Harvard Pilgrim, Elliot Health and Dartmouth-Hitchcock unveil new care-coordination network

Last modified: 9/10/2013 12:16:31 AM
Two of New Hampshire’s largest health care providers announced yesterday they have formed a unique partnership with Harvard Pilgrim Health Care, hoping to lower costs and improve patient care, but cutting out many of the other providers in the state.

The program, called ElevateHealth, will begin covering members in December, with premiums that should cost at least 10 percent less than Harvard Pilgrim’s full-network plans. The network offered by the company’s other plans will not be affected by this new partnership.

Officials from the founding organizations said yesterday that more than 400 primary care doctors and 2,600 specialists are included. The providers are the Dartmouth-Hitchcock Medical Center and the Dartmouth-Hitchcock Clinic, Elliot Hospital and its physician network, New London Hospital and New London Physicians, Foundation Medical Partners, Southern New Hampshire Internal Medicine, Southern New Hampshire Medical Center and Cheshire Medical Center.

Concord Hospital is not part of the network for ElevateHealth, but the officials at yesterday’s announcement said they hope and plan to grow the network as time passes.

The two founding hospital partners have agreed to take a lower reimbursement rate from the insurer in order to provide savings that are used to increase care coordination, said James Weinstein, CEO and president of Dartmouth-Hitchcock.

“The mantra is to create a sustainable health system in New Hampshire and in this country. We don’t have one,” he said.

Under the new plan, nurses will take on a larger coordination role, becoming a “trusted navigator” for patients as they interact with the health care system, Weinstein said.

A care coordinator would be alerted if, for example, a family frequently seeks care at the emergency room for a child’s asthma, said Eric Schultz, president and CEO of Harvard Pilgrim Health Care.

The coordinator, likely to be a nurse at the provider office, would then be able to help the patient and his family better control the condition on their own.

“It sounds simple and it is simple, but it’s also quite effective,” Schultz said.

Because the insurer is part of the conversation, the care coordinator will also know if a patient is seeking care outside of the network, Weinstein said.

Schultz said it is too early to estimate how many people will sign up for the new plan. Harvard Pilgrim covers about 145,000 people in the state. The company also sells plans in Massachusetts and Maine and is expanding into Connecticut, Schultz said. The organizations did not provide actual premium rates, figures that are usually negotiated with each insured group.

ElevateHealth won’t offer individual plans at this point, but it could in the future, Schultz said. Harvard Pilgrim has said it will begin selling plans on the Affordable Care Act health insurance marketplace in 2015, where it will compete with plans Anthem Blue Cross Blue Shield offers, which also feature a limited provider network.

There will be four ElevateHealth plans available for large groups, including two tiered co-pay plans and two health savings account plans.

The deductible options are $3,000 or $5,000. For small groups, ElevateHealth will offer six choices, with deductibles ranging between $1,500 and $4,000.

(Sarah Palermo can be reached at 369-3322 or spalermo@cmonitor.com or on Twitter @SPalermoNews.)

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