CARE NEW ENGLAND: Abandons Controversial ‘Case-Rate’ Plan
Care New England, the company that Blue Cross & Blue Shield of Rhode Island has contracted with to manage its mental health services, "abandoned [Thursday] the most controversial aspect of its proposal -- 'case rates.'" The Providence Journal-Bulletin reports criticism of case rates -- a flat, per-patient payment, which opponents argue "gives therapists a financial incentive to provide less care -- has been so intense that a bill was filed in the General Assembly to ban them." In addition, the state chapter of the National Association of Social Workers "brought a complaint to the Health Department saying the plan violated state laws." Care New England Vice President Frank Delmonico said his company abandoned the idea because it doesn't "want to enter into a program where therapists feel ethically that it's something they don't want to be associated with." However, abandoning the case-rate idea still leaves his company deciding how they will run the program. "We're essentially back to the drawing board," Delmonico said. The Journal-Bulletin reports that "Blue Cross' plan, even though incomplete, has spawned extraordinary anxiety because it involves 340,000 subscribers, could pave the way for other health insurers to try the same methods, and inevitably will affect the incomes and practices of some 1,200 therapists."
Between A Rock And A Hard Place
Under the defunct case-rate plan, therapists would have received "the same amount of money for each patient who walked in the door" but would have been able to "manage the care any way they saw fit without having to seek preauthorization." Delmonico said this could encourage therapists to "try creative alternatives." Therapists, on the other hand, said case rates would place them in "an unethical position" by allowing them to "make more money by offering less treatment" and causing them to "lose money by treating patients needing many sessions." Supporters of the bill banning case rates said they would continue to push for passage "to make sure no other plan tries the same thing" (Freyer, 4/6).