CalPERS Develops Coverage Rules for Contract Disputes

In the fallout resulting from the contract dispute between Blue Cross of California and Sutter Health, CalPERS is looking to establish "ground rules" for future contract negotiations in order to minimize disruption to patients, the Sacramento Bee reports. The California Public Employees' Retirement System has 40,000 members using the Blue Cross provider network and "has been [hard]-hit" by the end of the contract between Blue Cross and Sutter Health. To prevent enrollees from having to "fight for access to their doctors," CalPERS is "exploring options" such as "uniform guidelines" for transition coverage if a contract expires. These guidelines would be agreed to by both plans and providers and be sent to members in one letter. The Bee reports the plan CalPERS is developing has "heavyweight support." Peter Lee, president and CEO of the Pacific Business Group on Health, said employers are "considering similar measures." But he added that employers are also "looking at passing more health care costs to their employees." Walter Zelman, president and CEO of the California Association of Health Plans, said greater costs to employees would give "negotiating flexibility" to health plans, because they would be under "less pressure to give employers the lowest priced group plans." Duane Dauner, president and CEO of the California Healthcare Association, said companies are under "pressure" to "deliver consistent, affordable care" to employees. To help patients, he said "open disclosure" of what coverage remains and for how long would help patients if contact negotiations end in an impasse. He added, "Part of this situation is the hard business that goes with the financing and delivering of health care, and part of it is people being frustrated with confusing information. We could cut out the confusion." CalPERS Health Benefits Administrator Allen Feezor said, "Somebody outside the process has to step in and put the consumer back in the equation" (Rapaport, Sacramento Bee, 1/12).