The dispute between CareFirst BlueCross BlueShield and Johns Hopkins Health System is the result of structural issues within the state's unique health insurance system, Maryland State Medical Society President Gene Ransom said.
In a Sept. 20 op-ed for Maryland Matters, Mr. Ransom wrote the dispute "shouldn't come as a surprise," as CareFirst controls large shares of the state's insurance market.
Baltimore-based Johns Hopkins will go out-of-network with CareFirst, the state's largest payer, on Dec. 5 if the two sides are unable to reach an agreement.
Kevin Sowers, MSN, RN, Johns Hopkins Health System president, told the Baltimore Sun earlier this month that the cost of providing care has risen 21 percent in the past decade, but CareFirst's rate increase was only 10 percent.
Mr. Ransom wrote that the Maryland State Medical Society has raised concerns about lack of competition in the state's health insurance market for years. CareFirst controls more than 50 percent of most markets in the state and controls over 70 percent of the market in some areas.
These issues are compounded, Mr. Ransom said, by Maryland's unique hospital reimbursement system. The state has an agreement with the federal government that allows it to set prices for direct hospital services.
"Even though we know that CareFirst and other insurers pay about 25 percent less for hospital care compared to the rest of the country, it doesn't equate to lower premiums paid by employers and individuals," Mr. Ransom said.
Johns Hopkins and CareFirst have been unable to reach an agreement on the portion of patient bills that should go to physicians, other providers and fees.
Mr. Ransom said "everyone" wants Johns Hopkins to stay in-network with CareFirst.
"No matter how this is resolved, we need to look at the balance of power in the health insurance market; competition would result in a better marketplace for physicians, patients and the public health of Maryland," Mr. Ransom said.
Read the full opinion here.