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Frozen Out of HIX, NH Hospitals Feel Burned

Christopher Cheney, for HealthLeaders Media, January 27, 2014

New Hampshire hospital leaders are crying foul over being squeezed out of the single health insurance exchange plan available in the state. Anthem says offering a 'select network of providers' will offset premium increases.

Healthcare providers from Maine to California are being shut out of health insurance exchanges, but in New Hampshire, hospitals shut out of the state's insurance exchange network are not going quietly.


Marie Ryan

Marie Ryan
CEO, Cottage Hospital

The stage has been set for a clash over the issue in the Granite State, where Anthem Blue Cross Blue Shield of New Hampshire is the only insurer offering a plan—Anthem Pathway—on the health insurance exchange. Nine of the New Hampshire's 26 acute-care hospitals have been excluded from the network and Concord Hospital has declined to join over Anthem Pathway's relatively low reimbursement rates.


See Also: HIX Pains Now, But Hope for Long-Term Relief in NH


"Anthem [pays] providers at pretty much Medicare rates," said Scott Sloane, vice president of finance at Concord Hospital. "Over the long term, it's a really bad idea." Concord Hospital, based in the state's capital, is a non-profit regional medical center with 295 licensed beds.

While top officials at the out-of-network hospitals are concerned about the long-term financial effects of Anthem's narrow network, they are nearly apoplectic over the implications for two key goals of the PPACA reform effort: improving access to healthcare services and boosting population health.

'Swimming Against the Tide'
"It's not a money issue for me," said Maria Ryan, CEO of Cottage Hospital, a 25-bed critical access hospital in Woodsville serving 26 New Hampshire and Vermont towns. "It's making sure [the patients] stay healthy. I'm swimming against the tide now when it comes to making sure they are compliant and making their appointments."

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