Blue Cross Blue Shield of Massachusetts


Tension Between Harvard Researchers, Blue Cross Escalates

In case you missed this excellent post by The Boston Globe‘s Chelsea Conaboy on Friday, here’s a snippet of the escalating tension between Blue Cross Blue Shield of Massachusetts and Harvard-affiliated researchers from Cambridge Health Alliance who last week published a study that found it’s extremely difficult to get psychiatric care in Boston, even if you have top-notch health insurance.

As part of the study, which was published in the form of a letter in the Annals of Emergency Medicine, researchers posed as severely depressed patients with Blue Cross insurance and tried to get an appointment for psychiatric care at a facility in downtown Boston. Of the 64 facilities they called, they were only able to get 8 appointments, and only 4 of those were within two weeks.

Here’s Chelsea’s ongoing coverage of the dispute, which began when Blue Cross expressed annoyance to the researchers that its “brand” was used in the study without permission:

“We are VERY concerned about the use of BCBSMA’s name and brand in a published study without BCBSMA authorization,” [Blue Cross] spokesman Jay McQuaide wrote. “We’d like to talk with you about that.”

Today [Friday] in an e-mail titled, “Your intemperate 7/20/11 letter to Cambridge Health Alliance regarding the Annals study,” McQuaide received an admonishment of his own.

Dr. Sidney Wolfe, director of the Health Research Group at Public Citizen, a national consumer advocate, sent McQuaide an e-mail calling the idea that the researchers needed the insurer’s authorization “absurd.”

“Please send me a copy of the BCBSMA policy manual that specifies the need for such censorship,” he wrote.

Wolfe suspected that the statement from McQuaide was meant to bully the researchers, he said in an interview this afternoon.


Debunking The Myths Of Massachusetts Health Reform

An op-ed piece in The Washington Post this weekend by Blue Cross Blue Shield of Massachusetts CEO Andrew Dreyfus and Beth Israel Deaconess Medical Center physician Stuart Rosenberg seeks to debunk some myths that have taken hold about health care reform in the Bay State. For instance, they write:

Have you heard that the government has taken over health care in Massachusetts? Well, that’s false. More than 80 percent of residents who are not elderly have private insurance, and 76 percent of employers offer coverage to their workers — up five percentage points since 2007. Or that newly insured residents can’t find doctors? Also false. Everyone enrolled in the new subsidized plan for low-income residents belongs to a private health plan and has access to primary-care physicians. But isn’t health reform bankrupting the state? No. In fact, while there have been ups and downs due to the recession, overall state spending on health reform has been about what was anticipated.

It’s true there’s not much news here for local folks up to speed on the raging political and policy debates over controlling health care costs. Still, it’s interesting to see the insurer and the doctor pitching their new partnership to a national audience:

One model for collaboration is already up and running in Massachusetts, and so far, it’s working. For the past two years, physician groups and hospitals of all sizes have joined with Blue Cross Blue Shield of Massachusetts in a new kind of contractual relationship that gives patients, providers and insurers an opportunity to make health care work more effectively and efficiently. Instead of paying primarily for the quantity of services provided, the “alternative quality contract” aligns financial incentives with what the vast majority of medical professionals want to do with their time and talents — prevent illness, improve quality of life and produce better outcomes for their patients. Data from the first year indicate this approach is producing significant improvements in areas that are closely tied to both the cost and quality of care, such as screening, monitoring and effectively managing patients’ chronic conditions; preventing hospital readmissions; and reducing the use of emergency rooms for non-emergency care.

There’s no doubt that the changes needed to control health-care spending will be unsettling for many health-care providers. They require more teamwork, communication and coordination than many are used to, along with a growing reliance on data, information systems and process improvement. The payoff, however, is that their patients will receive more appropriate, better coordinated, more personalized and more effective care — better care that is more affordable. And, frankly, it’s the only way that we can hope to extend high-quality health-care services to everyone.

Breaking News: Blue Cross Suspends Pay For Board Directors

Facing criticism about its eye-popping pay packages for executives and outrage over fees paid to its directors, Blue Cross Blue Shield of Massachusetts, the non-profit health insurer suspended pay to board directors pending an investigation by the state Attorney General.

