Homecare Switching Heats Up

So what is going on out there? I have gotten more emails this past week about home care switching than ever.

Tom wrote in to ask if all Anthem Blue Cross patients with hemophilia will be required to use Precision Rx as their factor provider? He is livid, if this is true. Another mom wrote in to report that she is hearing that Anthem in Ohio is forcing a switch in home care companies. She heard that Anthem’s doses may be +2%, not the current industry of dose +10%. She is concerned that this means fiddling around with the vial sizes and number of vials we get.

Still another mom, employed by a home care company herself (so she buys factor from her employer) is being forced to switch to another home care company–a competitor!– that she doesn’t like and has not heard good things about. She is very concerned. I would be too: if my son is a source of revenue for my employer and then no longer supplies revenues, will my job be on the line? A lot of parents and patients are employed in the homecare industry.

I had a long conversation with Bob Robinson, the executive director of the Illinois chapter, and he tells me now that Blue Cross Blue Shield is doing the same thing in their state. This trend is gaining speed, and this will be happening more and more. Bob and I talked about how our community is going to have to start accepting that some change is inevitable and that we are going to have to learn to compromise. There is just no way we can have “our way” any more. Most disturbing is that the insurance companies are setting up their own in-house specialty pharmacies. So they are paying for factor and getting the profits at the same time. Can they can charge whatever they want? Who is monitoring this practice?

It seems shocking, but you know, this at first seemed like much more of a market correction than an out-of-the-blue change. Health costs have risen astronomically, so payers are naturally going to do something to lower costs, as long as this does not put the patients in danger. This is what managed care is all about, and it is here to stay, whether we like it or not. Best we can do immediately is to document everything, carefully, every call, every EOB, every charge. We do pay good money, but the payers can simply say “Then go find another plan.” Harsh reality but it is the reality.

But the scary part is this: it’s not just about lowering health care costs, but control. Insurers are definitely wrestling control of our health care management. Competition is dwindling. When insurers have their own in-house specialty pharmacy (to allegedly control costs) and see the profits rolling in, who will authorize cost control then? They will be fixing the reimbursement price, and reimbursing themselves. Conflict of interest? Big time. The questions become: what is competition, how is it defined and what is fair?

I’ve been predicting this trend for three years now, since the November issue of PEN in 2004. If you’ve been reading our work this should not be such a surprise. Only the speed at which it is happening is quickening. Keep those letters and emails coming to us; let us know your insurance and home care switching story so we can pass it along to NHF, HFA… we are all working to preserve care and control, at fair cost.