Will patients accept focused networks in today’s economy?

Will patients accept focused networks in todays economy?In a bid to save money, health insurers are coming out with what’s known as “focused networks,” which typically exclude the highest cost hospitals.

In the Boston area, one such plan comes from health insurer Harvard Pilgrim Health Care, whose plan excludes Partner’s Health Care institutions.  That’s significant, since Partners includes the famed Massachusetts General Hospital as well as Brigham and Women’s in Boston.

According to the Boston Globe, “The goal is to contain costs by giving businesses, municipalities, consumers, and other insurance buyers a new choice for coverage. While the new network limits where patients can receive care, it boasts a broad coalition of more moderately priced Boston teaching hospitals, such as Tufts Medical Center, Boston Medical Center, and Beth Israel Deaconess Medical Center; regional providers that include Lahey Clinic in Burlington and Baystate Medical Center in Springfield; and community hospitals such as Beverly Hospital, Cambridge Hospital, and St. Elizabeth’s Medical Center in Boston.”

Now, the hospitals mentioned are all great institutions. In fact, I’m a graduate of Boston Medical Center, and wouldn’t hesitate sending my own patients there. And I can understand the rationale to try any way to slow the soaring rate of premium increases.

But what about the patients?

I wrote previously that patient demand was the main reason why Partners Healthcare was able to charge the prices they do:

You have to remove the patient demand for the Massachusetts General or Brigham name, and brand-name medicine in general. Do this, and Partners’ clout will evaporate overnight. That’s a difficult task no doubt, but it’s clear that’s what Paul Levy and Charlie Baker, as well a cadre of health policy wonks, are trying to do both in blogs and various media interviews. A public re-education campaign delinking patient outcomes from brand seems to be the guerilla-style tactics Partners’ adversaries are taking.

Massachusetts is growing increasingly concerned at the impending monopoly in Boston’s health care market. Public health commissioner John Auerbach says that patient choice remains paramount, and that “the degree to which consolidation eliminates choice for patients, I don’t think that’s good. I think that patients should always have a choice.”

The problem is, patients have already made their choice. And so far, it’s resoundingly in favor of Partners HealthCare.

That several years ago, before the recession. With the economy the way it is now, will patients make the tradeoff of lower health premiums for restricted access to brand-name institutions?

As history has shown, patients will rebel if their choice is restricted, as they did against HMOs in the 1990s. If we can convince patients that they can still get great care from hospitals that are not routinely ranked in US News and World Report, then the bet Harvard Pilgrim is making is wise.

If not, this is nothing more than a glorified HMO.

is an internal medicine physician and on the Board of Contributors at USA Today. He is founder and editor of KevinMD.com, also on Facebook, Twitter, Google+, and LinkedIn.

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  • Anonymous

    The choices patients are given in the above commentary  are excellent hospitals, with a history of  patient friendly care. I have dealt with most of them This actually could fly, if the cost differential for patients were high enough. I can’t think of a service that a patient would not have access to.
    In other regions , if the choices limit access to  good care, it’s a different story.
    In my area, the Southwest, if the only patients a physician can attract are  HMO, it’s a quality indicator. Unfortunately, the previous HMO model went for the cheapest care, not necessarily the best, or excellent care.Multiple HMO’s went bankrupt because of this.
    I suspect the ACO model will look like this to patients.

  • http://onhealthtech.blogspot.com Margalit Gur-Arie

    I don’t know how good or bad these institutions are, but I think we live in a brave new world if restricting patients’ choices of providers can be described as a “new choice”.

  • Anonymous

    Harvard Pilgrim Health Care is already a glorified HMO; they simply don’t run their own clinics any more.

    I have HPHC & would have been perfectly happy with the new, cheaper network at one point, because all my doctors were at Tufts Medical Center anyway; it’s an excellent institution. Some of my specialists are still there, but my internist has gone over to the Dark Side (MGH) and my oncologist has moved to another Partners-affiliated hospital, and I’m not giving up either of those two docs.

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