Phyllis asks some questions

She should really send me her press realeses. From the TL:

What should Blue do for you, NEPA? COMMENTARY PHYLLIS MUNDY


RECENTLY, Blue Cross of Northeastern Pennsylvania announced a “bold and visionary initiative (to) ensure the ability of regional hospitals to deliver high-quality health care to its members.”

That’s certainly an inspiring statement. The initiative is indeed “bold” – disbursing $175 million of surplus subscriber funds to various health-care entities in the region.
But a closer examination of this proposal -- and the general reaction to it -- says as much about the misguided direction of health care in our state as it does about the lack of scrutiny in how these dollars are spent.

As you know, I’ve been an outspoken critic of the way in which Blue Cross of Northeastern Pennsylvania, a nonprofit insurer, has stockpiled surpluses while at the same time raising rates.
This situation is somewhat different, however. In fact, I find the intent of these initiatives -- such as the creation of a regional medical school -- very admirable.

But, once again, as an overall policy and plan, hard questions must be asked: Is this an appropriate use of the surplus? What are the anticipated measurable results? Are any of the ideas proposed in the initiative better than simply using the surplus to hold or reduce premiums? These are fair questions that I believe deserve straightforward answers.

In a recent editorial on this very subject, the Times Leader wrote, “Let’s not look this gift horse in the mouth.” I disagree. I’m not saying that we should criticize this action out of hand, but I also don’t think we should accept it sight unseen.

Not only should we look it in the mouth, but we also need to probe deeper to see what the finished product may look like. With all due respect to Blue Cross of Northeastern Pennsylvania’s good intentions, the fundamental question remains: Is this really the best, most effective way to improve rates and services? Judging by the current state of health care, I believe the answer is no.

The most obvious and some would argue the best approach would be for Blue Cross of Northeastern Pennsylvania to use the surplus to hold down or reduce rates. This is not a novel concept. In fact, some Blues in other states have already done so. For instance, in 2004, the New Jersey and Tennessee Blues refunded $55 million and $67 million, respectively, to their policyholders. North Carolina, on the other hand, used its surplus to roll back rate increases.
Unfortunately, Blue Cross of Northeastern Pennsylvania believes this approach “makes no sense.” To compound matters, it has continually stated that its multi-million-dollar surplus is not excessive. Yet, soon after the Pennsylvania Supreme Court revived class-action lawsuits against the Blues, Blue Cross of Northeastern Pennsylvania suddenly discovered that it had a spare $175 million. However, they decided not to return one penny to rate-payers.
To fulfill their nonprofit mission as insurers of last resort, the Blues in other states have done exactly what Blue Cross of Northeastern Pennsylvania believes “makes no sense.” Surely, if it has such excess to part with $175 million, some portion of that must be returned to subscribers – whose hard-earned money was the basis for the surplus – to provide them with economic relief.

This not only “makes sense” but reflects what a true nonprofit should do, namely, provide benefits to those most in need. Despite Blue Cross of Northeastern Pennsylvania’s position, Pennsylvanians who struggle daily to maintain critical health insurance are the ones most in need and who should be the principal beneficiaries of this new-found “generosity.”
I’m not saying that Blue Cross of Northeastern Pennsylvania should cut checks, but other options should be examined instead of investing ratepayer funds in a myriad of unproven ventures.

With that said, their regional focus sounds good at first. However, I fear that it will escalate the “technological arms race” between regional providers.
With so many independently owned ambulatory surgical facilities in the region, do we need more? Do we need more cardiology and oncology office space or a new medical office building? Without some process in place to determine need, the consumer who is paying the bills has no way to know. Is this duplication of existing services needed or does it just add to health-care inflation?

Also, Blue Cross of Northeastern Pennsylvania’s handout does not address one of the most critical cost drivers – preventable medical errors. Blue Cross could institute a list of “never events” that it will not reimburse, such as wrong-site surgery.
Shouldn’t Blue Cross do all it can to keep costs low and encourage best practices? Doing so would also address another preventable medical problem — hospital-acquired infections. It’s frustrating that many of these concerns could be corrected with simple administrative remedies that cost nowhere near $175 million. There is, of course, no price tag on the human toll.
On the other hand, one of Blue Cross of Northeastern Pennsylvania’s stated goals is to stem the flow of patients leaving the area. To that end, shouldn’t policyholders be allowed to utilize the Geisinger Health System?

I believe Blue Cross of Northeastern Pennsylvania’s policy toward Geisinger promotes competition, not cooperation. Clearly, this is an issue that needs to be examined.
As health-care costs continue to skyrocket, I feel I owe it to my constituents to, once again, ask the tough questions: Is this an appropriate use of ratepayer surplus dollars? What are the anticipated, measurable results?

Are any of the ideas proposed in the initiative better than simply using the surplus to hold down or reduce premiums? What else can Blue Cross of Northeastern Pennsylvania do to ensure access to high-quality health care without spending ratepayers’ dollars this way?
I believe that Blue Cross of Northeastern Pennsylvania customers and my constituents deserve better answers to these questions.