Here's the story. The state insurance exchange agency, the Connector Authority, recently offered a new option for the subsidized insurance plan offered under state auspices by Network Health. To save money, Network Health proposed and the Connector approved a limited network that excludes the hospitals in the Partners HealthCare system. This was in recognition of the dramatically higher rates charged by PHS hospitals and the doctors who work in those hospitals.
In choosing to exclude those hospitals but include other ones in the highly competitive Eastern Massachusetts market, the executive director of the Connector found that the result "must and does meet our network adequacy standards."
Now, along comes Health Care for All:
Health care advocates said they were pleased that the state was able to keep the program intact and affordable for patients, despite steeply rising health care costs.
Amy Whitcomb Slemmer, executive director of the advocacy group Health Care for All, said she is concerned, however, about narrowing patients’ choices for medical care. She said the group will watch to make sure residents get the care they need.
“Limiting networks is a short-term solution to our long-term problems of redesigning the health care system so it meets the needs of consumers’’ and controls costs, she said.
(By the way, nor will it be possible as ACOs are created and global payments are adopted, a policy result supported by HCFA. You need to put aside some aspect of consumer choice if these initiatives are to be successful.)
The good news is that there are several lower cost systems that are of high quality. So, we don't have to worry about whether "residents get the care they need" under the Connector Authority's decision.