Healthcare costs in the state are climbing 7.5 percent annually, according to the report, leading many state officials including Governor Deval Patrick and State Senate President Therese Murray to publically support such plans to reduce costs. Both legislators have proposed a bill that would require health plans in the state to offer limited networks at least 10 percent cheaper than plans that provide wider access.
The limited plans would encourage patients to use less-expensive community hospitals and freestanding outpatient facilities, according to the report. Patients would have to request permission from the insurer to receive coverage at an “elite” facility.
Harvard Pilgrim Health Care and Tufts Health Plan were required to develop restrictive plans this spring, and both limited networks exclude Partners Healthcare’s teaching facilities. Fallon Community Health Plan saw enrollment in its limited plan, which offers patients a 10-13 percent discount on premiums, increase 40 percent from 2006, according to the report.
Some insurers, including Harvard Pilgrim and Blue Cross Blue Shield of Massachusetts, have included opt out clauses for the influential teaching hospitals, allowing the providers to drop out of plans they don’t like, according to the report. BCBS has agreed to provide, in its contract with Partners, specific exclusion criteria if it decides to leave Partners’ hospitals out of its limited plans.
While small employers and patients have embraced the new plans, opponents fear that such a shift would harm chronically ill patients who require open-network plans to ensure they can receive treatment at the teaching facilities, according to the report. They note that as patients migrate away from the more expensive plans, rates could increase for those on open networks.
Read the Globe’s report on Massachusetts limited access insurance plans.
