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Mass. Hospitals Rate Local Health Plans, Knock Blue Cross Contract Talks

This article is more than 10 years old.
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This just in from the Massachusetts Hospital Association:

Massachusetts Hospitals Rate Performance of Health Plans

A performance satisfaction survey of the commonwealth’s 13 health insurers that the Massachusetts Hospital Association conducted has identified a variety of strengths and weaknesses among the health plans, with administrative burdens remaining frustratingly high across the board, but local- based insurers faring better overall than their national counterparts.

Some 30 hospital systems representing 35 Massachusetts hospitals shared their thoughts on the administrative performance of health plans in areas such as claims adjudication, communication capabilities, credentialing and re-credentialing processes, and conducting two-way, good-faith negotiations. This is the third insurer satisfaction survey that MHA has participated in or administered...

Some of the highlights of the survey include:

Overall satisfaction with the payers varied substantially by individual insurer. Harvard Pilgrim Healthcare (HPHC) received the highest marks. Problems that contributed to provider dissatisfaction with the insurers included plan rigidity even when resolving difficulties the plan itself created (Blue Cross Blue Shield of Massachusetts); glitches with the insurer’s billing system and long appeal lag time (Fallon Community Health Plan); and problems with insurers authorizing a visit, then stating at the time of payment that a member was not eligible (United Healthcare and Aetna).

HPHC, Tufts Health Plan (Tufts) and Fallon scored very well on their contract negotiation conduct with providers – more than 75% of the hospital respondents said those three insurers conducted two-way, good-faith negotiations with providers during contracting. But 73% of the survey respondents were dissatisfied with Blue Cross Blue Shield of Massachusetts' contract negotiation, and 59% were dissatisfied with Neighborhood Health Plan on this measure.

Both Massachusetts-based and national insurance companies did a reasonably good job of communicating their general policies, the hospitals found, but were less successful at addressing specific issues in a consistent and timely way.

All of the plans could do a better job providing more transparency around the cost and quality measures used for tiering. as well as educating members about the restrictions inherent in limited and tiered networks. As the popularity of these products grows, provider dissatisfaction is likely to increase even more unless the health plans improve on both of these metrics.

In 2012, companies licensed to provide care in Massachusetts will pay $45 million in rebates to insurance customers and employers for failure to meet federal or state medical loss ratio requirements that at least 88% of the premium dollar go to medical care and no more than 12 % for administrative expenses for 2011.

Readers, anything to add? Have your own suggestions on areas that should be marked Needs Improvement?

This program aired on October 10, 2012. The audio for this program is not available.

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



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