Monday, June 23, 2014

You gotta give me something to work with!

An un-bylined story in the Boston Globe notes:

"Representatives from state Attorney General Martha Coakley’s office and Partners HealthCare System continue to haggle over terms of a final settlement that would allow Partners to acquire South Shore Hospital in Weymouth and at least two other community hospitals while limiting its further expansion and capping its prices for up to a decade."

You can almost imagine the conversation:

Guys, you gotta give me something to work with.  I had this all planned so well.  Look at this announcement, timed carefully to precede the state Democratic convention.  We promised that we would "fundamentally alter the negotiating power of Partners HealthCare for 10 years and control health costs across its entire network." 

We coordinated that with your announcement.  You made the deal sound hard on you by talking about the "challenges we will face with these conditions."

Together, we got the Globe to write an editorial endorsing the deal, saying it will impose "significant restrictions on short-term rates and bargaining power."

The only problem is that people saw through it, saying:

[It] will go a long way toward killing a reasonable possibility for the emergence of any coalition that will have a chance to create effective, cost-lowering competition. What a deal! To steal a concept from Joel Chandler Harris and the tale of “Br’er Rabbit,”Partners has been thrown into a pretty comfortable “briar patch” with this deal.

Then, others jumped and demanded to see the deal before it was filed.  I had to promise they will.  I had to "commit to being transparent and allowing for feedback."

So now, we have to come up with something new.  If I just file what we had before or with minor changes, it will get eviscerated.

But if I file something with major changes, some people will say that I didn't do the job the first time and am only responding to public pressure.

That's ok, because I know I can count on you to talk about how much more difficult it will be for you and how tough I was, right?


Guys, you gotta give me something.


Barry Carol said...

From an insured member’s perspective, the practical question is how much cheaper would the health insurance premium be for a network that excluded the Partners hospitals, clinics and physicians? If Partners has, say, a 40% market share in the Boston region and its prices at contract rates are also 40% higher than its competitors, it implies that a health insurance policy that excluded the PHS would be about 16% cheaper than one that included it. Perhaps that’s not enough to get the attention of employers, unions or individual employees.

As I’ve noted numerous times before, insurers could chip away at this issue and try to create some countervailing power by promoting tiered networks that would require higher coinsurance to use Partners hospitals, clinics and physicians. They could also implement reference pricing where it makes sense. Insurers should also be allowed, through regulation if necessary, to exclude some Partners facilities but not others. That way, they could offer access to MGH and B&W but not some of the community hospitals where there are fine competing community hospitals nearby that also offer excellent routine care but at sharply lower prices. Are patients really going to trudge into Boston from the suburbs for routine care at the academic medical centers? I doubt it.

Anonymous said...

Hmm, not usual practice for the paper to have an un-named byline. Why is everyone skirting around this issue? Something seems clearly amiss when people are nervous about debate.

Anonymous said...

There's also the little aired fact that the only ACA-subsidized health insurance plan that includes Partners is the Partners-owned Neighborhood Health Plan. So, any person who needs a subsidy to afford a health plan and wants to have the option of seeing a Partners primacy care doc or specialist only has that one choice. How convenient that they can cross subsidize their own insurance plan.