Tufts, Blue Cross, Giving Patients A Voice And Re-Imagining The Pie

Scene from another negotiation, US-Russian arms talks in Geneva
Scene from another negotiation, US-Russian arms talks in Geneva

Yesterday, the news broke that contract talks have broken down between Blue Cross Blue Shield of Massachusetts and Tufts Medical Center, and if nothing changes, tens of thousands of patients may have to switch doctors or insurance plans next year. This seemed like the perfect moment to turn to Harvard’s Program for Health Care Negotiation and Conflict Resolution — and to Leonard Marcus, Barry Dorn and Eric McNulty, co-authors of the new edition of “Renegotiating Health Care: Resolving Conflict to Build Collaboration.”

Q: So how do you see this Blue Cross-Tufts situation?

Lenny: I see this as once again a partial negotiation where the insurance company and a provider are trying to figure out a business arrangement without including the full range of stakeholders — which would include the patients. Patients have an economic stake in health care just as insurers and providers do. So, it would be interesting to imagine, if the patients were at the table, what might they add to this negotiation?

Imagine if Blue Cross wound up paying less to Tufts than they do to Partners and they took that savings, passed it along to patients, and said, ‘If you are on a tight budget and want a lower-cost plan, we have it for you — if you go to Tufts providers. If you prefer to go to Partners providers, you pay more. Blue Cross would achieve cost savings it wants, Partners would get the premium price it wants, and Tufts would get some competitive advantage through a lower-priced offering. The economics would be transparent and consumers could exercise choice. If many of them chose the lower-cost Tufts option, it could cause Partners to rethink its model – and possibly result in reductions of overall system costs.

[module align="right" width="half" type="pull-quote"]"‘Us against them’ battling over a fixed pie where each side is trying to get the biggest piece of the pie"[/module]

But under the current rubrick, patients pay the same for Blue Cross Blue Shield coverage no matter where they go. So, one could assume that whatever money Blue Cross is extracting from this will go straight to their bottom line.

So if you were advising Blue Cross and Tufts right now about how to get their negotiations back on track, what would you say?

Barry: I would say first thing would be to move from a ‘positional’ basis — ‘Us against them’ battling over a fixed pie where each side is trying to get the biggest piece of the pie — to an ‘interest-based’ negotiation, where the possibility then becomes: How do we both re-imagine the pie in ways that meet all of our needs as well as the needs of our customers/ patients? If you are looking for the other party to solve your pain, conflict is likely. It’s better to approach the negotiation as “gain-gain” rather than “pain-pain.”

So what would that look like?

Eric: It could take the form of different baskets of services for different prices. It might involve different incentives in the system. For example, there’s an organization written up recently in the Atlantic called CareMore, where they have, as a provider, started doing things that were very novel in the system, and they found a way to increase patient satisfaction, improve outcomes and lower costs. But the doctor who started that had to fight like crazy to get that in place because what he proposed broke the rules of the old game. But in the end, rewriting the rules was better for everyone.

Barry Dorn (L), Eric McNulty (center) and Leonard Marcus (R)
Barry Dorn (L), Eric McNulty (center) and Leonard Marcus (R)

Well, so is it possible for Tufts and Blue Cross to improve their negotiations in their current institutional forms?

Barry: I think it absolutely is. We have done this with many organizations, but it’s a matter of how you approach it. If you allow yourself to think beyond the restrictions of the current model and say, ‘How might we structure this so we each make a reasonable amount of money and provide excellent care to the people we both serve, what might that look like? I recall one hospital merger in which we were involved where the outcome on facility location, payment model, and management structure were different than either party’s opening position – because they went beyond positions to underlying interests and were open to co-creating new possibilities.

So what would you advise to patients right now? Is there anything they can do to get the negotiators to pay more attention to their needs? Because having to switch is definitely not what they want.

Eric: You’re absolutely right. Patients tend to like things the way they’re familiar with. Just as Occupy Wall Street has brought previously unheard voices into that discussion, so too must patients make themselves visible and articulate their interests. Patients are part of this negotiation whether the insurance company and the provider want to acknowledge it or not. Patients have to assert their interests and make themselves impossible to ignore.

This program aired on November 16, 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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