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The California Dept. of Managed Healthcare released the final report of a "Non-Routine Survey" of Blue Shield of California that found significant inaccuracies in the provider director for the health plan's narrow network. The report revealed that "a significant percentage (18.2%) of the physicians listed in the directory were not at the location listed in the Provider Directory and that a significant percentage (8.8%) were not willing to accept members enrolled in the Blue Shield's Covered California products, despite being listed on the website as doing so." A non-routine survey of Anthem Blue Cross made similar findings: that a significant percentage (12.5%) of the physicians listed in the directory were not at the location listed, and a significant percentage (12.8%) were not willing to accept patients enrolled in the Plan’s Covered California products….” The report is available here.
NPR covers how the price transparency measures included in the 2012 reform requiring private insurers to post price estimates online, such as the tool available through Harvard Pilgrim Healthcare. These tools allow consumers to browse price differences among providers. As a result, patients with the incentive to shop now have resources to utilize when trying to spend less.
This study examined Florida’s 2006 Medicaid Reform, which mandated that Medicaid beneficiaries switch from the state’s FFS system to (1) insurer-owned plans, (2) hospital-owned plans, or (3) physician-owned plans. The study found that insurer-owned plans reduced costs by 7-12% in all markets, but insurers in different markets reduced costs in different ways. The results suggest that insurers have leverage in how they reduce costs, but that competition with provider plans may restrict their options.
This Governing article summarizes the transparency measures beginning in October 2014 as a result of the 2012 reform aiming to implement cost controls. Private insurers are required to post price estimates for services online and physicians must provide price estimates to consumers who ask. Concerns remain as to how accurate these prices are and how patients may be responsible for additional hidden fees. At this time, price information is only required to be available to plan members, compared to New Hampshire’s practice of comparing between insurers as well. Quality measures are a critical next step in transforming these cost estimates to value measures.
The Center on Budget and Policy Priorities reported that a 2012 Mathematica evaluation of Indiana’s existing HIP waiver showed that the required POWER account contributions (that is, the premiums under HIP) effectively restrict HIP enrollment. The evaluation found that over a five-year period from 2008 to 2012, some 17 percent of those found eligible for the program — or over 21,000 people — never enrolled because they didn’t pay the initial premium. Moreover, at the time of the evaluation, HIP covered people with incomes up to 200 percent of the poverty line, but 69 percent of those who didn’t enroll because of non-payment of the initial premium had incomes below 100 percent of the poverty line. And of those who did enroll, 12 percent subsequently lost coverage because they failed to pay premiums, with 58 percent of those being people with incomes below the poverty line.
The Colorado Health Foundation announced its support of a ten-year commitment to a community-level collaborative approach to address healthcare costs through delivery system and payment reform. The delivery system and payment reform initiative will focus on accelerating the “Triple Aim” of healthcare: better health for our population, better care for individuals and lower costs for all.
This Health Affairs blog post is the third post in a series by the Robert Wood Johnson Foundation that focuses on the payment and delivery reforms in Arkansas. This post focuses on the participation of Blue Cross Blue Shield (BCBS) and QualChoice - two private insurance companies located in Arkansas - in the creation and implementation of the AHCPII. This post identifies that BCBS had previously experimented with PCMH models and showed significant success in the pilot programs, therefore making the a good partner in the creation of this measure. Furthermore, BCBS and QualChoice’s participation in the episode based payment initiative has made the results more impactful than if the state run Medicare program attempted this initiative on their own.
California Gov. Jerry Brown signed legislation to boost oversight of so-called “narrow networks” and other business practices that affect timely access to care. Many patients in the state found it difficult to find a doctor or get an appointment in a timely way.
The law requires the California Department of Managed Healthcare to review Medi-Cal managed-care plans and plans sold through Covered California annually for compliance with standards related to timely access, network adequacy, continuity of care and quality management. Consumer groups supported the measure; health plans said it wasn’t necessary.
This story found that an emergency room visit to an out-of-network hospital resulted in even higher bills than if the patient had been uninsured.
This Boston Globe article reflects on the dynamics between the Greater Boston Interfaith Organization, a consumer group, and Massachusetts hospitals as they navigate health reform. Both groups are working together to achieve high quality, affordable care. The author suggests these kinds of engagement and collaboration are necessary in meeting the new state mandated limits on healthcare cost growth.