BCBS Tiering Strategy

Question: Discuss about the BCBS Tiering Strategy. Answer: Introduction: The insurance companys strategy to tier physicians seems to be a good platform for development in healthcare provision. Since the classification would be based on performance I still believe that the patient will have the right space to make informed choices on the type of services and the physicians to offer them. However, I have a few reservations and concerns with reference to your strategy. To begin with Brennan and Carrara (2008) note that tiering of physicians might end up affecting the patients loyalty to their already established healthcare providers. The patients are likely to end up making wrong choices by picking on physicians only because they are top tiered but not necessarily because they can adequately meet the clients medical needs. There is a dire need for consistency in healthcare provision hence the patients need to accustom to a definite and more direct approach when it comes to seeing medical intervention. I believe this strategy may have adverse effects on patie nt choices making it a not-so welcome innovation in my opinion. Secondly, due to the fact that the physicians will be tiered based on the quality of performance an external certification, those physicians classified in the lower tiers might be rendered jobless. In a tiered system, the consumer choices are largely based on the quality of service provision in addition to cost effectiveness. This would therefore see most patients opting for the top tiered physicians at the expense of those appearing the lower tiers. I would rather suggest a more liberal system in which all the physicians are given an equal platform for recognition and job opportunities. My third concern would be challenges associated with the process of switching service providers and hospitals. In the current state, the patients are subscribed to specific physicians. The process of tiering would see the physicians classified into different categories comprising low and higher tiers. Patients might subsequently choose to switch to the service providers falling in the higher tiers (Landon, 2012). The process of moving from one provider to another encompasses a cumbersome process which may see the patients lose out on insurance cover. This may happen when the chosen service provider fall out of the insurance companys scope of cover. Despite the fact that the company intends to use a performance based approach in classifying physicians, the transition might be accompanied by various economic implications. The tiering may also be based on cost-effectiveness which in turn affects not only the participants but also the service providers. Patients will most likely go for network tiers characterized by low medical expenses as much as the amount spent is derived from their contributions. Such choices may see patients settling for affordable option at the expense of the need for quality. Lastly, tiering may not only affect individual physicians and patient choices but also the hospitals. Depending on the network in which it is placed, tiering can either cause a hospital to gain or lose revenue (Dranove Sfekas, 2008). In addition to quality service provision, patients would be keen to consider the cost-effectiveness of the service provider choices. Subsequently, the hospitals not included in the narrow networks may lose their clients to the networked hospitals which in turn leads to loss of revenue for the former. It is important to note that your strategy will cover over 50 physicians from my organization and hence all the patients associated with them. The transition involving the implementation of this strategy might be time and resource consuming in addition to the costs involved. Suggestions of a better approach With the eminent challenges associated with this strategy, I would like to make a few suggestions on steps the company could take to make the project more acceptable and applicable to my organizational situation. As noted by (Draper Liebhaber, 2007), there is a vital need for patient empowerment and guidance when it comes to making choices for healthcare providers. This can be achieved may availing as much information as possible about the tiering strategy hence allowing them to make informed choices. The process of awareness and education of patients ought to be one of the insurance companys core objectives. This approach would offer the consumers a concise picture of the implications of their choices. In addition to patient education, the providers can also be educated on the need to uphold quality standards, transparency and integrity in service provision (Scanlon Chernew, 1997). This is because the process of tiering is solely based on performance hence a provider is likely to be tiered highly when they exhibit high standards in quality provision. The third strategy would be to sensitize the hospitals on the need to retain a close and constructive link with the patients and providers. The hospitals therefore ought to install effective network strategies which would ensure that the services provide adequately respond to the demands of the healthcare market place. This could be achieved when the hospital remain transparent with the aspects of pricing and quality. A clear record of the out of pocket of payments ought to be defined within the strategys plan. This approach would be pivotal in generating effective consumer behavior to the changes associated with the new strategy (Goldman Zheng, 2007). There also a need to exercise elasticity with respect to the prices in order to maximize on the benefits of the new projects. With flexible prices, the patients are covered from excessive spending which gives room for savings both by the service providers and participants. When such open ended approaches are used before implementing the strategy, the idea is likely to elicit positive consumer response hence widening the scope of benefits associated with the new idea. Furthermore, BCBS could deploy a strategy which would see all the patients involved in the planning process before the strategy is implementing. Through this approach, their views can be incorporated into the strategys design to minimalize the negative impacts of this implementation on the patients medical needs. The insurance company equally needs to ensure that the components of this strategy are aligned with both the legal environment and local policies. Lastly, the insurance company might consider the need for flexibility, constantly revising the prices, quality ratings as well as the value of the networks. The constant monitoring of the progress would ensure that the strategy positively impacts the patients, physicians, hospitals and other related organizations. References Brennan, A., Carrara, L. (2008). Do Managed Care Plans' Tiered Networks Lead to Inequities in Care for Minority Patients? Health Affairs, 27(4), pp. 11606. Dranove, D., Sfekas, A. (2008). Start Spreading the News: A Structural Estimate of the Effects of New York Hospital Report Cards. Journal of Health Economics, 27 (1), pp. 1201 1207. Draper, D., Liebhaber A. (2007). High-Performance Health Plan Networks: Early Experiences. Center for Studying Health System Change, 2(1), pp. 23-34. Goldman, D., Zheng, Y. (2007). Prescription Drug Cost Sharing: Associations with Medication and Medical Utilization and Spending and Health. Journal of the American Medical Association, 298(1), pp. 619. Landon, E. (2012). Keeping Score under a Global Payment System. New England Journal of Medicine. 366(5), pp. 3935. Scanlon, D., Chernew, M. (1997). Consumer Health Plan Choice: Current Knowledge and Future Directions. Annual Review of Public Health, 18(1), pp. 50728.