Chestnut Hill Hospital workers ask: You want us to travel how far for health care?

Jeanette Oakley, a secretary at Chestnut Hill Hospital, can't believe the health-care plan her new employers are proposing.

The plan being offered by Tower Health, which acquired Chestnut Hill Hospital last fall, doesn't appear to have any "in-network" doctors in Philadelphia. Sure, Oakley could get her blood drawn at Chestnut Hill, but if she wanted to see an actual doctor, she'd have to pay more. And Chestnut Hill doesn't have a pediatric unit or a maternity ward.

The biggest in-network hospital, the facility with the most extensive services and in-network doctors, is Reading Hospital — about an hour drive from Chestnut Hill.

"Why would I go to Reading?" said Oakley, who is in her late 50s. "I live in Philadelphia."

Another question on Oakley's mind: Why would a Chestnut Hill Hospital employee, especially a low-wage worker such as Oakley and her coworkers who are represented by SEIU Healthcare PA, even want to pay for a health-care plan like this?

These roughly 200 workers — phlebotomists, nursing assistants, emergency room technicians, most of whom live in Philadelphia — make  $12 to $20 an hour. Not all of them have cars.

Oakley, a union leader and Southwest Philly resident who has worked at the hospital for six years, says it seems clear to her: "You didn't consider us," she told Tower.

Tower Health spokesperson Ann Valuch said that she could not discuss negotiation specifics but that "the union's characterizations of some of these issues are not accurate." She wouldn't confirm whether there are currently any in-network doctors in Philadelphia but did say the proposed health plan "will provide" in-network access to "primary care, ob/gyn, and specialist physicians located in Philadelphia and the entire Tower Health service area" by January, which is when the plan is slated to go into effect.

The Chestnut Hill Hospital workers of SEIU Healthcare PA have been negotiating their first contract with Tower Health for almost a year, and health care is a huge sticking point — health-care costs will affect their demands around wages, Oakley said. But the ordeal is a window into some of the effects of the health-care consolidation frenzy and how there are few incentives for health-care systems getting into the insurance business to offer patients more options when it comes to care.

In the fall, Chestnut Hill Hospital was acquired by Tower Health (the former Reading Health), along with four other suburban hospitals in Southern Pennsylvania, to create a new health system. Earlier last year,  Tower Health formed a joint venture with Pittsburgh giant UPMC to offer health insurance in the Philly area.

The announcement triggered a dispute between Tower Health and Independence Blue Cross, the dominant insurance provider here. IBC was suddenly in the position of "funding a rival," as Anthony V. Coletta, president of facilitated health networks at Independence Blue Cross, said in an interview last fall. Eventually, the two parties reached an agreement, allowing Tower hospitals to still be considered in-network for those patients with IBC insurance.

But Tower isn't selling its insurance within city limits, Valuch confirmed.

The health system is selling insurance only in counties outside of Philadelphia. And, as Seattle-based health-care consultant Tory Wolff put it, "if you're not looking to compete in Philadelphia, there's no particular reason to build out a broad network there."

New Hope-based health-care consultant Joshua Nemzoff described the situation as a "power play."

Tower wants to push patients to its hospitals — that's a big reason health systems get into the insurance business, Wolff said — so it doesn't make financial sense to contract with other hospitals, Nemzoff said: That would mean sending business to Penn or Jefferson or Hahnemann.

"It's pure greed," Nemzoff said, adding that this proposal suggests that Tower is prioritizing its bottom line over its employees.

There are reasons an insurance provider would choose a "narrow network" and encourage its customers to get care within a subset of hospitals, instead of offering an "open network" with more freedom and choice. For one, narrow networks are generally cheaper for the insured because it means the insurer can negotiate a better deal with hospitals since it'll send so much business there, Wolff said.

There's also a health benefit, he said. Narrow networks allow for what's known as "population health," where doctors provide proactive care to keep people out of hospitals. If you're confined to a certain group of doctors, that means they can coordinate care better.

The trade off, though, is convenience and accessibility, Wolff said.

The situation of the Chestnut Hill workers is one that's become increasingly common in rural areas, as struggling hospitals shut down, forcing people to travel as far as 100 miles for certain kinds of care, such as the delivery of a baby. It's a phenomenon that has serious implications: Women go to fewer doctor's appointments, and more babies are born premature, according to experts at the University of Minnesota Rural Health Research Center.

With technological advances and a movement toward proactive care, people are going to the hospital less, Wolff said, which is a good thing — but it also means less money to keep hospitals open. The trend is exacerbated by the fact that hospitals have historically leveraged more profitable service lines, such as orthopedics or cardiology, to pay for those that don't make money, such as maternity wards or behavioral health. But if hospitals lose out on the more lucrative business to, say, a cheaper nearby hospital, then they don't have money to offer the other services.

In 2008, Chestnut Hill Hospital closed its maternity ward for financial reasons. At the time, it was the latest in a trend: 15 hospitals in the region had shut down their maternity wards over 10 years.

Staff writer Harold Brubaker contributed to this article.