blue cross blue shield


Doctor’s Musings As Insurance Call Makes Him Wait And Wait

Dr. Steven Schlozman

Dr. Steven Schlozman

Dr. Steven Schlozman is an assistant professor of psychiatry at Harvard Medical School and a staff child psychiatrist at Massachusetts General Hospital. He is also the Co-Director of Medical Student Education in Psychiatry. His first novel, “The Zombie Autopsies,” was published in 2011, and his affinity for zombies might explain his mind-numbing rage at being stuck on hold all the time. Readers, have you had muzak musings of your own lately? Please share in the comments below.

By Dr. Steven Schlozman
Guest contributor

I am a physician practicing in Boston. I do my best to get my work done as carefully and efficiently as possible.

I am writing to you right now, in real time, as I enter my…wait for it…38th minute on hold with Blue Cross/Blue Shield in my attempt to gain approval for a treatment that my patient absolutely needs. No one who knew the details of this case would argue otherwise; not politicians, or business specialists, or cost efficiency specialists, or medical school professors, or anyone really. Neither would anyone deny that the treatment that I am trying to procure for my patient is costly. Finally, no one would deny that it is legions more costly to not treat my patient with the treatment for which I am now sitting on hold and trying to procure.

Help. I love being a doctor. But this isn’t doctoring.

Still, here I sit. I sat initially for 26 minutes, at which point the very pleasant muzak stopped and a recorded and maddeningly soothing female voice told me that I would “have to call back later.” Then the line went dead.

So I called back later.

I called back exactly 12 seconds later, and that was now 42 minutes ago. I mean, 42 minutes, in real time, as I write this letter. I have patients in the waiting room who will understandably expect me to get to them soon. I also know that there are those who will tell me that this is what I signed up to do for a living.

But they’re wrong. I did not sign up to do this for a living. There are no courses in medical school about how to spend one’s time on hold while patients need your help.

Minute 58 just passed, by the way. Continue reading

Earnings Up For Large Mass. Health Plans

Blue Cross Blue Shield Chief Andrew Dreyfus

WBUR’s Martha Bebinger reports:

Earnings are up for all four of the state’s largest health insurance companies.

The largest — Blue Cross Blue Shield of Massachusetts — reports income for the first time in three years.

After losing money in 2009 and 2010, Blue Cross president Andrew Dreyfus says operating income for last year totaled $43 million. “I think it reflects the fact the company is healthy and doing well,” he says, “although the operating margin is very narrow.”

Tufts Health Plan, Fallon Community Health Plan, and Harvard Pilgrim Health Care are also reporting significant earnings increases.

The Boston Globe’s Rob Weisman reports on the latest health plan financials here, including a pointed comment from a consumer advocate about continually rising premiums.

“Premiums are still increasing, and they’re already too high,’’ said Deirdre Cummings, legislative director for the Massachusetts Public Interest Research Group. “This is the same dance insurers have been doing for some time, and this is what consumers are frustrated by. Insurers are reaping the benefits that should be going to consumers.’’

Breaking: Blue Cross, Tufts Medical Center Reach Agreement

This just in:

New Contract Agreement Reached between Blue Cross Blue Shield of Massachusetts, Tufts Medical Center and New England Quality Care Alliance

BCBSMA Members Can Continue to Seek Care at Tufts Medical Center and from its Community Physician Network

December 7, 2011 – Boston, MA – Blue Cross Blue Shield of Massachusetts (BCBSMA), Tufts Medical Center and New England Quality Care Alliance (NEQCA) announced today that they have agreed to a new three-year contract. The agreement ensures that BCBSMA members who receive care at Tufts Medical Center, Floating Hospital for Children or from a NEQCA community physician can continue to do so without any interruption. BCBSMA members who would like to be new patients of NEQCA, Tufts MC and Floating can receive care as well.

Under the agreement, the Tufts Medical Center and NEQCA network will receive an annual network-wide average increase of 3 percent. Continue reading

Talks Break Down Between Blue Cross and Tufts Medical, Patients May Need New Docs

A contract dispute between Blue Cross and Tufts Medical Center could leave at least 88,000 patients in search of a new primary care doctor, reports WBUR’s Martha Bebinger.

Blue Cross is alerting employers (whose employees have Blue Cross health plans) in letters today that they may no longer be able to go to Tufts.

