Blues Expand Their Holland Network

April 2, 2004
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HOLLAND — After finally securing a deal with Holland Community Hospital for its largest health plan, Blue Cross Blue Shield of Michigan is now pursuing participating agreements with area physicians in order to offer subscribers a more complete care network.

The new participating agreement with Holland Community for the preferred-provider organization (PPO) and point-of-service (POS) health plans, reached after years of prolonged and complex negotiations, provides the Blues the main lynchpin needed to begin signing more specialty- and primary-care physicians in the market who may have previously shied away from the health insurer's Community Blue plan because it lacked an agreement with the hospital.

"Hopefully we'll be able to make some agreements there," said Dale Robertson, vice president for West Michigan for Blue Cross Blue Shield of Michigan.

The Blues, he said, is "working diligently" to reach agreements with group and individual physician practices.

Blue Cross Blue Shield of Michigan presently has 140 physicians in the Holland market within its network, 62 percent of which participate on the traditional health plan and 39 percent who accept Community Blue PPO, which shares the same care network with the POS plan.

"We still have some improvements to make in the primary care side. We've got a ways to go there yet," Robertson said. "We're got a pretty aggressive team that's out there knocking on doors and doing our best to show our willingness to work with them."

That's the kind of competition and increased choice employers in the Holland area have been seeking in recent years as the premiums for health coverage escalated, said Jane Clark, interim president of the Holland Area Chamber of Commerce.

The 1,400-member chamber offers Community Blue PPO to its membership as an option for employee health coverage. The deal between the Blues and Holland Community makes the PPO a more viable option for employers to consider, Clark said.

"Hopefully this will offer another opportunity and another choice for businesses and individuals," she said.

Community Blue is Blue Cross Blue Shield of Michigan's largest health plan, with about 2 million subscribers statewide, 300,000 of them in the Ottawa-Kent-Muskegon county market. The Blues has about 4.8 million subscribers across all of its products.

Without the participating agreement, patients with Community Blue who went to Holland Community for care have had to make up the some times sizeable difference between what the hospital bills and what Blue Cross Blue Shield pays. Under discounts and reimbursement terms written into participating agreements, that difference is waived.

By signing Holland Community after years of talks, Blue Cross Blue Shield can now market a larger array of health plans to small and large employer groups, bringing more competition to the Holland-area market. The hospital has accepted Blue Cross Blue Shield's Blue Care Network HMO and traditional health plans for years.

"It gives us more of a complete and competitive package we can put in front of people," Robertson said. "It gives us another product option."

Blue Cross Blue Shield of Michigan and Holland Community Hospital – the only hospital in the state that did not accept Community Blue - had been unable to come to terms on a participating agreement for the PPO product for several years, with issues ranging from discounts built into reimbursement rates to local market share as the main obstacles.

As employers began demanding more options for health coverage, both sides a year ago finally began to get into what Robertson termed "serious" negotiations after years of discussions that built a better understanding between the two and set the groundwork for a final deal.

Those negotiations covered payment terms line-by-line for medical services as the two sides worked toward a final agreement that was reached in mid-March and announced last week.

"It was a matter of tying up loose ends," said John Speeter, Holland Community Hospital's vice president for marketing and communications. "It was very complicated. It involved everything."

In addition to the deal with Blue Cross Blue Shield, Holland Community Hospital last week announced a new participating agreement with United Health Care Inc., a national insurer based in Minneapolis, Minn., that offers a wide array of group, individual and self-insured health plans, including the low-cost Golden Rule Insurance Co.

The participating agreement with the Blues and United Healthcare took effect April 1.

"Our goal is to meet the health care needs of our community and we want to be an 'in-network' as whenever possible. With input from our employer groups, patients and physicians, we established priorities for our negotiations and are very pleased to offer the community a wide variety of health insurance options," Holland Community Hospital CFO Terry Steele said.

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