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Bill Caron is CEO of MaineHealth, the largest health care system in Maine.
I read with great interest the Aug. 23 BDN opinion column authored by Denise McDonough, president of Anthem Blue Cross and Blue Shield of Maine. McDonough’s column was written as an endorsement of Central Maine Healthcare’s Certificate of Need application to build an ambulatory surgery center in Topsham.
McDonough initially cites general issues about which most, if not all, those familiar with health care can agree. Health care costs in Maine are not affordable for many Maine residents. And the cost of health care in Maine is negatively impacted by Maine’s aged population (oldest in the nation), its burden of disease and the shifting of costs by governmental payers (Medicare and Medicaid programs) to commercial payers. The rates charged by commercial payers are significantly inflated by providers’ need to shift these governmental costs to commercial payers.
We also agree that all health insurers in Maine, not just Anthem, are working closely with their clients to implement value-based plan designs aimed at holding down healthcare costs.
However, McDonough doesn’t fully explain the true cost of health care in Maine and our neighboring state of New Hampshire.
McDonough correctly indicates that Central Maine Healthcare’s proposed center would provide several surgical services in the Topsham area, but fails to note that the project will add facilities that aren’t needed because physical capacity already exists in the market. Mid Coast Hospital, a part of MaineHealth, reports that its outpatient surgery center – located just seven miles from Central Maine’s proposed facility – is operating at 50 percent capacity and will be able to absorb future demand for the foreseeable future.
McDonough also incorrectly states that the new center will lower costs in the area when, in fact, it is well known in health care that this kind of duplication of facilities will increase the total cost of care in a community like Topsham. This is why Maine requires a Certificate of Need to build new, expensive health care facilities in the first place.
Even more importantly, McDonough points us to New Hampshire as the example of health care cost-efficiency that Maine should follow. She suggests that the proliferation of freestanding centers in New Hampshire has resulted in lower health care costs.
Yet, premiums paid by commercially insured individuals in New Hampshire are as much as 10 percent higher than premiums paid in Maine for similar insurance products. That means that Maine’s approach to managing investments in infrastructure through its Certificate of Need program and other efforts is much more impactful in holding down health care costs than the duplication of services and facilities being proposed by McDonough.
We need an honest discussion about health care cost drivers in Maine. Unfounded statements about those health care cost drivers are not helpful in addressing this important issue for Maine.