But Tufts Medical Center CEO Eric Beyer says he hopes negotiations will continue. Continue reading

Partners-Blue Cross Deal: ‘Squeezing Out Costs’

Partners: Rethinking care delivery to control costs

WBUR’s Martha Bebinger reports:

Partners HealthCare — the state’s largest hospital network — is telling State House leaders that it has agreed to a new contract with Blue Cross Blue Shield that will reduce Partners’ payments by $240 million over three years.

Partners, which includes some of the state’s highest paid hospitals, has said for months that it was willing to take less money. In this deal, that includes a move to global payments, Partners would receive $80 million less than its current contract in each of the next three years.

Representative Ron Mariano, who filed a bill to close the gap between high-cost and low-cost hospitals, says this is a good first step.

“The fact that we have gotten some action shows that there are a lot of costs in the system that we can squeeze out and I think it is the role of government to break the inertia that exists.”

Blue Cross says the deal is not final. There are no firm estimates on how the Partners savings would affect Blue Cross premiums.

Related: This post on the Partners blog “Connect with Partners” Monday about plans to save a total of $300 million over the next three years.

Also on Monday, Partner CEO Gary Gottlieb sent out this message to Partners employees:

Dear Colleagues,

As we all finalize our plans for the fall, I thought this would be an appropriate time to offer an update on our strategic plans for Partners HealthCare. I have shared with you the outline for that strategy that’s been developed in collaboration with clinical and administrative teams from our hospitals and institutions. We are focused on three specific areas that we are calling: Care Redesign, Patient Affordability, and our public Reputation and Communications.

As we consider our strategy, our mission remains front and center and will serve as our compass as we move forward. We must coordinate the strengths of our system so our patients will benefit from the value of the continuum of care that Partners hospitals are in the best position to provide.

There is a tremendous amount of work that has taken place. The senior leadership across our system has approved numerous recommendations that have been brought forth by our strategy teams and these proposals have been vetted by the hospitals and clinical care providers.

The ‘go live’ date to begin execution on these prioritized recommendations throughout the system is October 1. Here’s a link to the recommendations. [Note from Carey: Link omitted because it didn’t work for me.] Our communications teams will do their part by sharing more details about this thoughtful work in the weeks ahead. An important leg of our strategy is sharing our story with our Partners community and the public. Continue reading

Trend: You Choose More Costly Care, You Pay More Out Of Pocket

At the bottom: Practical tips

First, Eric Schultz, chief of Harvard Pilgrim Health Plan, the #1-ranked plan in the nation, told me with utter certainty: This is the wave of the future. Soon it will be as common as having a 401K plan.

That got my attention. Then Attorney General Martha Coakley put it at the top of her list of what should be done to cut Massachusetts health care costs. And the state’s Group Insurance Commissioner, Dolores Mitchell, declared at a hearing, “I think it’s an idea whose time has now finally come.”

What’s the idea? Please pay attention, because there will be a test on this topic — the next time you’re choosing health insurance.

The concept is called “tiered” health insurance. It is a major national and statewide trend. It has both major upsides and major downsides. And it goes roughly like this:

One way you can lower your painfully high health insurance premiums is to sign up for a plan that limits the doctors and hospitals you can use to cheaper ones. That’s called a “limited network.” But it can be scary to rule out any chance of going to a fancier, more expensive hospital or doctor.

So now, increasingly, you can opt for a cheaper-premium plan that lets you sign up for a lower-cost “tier,” or level of health care, but also gives you an out: If you ever want to get care that’s ranked by your health insurer in a more expensive tier, you can. You’ll just have to pay more out of pocket in a co-pay or deductible — maybe a lot more.

“What tiering does is it lets the consumer, the member, make a choice every time they have a medical need, and that makes people more comfortable,” said Jim Roosevelt, chief of Tufts Health Plan, which is ranked a close #2 in the nation and has about one-third of its members in tiered plans. Health insurance, after all, “is supposed to relieve the fear of the unknown,” he said.

Everybody’s Doing It

Blue Cross Blue Shield of Massachusetts made a big splash this winter when it introduced its “Hospital Choice Cost Share” plan, which would charge members up to $1,000 in co-pays if they choose (in non-emergency situations) to go to the 15 hospitals it ranks as high-cost.

