Episode 720 | Lovelace/Blue Cross Blue Shield Buyout


>>AGAINST THE BACKDROP OF THE
AFFORDABLE CARE ACT UNCERTAINTY, BLUE CROSS-BLUE
SHIELD OF NEW MEXICO ANNOUNCED THIS WEEK IT’S BUYING LOVELACE
HEALTH PLAN. THE CEO OF LOVELACE, RON
STERN, SAID THE PLAN HAD BECOME TOO SMALL TO SURVIVE
AFTER IT LOST A BID EARLIER THIS YEAR TO PROVIDE MEDICAID
TO RECIPIENTS OF THE CENTENNIAL CARE PROGRAM.
ABOUT 300 PEOPLE WORK FOR THE LOVELACE HEALTH PLAN AND THE
COMPANY SAID IT WILL TRY TO PLACE THOSE PEOPLE IN JOBS AT
BLUE CROSS OR IN THE LOVELACE HEALTH SYSTEM.
THE DEAL MEANS NOW THAT TWO COMPANIES BLUE CROSS AND
PRESBYTERIAN WILL CONTROL MOST OF THE MARKET IN NEW MEXICO.
AND, STEVE, SO THIS COULD MEAN MONOPOLY AND THIS COULD BRING
HIGHER COSTS, ALL THE THINGS THAT HAPPEN WITH A MONOPOLY.
IS IT TOO EARLY TO CALL THAT? DOES THE MARKETPLACE HAVE TO
SHAKE OUT HERE A LITTLE BIT?>>DAN KNOWS MORE ABOUT THE
INSURANCE BUSINESS THAN I DO, BUT THIS PERSONALLY AFFECTS
ME, BECAUSE MY COMPANY IS ON THE LOVELACE PLAN, AND,
PERSONALLY, I LIKED IT A LOT BETTER THAN BLUE CROSS WHICH
WE USED TO BE ON. NOW WE’RE GOING BACK.
I HAD AN INSURANCE PLAN I WANTED AND NOW I CAN’T HAVE IT
ANYMORE.>>SURE.
WHAT HAS BEEN THE TONE AND TENOR OF THE SHOP?
I AM CURIOUS, NOW THAT YOU MENTION THAT.
IS IT UNANIMOUS THE FOLKS ARE UNHAPPY OR JUST —
>>I HAVE TALKED TO A COUPLE, BUT I AM KIND OF ISOLATED
BECAUSE I AM IN THE STATE CAPITOL BUREAU.
I DON’T SEE EVERYBODY EVERY TIME.
>>IS THAT BY DESIGN, STEVE?>>PERSONAL STUFF.
INSURANCE FALLS UNDER THAT, IT IS A TRICKY THING.
FOLKS DON’T LIKE TO HAVE THEIR INSURANCE MESSED WITH.
ON THE WAY IN, I HEARD PRESIDENT’S NEWS PRESS AND HE
WAS TALKING ABOUT THIS AND HONORING, YOU KNOW, INSURANCE
FOR FOLKS, THE BIG NATIONAL DIALOGUE.
BUT FOR LOCALLY HERE, DOES THIS FUNDAMENTALLY MEAN WHAT
FOR LOVELACE PEOPLE? SHOULD THERE BE FEAR, SHOULD
THERE BE NO FEAR? WHAT IS THE SENSE OF IT.
>>SEEMS LIKE THERE SHOULD BE SOME CONCERN IN THE SENSE THAT
IT IS RIDING ON TOP OF THE AFFORDABLE CARE ACT SO THERE
ARE ALL KINDS OF OTHER THINGS AND HERE YOU CAN’T KEEP YOUR
INSURANCE AND MY INSURANCE COMPANY IS GOING UNDER BECAUSE
OF PERHAPS SOME OF THIS PROCESS AND SO HOW DO THESE
THINGS FOLD INTO EACH OTHER? IT IS A CONCERN THAT WE’RE
ONLY LIMITED TO TWO MAIN COMPANIES.
>>WHAT DO YOU MAKE OF THE IDEA THAT SOME FOLKS FEEL THE
INSURANCE COMPANIES ARE PLAYING GAMES WITH THIS, YOU
KNOW. THEY SENT OUT THE LETTERS
TELLING YOUR INSURANCE HAS BEEN CANCELED BUT LO AND
BEHOLD YOU END UP SIGNING UP WITH SOMETHING MORE EXPENSIVE,
NOT QUITE AS GOOD. YOU HAVE THIS TENSION POINT.
ARE INSURANCE COMPANIES CULPABLE HERE IN SOME CAPACITY
AS YOU READ IT?>>IN RELATION TO THE
AFFORDABLE CARE ACT?>>YEAH.
>>IT DOESN’T SEEM LIKE IT TO ME.
