June 26, 2013

Critics: Maine health deal hurts patients

A state agency will soon decide whether letting Anthem and MaineHealth be Obamacare partners is a good idea.

By Jessica Hall jhall@pressherald.com
Staff Writer

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click image to enlarge

In this September 2012 file photo, a patient is wheeled out of Barbara Bush Children's Hospital at Maine Medical Center in Portland. A state agency will soon decide whether letting Anthem and MaineHealth be Obamacare partners is a good idea.

Gregory Rec / Staff Photographer

The White House did not respond to the Portland Press Herald's calls Tuesday and Wednesday.

By controlling which hospitals are involved in the network, Anthem and MaineHealth can contain costs, the companies said.

The hospitals participating in the network agreed to accept reduced payments from Anthem in exchange for having more customers directed to their facilities, the companies said. For certain clinical services that aren't available in Maine but are offered in Boston, a consumer would still be covered under the plan.

The proposed plan "responded directly to some of our priorities of providing a less costly product for individuals and small businesses, and the opportunity to persuade more people that our hospitals and physicians are the right choice," said Francis McGinty, executive vice president and treasurer of MaineHealth.

Weeks said she has been a Blue Cross and Blue Shield subscriber for 29 years and doesn't want to change doctors or insurance plans.

"It would turn my world upside down," she said. "I've worked very hard building relationships with providers. It's not just as simple as going to the doctor and getting a Band-Aid. There's an awful lot involved in managing a chronic illness."

McGinty, with MaineHealth, said people will not be required to change doctors unless they buy the Anthem-MaineHealth product. If they want to keep their physicians and hospitals, they can buy the product being offered by Maine Community Health Options, he said.

"The only people who are going to be impacted are those who are buying this product because it is the right choice for them," McGinty said. "There are other choices available to them and we respect their decision."

Still, the possibility that they will have to change doctors or buy new insurance plans has upset some patients and providers.

"Most companies don't turn their back on their current customers. Sure, there are other options, but why should Anthem turn their back on their customers?" said Chuck Gill, a spokesman for Central Maine HealthCare.

Central Maine Healthcare, the parent of Central Maine Medical Center, and Bridgton and Rumford hospitals, slammed the Anthem-MaineHealth plan as a "backroom" deal that discriminates against consumers in central and western Maine. Central Maine Healthcare filed a lawsuit seeking the release of information filed by Anthem with the Bureau of Insurance. Some of that information was released by the bureau in the past week, such as the list of doctors and health care facilities in the proposed plan.

"We have been getting a peek at information here and there," Gill said this week. "But you play peek-a-boo when you're a child, not when you're dealing with people's health care. It's just three days before the hearing and we don't have all the information we need to respond."

Opponents also say the proposed Anthem-MaineHealth plan is more about shutting out competition than keeping down costs and maintaining quality of care.

For example, Central Maine Medical Center received the highest safety rating of four Maine hospitals examined by Consumer Reports in 2012, while MaineHealth's Maine Medical Center in Portland ranked fourth.

For 2013, Central Maine Medical Center and Maine Medical Center received "A" ratings from the LeapFrog Group, which measures hospital quality.

"It's not about high quality and low cost. Anthem and MaineHealth are basically not able to be believable about what they're saying," said Dr. John Kroger, a family practitioner in Rumford. "I can't take it seriously when they're saying this is about controlling costs and improving quality -- it doesn't meet any straight-face test."

Kroger said some patients from Bridgton to Rumford to Brunswick would have limited access and choice under the Anthem-MaineHealth plan. Kroger said he would lose dozens of patients, who would be forced to travel long distances to see doctors within the Anthem-MaineHealth plan.

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