Thursday, June 19, 2014

The AG-Partners deal: A view from a reader

It isn't often that I publish a comment as its own blog post, but this one is so thoughtful and comprehensive that I thought more people should see it.  The topic is the agreement reached by the Massachusetts Attorney General and Partners Healthcare System, one several of us believe to be a way of cementing PHS' market power for years to come.  [I have embedded explanatory links.]

There are so many aspects of this deal that are tailored to sound reassuring but are, in fact, hollow. Before any real information was available to understand how or if this approach could actually work, the Boston Globe was very eager to believe that a secret handshake between Partners and the Attorney General's Office would undo the damage caused by The Secret Handshake between Partners and Blue Cross that the Globe's own news division uncovered in 2009. It astonished me that without any information on how these "caps" would be enforced or monitored the Globe expressed such strong, unconditional support. How could they tell this deal would have the intended impact? For example, will this deal rely on the same insurers who kept silent for more than a decade (while doling out 10-15% annual price increases to Partners) to throw a flag on the field if they believe the cap is eclipsed? Or will there be a monitor keeping up with all of their contracts and systematically quantifying price increases/decreases in real time to ensure compliance? Will the increases be estimated projections or will actual total price increases be calculated as a look-back and adjustments made on actual service types and mixes? And the very simple physician market share math that Gene Lindsey laid out is of no concern even IF the caps can be enforced?

I'm afraid these admittedly tedious details matter quite a bit; an "estimated" 1.5% increase can easily become double or triple that as norms of care change and the clever people at Partners carefully select which services they decrease prices on by 5-6 % and which they increase prices on by 6 or 7 percent. And if Partners can add a number of physicians that effectively would give them all of the remaining unaffiliated physicians in Eastern Massachusetts, is that really a growth cap at all? The Globe blessed the deal (without reservation or caution!) in the absence of the answers to these reasonable questions and concerns; puzzling indeed.

I appreciate that your blog is a place where we can get a more realistic analysis of this situation rather than the blindly rosy acceptance of a story that hopes to put to rest an inconvenient political hot-potato. Ignoring the fact patterns of the past 20 years, and chalking up concerns with this deal as the wonky white noise of the sour grapes crowd, will not lead to an outcome the Commonwealth will be proud of in another 20 years. I continue to wonder what harm could possibly come of a transparent, thorough, fact-driven analysis of such an important settlement?

The future Gene Lindsey paints is all too possible and of national importance as other states look to Massachusetts to see what we will do to reign in costs. At least your blog will be one place where our national counterparts will see it was debated in the clear-eyed, analytical way it deserves. However it is a huge loss if, for the most part, our elected officials, local media, and public institutions choose not to insist upon and participate in a transparent and rigorously analytical process.

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