One of the major cost-saving initiatives behind ObamaCare is the consolidation of hospitals and doctors into “Accountable Care Organizations”, or ACOs. It is presumed that forcing these organizations to utilize the same doctors, hospitals, clinics, EMRs, labs, imaging centers and so on will create more efficient, seamless and less costly care. (This was not really borne out by Medicare’s own ACO pilot program, but that’s ObamaCare’s story and it’s sticking to it.)
Unfortunately, one of the first casualties of ACO mania is that solemn promise that ObamaCare wouldn’t force you to change either your current doctor or you health insurance. Sad to say, if the experience of pro-ObamaCare Oregon is any guide, the trusting among us have been suckered by their elected officials yet again.
Oregon is a major test case for ObamaCare due to the enthusiastic embrace of the ACA law by state government. Both houses of the legislature and the governorship are held by Democrats, and the governor has pushed for a state version of the ACO concept called “Coordinated Care Organizations” (CCOs) to care for the state’s Medicaid population.
The state’s healthcare systems have responded accordingly. Perhaps foremost of these is the Sisters of Providence Health System, which owns a health insurance company as well as a network of labs, imaging centers, outpatient clinics, hospitals and physicians all the way from Alaska to California. In a bid to bulk up its ACO/CCO credentials, Providence has enagaged in a buying spree that has slurped up physicians and medical practices like so many protein shakes. In addition to primary care practices, Providence has been buying up specialists and sub-specialists. It recently convinced a large cardiology group from The Oregon Clinic to become employees after hinting that independent cardiologists might no longer qualify for hospital privileges in the new CCO environment.
With all of this consolidation it came as quite a shock to many in the Portland-area residents when Providence announced that, as of 2013, patients who were perfectly happy with their HealthNet insurance policies would no longer be allowed to use their lifelong Providence doctors, hospitals or other resources. No reason was given, although it seems clear that Providence was unhappy with the prospect of allowing HealthNet patients to choose to use Providence doctors and hospitals for some aspects of their care, and non-Providence facilities for others. This is exactly in line with ACO philosophy and practice.
‘Chris Ellertson, president of Health Net of Oregon, admitted he was blindsided by Providence’s decision in email correspondence obtained by The Lund Report. “We’ve historically had a good working relationship with them,” he wrote. “And, we talked some time ago about how we could further support the work they are doing within their medical group. It’s the same sort of problem-solving that we’ve been focused on in our work with a number of providers. Then, seemingly out of blue, a termination notice. No phone call. No indication. Astonishing.”’
Providence Health insurance plan CEO Jack Friedman denied that there wan any anti-competitive hanky-panky involved in the decision, saying: “This was a mistake; I had no role in this, no voice,” Friedman told The Lund Report. “There is a huge wall between the health plan and the health system when it comes to payer contracting. The health plan has no voice in a decision on the delivery system nor should it have a voice.”
Regardless, the net affect of the Providence decision is to force HealthNet patients to either change their health insurance, or change the doctors, hospitals and other facilities they may have used for generations. Many people who literally live right next to Providence hospitals and clinics are now being forced to drive for miles to a different doctor and facility that they are allowed to use. Gone are the days when a patient might be allowed to pick and choose among doctors and hospitals based upon which one has the most skill and the best equipment rather than whether or not they happen to belong to the owner of a competing insurance company.
Another disturbing aspect of the decision is that it makes it clear that institutions like Providence are explicitly being given monopoly power under ObamaCare to control not only health insurance in a given market, but the doctors, hospitals, clinics, labs and imaging centers as well. This clearly has the potential to result in situations in which the amount and types of care provided are chosen to maximize overall profits to the Providence system rather than medical benefits to patients.
It seems clear that President Obama and the Democrats in Congress who passed this law either did not know what was in it, or deliberately lied about its implications for consumer choice in healthcare. Or perhaps they had to pass it so that they could find out what was in it?
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