blue cross blue shield


Mass. Blue Cross Reports High Marks For Global Payment Plan

Dr. Bob Weinstein, chief of family practice at Signature Healthcare

WBUR’s Martha Bebinger reports this morning on promising results from the first year of a Blue Cross Blue Shield global payments plan. Check out her full report, including audio, here.

As the state ponders a move to global payments to improve care and control health care spending, there is early evidence the strategy works.

Eight hospitals and physician groups that have been under this new payment model through Blue Cross and Blue Shield for at least a year are releasing the results. The groups all came in under budget and scores show they improved care. The verdict is out on whether patients like the change.

These hospitals and doctors say the move to global payments is a big deal. Doctors and hospitals receive a yearly budget for all their Blue Cross patients instead of getting paid for every office visit, test and procedure. The goal is save money while providing better care.

So let’s look at how these providers did in their fist year in three areas: cost, the quality of care and patient satisfaction.

Quality goes up

On quality, Blue Cross says at least twice as many patients under a global payment got cancer screenings, regular check-ups and kept their diabetes or heart disease under control as did patients in traditional plans.

Doctors at Tufts Medical Center boosted their patient quality scores, in part, by creating a registry of patients with a chronic disease and assigning nurses to track who needed a test or an appointment.

Jeffrey Lasker, CEO at the Tufts physician network, says the registry “helped us identify the patients who are in need of screenings or other follow-up measures so that’s been very highly effective.” Two years ago, Tufts fought pressure from Blue Cross to sign this global payment contract. But Lasker says once physicians started working under it things went well.

Costs go down

On costs, Blue Cross has pledged that over five years, the move to global payments will cut rising health care costs in half. Instead of going up at roughly 10-12% a year, the increase would be 5-6%.

So are these providers on track? Continue reading

Tracking The Blue Cross Lawsuits In Michigan

Kaiser Health News continues to track the lawsuits against insurer Blue Cross Blue Shield of Michigan (which has got to be sending chills down the spine of Blue Cross execs across the country).

Here’s the latest twist: the state’s largest insurer, Blue Cross of Michigan allegedly arranged to have a physical therapy program crushed because it considered the program competition.

USA Today: “As health care costs soared nationally, a small Michigan firm gave Ford Motor Co. a proposal to cut its physical therapy costs. The automaker signed up for an in-state pilot program, which was so successful Ford expanded it last year to cover about 390,000 employees, retirees and their families nationwide.” But court “records allege Blue Cross used its position as the state’s dominant insurer to try to crush TheraMatrix as it worked to also sign up Chrysler and General Motors. A USA TODAY review of hundreds of pages of e-mails and internal documents that are part of a lawsuit TheraMatrix filed against Blue Cross indicates that TheraMatrix’s efforts to carve out a niche market in managing outpatient physical therapy costs was seen as a threat by officials at Blue Cross and by some Michigan hospitals” (Young, 11/10).

Detroit Free Press: “The domination of Blue Cross Blue Shield of Michigan throughout the state makes it difficult for other insurers to compete and drives up insurance costs for consumers with other plans, the executive director of Michigan’s largest health insurance trade association said. … In fact, several larger insurers, including Humana and Aetna, recently have stopped selling some lines of insurance, in part because of this problem, said Richard Murdock of the Michigan Association of Health Plans” (Anstett, 11/10).

Mass. Health Insurers Punt On Premiums

WBUR's Martha Bebinger

WBUR’s Martha Bebinger reports today:

The state’s largest health insurers are hedging their bets on premium increases for businesses with fewer than 50 employees.

The approach boils down to: let’s wait and see who wins the tight race for governor. One candidate, Governor Deval Patrick, capped small business insurance premiums earlier this year — a step the insurers expect him to take again if re-elected.

To avoid another fight, with lawsuits and public battles, the insurers have decided to punt. The state’s top three health plans have all filed an extension of the capped rates, just under 10%, for the first three months of next year.

All the insurers continue to say they will lose money without a higher increase later next year. But they are leaving negotiations over what rate increase the state will allow until they know with whom they will be negotiating. Republican candidate Charlie Baker, a former Harvard Pilgrim CEO, does not support the insurance rate caps.
Continue reading

Squeaker in Mass. Health Plan Ratings

You may not feel yourself overflowing with love and appreciation as you pay your premium, but the fact is that several Massachusetts insurance plans are considered excellent — in fact, tops. (Our premiums also tend to be higher than elsewhere, by the way.) Massachusetts dominated the top ten in the latest national rankings that the non-profit National Committee for Quality Assurance issued. The top of the rankings looked like this:

1. Harvard Pilgrim Health Care

2. Tufts Associated Health Maintenance Organization

3. Harvard Pilgrim Health Care of New England

4. Capital Health Plan

5. Geisinger Health Plan

6. Grand Valley Health Plan

7. Group Health Cooperative of South Central Wisconsin

8. Fallon Community Health Plan

9. Kaiser Foundation Health Plan of Colorado

10. Health New England

11. Blue Cross and Blue Shield of Massachusetts

All the top-rated Massachusetts plans are non-profits. And just a bit of inside baseball: If you look at the complete list here, you’ll see that Harvard Pilgrim edged out Tufts for the top spot by just a hair: an overall ranking of 90.5 vs. 90.4. Last year’s scores followed a similar pattern, and the two plans have been neck-and-neck at the top for five years now. Readers, what do you think is up?

Dreyfus On Tough Love For Hospitals, Skewed Incentives And Happy Doctors

Andrew Dreyfus, the newly appointed CEO of Blue Cross Blue Shield Massachusetts, the state’s largest insurer, spoke about health care costs and how to control them on WBUR’s Radio Boston today.

Here are the interview’s top 3 nuggets:

1. The new CEO said he’s willing to “tangle” with hospitals who resist payment reform and might even drop certain hospital systems (Read: Partners) from the network if they don’t get on the global payment bandwagon.

2. He says some doctors are actually happier being paid one lump “global” fee per patient, rather than reimbursed for each individual procedure. (Really? Show me a cardiologist who’d prefer doling out dieting tips to inserting a stent?)

3. His salary? Well, we know it won’t be peanuts, given his predecessors earned between $2 and $4 million annually (yes, it’s still a non-profit). But Dreyfus said the Board hasn’t decided his compensation. Still, he added: “You’ll see different numbers than you’ve seen in the past.”

If you crave more from Dreyfus, here’s a longer talk he gave earlier this year on transforming the payment system: