Reforms, collaborations worry York's independent care providers
Editor's Note: This story originally ran on Oct. 19, 2015.
A collaboration between WellSpan and major medical insurance provider Geisinger in the York-Adams area has local independent health care providers fearing the future. Changes to take effect at the start of the new year include removing about 300 providers from the plan's network.
"With the health care system in this country transforming from just helping sick people to managing the health of populations, we want to transform health care by improving the outcomes," WellSpan spokesman Rick Ayers said. "By working with Geisinger, we think we enhance access and benefits to those in York and Adams counties."
Both companies mentioned health care reform as a major factor in the collaboration.
Julie Kissinger, spokewoman for The Hospital & Healthsystem Association of Pennsylvania, said reforms are all about expanding access and coverage, with part of the Affordable Care Act intended to "spur more innovative models and relationships," including those between providers and insurers.
In these partnerships, providers gain more access to data and analytics to better understand the populations they're serving, and insurers are able to lower costs by reducing claims, Kissinger said.
But Angie Hartman, spokeswoman for OSS Orthopaedic Hospital in York Township, one of two York County hospitals being removed from the plan's network, said the trend of health care providers and insurance companies aligning is "worrisome" for independent providers such as OSS.
"Local independent practitioners, as a result of recent changes to the health care system, have been forced to really stick together," Hartman said.
OSS officials met last Thursday with representatives from 14 other York County independent health care providers that were removed from Geisinger Gold's network, Hartman said, mostly to talk about how best to inform patients of their options.
Memorial Hospital in Spring Garden Township, the other local hospital removed, remains a part of the network for six other Medicare Advantage plans, according to spokesman Jason McSherry.
Rebecca Bruce, senior practice administrator at Leader Surgical Associates of York and one of those present at the meeting, said she was part of a group that filed complaints about Geisinger's cuts with the Federal Trade Commission and Centers for Medicare & Medicaid Services (CMS).
Employees at Leader, located at Apple Hill Medical Center, a WellSpan campus in York Township, were surprised when they received notice of their termination from the Geisinger Gold network, Bruce said, because the company had a good working relationship with WellSpan.
"Moves like this by WellSpan make (competing in this area) more difficult than it needs to be," she said.
What's left: The remaining Geisinger Gold network consists of 1,200 providers in York and Adams counties, according to Geisinger spokewoman Amy Bowen. Of those, 850 comprise WellSpan's network.
Ayers said WellSpan's network includes "others closely aligned with us, such that they agree to participate with us in strategies and activities," placing particular emphasis on participation in WellSpan's electronic records system to allow the sharing of data.
Bruce said Leader "very happily" participates in WellSpan's online records database.
Jim Gill, chief operating officer at Gastro Associates of York in York City, said the termination would affect business less than 2 percent. But the fear is "this is the first shot," he said.
"It scares the heck out of us, and it's pretty unusual," Gill said. "At some point, someone needs to look at whether this is a monopoly (with WellSpan) in York because this almost creates an unfair competitive advantage."
Neither Geisinger nor WellSpan is new to collaborations, as Geisinger leveraged a similar partnership with Meridian Health in New Jersey, and WellSpan began a similar relationship with Aetna for its commercial health insurance plan in 2013.
— Reach David Weissman at firstname.lastname@example.org.