September 11, 2013NORTH COUNTRY — Last week North Country residents from the Canadian border at Pittsburg south to northern Grafton County were startled to learn that Anthem Blue Cross Blue Shield of New Hampshire was only including one hospital — Weeks Medical Center in Lancaster — in its Pathway network of hospital providers for individual and small business policies under the Affordable Care Act's exchange or marketplace, set to go into effect on Jan. 1, 2014. Small businesses will be able to buy insurance through the Small Business Health Options Program (SHOP) exchange.
A number of leaders — hospital CEOs and legislators — worked quickly to overturn the insurance company's oversight in failing to include an easily reachable hospital that offers obstetrics and maternity care.
On Thursday, Sept. 5, Anthem decided to expand its network of hospital providers to three by adding two facilities: the Androscoggin Valley Hospital in Berlin and the Littleton Regional Healthcare (LRH) in Littleton, which both offer obstetrical-maternity services, reported Sen. Jeff Woodburn of Dalton.
"This is a coup for the North Country, leaving us with better and more comprehensive health care coverage than many (network dependent residents in other) areas of the state," Woodburn explained. "The key issue was the lack of obstetrics at Weeks, which left women far from needed services," he said. Woodburn's wife Kelly works as an obstetrical nurse at LRH.
Neither Weeks nor UCVH offer birthing or associated services.
Under the original plan, a pregnant woman in Pittsburg would have had to drive (or be driven) over three hours to Dartmouth Medical Center in Lebanon or Memorial Hospital in Conway, Woodburn pointed out. "This is not an issue of inconvenience, but rather impossibility," he said. "While Colebrook's Upper Connecticut Valley Hospital (UCVH) is not included in the network, I will continue to work with them to include them in other programs," Woodburn said. "I should note that UCVH would still provide emergency room (ER) services to those covered by the exchange, which accounts for a significant amount of the care that the facility provides. Under the Anthem plan, emergency care in non-network hospitals will be covered. This is vitally important as the region is developing a vibrant OHRV-ATV 1,000-mile-long trail system — 'Ride the Wilds.'"
Today, 16 of the 24 hospitals in the state are in the Anthem Blue Cross network. "Each hospital negotiated individually with Anthem," Woodburn explained. "Anthem is looking to create efficiencies and can offer volume of business in return for a discounted price; it is a balance between premium price and what they call network adequacy."
Woodburn, who represents District 1, believes that approximately 3,000 of the 55,000 residents in his district will be eligible to be covered under the new Anthem exchange, the state's only provider.
If Medicaid is expanded or if private companies with less than 50 employees drop private insurance, then that number could grow, he pointed out, noting that an exact figure cannot yet be known.
Woodburn praised the CEOs of North Country hospitals, as well as other health care professionals and elected officials' who united to make their voices heard. "I received plenty of support from new Senate President Chuck Morse's Republican leadership team," the freshman senator added.
"We were also lucky that North Country legislators and Executive Councilor Ray Burton had a previously planned meeting with all the hospital CEOs two days after Burton and I were both notified of the original plan," Woodburn said. "I'm particularly pleased by the bipartisan approach. Rep. Ralph Doolan, a Republican of Littleton, suggested the meeting, and Rep. Larry Rappaport, a Republican of Colebrook who wasn't at the meeting, helped by trying to secure a rural waiver. The hospital CEOs acted unselfishly, keeping in mind the good of the whole North Country."
The work the three northern hospitals have done to ramp up cooperation and collaboration, sparked by grants from the Neil and Louise Tillotson Fund, has opened up lines of communication and helped to develop a strong sense of trust that crosses watershed boundaries, he said.
The goal of ObamaCare, Woodburn reminded, is to provide health coverage to more people through a mix of private and public systems. The exchange is designed to cover people who now have no insurance and are not covered by Medicaid, Medicare or private insurance.
"Half of all the uninsured people in New Hampshire live in the North Country — and we would benefit more than anywhere else by expanding Medicaid to include low-income working people and by creating an affordable exchange," Woodburn said. "All those who live among us without any health insurance coverage still use health care, and this causes great economic stress to our local hospitals and instability in our neighbors' lives."
AVH CEO Russ Keene and his counterparts at the other three North Country hospitals worked "day and night" to ensure that the North Country women's need for obstetrical and maternity services could be met, explained AVH spokesman James Patry in a Friday telephone call. "We're very fortunate that AVH, Weeks, LRH and UCVH are able to work well together and understand our common regional needs," Patry said.
LRH CEO Warren West also said on Friday that the region's hospitals had worked together to ensure that their patients' need for good quality care, including obstetrical services, could be met.