solutions. Where are we overlapping? What can we stop doing? What can we do better?"
The announcement of ElevateHealth, with its six-hospital network, comes just a week after Anthem announced that 10 of the state's 26 hospitals would not be included in the Anthem network of providers when the online exchange goes live on Oct. 1, with Anthem as the only insurer in the first year.
"It certainly is interesting coming on the heels of what's been gong on with Anthem," said Lisa Kaplan Howe, policy director at New Hampshire Voices for Health. "Narrow networks are not new. They used to be more common in New Hampshire and are more common in other states. What we'll be watching for is where it crosses the line from a change that maintains access to one that creates barriers to care."
The savings in ElevateHealth that will allow for a 10-percent cost reduction are supposed to come from better coordination, elimination of duplication and an enhanced role for nurses in the delivery of care within the network.
"Nurses will play a pivotal role as patient advocate and clinical liaison with primary care providers and specialists," according to the joint news release issued by the three partners.
The limited number and location of ElevateHealth providers and the employer-only focus suggests a limited rollout to test the idea. There are no network providers in the Seacoast area or North Country, at least for now.
The partners are in the process of hiring an executive director for ElevateHealth, who will have a tough assignment, according to Schultz, "reporting to three masters."


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