AMA Documents Health Plan Market Concentration

IN THIS ISSUE:


? Consumer Choice Community

? Galen Briefing on June 18th – Physicians Respond

? Insurance Department Wants to Regulate Retainer Medicine

? AMA Documents Health Plan Market Concentration

? Most Favored Nation Clauses Scrutinized by FTC

? Health Plans Publishing Prices

Consumer Choice Community


For five years I have been running a ListServ on Health Benefits Reform (HBR). The list has been a fascinating mix of people from different areas of interest – physicians, brokers, economists, actuaries, legislative staff – who share a vision of consumer driven health care. It has also been enormously productive, with list members writing op-eds, being interviewed by the press, testifying before Congress, giving speeches and appearing on talk radio shows across America. The members provide great support to each other, congratulating people on accomplishments, posting interesting articles and studies, arguing the fine points of health care reform. The biggest problem is that it has been e-mail based, and members often get 100 or so e-mails a day, which can be overwhelming.


Now Grace-Marie and I have decided to take this concept to a higher level. We are forming the “Consumer Choice Community” that will be web-based. It will bring together leaders of the Consumer Choice movement from all over the country to form a community of activists. It will feature a web log (“blog”), a bulletin board, and plenty of supporting material.


Most importantly, members of the Community will be able to share their war stories and gain support from each other. For instance, a member might be looking for a little factoid for a speech, or want people to review and comment on a draft op-ed, or look for real-life examples of successful use of an HSA. Even among people who share a common goal there will be points of disagreement that will be thoroughly thrashed out – What, if any, limits should be placed on underwriting? Should importation of prescription drugs be allowed? Should hospitals be required (encouraged) to post their prices? To give discounts to the uninsured? These are the kinds of discussions we have on the HBR list, but in the Consumer Choice Community, you won’t have to load up your in-box with topics you aren’t very interested in.


The Community is intended to be self-supporting and will not be beholden to any interest group, so there will be a membership fee required. If you would like to find out more about the Consumer Choice Community, we have a packet ready to send out by snail mail. Please go to http://www.galen.org/cccintro.asp to request information.

Galen Briefing on June 18th – Physicians Respond


Many of the members of the HBR List will be attending the June 18th briefing on “Consumer Driven Health Care: Physicians Respond.” The briefing will feature six examples from across the country of physicians who have decided to by-pass insurance company rules and deal directly with their patients. This is a growing movement that will garner increased attention in the next few months and years. Our speakers have been recently featured in articles and stories in “The Wall Street Journal,” ABC and NBC news, Associated Press, and local dailies all over America. This is your opportunity to meet and ask questions of these leaders. If you can’t make it to Washington, the presentations will be available as a web cast after the event.

SOURCE: http://www.galen.org/eventrpts.asp?docID=643

Insurance Department Wants to Regulate Retainer Medicine


One approach the briefing will explore is “retainer medicine” (or “boutique” or “concierge” medicine, take your pick). An article in the “Seattle Times” says that a growing number of physicians in Washington state are taking this approach. The article by Carol Ostrom says the movement was started in Seattle in 1996 by a professional sports team doctor and his partner who charged $10,000 a year “for first-class, personal medical attention, including in-home or vacation cabin visits.” Now the movement has gone more mainstream with physicians charging $30 to $250 a month. Not everyone is happy about it, with one patient wanting to remain anonymous “because she wants to keep her doctor, whom she considers one of the best.” The insurance department isn’t thrilled, either, believing that “doctors who don’t bill insurers but promise to deliver certain services to patients for a set fee are operating as unregulated insurers.” [This is one of the most expansive definitions of “insurance” I’ve ever heard. If I pay a roofer $1,000 today to repair my roof in September, is that somehow “insurance?” Only in the mind of a power-mongering regulator.]

SOURCE: http://archives.seattletimes.nwsource.com/cgi-bin/texis.cgi/web/vortex/display?slug=concierge28m&date=20040528&query=Ostrom

AMA Documents Health Plan Market Concentration


Instead of picking on physicians who are trying to provide better service to their patients, perhaps the insurance regulators should pay more attention to the growing monopolization by real insurance companies. “AMNews” reports that, “Only a few weeks before the AMA issued its latest report on health plan market concentration, UnitedHealth Group announced it was paying $4.7 billion to buy Oxford Health Plans, Inc?.” Even without that merger, the AMA study finds that 78 of the 84 areas studied meet the FTC definition of “highly concentrated” in terms of HMO/PPO market penetration; this is 93% up from 87% just a year earlier. The article explains, “In 90% of the 84 market areas and 88% of the 26 states, one company represented more than 30% of the HMO/PPO market. In 37% of the metro areas and 42% of the states, one company represented more than half the market.” In many areas, only two companies control 90%+ of the market. These numbers predate UnitedHealth’s acquisition of MAMSI in the mid-Atlantic and the Anthem/WellPoint merger. The article says the AMA is trying to get FTC and the anti-trust division of Justice to be more wary about approving these mergers. It concludes, “physicians continue to desperately need the antitrust relief that would at least give them a chance to level the playing fields with health plans.”

