The plan could motivate doctors to engineer their patient base to exclude those most in need of care, experts say.
Blue Cross Blue Shield of Michigan (BCBSM) is offering a new small-group, employer-sponsored health insurance plan that rewards businesses whose employees obtain care from a narrow network of low-cost providers.
Blue Cross Personal Choice PPO, like other “preferred provider organization” (PPO) health insurance plans, allows members to obtain care at a discount from doctors within the PPO. This plan, which opened enrollment in October 2016, builds on the PPO concept by encouraging patients to obtain care from an even narrower network, called an Organized System of Care (OSC).
The plan “can save employers up to 9 percent compared with similar Simply Blue plans,” BCBSM’s website states.
The plan includes a network of 4,300 physicians and 118 hospitals in 38 OSCs, The Oakland Press (Michigan) reported when BCBSM unveiled the plan in July 2016.
‘Managing Population Health’
Dr. Megan Edison, a pediatrician in Grand Rapids, says the OSC-based plan is designed to manage costs by limiting patients’ choice of providers and their use of health care services.
“I find great irony in the name ‘Personal Choice’ when it is designed to limit personal choice and individual needs,” Edison said. “The patient has a limited selection of doctors. Those doctors are limited in the specialists and hospitals they may use. The whole system is focused on managing population health rather than the individual.”
Dr. Chad Savage, a direct primary care physician in the Detroit suburb of Brighton, says the plan rewards doctors whose patients cost the company less money.
“What it really means is your doctor can be paid more to deny you care,” Savage says. “The doctor who engineers his patient base to avoid sick people by being rude toward those people, delaying returning calls, etc., will drive those patients off and be financially rewarded for these bad behaviors.”
‘Potential Adversarial Position’
The OSC-based plan gives doctors an incentive to avoid providing needed care in order to maximize their profits, Savage says.
“This is a Hippocratic Oath-defying conflict of interest,” Savage said. “It has the potential to pit doctors’ best interest against their patients’ best interest. This artificially injects a potential adversarial position into the doctor-patient relationship that should never be there.”
Edison says doctors should resist the urge to shortchange patients out of the best treatment available.
“Faced with these limitations and confusing incentives, it takes a strong doctor to do the right thing for their patients regardless of insurance company pressures,” Edison said.
Edison said BCBSM’s PPO plan “could be viewed the same as ‘product shrink’ in the grocery store,” referencing a 2014 article in The Boston Globe about food manufacturers’ widespread downsizing of packages to keep costs in check.
Savage says the plan reflects the private sector’s struggle to hold down price increases caused by government interference.
“My main point would be the irony of policymakers assuming that the best way to suppress cost expansion is to implement a complex and costly payment mechanism: insurance.”
Ben Johnson (firstname.lastname@example.org) writes from Stockport, Ohio.