Sutter, Blue Cross Break ‘Angers’ CalPERS and DMHC
Both the California Public Employees' Retirement System and the Department of Managed Health Care are considering measures to protect patients in the wake of last week's break between Sutter Health and Blue Cross of California, the Sacramento Business Journal reports. CalPERs, the "largest health care purchasing pool in the world," is "angry that some of its members have been thrown into medical limbo," as the Blue Cross/Sutter split has forced more than 36,000 Northern California patients to either switch health plans or doctors. The Business Journal reports that CalPERS is "exploring" the possibility of imposing rules on participating health plans. For example, the purchasing pool could adopt a standard 45- to 60-day period prior to contract termination that would require health plans and providers to inform members of the status of any negotiations and their options in the event a contract is terminated. CalPERS spokesperson Pat Macht said, "Purchasers are not going to stand by and be whiplashed -- or see their members whiplashed. We want to bring some stability back to the process."
Daniel Zingale, head of the Department of Managed Health Care, which oversees the state's HMO industry, shared CalPERS concerns, and "suggested he may intervene" in the Sutter/Blue Cross dispute. Last summer, Zingale took action in a similar contract dispute between Blue Cross and Catholic Healthcare West when he blocked the unilateral transfer of 2,000 of the insurers' patients from CHW to the UC Davis Health System. Zingale is hoping to boost the department's watchdog role over HMOs. He said, "PERS got it right. What's missing is a voice for patients. When payers begin to understand there is a formidable voice for patients in the DMHC, there will be a tempering of the cavalier attitude toward them" (Robertson, Sacramento Business Journal, 1/8).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.