From: Mary & Patrick Jensen <mjensen@watervalley.net>
To: Therese Hanna <hannat@dfa.state.ms.us>
Subject: Re: AHS State Network
Dear Ms. Hanna:
Thank you for taking the time to respond. However, your answer fails
to address many of our concerns.
First, we do not accept your statement that because there was only one
network, employees did not need to make a benefit selection option for
health coverage in 2000. We did have to make decisions in the second week
of October concerning all of our fringe benefits. That meant we had to
make decisions about how much money to put in our medical spending accounts
to cover costs such as deductibles and unreimbursed percentages of various
health care costs. We do not have the option to make changes in those decisions
as we learn more about the network. The statute says all employees should
be provided with complete information about health care plans at least
30 days before having to make benefit choices for the coming year. We most
certainly did not have, and still do not have, complete information about
the plan.
The fault for our not having the information we needed at benefit sign
up time lies squarely with DFA and the Board. It is inexcusable that we
have not even been provided with a list of the providers who have signed
up via the Internet. The Internet provides an excellent way to make documents
which are changing available to a large widely dispersed group of people.
Why is it that I can go to web pages for many surrounding states and quickly
get to a list of providers for the year 2000 under their plans, but I can't
get that information from Mississippi, a state whose flagship University
is frequently found on the list of most wired colleges in America?
It is now November 2, less than two full months before the new plan
takes over. Many of us are having to make decisions now about surgery and
other health care decisions which will need follow up care in January.
Others of us are having to make our next appointments for early in the
new year and still can't find a physician in the required specialties who
are covered. We can't even plan an orderly transition to a new physician
if one were available because sufficient time has not been allowed. This
is not our fault, and we do not accept DFA's position that this problem
is solely the result of unreasonable positions taken by a group of doctors
in North Mississippi.
It is not the responsibility of the North Mississippi Physicians Association
to make sure the state employee health plan provides adequate coverage.
That is a responsibility which rests solely on the state and the Health
Insurance Management Board. How the Board decided to handle that responsibility
through the bid process is our second major concern. Simply because a choice
was made through the bid process does not make the choice the best or even
an adequate one.
Second, we question the decision to grant an exclusive bid to a single
preferred provider network which did not already have sufficient participating
physicians and other health care providers signed up in all necessary coverage
areas at the time the bid was accepted. The statute refers to the experience
needed by a claims administrator in order to be eligible to bid for that
contract. The experience is necessary to insure the bidders will have the
ability and the stability to meet the needs of the plan. We need no less
*existing* ability and stability in our network provider plans than in
our claims administration contracts. And letting an exclusive bid to a
network which either had no participating providers, or at least whole
areas of the state with no participating providers, at the time of making
that bid ignores this paramount need. Ignoring the need of employees in
North Mississippi for access to specialized health care in Memphis until
some time in September simply adds to our convictions that the health needs
of state employees were not a priority in letting and awarding this bid.
Third, we question the decision to reduce the number of networks at
all. It is clear from looking at plans for state employees in surrounding
states, that most states understand there is cost efficiency in contracting
with several existing networks which frequently concentrate their coverage
in a specific region of a state or states is a cost effective way to get
the benefits of preferred provider networks. Dumping several existing networks
which already had participating providers set up which met our needs only
adds additional levels of disregard for both employees and physicians.
Did the Board consider the costs to health care providers in evaluating,
making decisions and transferring patient records to a new network? Did
the Board consider the costs to patients of having to find out who would
be participating? Did the Board consider the costs of having to travel
much greater distances to get the services we need? Did the Board consider
the cost to employees and the state for the extra visits and tests which
would be needed to transfer care of continuing conditions to different
providers? All we see when we keep getting the same line that it is all
the fault of the physicians for not automatically accepting this new plan,
is further disregard for the health needs of state employees. That response
indicates that DFA and the Board do not accept their responsibility for
providing state employees with and an adequate health care plan.
