MCOs to Introduce ‘Network-Within-a-Network’ Plans Featuring Steep Copays for Certain Hospitals
Several California managed care organizations will launch new "hybrid" plans next year that feature a tiered system in which enrollees will have to pay more to visit non-preferred hospitals, the Sacramento Business Journal reports. PacifiCare, Blue Cross of California and Health Net will introduce some variation of these "network-within-a-network" plans, which offer savings for patients who elect to be treated at hospitals belonging to a discount panel of facilities in the MCO's regular hospital network. Members not using the MCO's "select" hospitals will have to pay a "severe" fee. For example, PacifiCare members who participate in the new Select Hospital Plan will be charged a copay ranging from $100 to $400 a day to use a hospital that is not on the plan's select list, while members treated at a select hospital will not be charged a copay. These plans aim to reduce employer premiums by "forcing workers to make cost-driven decisions about where they go to the hospital," the Business Journal reports. According to PacifiCare spokesperson Cheryl Randolph, employers who participate in the new plans will see savings of 5% to 20%. She added that about 50% of the 230 hospitals that serve PacifiCare members have agreed to become a select facility by providing an undisclosed discount to the insurer. The Business Journal reports that the tiered plans could give MCOs the "upper hand in negotiating with hospitals," providing them with a "way to steer patients to hospitals that are willing to go along with the HMO's terms -- and away from hospitals that balk."
Also attempting to increase employee control of health care spending, Hartford, Conn.-based Aetna is dropping its HMO plan in the Sacramento area at the end of the year and will replace it with Aetna HealthFund, a "high-deductible PPO" that is "tied to an employer-funded medical savings account." Annual deductibles, which can be offset by using funds from MSAs, will range from $1,500 to $3,000. The plan is "target[ed]" at "self-funded, middle-market employers with 300 to 3,000 employees" (Robertson, Sacramento Business Journal, 10/19).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.