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BlueCross BlueShield Association shifting support to narrower network plans

November 14, 2019

Topics: Quote of the Day

By Paige Minemyer
FierceHealthcare, November 13, 2019

Blues plans are launching a high-performance network nationwide.

The Blue Cross Blue Shield Association (BCBSA) revealed this week that its member plans would offer Blue HPN beginning in January 2021. The network will be available in 55 markets across the U.S.

Jennifer Atkins, vice president of network solutions at BCBSA, told FierceHealthcare that the goal in launching the network was to build on the plans’ existing value-based and patient-centered models.

There was strong interest in the individual markets for such a network, she said. About 70% of members in BCBSA plans are enrolled in a value-based contract.

Employers are taking a more “activist” role in healthcare, and part of that effort includes greater uptake of options such as direct contracting and high-performance networks to drive lower costs without pushing additional cost sharing for employees.

Atkins said that existing value-based contracts deliver an average of 10% in total cost savings and that the BCBSA members expect a high-performance network to grow that number further. With 74 million members in its base, Atkins said the Blues plans believe they can reach the “critical mass” necessary to gather quality providers.

In developing the networks, the plans will take a “best of local” approach that allows each plan to meet the needs of its markets under a shared set of standards. Quality metrics focus on offering the appropriate care, promoting adherence and boosting outcomes, and Blue HPN allows for individual plans to build in their own metrics to fit regional needs.

A key concern in a narrow-network plan is that members may not have a full grasp of what’s covered, which could put them at greater risk of unexpected medical bills that they cannot afford.

“We have been working hard to ensure that when we’re communicating to employees though employer that picked the high-performance network so that they can be confident that they’re receiving the best care at best price,” Atkins said.


Blue High Performance Network:


By Don McCanne, M.D.

One problem with employer-sponsored plans today is that cost sharing, especially high-deductibles, has been pushed to the limit. By making patients pay more out of pocket at the time of service, health care has been made less affordable and patients may forgo beneficial health care services because of these out-of-pocket costs. Employers have been recognizing these adverse consequences and thus are looking for alternative means of controlling health care spending.

Instead of pushing cost sharing even higher, BlueCross BlueShield Association is embarking on an ambitious national plan to establish a narrow “high-performance” network in selected markets nationally. Although they are marketing these networks to employers as being high performance, to achieve cost savings they actually are contracting for lower rates by promising health care providers greater exclusivity, thus reducing competition for those in the networks by keeping the provider networks narrow.

This is typical of the highly undesirable tradeoffs that are inevitable in a market of private health plans. In this case, patients lose their choices of physicians and hospitals in exchange for avoiding further increases in their out-of-pocket spending. But they may also be exposed to surprise medical bills because of care unavoidably provided out of network.

Contrast this with a well designed, single payer model of Medicare for All. Patients have free choice of their health care professionals and institutions, while financial barriers to accessing health care are removed. Of course there are endless other benefits such as guaranteed coverage for everyone for life, efficiencies through reduction in administrative waste, public administration of pricing, and care finally becomes affordable for each individual by the use of equitable (progressive) tax policies to fund the universal risk pool.

Blue Cross and Blue Shield plans are not inherently evil; it is our public officials who are evil when they insist that we continue with the fragmented, dysfunctional system of private and public plans when they have before them a model that would work well for everyone and they continue to reject its enactment and implementation, when their obligation is to inform the public on the moral imperative of single payer Medicare for All – a public that is much more influenced by sound bites than by policy science (what’s that?).

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About the Commentator, Don McCanne

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Don McCanne is a retired family practitioner who dedicated the 2nd phase of his career to speaking and writing extensively on single payer and related issues. He served as Physicians for a National Health Program president in 2002 and 2003, then as Senior Health Policy Fellow. For two decades, Don wrote "Quote of the Day", a daily health policy update which inspired HJM.

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