If it was necessary to reduce the plan to one network (a decision which
we do not accept as fact) and the state is offering physicians the same
terms as were offered under the Key network (another statement which we
do not have sufficient facts to determine the validity of), state employees
would have been in a much better position had the Board kept the Key network
and eliminated the other choices. From our point of view, it was imprudent
at the least, and probably a bad decision for which state employees, rather
than health providers and state decision makers, will have to suffer.
We have been told the decision was made for costs reasons. But at this
point that argument makes little sense, unless the reasoning was to force
some employees into higher deductibles and lower percentages of coverage.
Surely the Board understood the great costs which would be involved in
setting up a new network. Surely the Board must have understood that transition
costs would be expensive. If the Board didn't grasp these realities, why
not? All any of us need to do is read the PEER report on the bungled transition
in claims administrators a few years ago to know that transition was very
costly to employees and health care providers. And the report places the
blame for those problems squarely on the Board, DFA and Blue Cross, which
is the parent company of the AHS network. Did you not consider the fact
that after that debacle, some health care providers might not be comfortable
with a Blue Cross plan or at the very least might require considerable
time to evaluate and assurances their concerns would be addressed before
being willing to go with such a plan?
At the very least, the Board should have expected physicians would need
very detailed information and a very substantial period of time in which
to evaluate a new network. After all the Board says they have to review
the application of each physician. Did you not expect that physicians,
who frequently act in partnerships where decisions should not be made without
consent of all partners, would need months to make a decision about joining
a new network? These a major business decisions, not quick decisions like
which cheese to buy at the grocery store. So why wait until the end of
July to send applications to physicians if the bid winner was selected
in April or May? Why wait until September to contact out of state physicians?
If it is appropriate to deal with existing networks to contract for medical
services under the plan in major metropolitan areas just over our borders
to serve Mississippi employees, why is it no longer appropriate to contract
with existing networks to provide those services inside the state, at least
in regions where AHS did not have an equivalent number of providers already
participating at the time the bid was accepted?
From the information we have received from one physician, it appears
physicians were given no more information about this new network than the
summary plan description of the Key network from last year. It isn't enough
information for patients to evaluate much less health care providers. It
feels to many of us as if our health care providers are having their choice
stripped away just as our choices are being stripped away with little or
no information. It is a take it or leave it proposition based on inadequate
information. Small wonder then, that many physicians are saying no.
Please send me a copy of the information you are providing to physicians.
We won't believe this is the fault of anyone but the Board and DFA as long
as we have so little information. Please also send me a copy of the RFP
and all the bids which were submitted. The lack of this information is
yet another reason why state employees are signing petitions and asking
PEER to review this debacle.
Please also tell us explicitly what you are doing to address the concerns of physicians in North Mississippi and exactly what you are doing to get more providers signed up in North Mississippi and Memphis. We keep hearing you are working on it. But from all we can figure out, the meaning of "working on it" is simply drawing a line in the sand and insisting that providers cave in and accept exactly what AHS originally offered. That isn't negotiating. We don't buy the argument in your position that all doctors in the state have been offered exactly the same terms so it must be fair and all the movement on this impasse has to come from the North Mississippi providers.
Costs are not the same all over Mississippi. The industry has long accepted
the reality that costs differ from one metropolitan area to another and
certainly between metropolitan and primarily rural areas. AHS is certainly
in a position to negotiate in good faith and address regional concerns.
If they can contract with other networks in Memphis, they can contract
with other networks in regions within Mississippi where they do not have
enough providers signed up. We have heard negotiations are going on with
the Baptist Health network for Memphis coverage. The Baptist network also
has an excellent group of participating providers in the North Mississippi
area. It would be a good faith effort on the part of AHS to immediately
open negotiations with Baptist to provide coverage in North Mississippi
as well.
Mary Brandt Jensen
1907 Wolfe St.
Oxford, MS 38655-4523
fax (209) 769 4032
mjensen@watervalley.net
Other Pertinent Documents:
Letter to Max Andriner, Director,
Performance Evaluation and Expenditure Review Committee - Nov. 4, 1999
E-mail to Mary Brandt Jensen from Therese
Hanna - Nov. 2, 1999
E-mail to Max Andriner, Director,
Performance Evaluation and Expenditure Review Committee - Nov. 1, 1999