Brace yourself: Health plan contracts may be an even bigger pain

by Anne Zieger on September 9, 2012

contractWhile some aspects of healthcare reform be profitable for healthcare providers, such as the likelihood that most will be carrying health insurance, others may turn out to be a threat.

For example, new health reform-driven demands for quality may prompt health plans to cut long-time network members — or refuse others they’d happily have taken in the past,  as a new piece in the Chicago Tribune points out.

Another nasty possibility is that they’ll keep your facility or practice in the network, but force patients that see you to pay higher co-pays or deductibles. Now *that’s* not good for business.

Now, I’m not suggesting that your practice or hospital will be squeezed out because it truly does produce inferior care. But we all know that when health plans say “quality” they usually mean “low cost,” deny it though they may.

At minimum, it looks like insurers are going to catch a lot more heat — and face a lot more scrutiny — over the way they measure physician quality.  Until now, there have been some pitched state battles over physician ratings, especially in New  York, which imposed its own set of rules on plans operating there, but we haven’t seen a cleanly defined national standard put into place yet.

This next year or two is a great time to position and get yourself prepared to fight these battles.  Start your engines!

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