THE NUMBER IN LOVELACE WAS 3/4 THE ARTICLE IN THE NEW
MEXICAN, 3/4 OF THE INDIVIDUALS WERE GETTING
KICKED OFF. I KNOW PEOPLE WHO WERE GETTING
KICKED OFF AND HAVING TO PAY THREE TIMES AS MUCH FOR LESS
INSURANCE. IT IS NOT QUITE WHAT THEY WERE
SOLD.>>RIGHT.
THIS COMES WITH THE IDEA WE HEAR THIS ALL THE TIME IN
BUSINESS, THAT YOU NEED SCALE, YOU GOT TO HAVE SCALE TO BRING
PRICES DOWN WHICH MEANS YOU HAVE TO HAVE A LOT OF PEOPLE,
DOESN’T QUITE WORK OUT THAT WAY, BUT THAT IS WHAT THEY
SAY.>>I AM NOT AFFECTED BY IT AT
ALL AND BY THE SAME TOKEN A LOT OF LOVELACE MEMBERS, WHEN
THEY LOST THEIR ABQ HEALTH PARTNERS, SO, FOR THEM, I
WOULD THINK THIS NOW GIVES THEM A BROADER NETWORK OF
SERVICES AND DOCTORS, SO, AGAIN, I AM NOT AN EXPERT.
>>IS THIS A MATTER OF CHOICE, IN YOUR VIEW?
YOU LOOK AROUND THE COUNTRY, A LOT OF STATES HAVE CHOICE,
THERE IS A LOT MORE CHOICES.>>THAT MAKES A DIFFERENCE FOR
CONSUMERS. WE HAVE ENOUGH CHOICES IN NEW
MEXICO NOW?>>PROBABLY NOT BUT LOVELACE
WAS GETTING SO SMALL, I AM NOT SURE IT OFFERED MUCH CHOICE TO
ITS MEMBERS AFTER A CERTAIN POINT.
>>ON THAT CHOICE THING, WE HAVE ENOUGH CHOICE?
>>WE REALLY ONLY HAVE FOUR PROVIDERS AND NOW WE HAVE
THREE. SO, YOU GUYS ARE FORGETTING
UNITED HEALTHCARE, BLUE CROSS, PRESBYTERIAN AND THEN
STATE-WIDE, YOU ONLY HAVE GOT TWO.
PRESBYTERIAN IS REALLY A GREAT — THEY HAVE STUFF
STATE-WIDE. I DON’T WANT JIM HINTON COMING
IN HERE AND SAYING I DIDN’T — THEY ARE REALLY IN
ALBUQUERQUE. THEIR HOSPITALS ARE HERE.
SO, WE HAVE GONE FROM FOUR TO THREE AND WE HAVE HAD FOUR FOR
100 YEARS HERE. SO, WE HAVEN’T REALLY HAD ALL
THIS GREAT CHOICE THAT YOU HEAR ABOUT.
I DON’T THINK THE INSURANCE COMPANIES ARE DOING A BIG
SWITCH, GENE. WHAT YOU’RE SEEING, IN MY
OPINION, YOU’RE SEEING WHAT HAPPENS WHEN THE GOVERNMENT
COMES IN AND TOTALLY REGULATES EVERYTHING IN A BAD WAY.
THE AFFORDABLE CARE ACT SAID WE’RE GOING TO TELL YOU WHAT
THE MINIMUM LEVEL POLICY IS YOU CAN HAVE.
THE MARKET DICTATED THOSE POLICIES IN THE PAST.
SO, NOW A WHOLE LEVEL OF POLICIES HAVE GONE AWAY,
PEOPLE SAID THIS IS LEVEL OF COVERAGE I WANTED.
NOW YOU CAN’T GET THAT. YOU HAVE GOT TO PAY FOR THE
HIGHER STUFF. SO, I THINK THAT IT IS
INTERESTING, YOU KNOW, PEOPLE HAVE GOT TO REMEMBER THAT A
LOT OF THESE FOLKS GOT INTO THE PLAN DESIGN BACK IN THE
HMO DAYS BECAUSE YOUR PLAN COULD DRIVE YOUR PEOPLE TO
YOUR HOSPITAL. AND NOW, THAT MODEL IS GONE,
BEEN GONE FOR A WHILE AND, YOU KNOW, HERE IN ALBUQUERQUE,
LOSING ABQ HEALTH PARTNERS, HAVING DOCTORS THAT CAN ONLY
GO INTO ONE HOSPITAL VERSUS ANOTHER HOSPITAL, THEY ARE NOT
GETTING ACCREDITED IN BOTH PLACES, HAS RISEN TO A LEVEL
OF CONSTERNATION AND I THINK WHAT IS A BIGGER QUESTION FOR
NEW MEXICO, AND FOR PEOPLE AT THIS TABLE, IS THE FACT THAT
LOVELACE LOSES THE MEDICAID CONTRACT, FORCES THEM TO CLOSE
THEIR HEALTH PLAN, THAT THERE IS NOT ENOUGH OPPORTUNITY IN
THE PRIVATE SECTOR. THAT IS WHAT PEOPLE IN NEW
MEXICO SHOULD BE SCARED ABOUT.>>INTERESTING POINT RIGHT
THERE AND STEVE, AGAIN, COMING BACK TO YOU ON THIS IDEA OF
CHOICE AND IDEA OF WHERE NEW MEXICANS NOW STAND, HOW SHOULD
WE BE INTERNALIZING THIS? THIS IS THE FUNDAMENTAL
QUESTION. IT IS SUCH A MYSTERY FOR
PEOPLE AND YOU CAN’T BLAME ANYBODY FOR FEELING VERY
UNSURE RIGHT NOW, SO, AGAIN, IS IT JUST WE NEED TIME HERE?
