Local health care is still closed to many

Published 10:32 pm Saturday, April 17, 2010

The biggest problem with health care in Dalton isn’t whether you can get quality care here — you can.

No, the biggest problem continues to be whether Hamilton Health Care System and local doctors will take your insurance, allowing you to access this care. And despite nearly a year’s worth of rhetoric and promises to open up local health care to more insurance providers, we don’t seem to have made much progress.

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

At the time, local health care representatives said they would try to have some new agreements in place by late 2009, in time for companies to include the new options in their open enrollment for this year. That pledge was repeated in September by then Hamilton Health Care System CEO John Bowling.

Also in September, officials for both Hamilton and Physicians Health Services (PHS), which represents almost all of the doctors in Whitfield and Murray counties, said a process called clinical integration, a common set of clinical protocols for all physicians, would be key to those contract negotiations.

But while the process of clinical integration has proceeded apace, the more pressing problem of people being able to access this care has not kept up.

David McCreery, president of Physicians Health Services, recently said that about 90 percent of the roughly 200 doctors in Whitfield and Murray counties have signed on to the clinical integration process.

So far, the group has developed protocols for 10 different diseases or conditions — including asthma, coronary artery disease, diabetes and some cancers — that affect 25,000 area residents  and cost more than $7 million annually to treat.

“We polled the major employers in the area — Shaw, Mohawk, Beaulieu — and asked them what conditions are driving their health costs,” said McCreery.

Compliance reports and support tools for physicians on how to meet those protocols will begin rolling out in May, and the system should be implemented by June.

It appears to be a good step forward for improving health care for those who are able to access the system.

But it is unclear how this is going to open up the doctor’s offices for those whose insurance is not accepted.

So far as we know, no new insurance contracts have been signed, and new CEO Jeff Myers said in a recent discussion with The Daily Citizen that clinical integration does not make the negotiations simpler for the insurance companies.

McCreery, however, said that since the physicians are now clinically integrated, PHS can negotiate on their behalf with insurance companies, something it could not do before.

“This will allow us to go out to, say, a Blue Cross and say, ‘We bring 90 percent of local physicians, Hamilton Medical Center, Murray Medical Center, and we want to negotiate a contract with you,” McCreery said. “We are currently involved with Blue Cross Blue Shield of Georgia, Blue Cross Blue Shield of Tennessee, Humana and Aetna. In addition, we offered to enter into negotiations with United Healthcare and Cigna, but they have not responded.”

What is frustrating to all of us is that a year after business leaders challenged the medical community to become more open, that still hasn’t happened.

We don’t know if clinical integration will ultimately make the local health care system accessible to more people, but what we need to see is real progress, not just more talk, on the issue.

Access to health care for all people is a key issue for economic development and the quality of life of a community. As long as our health care community continues to shut out many health care policies, we will all continue to suffer.