The Boston Globe reports that Blue Cross of Blue Shield of Massachusetts is expanding its capitated, or "global payment," form of medical reimbursement.
The Massachusetts health care industry’s traditional system of paying doctors for every office visit, test, and procedure may be nearing its end.
Blue Cross will essentially pay doctors a set amount to care for their patients but payments will ultimately be tied to how well doctors and hospitals score on a variety of quality measures.
The company CEO is quoted:
“This is definitely a new phase. It’s a very important signal to the community and to the market that we want to continue to advance payment reform, promote accountability for quality and costs, and continue to move away from the fee-for-service system.”
The story takes as a given the possible benefits of this approach, but gives short shrift to any alternative points of view. Beyond that, with all the encomiums included in the story, it lacks any mention of some very important unanswered questions. I've noted these before, with reference to issues that ought to be reviewed by the state's Attorney General:
[BCBS of MA] also acted to increase the disparity in payments among hospital networks, even after those disparities were documented by the previous AG as being one of the major causes of health care inflation in the Massachusetts. A study commission is supposed to review this issue of disparities and make recommendations to narrow them. What's the AG's role in that process? Might she, for example, pursue a reference pricing approach that would require an insurer to justify payments rates outside of a normal band?
BCBS of MA has also persuaded the state to adopt a policy that shifts risks from the insurance company to doctors and hospitals but has made no adjustment to its capital structure to compensate for that savings. Will the AG consider clawing back excessive earnings given the company's new risk profile?
All other financial service industries have been able to reduce administrative and transaction costs over the years. What is it about this company that gives them a pass? As premiums rise, the percentage the company keeps for administration and profit stays the same. Here's another area worthy of attention by the new Attorney General. Shouldn't we expect some technological improvements and the resultant savings to passed along consumers?
The Massachusetts health care industry’s traditional system of paying doctors for every office visit, test, and procedure may be nearing its end.
Blue Cross will essentially pay doctors a set amount to care for their patients but payments will ultimately be tied to how well doctors and hospitals score on a variety of quality measures.
The company CEO is quoted:
“This is definitely a new phase. It’s a very important signal to the community and to the market that we want to continue to advance payment reform, promote accountability for quality and costs, and continue to move away from the fee-for-service system.”
The story takes as a given the possible benefits of this approach, but gives short shrift to any alternative points of view. Beyond that, with all the encomiums included in the story, it lacks any mention of some very important unanswered questions. I've noted these before, with reference to issues that ought to be reviewed by the state's Attorney General:
[BCBS of MA] also acted to increase the disparity in payments among hospital networks, even after those disparities were documented by the previous AG as being one of the major causes of health care inflation in the Massachusetts. A study commission is supposed to review this issue of disparities and make recommendations to narrow them. What's the AG's role in that process? Might she, for example, pursue a reference pricing approach that would require an insurer to justify payments rates outside of a normal band?
BCBS of MA has also persuaded the state to adopt a policy that shifts risks from the insurance company to doctors and hospitals but has made no adjustment to its capital structure to compensate for that savings. Will the AG consider clawing back excessive earnings given the company's new risk profile?
All other financial service industries have been able to reduce administrative and transaction costs over the years. What is it about this company that gives them a pass? As premiums rise, the percentage the company keeps for administration and profit stays the same. Here's another area worthy of attention by the new Attorney General. Shouldn't we expect some technological improvements and the resultant savings to passed along consumers?
2 comments:
Paul, How can we get this done in our state? Referencing: "I've noted these before, with reference to issues that ought to be reviewed by the state's Attorney General:
[BCBS of MA] also acted to increase the disparity in payments among hospital networks, even after those disparities were documented by the previous AG as being one of the major causes of health care inflation in the Massachusetts. A study commission is supposed to review this issue of disparities and make recommendations to narrow them. What's the AG's role in that process?"
Since capitation shifts risk to the providers, it would seem that we will no longer need insurance companies, and BCBS and the rest can quietly walk off into the sunset. Since that's not likely, how will they justify their (costly) existence?
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