WHAT IS THE ANSWER FOR FOLKS?>>APPARENTLY WE DO NEED TIME.
THERE IS REASON FOR CONCERN.>>IF YOU HAD A PERFECT WORLD
SCENARIO, THINKING ABOUT YOURSELF, YOUR SHOP,
EVERYTHING ELSE, WHAT WOULD BE THE BETTER SETUP?
WHAT WOULD BE THE BETTER WAY TO GO HERE.
I AM CURIOUS.>>LIKE I SAY I WAS SATISFIED
WITH THE LOVELACE PLAN I HAD. SHORT YEAR-AND-A-HALF WE HAVE
HAD THEM. SO, THAT WAS PRETTY IDEAL.
I MEAN, IDEAL WORLD, I WOULD LIKE TO PAY LESS.
>>ARE THERE POLITICAL UPSHOTS TO THIS IN THE LEGISLATURE?
FOLKS ARE TALKING ABOUT HEALTH ISSUES UP THERE ALL THE TIME
CERTAINLY BUT DOES THIS CHANGE THE CONVERSATION IN ANY
APPRECIABLE WAY IN YOUR VIEW?>>I CAN’T SEE ANYTHING REALLY
COMING, MAYBE, SOME TALK, BIGGER SPEECHES IN THE SENATE.
>>GOOD POINT.>>THE BIGGER QUESTION,
THOUGH, IS YOU HAVE TO REMEMBER, UNITED HEALTHCARE IS
A NATIONAL HEALTH PLAN. BLUE CROSS-BLUE SHIELD IS
OWNED BY FOLKS OUT OF ILLINOIS.
LOVELACE AND PRESBYTERIAN WERE NEW MEXICO PLANS RUN BY NEW
MEXICANS. THE QUESTION IS ARE WE GOING
TO LOSE INDIVIDUALITY OF PEOPLE UNDERSTANDING WHAT IT
TAKES TO PROVIDE RURAL MEDICINE IN NEW MEXICO, WHICH
I ASSURE YOU IS NOTHING LIKE PROVIDING MEDICINE IN ILLINOIS
OR EVEN TEXAS AND, YOU KNOW, NOW YOU ARE LOOKING AT ALL THE
ECONOMIES OF SCALE THEY ARE MOVING THE UNDERWRITING OUT OF
STATE. ARE THEY TRULY GOING TO
UNDERSTAND, YOU KNOW, THE FACT THAT WE GOT CERTAIN PORTIONS
OF NEW MEXICO SEGMENTS THAT HAVE HIGH DIABETES PROBLEMS,
OR HAVE VERY HIGH CHOLESTEROL PROBLEMS.
WHAT IS A WELLNESS PLAN; A WELLNESS PLAN THAT WORKS IN
CHICAGO DOESN’T WORK IN GALLUP.
SO, WHAT I AM MORE CONCERNED ABOUT IN GENERAL IS WE’RE
LOSING THAT LOCALLY DRIVEN WELLNESS DECISIONS, LOCALLY
DRIVEN PRICING, BY FOLKS THAT YOU GET TO LOOK AT EVERYDAY.
YOU CAN SAY WHAT YOU WANT ABOUT PRESBYTERIAN AND
LOVELACE AND PLANS LIKE THAT, BUT, YOU KNOW, YOU BUMP INTO
HIM AT THE GYM AT THE LOBO FOOTBALL GAME.
IF YOU DON’T LIKE SOMETHING THAT IS GOING ON AND YOU SEE
HIM — YOU AIN’T GOING TO BUMP INTO THE GUY FROM BLUE
CROSS-BLUE SHIELD. HE AIN’T COMING FROM CHICAGO
AND UNITED HEALTHCARE AIN’T FLYING OUT.
>>JUST AHEAD, TWO EXPERTS ON DEATH AND LOSS TALK ABOUT HOW
SOCIAL MEDIA HAS SHIFTED THE WAY WE TALK ABOUT THESE
ISSUES.

Leave a Reply

Your email address will not be published. Required fields are marked *