Blue Cross and Blue Shield of Massachusetts wants to stop paying doctors and hospitals for each patient visit or treatment, a common arrangement that most experts agree has led to unnecessary, inefficient, and fragmented care that is sometimes harmful to patients.Blue Cross is already my family's insurer and has done an awful job. Aside from the denial of several prescriptions for my wife, they are currently telling my family that we owe many thousands of dollars in bills because a doctor at BMC referred us to an Albany specialist rather than one in Boston. Did I mention that the Albany doc is a BCBS provider, but he's 'not in our network.'
Instead, they want to pay doctors and hospitals a flat sum per patient each year, adjusted for age and sickness, plus a significant bonus if the providers improve care, Blue Cross officials said. In most cases, the payment would cover all services from primary care doctors, specialists, counselors, and hospitals - forcing them to work together closely.
"We're not looking to spend less than we do today, but we want spending to grow at a rate that's affordable," said Andrew Dreyfus, executive vice president for healthcare services at Blue Cross. "And we want to empower physicians and hospitals to provide the right care."