DirigoChoice Health switches from the crooks at Anthem to non-profit Harvard Pilgrim

By partnering with a nonprofit health insurer eager to expand its business in Maine, the state's Dirigo Health program has made a modest improvement to a modest program aimed at helping with health-care cost and access issues.
On Thursday, state officials announced a two-year deal with Harvard Pilgrim Health Care to operate the DirigoChoice insurance product that is the centerpiece of the reforms championed by Gov. Baldacci. This means that 15,000 Mainers now enrolled in DirigoChoice will no longer get coverage through the state's largest carrier, Anthem Blue Cross and Blue Shield, as of Jan. 1.

It also means that the state will be working with a private insurer that does not require a profit guarantee to operate the state program. And, unlike Anthem, Harvard Pilgrim does not have a significant line of business that is in competition with Dirigo.

All that adds up to a coup for the Dirigo Health agency overseeing the program. It would have been risky for DirigoChoice to self-insure, as some had advocated. The state would have to acquire expertise and money to run DirigoChoice on its own, and the taxpayers would have been at direct risk for any potential losses.

At the same time, having Anthem manage DirigoChoice was always an imperfect arrangement. The for-profit insurer had to make a certain amount of money for the venture to be worthwhile. Also, while Anthem may have done its level best to make DirigoChoice a success, the fact that DirigoChoice sought some of the same customers Anthem wanted for other lines of business made the arrangement awkward at best.

Harvard Pilgrim, on the other hand, is a nonprofit and did not seek any profit guarantees in taking on DirigoChoice. It has about 12,000 customers in Maine, and, therefore, growing DirigoChoice will more likely bring it new business, not take it from somewhere else under the Harvard Pilgrim umbrella.