Hamilton Health Care reports progress with insurers

Published 11:27 pm Saturday, September 12, 2009

Hamilton Health Care System sent a letter last week to several major health insurance companies asking them to discuss Hamilton joining their preferred provider networks.

“Included in the letter is proposed contract language to serve as the basis of our relationship,” said Hamilton CEO John Bowling. “Once the contract language is negotiated, we should be in a position to discuss financial terms of the agreement.”

Bowling said the letter was sent to Blue Cross Blue Shield, Aetna, United Healthcare and Humana.

In April, several local business leaders sent a letter to Bowling expressing concern that Hamilton and many local doctors accept few major health insurance plans and asking for local health care providers to take part in a larger number of health insurance networks.

“We remain committed to the development of a meaningful relationship with national insurers that will allow their beneficiaries to access the services of Hamilton as a network,” said Bowling. “Now is the time for insurers to come to the table.”

“It is the business community’s hope that some competitive insurance plans be more widely accepted, both at the hospital and by the physician community,” said Dalton-Whitfield Chamber of Commerce president Brian Anderson.

In April, health officials said they would try to have some agreements in place by the time companies begin open enrollment later this year. Bowling said they still hope to meet that goal.

Hamilton and Physicians Health Services, which represents almost all of the doctors in Whitfield and Murray counties, say clinical integration — developing a common set of clinical protocols for all physicians — will be key to contract negotiations. They had set a deadline of July 31 to complete that process. Some of the major insurance companies have said they do not believe clinical integration is a prerequisite to negotiations.

“This is an 18-month process that the chamber and local business have asked us to compress into five or six,” said David McCreery, president of Physicians Health Services. “We have made amazing progress. We’ve adopted about 30 out-patient protocols to cover almost all of our doctors. We’ve still got a little bit of work to do with the hospital-based specialists, which we are working diligently on. And we have run into a few computer snags.”

But McCreery said clinical integration has progressed far enough for contract negotiations to begin and the rest of the work should be finished by the time Hamilton and the insurance companies start discussing financial terms.

“I’m hopeful that with what I’ve got to do with clinical integration that I’m within 30 days,” he said. “Interestingly, we’ve already had phone calls from two of the companies we sent letters to asking if they could talk to us. The fact the two companies called us indicates a willingness to work with us, which is a very positive sign.”