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Yes, they blinked: Thoughts about Hospitals, Medicine and Health Care Issues October 24, 2011
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Paul Levy About the Author
Paul Levy

Provided by Not Running a Hospital

I ran into an insurance company executive the other day who questioned whether I really thought that Blue Cross Blue Shield of MA could have done better in its recently signed contract with Partners Healthcare System here in Massachusetts.  Recall that the state's largest insurer gave away a huge rate increase to the state's dominant health care system  --  a 2-3% increase on a base that is, what, 15 to 20% higher than the rest of the market.   I said, "Whether it is fear of government regulation or a desire to go along to get along, a tremendous opportunity to truly control costs has been squandered."
 
This person said, "Remember, this was a private negotiation between two parties."  I allowed how I wasn't in the room, and it is easy to criticize, but, as I thought about it later, this statement alone might be indicative of why the insurance company blinked in this case.
 
A negotiation of this sort is never a private negotiation between two parties.  When two economic behemoths talk, there are a huge number of interested parties in the community.  And, those constituencies had already made their views known, views that could have been leveraged in this discussion.  Here are examples:
 
The Attorney General had pounded away two years running that a major issue facing the health care system, one that was driving up costs for the entire state, was the large disparity in rates paid to this provider group compared to others in the state.
 
The Governor had filed a bill to expand the authority of the Insurance Commissioner to review the rates paid by insurers to providers.  (By the way, many current and former state officials feel that the Commissioner already has that power.)
 
The Inspector General had expressed concerns that PHS would try to rush through a new contract before legislation passed that could limit payment increases.
 
Members of the legislature were publicly expressing concern about the rate disparity issue.
 
The insurance company had had noticeable success in marketing a tiered product, requiring higher co-pays from patients visiting the high-priced providers.

Lower cost competing hospital groups were creating ever more integrated alternative clinical networks.
 
Business groups in the state were clamoring for real cost controls in premium increases.  Given the unemployment situation, with people less likely to leave jobs for new ones, they felt that tiered insurance products could gain greater acceptance than in the past.
 
This provider group had not paid a promised $40 million to reduce insurance rates and was being derided for that delay.  It had every reason, given the pending legislation, to try to strike a deal before the law changed.  The insurance company, in contrast, had no reason to hurry.  Further, it had the moral upper hand, having forced other, more poorly paid, providers in the state to take dramatically lower rate increases.
 
In a public hearing about two years ago, this insurance company had said that it did not have the heft to fight the market power of PHS.  It seemed to fail to understand that the world had shifted.  If there was ever a time to go head-to-head, publicly if necessary, this was it.  An opportunity was lost.

Paul Levy is the former CEO of a large Boston hospital. He blogs to share thoughts about hospitals, medicine, and health care issues. Paul is an advocate for patient-driven care, eliminating preventable harm, transparency of clinical outcomes, and front-line driven process improvement.


The viewpoint expressed in this article is the opinion of the author and is not necessarily the viewpoint of the owners or employees at Healthcare Staffing Innovations, LLC. 
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