New Partners Option Aims To Keep Employees In-House For Care

Partners: Rethinking care delivery to control costs
Partners: Rethinking care delivery to control costs

The plan would begin Jan. 1. A notice that already went out at one Partners hospital explains, "We want to encourage employees and their families to receive their health care from providers within the Partners HealthCare System."

Now, this is nothing new, for a hospital network to aim to keep employees in-house for care. But when Partners does it, it raises an obvious question: Partners — which includes Massachusetts General Hospital and Brigham and Women's Hospital, as well as community hospitals and health centers — has repeatedly been cited by state authorities as a key driver of high medical costs. If more people from among its multitudinous employees get care at Partners, won't that drive costs still higher?

The notice addresses that issue:

Why We’re Making Changes
Numerous surveys confirm that Partners has the best providers not only in Massachusetts, but nationwide. We want our employees to benefit from Partners’ world-class care while paying the lowest possible cost. It is often reported that care at Partners facilities costs more. However, Partners’ higher unit costs are significantly offset by greater value and better quality care through fewer visits and better outcomes.

Encouraging our employees and their families to receive care from Partners providers not only benefits our employees, but also will help us meet future financial challenges by broadening our patient base.

Readers, thoughts? My own initial reaction: Health insurers have been creating plans that use financial incentives to push patients away from higher-cost providers like Partners. Is this the counter-push?

More details from the notice:

Employees and their families who use providers within the Partners Preferred Network will retain their current co-pay when seeing a provider and will pay no deductibles.

If you use Partners providers, the only other plan changes are:
· Emergency room co-pays will be $100 (waived if admitted to the hospital).
Durable Medical Equipment reimburses 80% up to $500

Employees can also receive care from non-Partners institutions and medical professionals who fall within the Blue Cross Blue Shield and Harvard Pilgrim network of providers. This second level of coverage will be known as the Plan Network.

The Plan Network has the following plan changes
· Inpatient hospital admissions have a $250 deductible and $250 per admission co-pay
· The deductible does not apply to any other services
· Specialist co-pay: $40
170 Emergency Room co-pay: $100
171 Outpatient Surgery: $150
172 High cost imaging co-pay: $150
173 Physical Therapy co-pay: $40
174 Durable Medical Equipment reimburses 80% up to $5,000

In addition, our Partners Plus will continue to offer employees the option of using providers and facilities that fall outside of their Plan Network. Medical services provided by out-of-network providers and facilities will require the payment of deductibles and 30% of the costs for the service. Harvard Pilgrim does not offer this third tier.

Employees who do not live close to Partners HealthCare facilities, such as in Western Massachusetts or on Cape Cod, will not be affected by these changes. If you live in zip codes 02501 through 02799 or 01001 through 01699 your coverage will remain the same, except Emergency Room visits will have a $100 co-pay and durable medical equipment will be reimbursed at 80% up to $5,000 provided you remain in-network.

Note: The notice also explains that employees' Partners Plus, an existing plan, and Harvard Pilgrim plans will "include a Partners Preferred Network that incorporates all Partners HealthCare providers and our key affiliates." Those affiliates include Children's Hospital Boston, Dana-Farber Cancer Institute, Emerson Hospital and others.

This program aired on September 22, 2011. The audio for this program is not available.

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Carey Goldberg Editor, CommonHealth
Carey Goldberg is the editor of WBUR's CommonHealth section.



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