Physician Patient

Health Care Competition In Minnesota – Missing In Action


Blue Cross/Blue Shield of MN is exiting all but its HMO product on a floundering MNsure public insurance exchange causing anxious concern for many rural-dwelling Minnesotans dependent on BCBSM. And, large insurance conglomerates such as UnitedHealthcare, Humana and Aetna are dropping offerings on the ACA (Obamacare) insurance exchanges nationally.

What impact do these developments have on care and insurance options for patients and potential patients (consumers) in Minnesota? For the cost of their health care insurance in 2017? On competition between clinics and doctors for their loyalty? And, competition for dollars among Minnesota insurance companies?

It depends on your point of view. Obviously the only way to find a low cost, best value health care procedure or select an insurance policy is to compare prices and benefits. But that is neither the rule or the goal in Minnesota. There are incentives and (designed) barriers to real cost transparency for the purchasers of medical care and health care insurance coverage in Minnesota. The messages and warnings from our health plans and government authorities are mixed, and we are warned about the consequences of working for true price disclosure to Minnesota citizens.

Hospital costs are so amazingly complex, bundled, and difficult to tease out that it’s impossible for a potential patient (consumer) to know in advance or even retrospectively the answer to the simple but essential question “What does this cost?”

For outpatient procedures, which theoretically are easier to price and evaluate, we should be able to shop for imaging, outpatient surgical procedures, and professional relationships. We need a market for HSA-insurance linkages which encourage consumers to shop for value as they determine this to be. See

Shopping based on knowing the price of a medical procedure or visit becomes irrelevant if there are very few competitors who are available in business offering real options for consumers. We have seen a dramatic decline of independent, entrepreneurial private medical practices in Minnesota. In 2016 most Minnesota physicians are employees of hospital-clinic organizations which are governed by (secret) provider network contracts with insurance companies which actually determine the financial terms of engagement for patients.

Some policymakers and analysts call for more health care data and more analysis. First it is apparent that we need a hard-nosed cost-effectiveness analysis of our massive and expensive Minnesota all claims data base (ACDB). What value is the ACDB to consumers (patients and potential patients)? How is it used now by private and government purchasers of health care and insurance products? Who pays for, collects, and analyzes all this big data now? And what do we need to analyze?

Minnesota’s health plans do not want public price disclosure for services or insurance claiming they will lose money if there is public knowledge of the finances in contracts they write with network providers (clinics) or the insurance products they offer. They are selling pre-paid medical care and the health plans claim that public knowledge of their business dealings with government and other purchasers will result in higher health care prices. This is adverse selection they claim. People will choose the richest health plan they can get paid for with someone else’s money rather than choosing the lowest cost health plan that meet their needs for specific benefits and protections.

Our current state of affairs confirms four facts: 1. Health care insurance in Minnesota does not operate in a competitive, consumer-directed marketplace. 2. Health plans which are selling pre-paid benefits must raise their prices and/or shift costs to patients and families. 3 There is little likelihood of competition for patients between health care providers or health plans until Minnesota citizens are given incentives to make prudent health care decisions (skin in the game). 4. Minnesota is spending a lot of time, money and analytic effort collecting a lot of expensive data to keep things as they are.

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