PPOM, a preferred-provider organization that provides access to a care network through third-party commercial insurance carriers and self-funded group health plans, will aggressively pursue new subscribers in the Holland-area market, regional manager Kelley Monterusso said.
“Our hope is that we’re going to move business and we’re not going to be shy about it,” Monterusso said. “It’s a growing market and it’s a whole new open territory for us”
Holland Community Hospital previously was one of a few hospitals in the state that did not have a participating agreement with PPOM, which is owned by Blue Cross Blue Shield of Michigan but operates independently. PPOM has agreements with most of the other hospitals in West Michigan, including Zeeland Community and North Ottawa Community in Grand Haven. The lone non-participating facility in the region is Allegan General Hospital.
A push by area employers for another alternative to consider for their employee health plans in response to escalating health premiums helped PPOM secure a deal with Holland Community Hospital, Monterusso said. At the same time, the rapidly growing population base in the Holland area made the market a desirable one for PPOM to penetrate and pursue, she said.
“It completes us,” she said of the new participating agreement that takes effect April 1. “Holland, for us, has always been a goal to bring into our network. The environment was right and both parties were motivated to get the contract done.”
The Southfield-based PPOM has a care network that includes 300 hospitals and more than 40,000 physicians in six states and a subscriber base of 1.1 million people. In Ottawa, Kent and Muskegon counties, PPOM has grown its network from 1,500 providers in 1999 to more than 2,300 as of late 2002.
The new participating agreement with Holland Community covers the hospital and its subsidiaries that provide a myriad of medical services, as well as a large majority of affiliated physicians that are part of the Principal Health physician-hospital organization.
PPOM will pursue new subscribers “aggressively yet cautiously,” working through the established network of insurance agents in the Holland market to reach out to employers, Monterusso said.
“They’re the folks that have the relationships with the employer groups. They are the experts,” she said.
As PPOM sets the groundwork for moving into the market, the agreement has sparked some hope that parent company Blue Cross Blue Shield of Michigan and Holland Community Hospital can eventually come to terms on a deal for the Blues’ preferred-provider product, Community Blue.
Holland is the only hospital in the state that does not accept Community Blue, which is Blue Cross Blue Shield of Michigan’s most popular and faster-growing product statewide with 2 million subscribers, or about 42 percent of total subscribers.
While a hospital executive says the two situations are “totally and completely unrelated,” Jeff Rubleski, sales team manager for the Blues in West Michigan, hopes Holland Community Hospital’s participating agreement with PPOM will lay the groundwork for a future settlement on Community Blue.
“We hope that that will certainly open the door for us to contract with Holland Hospital,” Rubleski said. “Whenever there can be more competitors in a market that’s good for everybody, and hopefully it bodes well for us.”
The Blues and Holland Community Hospital have negotiated for years but never have been able to reach an agreement on a participating agreement for Community Blue. Negotiations are progressing “at a snail’s pace,” Rubleski said, “but at least we’re still talking.”
Community Blue late last year did sign a participating agreement with the physicians group at Mercy General Health Partners in Muskegon, the Westshore Health Network, which strengthened its PPO network in that market during the first quarter.