A Healthy Blog

Massachusetts health care — wonky, with a healthy dose of reality

Blue Cross / Tufts Medical Center Impasse - Who's Looking Out for the Patients?

Blue Cross / Tufts Medical Center Impasse - Who's Looking Out for the Patients?

November 16, 2011

Today’s announcement that Tufts Medical Center and its physicians at the New England Quality Care Alliance (NEQCA), and Blue Cross Blue Shield of Massachusetts hit a contracting impasse (see coverage from WBUR, and this personal story, and the Globe story), has our heads spinning. As advocates for creating a more patient centered health care system, we see today’s announcement as both a step in the wrong direction, and a clarion call for a more comprehensive solution to the problem of escalating health care costs. Most importantly for us is our concern about the effect that this will have on the some 130,000 Blue Cross members who depend on Tufts Medical Center for their health care. Consumers are caught in the middle of a fight over which we have no control, yet which will have the direct consequence of disconnecting more than 100,000 of us from the care we depend on. These two critically important members of the Massachusetts health care community -- Tufts and Blue Cross -- went through a similar exercise three years ago, which was also painful, confusing and unnecessarily disruptive to patients and consumers. We are concerned to find ourselves here again, and believe that similar disruptions will be threatened, and perhaps experienced without some sort of systemic response. Health Care For All believes strongly that this is a wake up call about the role that government will have to play to provide consumer protections, rate reviews and, when necessary, perhaps even direct intervention to prevent the outcome that is being threatened today. Is the Tufts contracting request reasonable? Is Blue Cross acting prudently to control costs? Are Tufts’ patients having better outcomes and receiving higher quality care than they are from other providers, so increased or higher rates are justified? We don’t know. What we know is that these two entities are at loggerheads because of money. What we also know is that the contracting price that insurers like Blue Cross and hospitals and physicians like Tufts negotiate is influenced by a whole host of factors that are not directly tied to the cost or quality of the services being delivered. Rather, much of the price reflects the relative market power of the insurers and the hospitals, and the price that the market will bear. That is extraordinarily difficult for consumers, because those factors are beyond our control. At the top of our always ambitious and full policy agenda is to change the way we in Massachusetts pay for and receive health care services. Health Care For All believes that health financing should reward coordinated, high quality care, and should incentivize keeping us well. We see a future with a true health care system, rather than the sick care system we are living in today. Today’s announcement was a sure sign that our system is not healthy or required to act in the best interest of patients. Over 130,000 Massachusetts residents are threatened with feeling the brunt of this disagreement. After tomorrow, the 2011 legislative season will be over, and the legislature can turn to next year's agenda. We know the leadership and staff are working on comprehensive reform legislation. We hope today's news will push them to do their best for the patients and consumers at the heart of health care. -Amy Whitcomb Slemmer Are You Affected?: The HCFA Helpline - 800-272-4232 - is available to help members of Blue Cross who receive care from a Tufts-affiliated clinician. People with questions can also refer to this BCBS web resource, and Tufts Medical Center has set up a site on the issue at www.keepmydoc.org.