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Published in Health Care

Health Alliance Plan to expand West Michigan presence with Spectrum Health agreement 

BY Wednesday, May 25, 2022 09:47pm

Health Alliance Plan filled a significant gap in its West Michigan care provider network with a new deal with BHSH Spectrum Health West Michigan.

Under the agreement, 11 Spectrum Health hospitals, 128 outpatient care locations, and 2,300 physicians and advanced practice providers will join the Detroit-based HAP’s statewide care network July 1. The deal announced Wednesday covers all products that HAP offers, including the small employer group HMO that previously lacked a participating agreement with Spectrum Health.

Michael Genord, HAP president and CEO. COURTESY PHOTO

Filling that network gap could elevate HAP’s viability as an option for employers to consider for employee health coverage in the market that’s largely controlled by Blue Cross Blue Shield of Michigan and Grand Rapids-based Priority Health.

“We’ve been committed to competition. Competition drives quality, access to care and control of total cost of care for the people who pay the bills,” HAP President and CEO Dr. Michael Genord told MiBiz on Wednesday.

“So, we’ve been committed under the leadership team at HAP over the last several years to grow across the state and to partner with provider groups and facilities like Spectrum to make that happen,” Genord said. “Our entrance into a market that we haven’t been able to get into over the last decade … is a very important achievement and really changes the trajectory for HAP, making us more of a statewide organization.”

Blue Cross Blue Shield and Priority Health together controlled 84 percent of the market in the Grand Rapids area in 2020 for all insurance products, according to the latest insurance market share report that the American Medical Association issues annually.

The AMA last year ranked Michigan as the second-least competitive market in the nation for health coverage. In the Grand Rapids area, Blue Cross Blue Shield held a 56 percent market share and Priority was at 28 percent, according to the AMA. Statewide, Blue Cross held 68 percent of the market to Priority’s 10 percent.

In a statement to MiBiz, BHSH Spectrum Health West Michigan said it was “pleased to offer a high-quality health care choice to HAP members. At BHSH Spectrum Health West Michigan, we are focused on improving the health of people in our communities.”

HAP’s contract with Spectrum Health includes commercial HMO and PPO coverage, and its Medicare HMO and PPO. The deal does not include commercial coverage at Spectrum Health Lakeland in Southwest Michigan, which does accept HAP’s Medicare Advantage HMO and PPO.

HAP hopes to eventually extend commercial products to Lakeland, as well as contract with other health care providers on the west side of the state, said Margaret Anderson, HAP’s senior vice president and chief sales and marketing officer.

“This is our first big step in entering into this market in a meaningful way. Not only is it Lakeland, I think it’s several other provider organizations that have expressed interest in contracting with us as well,” Anderson said. “Several of the large multi-specialty practices (and) some additional hospitals are interested now that we’ve demonstrated that we’re going to be coming into that market in a meaningful way.”

Owned by Henry Ford Health System, HAP began moving into the West Michigan market with commercial health coverage in 2021, a year after introducing a Medicare Advantage plan formed with Trinity Health in Kent, Ottawa, Muskegon and Oceana counties that has about 3,000 enrollees.

The market entry for commercial coverage included large group plans for two types of policies: Preferred provider organization (PPO) and exclusive provider organization (EPO), which uses a PPO care network but lacks an out-of-network benefit.

Since 2021, HAP has only reached about 500 members in West Michigan, a reflection of the small group HMO’s lack of an agreement with Spectrum Health, the largest provider of health care in West Michigan.

After filling the gap in the care network through the new contract with Spectrum Health, HAP aims to pursue much more enrollment across the region and will begin quoting right away for policies that start in the third and fourth quarters, Anderson said.

“We have pretty expansive growth plans,” Anderson said. “It means choice, and choice is really what this is all about. Giving people options and making sure there is a landscape that makes sense for employer groups. We’re coming in with the same mindset that we have in Southeast Michigan, and that is delivering access to high-quality, affordable care.”

HAP’s HMO had more than 173,000 members at the end of 2021 and about 430,000 across all product lines.

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