Harvard Pilgrim Health Care is teaming up with more than 50 hospitals and 16,500 doctors across the state to offer Massachusetts employers and their workers a 10 percent savings on health insurance by forming what they call a “focused network’’ of medical care groups that excludes Partners HealthCare System Inc. and other high-priced providers.
The goal is to contain costs by giving businesses, municipalities, consumers, and other insurance buyers a new choice for coverage. While the new network limits where patients can receive care, it boasts a broad coalition of more moderately priced Boston teaching hospitals, such as Tufts Medical Center, Boston Medical Center, and Beth Israel Deaconess Medical Center; regional providers that include Lahey Clinic in Burlington and Baystate Medical Center in Springfield; and community hospitals such as Beverly Hospital, Cambridge Hospital, and St. Elizabeth’s Medical Center in Boston.
By requiring providers in the network to keep the cost of their services below a certain level, Harvard Pilgrim hopes to pressure more expensive hospitals to cut their own rates to compete - or risk losing market share to lower-priced rivals.
The insurer, based in Wellesley, also believes the new offering - called Focus Network MA - can generate strong sales by appealing to employers who have long complained that escalating premiums limit their ability to expand markets and services. Health insurers have rolled out an increasing number of limited network plans during the past year, restricting members to certain doctors or hospitals. But some insurance subscribers have balked at the changes, saying overly narrow plans force them to travel too far, switch doctors or specialists, or lose access to high quality care.
The new collaboration - which still needs state Division of Insurance approval - is designed explicitly to allay such concerns and “move the needle’’ toward lower prices, according those involved in its development....
Partners spokesman Rich Copp said it knew Harvard Pilgrim was working on a new product. But he would not say whether Partners hospitals might reduce prices so they can participate. “It’s similar to other efforts in the marketplace to develop new models of care,’’ Copp said. “We’re always paying attention to what’s happening in the marketplace.’’
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Two key questions in determining the new network’s impact on health care costs will be how widely employers embrace it and whether patients are willing to leave Partners’ prestigious hospitals, including its Harvard-affiliated academic medical centers, for lower-cost care elsewhere.....
“We have been hoping for something just like this,’’ said Richard C. Lord, president of Associated Industries of Massachusetts, a trade group representing 6,000 businesses, referring to the new Harvard Pilgrim product. “For years, the health insurers have been offering employers products that were all the same - and were priced all the same. This gives employers choices they didn’t have before. The market is getting more competitive.’’
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