Anthem seeks to keep health care affordable for Mainers

By Denise F. McDonough

As Mainers, we need access to high-quality health care that doesn’t break the bank. That’s why I want to share some important facts about our current contract negotiations with Northern Light Health — and what they mean for families, businesses, and communities across the state.

Anthem Blue Cross and Blue Shield is working in good faith with Northern Light Health to renew our contract, which sets the prices Northern Light Health charges to patients with Anthem insurance. The current agreement is set to expire on Sept. 30, for their doctors, specialists, other professionals, and outpatient centers and facilities; and on Dec. 30, for their hospitals.

It’s complicated to have doctors leaving the network on one date and hospitals on another. We asked Northern Light Health to align these dates to Dec. 30 to avoid patient confusion and unnecessary care disruption, but they have not replied to our repeated requests. 

What’s most concerning about our negotiations is the size of the price hikes Northern Light Health is requesting: a 30 percent price increase over three years. That’s not a small adjustment — that’s $218 million more in health care costs that would ultimately be paid by patients, school districts, towns, and employers across Maine. It would directly increase copays, deductibles, and insurance premiums for hardworking Mainers. 

In a state where many already struggle with the cost of care, we need to ask ourselves: Can our communities afford these hikes? Can local businesses keep up while also trying to grow, hire, provide benefits, and give raises?

Northern Light Health has claimed to be underpaid by Anthem but that’s inaccurate at best. Northern Light Health is not underpaid by employer-sponsored or individual health plans. In fact, according to the publicly available data, Northern Light Eastern Maine Medical Center is paid more by commercial payors than Maine Medical Center and all of the other largest teaching hospitals in New England, including Massachusetts General Hospital, Dartmouth-Mary Hitchcock Memorial Hospital, and Yale-New Haven Hospital. Anthem’s current payment rates to Northern Light Health are in line with other Maine hospital systems, and Northern Light Health earns a 22 percent to 40 percent profit margin on patients covered by employer-sponsored insurance — the same patients for whom they now want to increase prices by 30 percent.

It’s true that Northern Light Health has received increases in recent years that were below the rate of inflation, but this is only because they did not meet the quality-of-care measures built into the contract. These measures were previously agreed to by Northern Light Health and Anthem. 

Higher reimbursement for higher quality is now standard in the health care industry and has proven to improve patient outcomes. Northern Light Health’s failure to meet those agreed-upon benchmarks resulted in them losing out on earning additional revenue. That’s not unfairness — that’s accountability and a commitment to better patient care.

We’re offering Northern Light Health what we believe are fair increases that are above the inflation rate and the opportunity to again earn millions more through quality-based measures. That way, we can reward improvements in quality while protecting Mainers from excessive cost hikes.

We’re committed to keeping Northern Light Health in our network. But we also have a responsibility to stand up for Maine’s families and employers. Affordable health care is accessible health care. Northern Light Health’s drastic requested price increases would create barriers to care for many patients and employers. At Anthem, we will always protect our members’ access to care that is both high-quality and affordable.

McDonough is the president of Anthem Blue Cross and Blue Shield.