CalPERS Health Panel Mulls Ending HMO Plan in Rural Counties
The CalPERS Health Benefits Committee on Tuesday will consider a proposal by Blue Shield of California to drop HMO coverage for members in four rural counties that are among the most costly in the state for health care services, the Sacramento Bee reports.
The proposed withdrawal would affect 9,100 CalPERS members and dependents in:
- El Dorado;
- Napa; and
- Plumas counties.
Paul Markovich, Blue Shield executive vice president, said the proposal would generate $30 million in premium savings for Blue Shield's remaining 356,000 CalPERS members in other counties.
Blue Shield estimates that the costs in rural counties are 21% to 63% higher than in urban counties. Over the last three years, membership in rural counties has increased to 15% of total enrollment.
Experts say the higher health care costs in rural areas could be attributed to:
- Low patient volumes at hospitals;
- Limited availability of physicians and specialists;
- A large uninsured population; and
- Above-average incidences of chronic conditions.
Blue Shield officials since September 2006 have traveled to 10 rural counties to encourage labor groups, businesses and medical providers to devise plans to reduce health care costs. The health plan also sent letters to physicians encouraging them to participate in HMOs (Chan, Sacramento Bee, 5/13). This is part of the California Healthline Daily Edition, a summary of health policy coverage from major news organizations. Sign up for an email subscription.