Tag Archives: Blue Cross Blue Shield of Vermont

News You Should View (Or Listen To)

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The title of this weekly feature is never entirely accurate, since I often include audio content that you really can’t “view.”. But I’m amending the title this week because we have a really great audio piece in the leadoff spot. And, for those monitoring their Trump-related consumption, you’ll find a relatively moderate number of stories about That Manbaby in the White House.

A day in the life. From Vermont Public, a tremendous 20-minute audio documentary about a rare animal in modern times: the do-it-all rural primary care doctor. Producer Anna Van Dine’s voice only appears at the beginning and the end. In between, your narrator is the documentary’s subject: Dr. Bob Primeau, the only primary care doc in the Northeast Kingdom town of Island Pond. This must have taken a ton of time and effort, but it gives you a real sense of what it’s like to be a doctor, and a patient, in rural Vermont.

Also what it’s like to be a cog in a machine. “These days, it feels like the health care system has begun to disregard the most essential part of what it means to be a doctor,” Primeau says, citing ever-more-stringent demands for data entry that takes time away from stuff like talking to your patients. I spent many years working in public radio (never in Vermont), and the opportunity to produce this kind of content is what made the job so challenging and so rewarding.

Vermont’s health care system, teetering on the brink. VTDigger and Seven Days each delivered vital stories about financial troubles in our health care system. They spotlight different aspects of an issue, which is the kind of coverage we’ve largely lost in our teeny-tiny media ecosystem. We used to get a lot more of this when there were several strong outlets competing with each other, and we rarely get it anymore. Digger’s Peter D’Auria focused on Blue Cross Blue Shield of Vermont, which (a) insures roughly one-third of all Vermonters, (b) is the only in-state health insurer, and (c) has spent most of its financial reserves to cover a surge in claims.

Seven Days’ Colin Flanders, meanwhile, took a broader but equally sobering view of our health care landscape.

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Trying to Remove One Hand from Our Health Care Pocket

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If you’re unfamiliar with the term, you might think “pharmacy benefit manager” is a job title for some anonymous mid-level health insurance executive. Like, say, the guy pictured above. But no, a pharmacy benefit manager is a corporation that sticks its big fat nose into the middle of America’s misbegotten prescription drug system and snorts up all the loose cash it can.

That’s my definition anyway. If you’re a high-priced lobbyist for the national PBM trade association, things look a little different. “Pharmacy benefit managers exist for one purpose: to drive down cost of prescription drugs,” said Sam Hallemeier of the Pharmaceutical Care Management Association (PCMA). PBMs, he continued, “reduce costs for insurers and consumers, reduce waste, and improve patient care.”

Wow, I hadn’t realized that PBMs are charitable enterprises that simply want to make the world a better place.

Oh wait, they’re not. The PBM marketplace is dominated by three large firms that are owned by three of America’s largest for-profit health care firms: Caremark, operated by drugstore chain CVS; Express Scripts, operated by insurance giant Cigna; and OptumRx, brought to you by insurance giant (and sworn foe of spaces between words) UnitedHealth. These mega-corporations are in business to make profits. If their PBMs are holding down costs, you can bet your life they’re doing it for their own benefit, not yours or mine.

You may wonder when I’m going to get to the Vermont political point of this. Well, the Legislature is considering a bill, H.233, that would impose substantial new restrictions on PBMs. And while our state has a track record of disappointment when it comes to health care, this thing might actually stick.

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A Deal We’re Likely to Regret Someday

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Blue Cross and Blue Shield of Vermont is about to be swallowed whole by one of its much larger cousins. The deal seems benign and, since it holds out the promise of lower costs for health insurance, it’s virtually certain to go through.

The unintended consequences will come later. As will the intended consequences.

The proposed deal, first announced in May, is on a fast track to approval. The state Department of Financial Regulation set aside a two-week window for public comment, which closes the day after tomorrow. Next week, the DFR will hold a public hearing. After that, approval seems a certainty. The two partners have said they want to finalize the arrangement by October 1.

