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MCH hopes to be a part of future state network

The Affordable Care Act, passed in March of 2010, aims to extend access to health insurance coverage to about 32 million uninsured Americans by expanding both private and public insurance. Legislators all agree it is a very complex law involving both federal and state agencies. With few exceptions, it requires individuals to have insurance. To help that occur, the law mandates the creation of state-based (or multi-state) insurance exchanges, to help individuals without insurance to purchase plans through the exchange. The State Health Benefit Exchange goes into effect Jan., 1, 2014. In addition, small businesses with fewer than 50 employees will be given the option to purchase similar plans through networks referred to as “Shop Exchange” administered through the federal government.

Here in New Hampshire, Anthem/Blue Cross, Blue Shield has applied and been identified as the insurance provider charged with creating and managing the limited provider network created for the ACA. Consequently, Anthem was given the responsibility and resources to control the network negotiations. Those organizations not selected (including MCH) were only notified after decisions had already been made. Unfortunately, we were not given the opportunity to negotiate our participation. We believe decisions were made primarily on the basis of geographic coverage, not other factors such as quality or patient satisfaction

Those not affected by the legislation in the upcoming year include the following groups: employees of companies with 50 or more individuals, those in small businesses who do not elect to purchase coverage for their employees through the Shop Exchange, those who have Medicaid or Medicare or other private coverage and those in the Children’s Health Insurance Program.

Again, this process only impacts individuals who purchase their insurance independently through Anthem Blue Cross Blue Shield’s new “Pathway Network.” The decision on Anthem’s part does not affect the majority of patients utilizing MCH’s services and participants in the exchange will still be able to utilize MCH for emergency care

What does this mean for those of us in the Monadnock region? One thing is certain, increasingly we all need to be better educated health consumers – and more conscientious stewards of our own health. Here at MCH, we have taken a very active stance in promoting health, improving quality and patient satisfaction, and reducing costs. These efforts have has earned us statewide and national attention with industry-leading results. In addition, we are grateful to have earned national recognition for quality and patient satisfaction measures. All of this would not be possible without the tremendous support of our dedicated employees, our physicians and you, our community. Looking forward, we are hopeful in 2015, the 2nd year of the contract that Anthem will allow us to be included in the discussion of participation options for the future. We also anticipate there will be other insurance payers in NH who will consider offering exchange coverage in 2015 as well.

Peter Gosline is the CEO of Monadnock Community Hospital.

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