Massachusetts program changes in attempt to restrain costs
Massachusetts' Commonwealth Health Insurance Connector Authority, which oversees the Commonwealth Care insurance portion of the state's comprehensive health reform plan, is making significant program changes in an effort to hold down costs to taxpayers. Observers say as a result of the changes, payments to providers will likely be cut, patient choices could be reduced, and patient charges may increase.
In its first year, Commonwealth Care, the program for low-income people, has enrolled nearly 160,000 beneficiaries, far more than had been projected. State officials have says the cost could be $147 million over budget to a total of $619 million for the current fiscal year.
"The goal is to make this great health care reform effort sustainable," says authority chairperson Leslie Kirwan, the state's secretary of administration and finance.
Bid specifications are expected to direct the insurers that administer Commonwealth Care to cut provider payments by 3% to 5%. And there were indications that costs per member could go up as much as 14%.
"There's no justification to be paying more than Medicaid rates," says authority chief financial officer Patrick Holland, commenting on the likely cut in provider payments.
The board reportedly has not considered reducing the comprehensive range of services the plan covers, but will push insurers to control spending on patients with substance abuse and chronic conditions through better oversight and follow-up care.
The board also voted to eliminate an expensive program provision allowing patients to pay a higher monthly premium in return for lower fees each time they receive care. That option drew the sickest and oldest patients, observers says, and was twice as expensive for the state as a plan with lower premiums. The 3,500 patients who chose that option will have to transfer into another plan that will impose a higher copay for each doctor or hospital visit.
Commonwealth Care members currently pay much less than those with private insurance to visit a doctor, get hospital care, or get prescription drugs, observers says. But the authority postponed a decision on a proposal to increase copayments and other out-of-pocket costs for tens of thousands of patients whose income is above the poverty level.
Massachusetts' Commonwealth Health Insurance Connector Authority, which oversees the Commonwealth Care insurance portion of the state's comprehensive health reform plan, is making significant program changes in an effort to hold down costs to taxpayers.You have reached your article limit for the month. Subscribe now to access this article plus other member-only content.
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