COVERED CALIFORNIA: WHAT’S A PROVIDER TO DO?

Several issues arise from the proposed agreements for providers from Qualified Health Plans (“QHP”) under Covered California. Some issues that physicians and other providers should be watching out for:

1. Payment Schemes. Initial contracts from the various QHP’s are offering low payment options, particularly the “80% of Medicare” option. Physicians should be wary of such agreements. Under QHP contacts with Covered California, the plans have agreed to work on value-based payments in the future, making future contracts even less attractive for providers.

2. Hospital Contracts. There still is no clarity on which hospitals will take part in Covered California and under what plans. Covered California has no listing of participating hospitals at this time. The prospect of narrow networks (fewer providers offered to consumers) makes it troublesome to predict the future on hospital participation.

3. Administrative Burdens. QHPs are imposing difficult and legally thorny administrative tasks on providers, particularly providing information about patients and payments.

4. Populations. Get information on the types of patients expected under contracts. The initial rounds of patients are predicted to be populations that are in fair to poor health. Since they are not used to traditional medical care, they are expected to have a large percentage of missed appointments and compliance issues.

5. Collections. What is the providers obligations to collect? Some Covered California plans leave high deductibles and copays for enrollees. Yet, the newest enrollees are not used to paying such amounts. Also, determine risk for patients who fail to pay premiums to Covered California QHPs. Providers may be on the hook.

With all the problems with exchange products, providers may want to sit out this first round

Several issues arise from the proposed agreements for providers from Qualified Health Plans (“QHP”) under Covered California. Some issues that physicians and other providers should be watching out for:

1. Payment Schemes. Initial contracts from the various QHP’s are offering low payment options, particularly the “80% of Medicare” option. Physicians should be wary of such agreements. Under QHP contacts with Covered California, the plans have agreed to work on value-based payments in the future, making future contracts even less attractive for providers.

2. Hospital Contracts. There still is no clarity on what hospitals will take part in Covered California and under what plans. Covered California has no listing of participating hospitals at this time. The prospect of narrow networks (fewer providers offered to consumers) makes it troublesome to predict the future on hospital participation.

3. Administrative Burdens. QHPs are imposing difficult and legally thorny administrative tasks on providers, particularly providing information about patients and payments.

4. Populations. Get information on the types of patients expected under contracts. The initial rounds of patients are predicted to be populations that are in fair to poor health. Since they are not used to traditional medical care, they are expected to have a large percentage of missed appointments and compliance issues.

5. Collections. What is the providers obligations to collect? Some Covered California plans leave high deductibles and copays for enrollees. Yet, the newest enrollees are not used to paying such amounts. Also, determine risk for patients who fail to pay premiums to Covered California QHPs. Providers may be on the hook.

With all the problems with exchange products, providers may want to sit out this first round of patients.

FORNIA: WHAT’S A PROVIDER TO DO?

Several issues arise from the proposed agreements for providers from Qualified Health Plans (“QHP”) under Covered California. Some issues that physicians and other providers should be watching out for:

1. Payment Schemes. Initial contracts from the various QHP’s are offering low payment options, particularly the “80% of Medicare” option. Physicians should be wary of such agreements. Under QHP contacts with Covered California, the plans have agreed to work on value-based payments in the future, making future contracts even less attractive for providers.

2. Hospital Contracts. There still is no clarity on what hospitals will take part in Covered California and under what plans. Covered California has no listing of participating hospitals at this time. The prospect of narrow networks (fewer providers offered to consumers) makes it troublesome to predict the future on hospital participation.

3. Administrative Burdens. QHPs are imposing difficult and legally thorny administrative tasks on providers, particularly providing information about patients and payments.

4. Populations. Get information on the types of patients expected under contracts. The initial rounds of patients are predicted to be populations that are in fair to poor health. Since they are not used to traditional medical care, they are expected to have a large percentage of missed appointments and compliance issues.

5. Collections. What is the providers obligations to collect? Some Covered California plans leave high deductibles and copays for enrollees. Yet, the newest enrollees are not used to paying such amounts. Also, determine risk for patients who fail to pay premiums to Covered California QHPs. Providers may be on the hook.

With all the problems with exchange products, providers may want to sit out this first round of patients.