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Saturday, October 12, 2013

Saturday, October 12, 2013

Some Further Questions about UC Care (UPDATED BELOW)

In his two posts (here and here) Chris has raised a series of issues concerning the failure of UCOP to ensure that all campuses have access to Tier 1 coverage in UC Care.  Although his focus has been on the Santa Barbara case, there are indications from other non-medical school campuses that there are tremendous concerns over access and costs.  But the issues do not stop there.  I want to raise here a few issues concerning the impact of the health insurance changes even at the Medical Center campuses and then raise some questions which it seems to me is incumbent on UCOP to answer--and to answer with real data and reasons.

I should say that my first thought on the changes was that it would make little difference to those on Medical Center campuses.  But as I looked into the issues a little more I began to doubt that.  Given that we have not yet had a full accounting of the details of the new plan these concerns are somewhat tentative.  But I think faculty and staff need to look into this issue with some care--and not just with UCcare.

Just so we are all on the same page I am basing this discussion on three documents available at UCOP.  They are descriptions of the benefits for Anthem Blue Cross Plus, Anthem Blue Cross PPO, and the new UC Care.  If I am reading these documents correctly (and I am happy to have others correct any errors) then the following is the case.

If you have the Anthem Blue Cross Plus AND you are already in a UC Medical group your changes will be relatively small.  In fact, if you are able to select a Tier 1 physician your co-pays will drop slightly, and your yearly co-pay max is the same.  That is true with specialists as well so long as they are at a UC medical center (I am assuming that the sort of intervention that occurred at UCSC to obtain a non-UC Tier 1 provider is off the table since that would defeat the whole purpose of the shift).  Your fees for physician services in emergency rooms apparently will go up although not the hospital fees. (compare pg,5 with pg.2)  It is less clear to me about the costs and availability of medications since I have not located those lists.  Nor is it clear whether or not the shift to an HMO type plan for Tier 1 will affect the pressures on doctors in terms of referrals or procedures.

But if you were in Anthem Blue Cross Plus and you ARE NOT already in a UC Medical group then things look quite different.  For one thing, it isn't clear that there are enough spaces at the Medical Centers to accommodate people shifting in.  And second if you wish to keep your non UC doctor they will now be in Tier 2 (even if they had been considered "in network" for the purposes of Anthem Blue Cross Plus).  Vice-President Duckett indicated that there would be a high overlap in doctors between the old system and the new.  But the only way that I can figure out for that to be true is if he means that doctors who were formerly "in-network" (the de facto equivalent of UC Care's Tier 1) will now be available in TIER 2.  In THAT case employees co-pay and costs will go up considerably.

If on the other hand, you were in the Anthem Blue Cross PPO, your Tier 1 or Tier 2 costs and access should not be strongly affected.  On the other hand, your costs outside of the network will go up for any specific event although your yearly maximum contributions will go down somewhat.

To sum up, despite the focus that UCOP has placed on premiums if you are at one of the medical center campuses it is looks pretty clear that access AND cost will not be maintained for those in the discontinued plans unless you are able to move into a UC medical center for your health care.

If this is the situation I think that it raises a series of questions:

1) Vice-President Duckett reportedly indicated that this transformation was instigated by the Medical Centers themselves.  It would be good to have a fuller accounting of this process.  I understand that UC might be interested in being able to retain its revenues within itself rather than having to release them to the outside.  But in this case, it seems as if the interests of the majority of faculty and staff are being subordinated (in some cases sacrificed) to the interests of the medical centers.  Vice Presidents Taylor and Brostrom have claimed that the University will secure important savings from these changes.  If that is the case how are those savings going to spent?  If UC faculty and staff are going to be pushed into the medical centers where is that revenue going to?  For what? Taylor and Brostrom speak as if these changes benefit everyone.  But how exactly?

2) Given this first set of questions I think it is fair to ask about the general relationship between the medical centers and the campuses.  I should make clear that I think that medical education is an important part of the UC system.  And I know that there are important synergies between the medical faculty and the campus faculty at least at UCLA.  But we know from its own statements that UCSF is facing a difficult future, no one seems to know about the financial future of the medical centers after ACA, and as Dan Mitchell has tirelessly pointed out in his analyses of the sometime-in-the-future-who-knows-when hotel convention center at UCLA the medical centers can have enormous effects on UC's spending priorities. 

3) There is also a question of the timing of all of this.  I recognize that this actually took a while to develop.  But in the event we have learned that the new system could not complete a successful negotiation for the faculty at UCSB and only did so through outside intervention at UCSC.  Berkeley people are complaining about the effects.  And I am not sure what is going on with either Riverside or Merced.   Why exactly UCOP was willing to do this when there was so much uncertainty for so many campuses is a fundamental question.

I remain proverbially naive about the Academic Senate.  But from my vantage point it seems to me that the least the Academic Council can do is insist on answers to these questions and plans for the rectification of the obvious problems.  This issue is a large one for Faculty Welfare after all. 

Of course UCOP makes the decisions here.  Vice-President Taylor is constantly insisting that UCOP is incredibly transparent.  This would be a fine issue to provide some evidence of that claim. 

UPDATE: In conversation with different faculty it appears that there may be some non-UC doctors who will fall into Tier 1 status.  As a result I would urge people to check carefully the status of their various doctors.  We are hoping to be able to provide more information and analysis as time goes on.  And feel free to use the comment sections if there are clarifications that you can provide.

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