Payers, providers disagree over how to lower healthcare costs

The largest insurer and hospital system in Maine each have their own opinions about how to best lower healthcare costs in the state. Anthem Blue Cross and Blue Shield of Maine thinks there should be more community-based primary care options, while MaineHealth wants to focus on economic development and growth, reported Government Health IT.

Whichever direction Maine's payers and providers head, there could be nationwide implications. That's because Maine had the fifth-highest per capita health-related costs in the country in 2009, the last year the Kaiser Family Foundation has data. Those costs were 25 percent higher than the national average, yet Maine's per capita income was 10 percent lower than the nationwide average income.

To address those costs, Anthem President Dan Corcoran believes the state has too many hospitals and too few community-based primary care clinics. In fact, federal officials are considering requiring insurers include more essential community providers in their health insurance exchange plans, FierceHealthPayer previously reported.

"We have 1.3 million residents and 39 hospitals. In New Hampshire, they have the same population and only 26 hospitals," Corcoran said at a panel hosted by the Maine Health Management Coalition. "Maine is much bigger in land size, but that only explains some of it. It might suggest that we don't have the ideal rationalized infrastructure to serve the state well."

He wants the state's hospital systems to focus on primary care and preventive medicine by implementing value-based models like patient-centered medical homes. "I believe in global risk arrangements," Corcoran said. "We will preserve revenue in flow while hospital systems focus on cost-reductions."

But Maine's providers want to determine the underlying cost drivers. "We need to be in agreement more on what drives the cost of healthcare in Maine," said William Caron, president of MaineHealth, the state's largest healthcare system. "There is a focus on price, which I think is misdirected and is going to be derisive."

Instead, payers and providers should emphasize "economic development and growth" so the state can fund new health-related infrastructure, Caron added. 

To learn more:
- read the Government Health IT article
- here's the KFF data