Thursday, February 17, 2011

Who Is Restricting Your Choice of Health Care Provider?

Opponents of health care reform scared people with a Boogie Man which had the federal government coming between you and your doctor. Now for over 20,000 people in the Seacoast area, that is exactly what is happening. But it isn’t the government; it’s an insurance executive at Anthem forcing them to give up their primary care provider. Anthem subscribers who receive their care from providers affiliated with Exeter Hospital have been notified that they must change their primary care provider or specialist, and can no longer be treated at Exeter.

Most of the press reports have implied that this is merely a problem brought on by Exeter Hospital and CORE providers being accused of charging too much; a business decision about the bottom line. For Anthem, whose parent company, Wellpoint made $4.2 billion in 2009, that is true. When they talk about cutting costs, it’s not overall health care costs they are concerned about, it’s their own costs. Negotiating lower reimbursement to care providers allows them to continue to keep a healthy profit margin for their stock holders and to keep their triple A stock rating on Wall Street.

However there may be another aspect to this story. Recently passed health care payment reform will require insurance companies to spend 95% of what they bring in on your care (Anthem only spends approximately 84% currently). This would mean Anthem wouldn’t have that 11% of your money to do other things with, like high executive compensation, and contributions to candidates who work in their favor both at the state and federal levels (see recent Supreme Court decision Citizens United v. Federal Election Commission, No. 08-205). You can also Google “Anthem profits” to see many stories about what Anthem has tried to do in many other states. We are not unique.

In our state this appears, however, to be a test case. Exeter Hospital and its affiliated providers are the only ones whose contract is up for negotiation this year. If Anthem succeeds, next year this will occur in many more places in NH since Anthem controls a 70% market share in providing group health insurance (in my mind an unhealthy monopoly situation). If Anthem does succeed and is able to decrease their costs, their subscribers should receive a rebate check for those savings, yes? (Personally I won’t be holding my breath waiting for it). Let your imagination run free thinking about where that money will go instead.

This is just business, right? Unfortunately, the pawns in this game by Anthem are real people, who count on continuity of care to maintain their health. Anthem has told patients there are plenty of primary care providers in the area to absorb these 20,000 plus patients. (ask anyone who has recently changed providers what the wait is or how difficult the process is to make sure you have all of your medical records). Of course you could self pay as long as your health problems don’t make it prohibitive. One provider is just as good as another, no long term relationship counts, correct? Someone who has known your history or your whole family doesn’t matter. What happens while the change is in process and you need a medication refill, can’t get in to see the new provider who knows nothing about you or your problems? What happens if you get sick while you are waiting to change? Does this mean an ER or Urgent Care visit? Will you end up in the hospital because your chronic illness now isn’t being managed effectively, like it has been for the last however many years by the provider you know and trust? Remember, insurance companies have never treated you, held your hand when you were in pain or received bad news, identified a life-threatening disease or prevented an illness. They are a payment mechanism, which doesn’t know you personally and doesn’t have any idea of what happens to you unless it costs them money.

Anthem says they have no further interest in negotiating. Governor Lynch says he won’t get involved (perhaps he has no constituent voters in this area?). The Insurance Commissioner says he won’t make an additional sixty-day extension to force further negotiations. Seems no one in NH government has any particular concern about the needs of over 20,000 people in the Seacoast area. The message is clear. This is about an insurance company, a business, not about maintaining the health of people in the Granite State. This is for Anthem, not you.

I have two stakes in this situation. I am being forced to give up the provider who has provided me with quality care for the last ten years, and I am a Nurse Practitioner comforting patients who are being told they can no longer be seen in our practice. One patient told me recently that she feels like killing herself (after counseling she agrees not to). It had taken nearly a year to find our practice where she received top quality care, had a chronic condition identified and effectively managed, and where everyone was caring. Now she is being forced out. She must start the search again and we, in frustration, can only wish her luck.

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