Influence of Blue Cross Blue Shield Grows in Boston

Continued Ascendance of Blue Cross Impacting Health Plans, Providers and State Policy

News Release
Dec. 1, 2005

FURTHER INFORMATION, CONTACT:
Alwyn Cassil (202) 264-3484 or acassil@hschange.org

WASHINGTON, DC—Blue Cross Blue Shield of Massachusetts’ growing ascendance is felt across the Boston health care market, influencing nearly all aspects of the marketplace from provider contract negotiations to state-level policy deliberations, according to a new Community Report released today by the Center for Studying Health System Change.

Blue Cross enrollment has reached almost 1.5 million people in the Boston market, nearly the combined size of its two main local rivals—Tufts Health Plan and Harvard Pilgrim Health Care. The relative market stability forged by the presence of such a large health plan is reinforced by the similarly strong presence of Partners HealthCare—the market’s largest hospital system—and growing cooperation between these two major players.

"Boston’s health care market is increasingly dominated by two large players—Blue Cross among health plans and Partners among providers-that are working together on issues ranging from pay-for-performance initiatives to pressing the state for higher provider Medicaid payments," said Paul B. Ginsburg, Ph.D., president of HSC, a nonpartisan policy research organization funded principally by The Robert Wood Johnson Foundation.

Other key findings of the report, Blue Cross Influence Grows in Boston as State Revisits Reform Debates, which is available here, include:

• Continued movement away from capitation payments for hospitals and physicians and expansion of pay-for-performance programs.
• Increasing efforts to strengthen quality improvement initiatives and information technology capacity, building on Boston’s long-time leadership in these areas.
• An easing of state budget difficulties that has provided a political window for renewed discussions of health care financing reform, amid concerns that dedicated funding for care for low-income and uninsured people may be curtailed.

Boston is one of 12 communities across the country tracked intensively by HSC researchers through site visits. The new report is based on a June 2005 site visit and interviews with more than 90 Boston health care leaders, representing health plans, employers, hospitals, physicians and policy makers.

The Center for Studying Health System Change is a nonpartisan policy research organization committed to providing objective and timely research on the nation’s changing health system to help inform policy makers and contribute to better health care policy. HSC, based in Washington, D.C., is funded principally by The Robert Wood Johnson Foundation and is affiliated with Mathematica Policy Research, Inc.