State officials need to step in and mediate an alarming clash between the Minnesota Hospital Association (MHA) and one of the state's largest nonprofit insurers, Blue Cross Blue Shield. The insurer and the trade group should welcome this effort and cooperate.
A strong working relationship between the two is vital so that Minnesotans can access quality health care, and it's clear after talking to both that this isn't going to end on its own.
The dispute centers on these issues: one, a new Blue Cross policy that denies hospitals payment for colonoscopies and other similar procedures that could be done in a lower-cost outpatient care center nearby. Two, its use of a new for-profit outside company called eviCore to approve coverage of other types of medical care.
A respected third party from a state office or agency with oversight clout is a logical next step to forge a compromise. Sensible choices are Attorney General Keith Ellison, Commerce Commissioner Steve Kelley or Health Commissioner Jan Malcolm.
The trio are the recipients of a disturbing 27-page letter the hospital association sent to the state on July 15. In it, MHA makes very serious allegations. It contends that Blue Cross' new policies are potentially violating state law and harming patients by delaying care, restricting access and imposing financial burdens when care is not covered unexpectedly. MHA represents 141 hospitals and health care systems.
Blue Cross disputed these characterizations through a spokesman, saying that Minnesota faces rising health care costs because it's lagging behind other states that have put policies in place to reward better care instead of more care. MHA's concern has to do with "potential reduction in their revenue from providing unnecessary care that does not qualify for payment."
While reining in costs is important, there are other legitimate concerns to balance, such as access to care and certainty about what will be covered. It's difficult to get it right and few have in the past. Scandals and lawsuits abounded in the 1990s and 2000s, when poorly managed medical gatekeeping created widespread distrust.
MHA is a respected organization whose members have cared for generations of Minnesotans. Its powerful push back has provided a valuable public service. Blue Cross regrettably has done little, if anything to alert individual policyholders to the new payment and prior authorization policies. MHA has ensured the changes will get the scrutiny deserved.
The hospitals note that the new Blue Cross policy limits choice for other procedures besides colonoscopies. Adenoidectomies and infusion therapies may also have to be done in an ambulatory care setting, the letter states. That might expand in the future to include carpal tunnel surgeries, cataract surgeries, gynecologic procedures, hernia repair and urology procedures, among others. "Endoscopy services are only the beginning," wrote MHA CEO Lawrence Massa.
The letter also details alarming examples of red tape and billing nightmares due to eviCore, the new medical claims management company Blue Cross has begun using. None of the state's other three major nonprofit insurers utilize eviCore, suggesting they have reservations about the company.
There is strong precedent for a state official to mediate. Former Attorney General Lori Swanson did so when talks broke down between Blue Cross and Children's Hospitals and Clinics. In July 2017, her office announced a deal to make Children's an in-network provider again.
State officials have said little publicly about their response to MHA's letter. Minnesotans need swift reassurance that this troubling health care conflict will be resolved in a manner that best serves patients. Having Kelley, Malcolm or Ellison call for and anchor mediation would provide that.
