I keep hearing from numerous sources that tiered in-network insurance products have lots of potential to create countervailing power against hospitals that currently command high prices because of their market power and not their care quality.
Well, Blue Cross Blue Shield of MA has announced it will offer a product along those lines, but not based on an exclusive network, called Hospital Choice Cost Sharing. The description is here, with the following plain English introduction:
With Hospital Choice Cost Sharing, your choice of hospital and other related facilities determines what you pay for hospital care.
- Lower Cost Share ($) applies to hospitals and related facilities that have met our quality benchmarks and are lower cost. You pay less when you get care at these hospitals.
- Higher Cost Share ($$) applies to hospitals and related facilities that have met our quality benchmarks and are higher cost. You pay more when you get care at these hospitals.
These costs apply to services such as:
- Inpatient Care
- Outpatient Day Surgery
- Outpatient Diagnostic High-tech radiology
- Outpatient Diagnostic Lab Tests
- Outpatient Diagnostic X-rays, and other imaging tests
- Outpatient Short Term Rehabilitation therapy
These cost levels don't apply to emergency care. If you get care at a hospital during an emergency you will pay the lower cost share, no matter where you go. This also applies if you're admitted to the hospital from the emergency room.
How much of a higher cost? Here are some examples:
And then a list of the hospitals is provided, indicating whether they are in the higher costs or lower cost category. Here is part of the list:
Lower cost non-hospital imaging providers and laboratories are also provided.
Customers are offered a simple worksheet to help them make choices, and a toll-free number to call with questions:
It will be revealing to see the degree of acceptance of this new plan over the coming months. According to the article cited above, "Businesses who join the Hospital Choice plan would see an average premium increase of 4.5 percent on Jan. 1, compared with nearly 10 percent if they continued without any change."
In the past, such plans might not have received favor, but times have changed. Congratulations to BCBS for testing the market and for offering consumer information that is clearly presented and understandable.
Congratulations to BCBS MA for its planned introduction of a tiered in network health insurance product.
ReplyDeleteTo maximize the potential of this approach to reduce healthcare costs, I think we need the following:
1. Employers who offer their employees both a tiered and non-tiered insurance option should require employees who select the non-tiered product to pay the entire additional premium cost out of pocket.
2. To help both patients and referring doctors to fully understand the magnitude of cost differences among providers for a given service, it would be helpful if actual contract reimbursement rates were disclosed in an easy to access, user friendly format.
3. It would also be useful to patients, doctors and hospitals if insurers provide information about how quality is defined and measured.
4. Finally, as the healthcare reform law requires starting in 2012, I believe, employers need to clearly communicate exactly how much they are paying for health insurance on the employee’s behalf and that this is a significant part of his or her total compensation.
I have been watching you patiently repeating your same good ideas for awhile now, Barry. Maybe this just goes to show that patient repetition is sometimes rewarded! It will be very interesting to see how many businesses purchase this product. I have been mystified for some time why employers have not been more forcefully engaged in exerting pressure to reduce health care costs (premiums) - especially in an employer-advantaged job market as in recent times.
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From Facebook:
ReplyDeleteJonathan: Great idea.
Joe: Agreed!
Where can we see the whole list?
ReplyDeleteIf you follow the link embedded in the post, you can find it: http://www.bluecrossma.com/plan-education/medical/hospital-choice-cost-sharing.html
ReplyDeleteI don't agree. We are going the wrong way. All this is a shell game where the sick customer pays more. We have MGH and DFCI in the top 10 in this country for Cancer and I am going to be reaped for going to use their expertise. Reform has not slowed anything and the only solution for both Insurance companies giving out too much money and for Hospitals and Drs asking for too much money is that I get the short end of the stick. This is not a solution but a reflection of bad insurance and hospital/physician policy run amuck.
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