It sparked some controversy when it was announced. To many — including me — it is daunting to contemplate giving up free access to prestigious but expensive hospitals like Massachusetts General and Brigham and Women’s. But Blue Cross chief Andrew Dreyfus now says it’s one of the fastest-growing products in the insurer’s history. Continue reading

Breaking: Blue Cross To Rebate Killingsworth $4M Severance To Customers

Here’s the WBUR report, and below is the full release from Coakley’s office and the full Blue Cross statement:

BOSTON — The state’s largest insurer plans to rebate $4.2 million to its ratepayers to offset the cost of a controversial severance package to former chief executive Cleve Killingsworth.

Attorney General Martha Coakley disclosed the decision by Blue Cross Blue Shield of Massachusetts on Wednesday following an investigation by her office.

Coakley said the probe determined that Killingsworth was entitled to the hefty severance package under his contract with the insurer, but that such contracts were “costly both in dollars and public perceptions.”

Killingsworth resigned in March 2010 after five years on the job. He left with a total compensation package of $11.3 million. That deal angered many Blue Cross members who are struggling to pay rising health care premiums.

“To put this issue behind the company and as a gesture of good faith to our customers and the community, the board has decided to credit customers the $4.2 million in severance that was paid to our former CEO,” said spokesman Jay McQuaide, reading from a prepared statement.

The rebate breakdown is just under $2 per person. Continue reading

Radio Boston Today: Equalizing Hospital Rates, And ‘Pox’ History

Tune in to Radio Boston at 3 today for a health coverage bonanza:

Meeting in the middle:
Doctors and hospitals in Massachusetts charge vastly different rates for the same services—that’s the big finding of a recent Patrick administration report. But buried within that report was another finding: the state could save hundreds of millions of dollars a year if all health care providers met in the middle and charged the median rate for procedures. Blue Cross Blue Shield Foundation president Sarah Iselin says that would be a hard sell, as it would require the government setting the prices for providers.

Fascinating vaccine history:
An interview with Brandeis professor Michael Willrich, author of “Pox: An American History.” He tells riveting tales of the Draconian vaccine policies during the smallpox epidemic at the turn of the 20th century. From WHYY’s Fresh Air: “There were scenes of policemen holding down men in their night robes while vaccinators began their work on their arms. Inspectors were going room to room looking for children with smallpox. And when they found them, they were literally tearing babes from their mothers’ arms to take them to the city pesthouse [which housed smallpox victims.]”

Coming Soon To Your Smartphone: Where The Cheaper MRIs Are

Picture it: Your doctor tells you that you need an MRI. Okeydoke, you say, pulling out your smartphone and typing in your zipcode. Up pop the 20 closest high-quality imaging centers, and you choose the most convenient.

That’s my visualization based on a casual mention that Blue Cross Blue Shield chief Andrew Dreyfus made last week of a new app now in development. “We’re pretty close to delivering this,” he told a health reform forum at Suffolk.

He pointed out that MRI prices can range from $500 in a community imaging center to $1500 at an academic medical center. That’s certainly an incentive to help members find cheaper, free-standing centers. And we all have an incentive to seek lower cost care as we shoulder more of our own medical bills.

I asked Blue Cross for more details, and spokesperson Jenna McPhee responded that the “PILOT” app is indeed well along and should be ready for a small group of Blue Cross members to try out in the next couple of months.

The tool is designed to identify the closest free-standing imaging facilities (for MRIs, CT scans, and lab work) sorted by zip code proximity. While it does not provide specific cost information, it locates high-quality free standing imaging facilities that are lower cost than getting an MRI, etc. in a hospital setting.

Here are the key features:
Member starts search by entering a zip code
MRI Locator lists the closest free standing imaging facilities sorted by zip code proximity
Other features include:
Uses Google Maps
Member can map facilities and get driving directions
Ability to dial the facility with a click

My blue-sky dream: The app not only gives you locations, but tells you what the overall price would be at each center, and how big your co-pay would be. They can do it for gas station prices already. Maybe someday…

Expert On Possible Blue Cross Status Shift: ‘Movement Without Progress’

Bob Oakes

WBUR’s Bob Oakes spoke on Morning Edition today with Boston University School of Public Health professor Alan Sager about the possibility that Blue Cross could change its status from a non-profit to a mutual insurance company owned by its members.

That move, Sager noted, would spare Blue Cross scrutiny by the attorney general on practices including executive compensation (like, say, paying out $11 million to an outgoing CEO.)

Listen to their interview here.

My favorite Sager quote: “There are no villains here, and Blue Cross has certainly been trying, in its way, to address health care costs. But this may be another example — this proposal to change to a mutual — another example of movement without progress in health care.”