Unasked Questions Almost Global Payments
Saturday, October 6, 2018
The Boston Globe reports that Blue Cross of Blue Shield of Massachusetts is expanding its capitated, or "global payment," degree of medical reimbursement.
The Massachusetts wellness assist industry’s traditional arrangement of paying doctors for every utilization visit, test, in addition to physical care for may hold out nearing its end.
Blue Cross volition essentially pay doctors a gear upwards amount to assist for their patients but payments volition ultimately hold out tied to how good doctors in addition to hospitals score on a diversity of character measures.
The fellowship CEO is quoted:
“This is definitely a novel phase. It’s a really of import signal to the community in addition to to the marketplace that nosotros desire to maintain to advance payment reform, promote accountability for character in addition to costs, in addition to maintain to motion away from the fee-for-service system.”
The storey takes every bit a given the possible benefits of this approach, but gives brusk shrift to whatsoever choice points of view. Beyond that, amongst all the encomiums included inward the story, it lacks whatsoever elevate of roughly really of import unanswered questions. I've noted these before, amongst reference to issues that ought to hold out reviewed past times the state's Attorney General:
[BCBS of MA] besides acted to increase the disparity inward payments amid infirmary networks, fifty-fifty afterwards those disparities were documented past times the previous AG every bit existence 1 of the major causes of wellness assist inflation inward the Massachusetts. A study committee is supposed to review this number of disparities in addition to brand recommendations to narrow them. What's the AG's utilization inward that process? Might she, for example, pursue a reference pricing approach that would postulate an insurer to justify payments rates exterior of a normal band?
BCBS of MA has besides persuaded the pose down to adopt a policy that shifts risks from the insurance fellowship to doctors in addition to hospitals but has made no adjustment to its uppercase construction to compensate for that savings. Will the AG regard clawing dorsum excessive earnings given the company's novel opportunity profile?
All other fiscal service industries direct hold been able to trim back administrative in addition to transaction costs over the years. What is it almost this fellowship that gives them a pass? As premiums rise, the percent the fellowship keeps for direction in addition to turn a profit stays the same. Here's roughly other expanse worthy of attending past times the novel Attorney General. Shouldn't nosotros hold off roughly technological improvements in addition to the resultant savings to passed along consumers?
The Massachusetts wellness assist industry’s traditional arrangement of paying doctors for every utilization visit, test, in addition to physical care for may hold out nearing its end.
Blue Cross volition essentially pay doctors a gear upwards amount to assist for their patients but payments volition ultimately hold out tied to how good doctors in addition to hospitals score on a diversity of character measures.
The fellowship CEO is quoted:
“This is definitely a novel phase. It’s a really of import signal to the community in addition to to the marketplace that nosotros desire to maintain to advance payment reform, promote accountability for character in addition to costs, in addition to maintain to motion away from the fee-for-service system.”
The storey takes every bit a given the possible benefits of this approach, but gives brusk shrift to whatsoever choice points of view. Beyond that, amongst all the encomiums included inward the story, it lacks whatsoever elevate of roughly really of import unanswered questions. I've noted these before, amongst reference to issues that ought to hold out reviewed past times the state's Attorney General:
[BCBS of MA] besides acted to increase the disparity inward payments amid infirmary networks, fifty-fifty afterwards those disparities were documented past times the previous AG every bit existence 1 of the major causes of wellness assist inflation inward the Massachusetts. A study committee is supposed to review this number of disparities in addition to brand recommendations to narrow them. What's the AG's utilization inward that process? Might she, for example, pursue a reference pricing approach that would postulate an insurer to justify payments rates exterior of a normal band?
BCBS of MA has besides persuaded the pose down to adopt a policy that shifts risks from the insurance fellowship to doctors in addition to hospitals but has made no adjustment to its uppercase construction to compensate for that savings. Will the AG regard clawing dorsum excessive earnings given the company's novel opportunity profile?
All other fiscal service industries direct hold been able to trim back administrative in addition to transaction costs over the years. What is it almost this fellowship that gives them a pass? As premiums rise, the percent the fellowship keeps for direction in addition to turn a profit stays the same. Here's roughly other expanse worthy of attending past times the novel Attorney General. Shouldn't nosotros hold off roughly technological improvements in addition to the resultant savings to passed along consumers?