The move was voluntary and unanimous, Blue Cross said, noting that it is currently in discussions with the AG over its classification as a public charity. Today’s action comes after a public uproar following disclosures about Blue Cross’ $11 million pay package to its former CEO Cleve Killingsworth.

Here’s the press release from Blue Cross:

BOSTON –March 8, 2011 – Blue Cross Blue Shield of Massachusetts is a locally-based, community- minded company that has been proudly serving the Commonwealth for nearly 75 years.We are committed to working earnestly and collaboratively with others on the central challenge of health care affordability for individuals, families, employers, and government in Massachusetts.

Over the past several days, we have heard clearly the community’s anger at the compensation package paid to our former CEO Cleve Killingsworth.

At a time when health care costs and premiums continue to rise at unacceptable and unsustainable rates, Cleve’s compensation has caused the community to appropriately question the sincerity of our commitment to improving the affordability of health care for our members, employer customers and the community.

With regard to Cleve’s package, we accept full responsibility for the decision. Continue reading

Ex-Blue Cross CEO Got $8.6M Pay Package

Bending the cost curve? Sure, but which way?

In a disclosure already generating public outrage, Blue Cross Blue Shield of Massachusetts reports today that its outgoing CEO Cleve Killingsworth received $8.6 million in compensation last year, including $1.4 million in severance pay.

The details of the pay package were part of a state insurance filing by Blue Cross, the state’s largest insurer. Here’s more from The Boston Globe.

And here’s a statement (aka damage control) from former Blue Cross Board Chairman Paul Guzzi about the compensation filing:

Today, Blue Cross Blue Shield of Massachusetts filed its annual compensation report with the Massachusetts Division of Insurance. Included in the report is the compensation paid to former CEO Cleve Killingsworth upon his resignation in March of last year.

Cleve chose to resign his position following discussions with the Board about the direction of the company. He agreed to resign on the condition that he would receive the same severance benefits that were called for if he were terminated under his employment contract. The Board agreed to proceed on that basis. Cleve’s severance and retirement benefits were negotiated as part of the employment contract signed in 2005 when Cleve became CEO.

The Board understands and is sensitive to the community’s interest and concern about executive compensation. With the full support and urging of our new President and CEO Andrew Dreyfus, we have significantly reduced the CEO’s compensation and benefits.

(Guzzi was Chairman of the BCBSMA Board when Killingsworth resigned.)

Outrage-filled comments are already stacking up on The Globe’s website:

“Nonprofit they say? Sounds like plenty of people are profiting. Keep paying those premium[s],” feedbass writes

Rileysdad adds: “As a right leaning, free-market independent, even I am speechless.”

And here’s Dianadot: “OMG This is so disgusting. Why on earth was he receiving that kind of compensation??”

Reached at his home in upstate New York, Killingsworth told The Globe: “The payment I got was consistent with my contract, no more, no less.”

And then comes this irony-rich kicker:

He said he is currently serving on the boards of a half dozen companies and universities and writing about health care issues, including the need for reforms in how doctors and hospitals are paid.

(Italics mine.)

This just in from Attorney General Martha Coakley’s office, also clearly not pleased:

“Today, Blue Cross Blue Shield reported the compensation owed to its former CEO as a result of his employment contract negotiated back in 2005. While Blue Cross may be required to meet its contractual obligations to its former CEO, we continue to be concerned about high levels of executive compensation at health care organizations given current fiscal conditions and efforts to control costs in health care. Blue Cross has assured us that significant changes have been made in its contract with its current CEO to bring it more in line with current fiscal conditions. Every board is primarily responsible for establishing CEO compensation and more transparency is needed to enhance public confidence in our charities.

Two years ago, our office issued new findings regarding our investigation into executive compensation at non-profits and brought additional levels of transparency on these issues. We also are continuing our review of compensation practices at health care organizations as part of our work to help achieve quality, affordable health care in our Commonwealth. Today’s news is yet further evidence of the importance of that work.”