Friday, September 13, 2013

Self-dealing between a health system and its insurance company

Just when you think you've seen the limits of market power, creativity emerges.  Julie Donnelly at the Boston Business Journal reports:

Partners HealthCare aims to drive new members to its newly acquired health insurer, Neighborhood Health Plan, by cutting off access to some doctors within new health plans offered under ObamaCare.

Neighborhood Health Plan is one of 10 insurers that has been certified to offer subsidized and un-subsidized ObamaCare plans through the state’s Health Connector.

But what Neighborhood Health Plan has is exclusive access to primary-care doctors at Brigham and Women’s Hospital and Massachusetts General Hospital.

Now that Partners, the parent organization of the Brigham and Mass General, owns a piece of the insurance pie, they have decided to offer access to their primary care doctors only to those members who choose Neighborhood Health Plan.

This is likely to drive new business to Neighborhood Health Plan from Boston-area patients who want to keep or begin a relationship with a primary-care doctor at one of the two most prestigious hospitals in the state.
This is a departure from Partners’ strategy in the past. Before its purchase of Neighborhood Health Plan, Partners’ offered access to its doctors to all of the health plans within the state-subsidized health plans that were launched under Massachusetts' own statewide health reform.


Anonymous said...

Paul - This really is a game changer. State officials should never have allowed them an insurance license... especially when they are already a monopoly along with Children's Hospital. It's all about PCPs and their affiliations... people want to go to Partners and they will seek out a PCP that allows them this access. As the current Partners' PCPs fill their panels they will need more and more PCPs to join. The state is all over Steward being "for profit" while Partners mints money and builds more and more capacity. Steward buys empty, old hospitals and leaks half of their patient revenue to other networks while Partners pulls this off and is in line to get South Shore. If it were not SO bad you would have to tip your hat to them for playing the game so well.

Anonymous said...

One very important element in all of this -- THE Patients don't pay! - TAXPAYERS DO!

This announcement is only for SUBSIDIZED PLANS.

Partners high costs will be invisible to patients, since this is all paid for as part of Obamacare.

This is having their cake - helping their health insurer - and eating it too - not having to subsidize NHP out of pocket to get this advantage.

This REQUIRES a STATE and FEDERAL investigation!

Anonymous said...

Yeah, I am sure Martha Coakley will investigate Jack Connors and Partners... when pigs fly. Feds won't get involved.... who is complaining to them about Partners or even understands it well enough to know about this obvious monopoly? Horse is out of the barn in this case and it is costing residents and companies here in Mass a fortune in increased healthcare costs. They should have been investigated when they cut the back room deal with BCBS. Cripes, the state is even about to let them add on South Shore... just crazy to anyone who understands the market.

wrinkledman said...

Why am I surprised by greed and selfishness? Who is pocketing the cash? When I say who, I mean that very literally. What are their names? Who will be putting more money in his already deep pocket at the expense of someone/anyone/everyone?

Anonymous said...

Wait... Partners is not for profit... they are not doing this for $$, but for the health of everyone. There isn't an elephant behind the curtain.

globetrotter said...

Non-profit is a tax classification, not a business plan. Non-profit only means that there are no shareholders. There is intense interest on the part of non-profit hospitals to increase their margins (revenues minus costs, i.e., profits.)