Some businesses and health plans read the formation of regional networks as a possible sign of hard choices ahead.
Potentially, their contracting decisions could be complicated further when those networks are bound by a shared religion or the lack of religious ties. Such is the case in Portland, Ore., and also, to a large degree, in St. Louis.
"There are potential dilemmas if buyers must choose (between networks)," said Stephen Jackstadt, principal at the St. Louis office of Towers Perrin, a benefits consulting firm. "And if the hospitals have joined around denominational lines, it creates an interesting ethical and social dilemma. Which is it, the Catholic or the non-Catholic?"
In Portland, St. Louis and several other cities, hospitals have united into a handful of large alliances. Employers and payers fear someday the hospitals might demand the system be taken as a whole.
Many hospitals in systems or alliances now contract individually and might continue to do so; others might market sections of an alliance, health plan managers said. The possibility of "all-inclusive" contracts, however, is provoking nervous discussions.
That's because all-inclusive contracts might become "exclusive" contracts, in which the plan or the employer works with no other system, Mr. Jackstadt said. If health plans emphasize cost above access, they might contract with fewer hospitals, and one large system might provide all hospitals necessary.
This would be troublesome, some benefits managers said, because the systems might not be the best combination of hospitals for their companies. Meanwhile, the division of hospitals into Catholic and non-Catholic networks adds another twist.
"I've had a client that refused a Catholic network because it didn't want to say people can't have abortions," said Patricia Hogan, vice president at the Portland office of benefits consultant Sedgwick Noble Lowndes.
Generally, issues such as quality of care and cost-effectiveness are far more important to employers than the availability of abortions or sterilizations, said Lorry LeVine, director of communications at the Sisters of Providence Oregon region, one of three Portland networks and the only Catholic system. "To focus on whether a delivery system is Catholic-sponsored or not is missing the point," he said.
Sisters of Providence wants to contract as a whole system because then it can deploy resources among its facilities most efficiently, Mr. LeVine said. But it would work with buyers designing their own networks, he said.
In Portland, companies and payers often contract with two systems, managing employees' choice of networks instead of the networks, Ms. Hogan said. Generally, the flexibility has a premium, perhaps 15% above the cost of contracting with a single network because of more complex administration and higher rates, she said.