SOURCE: http://www.ama-assn.org/amednews/2004/06/07/edsa0607.htm

Most Favored Nation Clauses Scrutinized by FTC


The same issue includes an article by Robert Kazel about a federal inquiry into Anthem’s “most-favored-nation” contract clauses. These provisions require that doctors and hospitals always charge Anthem the lowest price. Such provisions have been prohibited in some states and Anthem claims to use them in only about half the states where it does business. Physicians are often prohibited from discussing these arrangements by other contract provisions, but the article says two federal cases in the 1990s established that such clauses can be thrown out as anti-competitive under certain market conditions. [On the other hand, a physician might decline to sign such a contract.]

SOURCE: http://www.ama-assn.org/amednews/2004/06/07/bil10607.htm

Health Plans Publishing Prices


On the other hand, the “Boston Globe” reports that some insurers are beginning to post the actual prices they pay for certain services. This effort was launched partly by the experience of Harvard Pilgrim CEO Charles Baker. Mr. Baker is enrolled in his own company’s high-deductible “Best Buy” plan and was urged to get a chest x-ray by his doctor. He would have to pay the fee himself, so he asked what it would cost, and was surprised that the doctor had no idea. He concluded, “If consumers are supposed to take more financial responsibility, then they need the information.” The company still doesn’t post provider-specific prices, but lets consumers know the range of prices they pay.

SOURCE: The “Globe” charges for archives, but this article ran on May 29, 2004 and can be accessed at http://www.boston.com

Please send all comments/questions directly to me at gmscan@aol.com.


“Consumer Choice Matters” is a free weekly newsletter published by the Galen Institute, a not-for-profit public policy organization specializing in research and education on health policy. Visit our website at http://www.galen.org for more information.


If you wish to subscribe/unsubscribe or update your address, please send an e-mail to galen@galen.org.


The views expressed in this newsletter are the opinions of the authors and do not necessarily reflect the views of the Galen Institute or its directors.







SHARE THIS ARTICLE

About the author

IN THIS ISSUE:


? Consumer Choice Community

? Galen Briefing on June 18th – Physicians Respond

? Insurance Department Wants to Regulate Retainer Medicine

? AMA Documents Health Plan Market Concentration

? Most Favored Nation Clauses Scrutinized by FTC

? Health Plans Publishing Prices

Consumer Choice Community


For five years I have been running a ListServ on Health Benefits Reform (HBR). The list has been a fascinating mix of people from different areas of interest – physicians, brokers, economists, actuaries, legislative staff – who share a vision of consumer driven health care. It has also been enormously productive, with list members writing op-eds, being interviewed by the press, testifying before Congress, giving speeches and appearing on talk radio shows across America. The members provide great support to each other, congratulating people on accomplishments, posting interesting articles and studies, arguing the fine points of health care reform. The biggest problem is that it has been e-mail based, and members often get 100 or so e-mails a day, which can be overwhelming.


Now Grace-Marie and I have decided to take this concept to a higher level. We are forming the “Consumer Choice Community” that will be web-based. It will bring together leaders of the Consumer Choice movement from all over the country to form a community of activists. It will feature a web log (“blog”), a bulletin board, and plenty of supporting material.


Most importantly, members of the Community will be able to share their war stories and gain support from each other. For instance, a member might be looking for a little factoid for a speech, or want people to review and comment on a draft op-ed, or look for real-life examples of successful use of an HSA. Even among people who share a common goal there will be points of disagreement that will be thoroughly thrashed out – What, if any, limits should be placed on underwriting? Should importation of prescription drugs be allowed? Should hospitals be required (encouraged) to post their prices? To give discounts to the uninsured? These are the kinds of discussions we have on the HBR list, but in the Consumer Choice Community, you won’t have to load up your in-box with topics you aren’t very interested in.


The Community is intended to be self-supporting and will not be beholden to any interest group, so there will be a membership fee required. If you would like to find out more about the Consumer Choice Community, we have a packet ready to send out by snail mail. Please go to http://www.galen.org/cccintro.asp to request information.

