Lots of people expressed dismay at my Friday report concerning the self-dealing between Neighborhood Health Plan and its owner, Partners Healthcare System.
The unanswered question, though, is which of the alphabet soup of state agencies has responsibility for this matter. Who approved this? Who can investigate it? Who can change it?
It is definitely not the Center for Health Information and Analysis (CHIA). Is it the Health Connector? It is the Health Policy Commission? Is it the Executive Office of Health and Human Services? Is this a matter for the Attorney General's jurisdiction because of anti-trust issues?
I fear that Chapter 224 of the Acts of 2012, titled “An Act Improving the Quality of Health Care and Reducing Costs through Increased Transparency, Efficiency and Innovation,” has created a hodgepodge of jurisdiction that leaves no one in charge when this kind of thing happens.
Here's the pertinent background. As I quoted Julie Donnelly at the Boston Business Journal:
Partners HealthCare aims to drive new members to its newly acquired health insurer, Neighborhood Health Plan, by cutting off access to some doctors within new health plans offered under ObamaCare.
Neighborhood Health Plan is one of 10 insurers that has been certified to offer subsidized and un-subsidized ObamaCare plans through the state’s Health Connector.
But what Neighborhood Health Plan has is exclusive access to primary-care doctors at Brigham and Women’s Hospital and Massachusetts General Hospital.
This is a departure from Partners’ strategy in the past. Before its purchase of Neighborhood Health Plan, Partners’ offered access to its doctors to all of the health plans within the state-subsidized health plans that were launched under Massachusetts' own statewide health reform.
Why does this matter? Because the PHS doctors dominate the state. With newly acquired South Shore Hospital, PHS has about 1258 primary care physicians in 16 groups, roughly 27 percent of the 4684 statewide total associated with groups.* In a 2009 study prepared by its COO, PHS was shown to have about 850 of the 3700 primary care physicians in Eastern Massachusetts, or about 23 percent.**
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* Data on provider networks and medical groups is derived from Massachusetts Health Quality Partners’ Massachusetts Provider Database. Approximately three quarters of all primary care physicians in Massachusetts are associated with a major medical group. The remaining physicians are either in very small practices or are licensed but not practicing.
** "Influence of Market Forces on Healthcare: A Case Study," April 9, 2009.
The unanswered question, though, is which of the alphabet soup of state agencies has responsibility for this matter. Who approved this? Who can investigate it? Who can change it?
It is definitely not the Center for Health Information and Analysis (CHIA). Is it the Health Connector? It is the Health Policy Commission? Is it the Executive Office of Health and Human Services? Is this a matter for the Attorney General's jurisdiction because of anti-trust issues?
I fear that Chapter 224 of the Acts of 2012, titled “An Act Improving the Quality of Health Care and Reducing Costs through Increased Transparency, Efficiency and Innovation,” has created a hodgepodge of jurisdiction that leaves no one in charge when this kind of thing happens.
Here's the pertinent background. As I quoted Julie Donnelly at the Boston Business Journal:
Partners HealthCare aims to drive new members to its newly acquired health insurer, Neighborhood Health Plan, by cutting off access to some doctors within new health plans offered under ObamaCare.
Neighborhood Health Plan is one of 10 insurers that has been certified to offer subsidized and un-subsidized ObamaCare plans through the state’s Health Connector.
But what Neighborhood Health Plan has is exclusive access to primary-care doctors at Brigham and Women’s Hospital and Massachusetts General Hospital.
This is a departure from Partners’ strategy in the past. Before its purchase of Neighborhood Health Plan, Partners’ offered access to its doctors to all of the health plans within the state-subsidized health plans that were launched under Massachusetts' own statewide health reform.
Why does this matter? Because the PHS doctors dominate the state. With newly acquired South Shore Hospital, PHS has about 1258 primary care physicians in 16 groups, roughly 27 percent of the 4684 statewide total associated with groups.* In a 2009 study prepared by its COO, PHS was shown to have about 850 of the 3700 primary care physicians in Eastern Massachusetts, or about 23 percent.**
---
* Data on provider networks and medical groups is derived from Massachusetts Health Quality Partners’ Massachusetts Provider Database. Approximately three quarters of all primary care physicians in Massachusetts are associated with a major medical group. The remaining physicians are either in very small practices or are licensed but not practicing.
** "Influence of Market Forces on Healthcare: A Case Study," April 9, 2009.
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