DIRIGO’S SWITCH

The state’s Dirigo Health coverage has new opportunities to provide better care more affordably under a change in administration announced this week that ends the state’s arrangement with Anthem Blue Cross and signs on with Harvard Pilgrim Health Care. The key for the state is to create a stable relationship with this insurer, with an emphasis on expanding affordable preventive care.

The reasons Maine’s health insurance program and Anthem split were clear enough from their joint announcement: “The parties were unable to agree on acceptable financial terms to extend the contract for one year.” The for-profit Anthem wanted considerably more than the state was willing to pay, including a risk payment of $4 million. The nonprofit Harvard Pilgrim was willing to forgo that cost and others in reaching a $172 million deal with the state to cover about 15,000 people initially. The Dirigo insurance product will continue without interruption, with Harvard Pilgrim offering services beginning Jan. 1, 2008.

Both Harvard Pilgrim and Anthem rate high in the latest National Committee for Quality Assurance rankings for insurers, but Harvard Pilgrim ranks first while Anthem is 33rd, behind its corporate counterparts in New Hampshire and Connecticut. Perhaps more important, Harvard Pilgrim hasn’t sued the state over DirigoChoice’s funding mechanisms, as Anthem has, nor has it lobbied as vigorously against legislative changes as Anthem has. The small miracle in the current relationship between state government and Anthem is that their Dirigo contract lasted three years.

It’s impossible to predict how similar future issues will work out between the state and Harvard Pilgrim, but the insurer’s mission of emphasizing wellness programs and access blends well with state objectives. Maine’s expensive health care system hurts residents and, ultimately, affects their health when they lose coverage because of cost and do without needed care.

DirigoChoice has too often been at the center of political debate to have had enough of an effect on health care costs, but a steady insurer that can offer competitive prices and good service would help calm the politics and let Dirigo become more effective. Let’s hope Harvard Pilgrim is ready for this challenge.