It’s all turning out to be about contracts as to where consumers can get care today and we have this here in Massachusetts and there’s a bit of this too in California with the HMO managed programs.  The pricing is quoted as being 30% less than other policies so we have a hospital system now selling insurance.  We have seen quite a bit of this with Prime Healthcare in California relative to “contracts” and they run Cadillac ER rooms for the most part.  In addition, Steward, owned by Cerberus bought a hospitals in Florida and recently they stated they intend to go national.

Caritas Hospital Owner Steward States They Aim to Go National Under Management from Private Equity Firm Cerberus Capital

What I found interesting too is the name of the administrator of the plan, Tenet Health Plans?  Is this part of Tenet Healthcare hospital systems, a good guess might say there’s a very familiar ring here.   The insured will also be able to go to Mass General or Brigham & Woman’s for more complicated care if the services needed are beyond those offered in the Steward System.  Now if you go back to January of this year, Blue Cross has their offering which encourages consumers to avoid what they determined to be 15 high costs hospitals and their agreement left out Mass General and Brigham and Woman’s as they were part of the 15 member group high priced hospitals. 

Blue Cross Launching New Health Coverage Option in Massachusetts-Encourages Consumers Via Employer Plans to Avoid 15 Named High Cost Hospitals

When you are sick, you want care so again who knows how this will end up shaking out as all are marketing and contending for business.  Contracts get signed and it’s tossed out to consumers to make heads or tails of what each plan offered and which would be the best choice…complicated and getting more so every day. 

So the next step here for consumers, someone is going to make some money writing another algorithm on a website to make the complication easier for you to wade and select the plan that may work best for you.   Software just works this way and keeps building on itself. 

HHS has their hospital compare website for looking at both prices and quality of care and I might guess they are challenged as well to keep up with the the formulas and prices.  I read somewhere on the web that someone from Steward said they are happy to be the “Filene’s” of hospitals.  BD 

Right now, health insurers and hospitals are separate entities. This is something different: a hospital selling coverage, with the restriction that  you only seek care at its locations. The hospital chain is Steward, a Massachusetts-based business that has been buying up community-based hospitals for more than a year now. And the gamble it made was rolling out a health insurance plan that almost-exclusively serve its hospitals (there are a few exceptions). The plan, administered through Tenet Health Plans, is called Steward Community Choice.

The Community Choice plan, as outlined Friday, is targeted at small businesses in Massachusetts. It offers them a trade-off. Premiums will be 20 to 30 percent less than what other Massachusetts insurers charge. In return, subscribers will by-and-large be limited to treatment at Steward locations (there are some exceptions to this, helpfully outlined in this report from WBUR’s Martha Bebinger).

“A lot of what health reform is is a public finance problem,” he told me. “As we’ve done health reform in Massachusetts, it’s been a lot about how do we pay for coverage. A lot of these small businesses are really struggling as premiums keep going up. This is about making insurance affordable for them.”

That could create more of a space for a less expensive, more limited insurance product. As de la Torre described Steward’s strategy to investors recently, “In a world of Neiman Marcuses, we’re OK being Filene’s. “ Now that we have a hospital that wants to be the Filene’s of health insurance, we’re about to find out whether Americans are willing to shop there.


Post a Comment

Google Analytics Alternative