Galen Briefing on June 18th – Physicians Respond


Many of the members of the HBR List will be attending the June 18th briefing on “Consumer Driven Health Care: Physicians Respond.” The briefing will feature six examples from across the country of physicians who have decided to by-pass insurance company rules and deal directly with their patients. This is a growing movement that will garner increased attention in the next few months and years. Our speakers have been recently featured in articles and stories in “The Wall Street Journal,” ABC and NBC news, Associated Press, and local dailies all over America. This is your opportunity to meet and ask questions of these leaders. If you can’t make it to Washington, the presentations will be available as a web cast after the event.

SOURCE: http://www.galen.org/eventrpts.asp?docID=643

Insurance Department Wants to Regulate Retainer Medicine


One approach the briefing will explore is “retainer medicine” (or “boutique” or “concierge” medicine, take your pick). An article in the “Seattle Times” says that a growing number of physicians in Washington state are taking this approach. The article by Carol Ostrom says the movement was started in Seattle in 1996 by a professional sports team doctor and his partner who charged $10,000 a year “for first-class, personal medical attention, including in-home or vacation cabin visits.” Now the movement has gone more mainstream with physicians charging $30 to $250 a month. Not everyone is happy about it, with one patient wanting to remain anonymous “because she wants to keep her doctor, whom she considers one of the best.” The insurance department isn’t thrilled, either, believing that “doctors who don’t bill insurers but promise to deliver certain services to patients for a set fee are operating as unregulated insurers.” [This is one of the most expansive definitions of “insurance” I’ve ever heard. If I pay a roofer $1,000 today to repair my roof in September, is that somehow “insurance?” Only in the mind of a power-mongering regulator.]

SOURCE: http://archives.seattletimes.nwsource.com/cgi-bin/texis.cgi/web/vortex/display?slug=concierge28m&date=20040528&query=Ostrom

AMA Documents Health Plan Market Concentration


Instead of picking on physicians who are trying to provide better service to their patients, perhaps the insurance regulators should pay more attention to the growing monopolization by real insurance companies. “AMNews” reports that, “Only a few weeks before the AMA issued its latest report on health plan market concentration, UnitedHealth Group announced it was paying $4.7 billion to buy Oxford Health Plans, Inc?.” Even without that merger, the AMA study finds that 78 of the 84 areas studied meet the FTC definition of “highly concentrated” in terms of HMO/PPO market penetration; this is 93% up from 87% just a year earlier. The article explains, “In 90% of the 84 market areas and 88% of the 26 states, one company represented more than 30% of the HMO/PPO market. In 37% of the metro areas and 42% of the states, one company represented more than half the market.” In many areas, only two companies control 90%+ of the market. These numbers predate UnitedHealth’s acquisition of MAMSI in the mid-Atlantic and the Anthem/WellPoint merger. The article says the AMA is trying to get FTC and the anti-trust division of Justice to be more wary about approving these mergers. It concludes, “physicians continue to desperately need the antitrust relief that would at least give them a chance to level the playing fields with health plans.”

SOURCE: http://www.ama-assn.org/amednews/2004/06/07/edsa0607.htm

Most Favored Nation Clauses Scrutinized by FTC


The same issue includes an article by Robert Kazel about a federal inquiry into Anthem’s “most-favored-nation” contract clauses. These provisions require that doctors and hospitals always charge Anthem the lowest price. Such provisions have been prohibited in some states and Anthem claims to use them in only about half the states where it does business. Physicians are often prohibited from discussing these arrangements by other contract provisions, but the article says two federal cases in the 1990s established that such clauses can be thrown out as anti-competitive under certain market conditions. [On the other hand, a physician might decline to sign such a contract.]

SOURCE: http://www.ama-assn.org/amednews/2004/06/07/bil10607.htm

Health Plans Publishing Prices


On the other hand, the “Boston Globe” reports that some insurers are beginning to post the actual prices they pay for certain services. This effort was launched partly by the experience of Harvard Pilgrim CEO Charles Baker. Mr. Baker is enrolled in his own company’s high-deductible “Best Buy” plan and was urged to get a chest x-ray by his doctor. He would have to pay the fee himself, so he asked what it would cost, and was surprised that the doctor had no idea. He concluded, “If consumers are supposed to take more financial responsibility, then they need the information.” The company still doesn’t post provider-specific prices, but lets consumers know the range of prices they pay.

SOURCE: The “Globe” charges for archives, but this article ran on May 29, 2004 and can be accessed at http://www.boston.com

Please send all comments/questions directly to me at gmscan@aol.com.


“Consumer Choice Matters” is a free weekly newsletter published by the Galen Institute, a not-for-profit public policy organization specializing in research and education on health policy. Visit our website at http://www.galen.org for more information.


If you wish to subscribe/unsubscribe or update your address, please send an e-mail to galen@galen.org.


The views expressed in this newsletter are the opinions of the authors and do not necessarily reflect the views of the Galen Institute or its directors.







SHARE THIS ARTICLE

About the author