Blue Cross Blue Shield of Massachusetts continues to set the trend to control spiraling health care costs by offering cheaper health care plans to employers and employees.  In today’s Boston Globe (Feb. 10, 2011), the front page article by Liz Kowalczyk – “Plans Steer Patients to Lower-Cost Hospitals”- describes how this approach has rapidly taken off. Companies who choose this type of plan (launched last month as Blue Cross Hospital Choice Plan), will have reduced premiums which along with employees, will be seen as cost savings.

“The popularity of the plan — Blue Cross Blue Shield of Massachusetts says it is the fastest launch ever of a new product — is the latest sign that the once radical idea has been embraced as a way to control soaring health care costs, even as pricier hospitals warn of a possible backlash and cuts in services.”

As a way to control excessive costs, patient will have an additional out of pocket expense if they choose one of the 15 “higher cost” academic hospitals. According to the Boston Globe article, that would include $1,000 for an inpatient stay or $450 for an MRI.

This brings up two issues. First, will this lead to inferior or limited care for those who choose this type of plan? Second, what should be the response and role of these “more expensive” larger tertiary care/academic hospitals who also serve the general community?

Like it or not, what was thought to be a system impossible to change, is now on a pathway with no looking back. Employers and employees can no longer sustain the spiraling health care costs cutting into salaries, business profits, and the ability of the American public to pay for care and save money for retirement. Solutions are being left up to hospitals and providers to determine how to provide optimum health care in way that is fiscally sound as a reaction to these changes.

Perhaps the question we should ask is how can we bring the interests of the patients, providers, hospitals, insurers, and businesses all together and avoid working separately on solutions?  The emphasis now is on cost payment reform while letting the solutions fall out. However, without an emphasis on solutions or thoughtful systems to provide care, we take a risk that an integrated strategy won’t happen. Will cost savings lead to patients receiving suboptimal care? Will major academic centers which are the training site of our next generation of physicians and researchers as well as the place for development of new technologies go bankrupt?

Although it is important to control health care costs, we must address a simple business concept. Patients and caregivers must be able to understand how tests or treatments will change management if that are to make an informed, costs effective decision, even if that means paying additional out of pocket costs. Instead of simply telling patients that more expensive hospitals will cost them more, they need to understand the value of such a decision. This is the missing discussion. This is the 800 pound gorilla in the room that everyone is ignoring.