The deal involves BCBSVT, which I will call “Vermont Blue” for clarity’s sake, becoming “affiliated” with Blue Cross Blue Shield of Michigan, or “Michigan Blue.” And despite the seemingly collegial tone of “affiliation,” it’s a takeover. Like a shark devouring a tasty fish.

Or, to change midstream to a different animal analogy, Michigan Blue is the dog and Vermont Blue will be the tail. Michigan Blue insures more than five million people; Vermont Blue, at 200,000, will effectively be a rounding error on Michigan Blue’s bottom line.

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What Is This “Health Care System” Of Which You Speak?

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If there was an organizational chart outlining America’s process for supplying and paying for health care, it would look something like this. It’s not a “system” as much as a mare’s nest that grows more and more complicated — and less efficient and increasingly unjust — over time.

I’m guessing here, not a health care management expert or anything, but this mess has got to be costing us untold billions that might otherwise go to, I don’t know, making people healthier? There are inefficiencies, redundancies, and a massive amount of profit-skimming at every turn. That’s why other developed countries can provide much broader and more equitable coverage at a much lower cost. I have often thought that health care in America would be cheaper if we simply left big bags of cash everywhere.

Aside from the inadequacies and inequities of our “system,” there’s also the fact that it’s completely out of our control. Decisions made at high corporate levels trickle down like warm piss upon our heads, and damn but we’d better be grateful for the golden showers.

This line of thought was triggered by VTDigger’s story about likely reform efforts in the state Legislature. A story that could have been published, with alterations in the details, just about any time in the past. Yep, our health care “system” needs reform, and by God, our elected officials are gettin’ to work.

But the scope of that work will be limited indeed.

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The Curious Case of the Single Intolerable Word

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Gather ’round, children, and you shall hear… how Vermont’s biggest health insurer has gotten its knickers in a twist about one single word in a Green Mountain Care Board decision. The word was so objectionable that Blue Cross Blue Shield of Vermont appealed the decision solely because of that word. It did not object to any other part of the ruling.

When the appeal was denied BCBSVT took the case to the Vermont Supreme Court, where it awaits action. Seems like a whole lot of time, trouble and billable hours for a single word, but what do I know.

Let’s go back to the beginning. On May 7, Blue Cross Blue Shield of Vermont filed a request for 2022 insurance rates with the Green Mountain Care Board. The Blues asked for a 7.9% increase on individual policies, and smaller increases for group plans.

The request meandered through a lengthy series of briefs, filings, hearings and testimony. (All can be downloaded from this webpage.) On August 5, the GMCB issued its decision, knocking down the rate hike on individual policies to 4.7%. In its decision, the GMCB characterized the 7.9% request as “excessive.”

There. That’s the fatally toxic word. ‘Excessive.”

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Just what we needed: More bad news on Vermont Health Connect

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The headline says it all, thanks to Erin Mansfield of VTDigger:

VERMONT HEALTH CONNECT IS GOING BACKWARD, STAKEHOLDERS SAY

The “stakeholders” are Blue Cross Blue Shield of Vermont and Vermont Legal Aid, an unlikely pairing to be sure. BCBS is calling for an independent review of the troubled health care exchange, and Legal Aid is fielding scores of complaints from “frustrated consumers.”

“We’re going backwards,” said Trinka Kerr, the chief health care advocate for Vermont Legal Aid. “Towards the end of last year, we were making progress. You could get things straightened out relatively quickly, and now things are more complicated than they used to be.”

Some of Governor Shumlin’s high-profile declarations of victory are now looking inoperative. The “change of circumstance” function, which was supposed to be a benchmark for VHC, had to be taken off line because it simply wasn’t ready to handle the workload. And as a result, the backlog is back!

Yes, VHC has a backlog of change orders numbering about 4,000. To put that number in perspective, VHC has a total of 33,000 customers who buy individual policies through the website.

Now, I stopped being good at math in about the seventh grade, but to me that looks like the backlog amounts to 12 percent of all customers served. Which is, in a word, dreadful.

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