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Maine is an expensive state for health care – so expensive, in fact, that some Maine employers find it more cost effective to send their employees to Boston for certain surgeries or care.
We have a number of factors working against us: An aging population that requires more health care services; many rural areas with very few care choices; and some of the lowest average incomes in the nation, making it difficult for some Mainers to afford medical care.
There is no one-size-fits-all solution to addressing Maine’s high health care costs. As the largest health insurer in the state, Anthem Blue Cross and Blue Shield is taking steps such as promoting value-based care, designing health plans and tools that empower consumers to use high quality, lower cost options and looking at alternatives to the hospital setting for care. But ultimately, health insurance premiums are a reflection of health care costs.
That’s why we support Central Maine Healthcare’s proposal to build a new freestanding ambulatory surgical center (ASC) in Topsham. This new center will provide services such as colonoscopies, endoscopies, orthopedic procedures, urological care and other specialties at much lower rates compared to when they are performed in a hospital. For example, a routine colonoscopy performed in a hospital can be double or triple the cost compared to one performed in an ambulatory surgical center. If approved by the Department of Health and Human Services, the development of this center can help lower health care costs for many Mainers.
There is no question Maine needs additional options for care to help lower costs. In a February 2019 Press Herald article, a representative of the Kaiser Family Foundation said, “if [hospitals] don’t have very many, or no competitors, they can charge more.” That same article highlighted examples of the higher costs for a routine procedure like knee surgery in areas of the state where no lower-priced option exists.
Maine is far behind other states in its development of ambulatory surgical centers, and it’s a contributing factor to our health care costs being higher. The adoption of ASCs in other regions of the U.S. has had a dramatic effect in reducing health care costs in these states, even those states with similar rural characteristics, like New Hampshire, which currently has twice as many of these centers as Maine.
Some health systems have opened their own ambulatory surgical centers, but they continue to charge the same high rates as they do in their hospitals. Centers that bill at lower, non-hospital rates to reflect lower overhead costs, such as the one in Topsham proposed by Central Maine Healthcare, are what the market needs to control costs and provide consumers with more options for care. In fact, based on our internal data, we estimate Anthem’s Maine employer customers and members could save up to $80 million to $115 million annually if such centers made up a similar proportion of the delivery system as they do in New Hampshire and other states.
Anthem’s employer customers are demanding better access to high quality, cost-effective surgical alternatives to hospitals and are employing strategies such as plan designs that incentivize employees to consider lower cost options for care. While these strategies are currently working for employers in the greater Portland area, the Midcoast needs additional alternatives to support models premised on consumer choice. Looking to greater Portland as well as New Hampshire and other markets, we see that hospitals can successfully coexist with ambulatory surgical centers as the delivery system seeks to meet the choice, access and affordability needs of consumers.
Maine already has some of the highest health care costs and premiums in the nation, and failure to support this project — and others like it — will only prolong an unsustainable health care cost problem. Central Maine Healthcare’s proposed ambulatory surgical center in Topsham is an important step toward our shared goal of lowering health care costs for Mainers and it deserves your support.
Denise McDonough is president of Anthem Blue Cross and Blue Shield in Maine, the largest health insurer in the state.