He said, she said

On Monday, the Boston Globe reported that for the first time in quite a while, insurance carriers are trying to reduce or cut rate hikes to providers.  The carriers have asked many hospitals and large physician groups to negotiate these lower rates through their contract negotiations.  

The carriers are acting, in large part, because the state has clamped down on premium increases for the merged insurance market leaving them with a lot less money to spend on providers.   Carriers say they must take this action.  On the flip side, the hospitals are citing shortfalls in Medicaid and Medicare as the reason to reject the carriers’ lower rates.    Stuck in the middle of this ‘he said, she said’ is the patient. 

Patients must not be used as pawns in these negotiations.  Patients are paying their premiums- living into their responsibility for the individual mandate, and they must receive the services that they need.  “Contract negotiations” is a sterile concept until you consider that in the past, letters have gone out to patients explaining that they may no longer have access to their existing providers.  While patients appreciate the heads-up, families struggling with chronic or acute illnesses should not have to worry about contract negotiations between their providers and their insurance company.  The last time this battle was fought, our Helpline received hundreds of calls from confused patients who just wanted to get treatment. 

Both the carriers and the providers argue that their action is in the best interest of the patient.  Carriers pay providers less, perhaps forcing them to be more efficient, which results in lower premiums for the patient.  Providers want to ensure that there is continuity of care for patients and that treatment is not disrupted.  Both are very concerned about their ability to stay in business as they are buffeted by changes in their funding stream.

Patients deserve to have the best quality care at a price that is affordable.  The state, providers, payers, employers, and consumers have all decided that we need to focus on this goal.  However, it will not be easy to get there.  It will require changes in the usual course of business- instead of using the patient against one another, providers and carriers should both do what is best for the patient.  Instead of a battleground, these contract negotiations should be viewed as an opportunity by both carriers and providers to be innovative, to become more efficient, to deliver more coordinated care.  They should be a building block towards comprehensive payment reform.

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