MGB’s Response to Primary Care Shortage

MGB has initiated several strategies to tackle the ongoing shortage of primary care. One notable proposal involves teaming up with CVS to deliver primary care services through retail clinics located within pharmacies.

Blue Cross Blue Shield’s clientele includes patients from two of MGB’s physician groups: Harbor Medical Associates and North Shore Physicians Group.

A representative from UnitedHealthCare indicated that these changes will impact many Medicare Advantage customers. However, those receiving primary care at Nantucket Cottage Hospital, Martha’s Vineyard Hospital, and Coolie Dickinson Hospital in Northampton will not be affected. All of these facilities are part of the MGB system.

Medicare Advantage plans, which are authorized by federal insurers, are made available by private companies as an alternative to traditional Medicare. These plans often come with added perks such as vision and dental benefits.

Following MGB’s decision to end the in-network status for certain primary care patients, individuals will need to use in-network MGB primary care if they wish to consider different insurance options. They could continue seeing MGB doctors, but it would require higher out-of-pocket expenses.

This transition won’t impact patients looking for specialist or hospital care; those services will still be covered within the network.

Unsettling, perhaps, for primary care patients.

“I’m really not happy about this. I’ve been seeing my doctors at Mass General, my primary care physician, for years,” voiced Mary Jane Patrone, a UnitedHealthcare member living in Boston. “I’m also confused—this change could affect my finances.”

A letter directed to Patrone noted that sticking with UnitedHealthcare amid these out-of-network rules would lead to an increase in primary care expenses. The options presented included switching to alternative Medicare Advantage plans offered by Aetna or the Mass General Brigham Health Plan, according to MGB.

In a statement to Earth, MGB chose not to disclose the reasons behind the shift or the number of patients it would affect. The communication sent to the patient didn’t clarify what had spurred the change.

According to the healthcare system, “We understand that this change can affect patients and their families. Our care team is here to assist patients in navigating their care and transitional options when they need that support.”

Susie Souju Soup O’Brien, the CEO of UnitedHealthcare in Massachusetts, mentioned that some primary care providers within MGB are now out of network “due to MGB modifying their participation in Medicare Advantage.” Specific details were not provided.

For several months, there have been signs suggesting a possible impasse between certain insurance companies and healthcare providers concerning medical reimbursements.

The provider is encountering significant cuts in funding from Medicaid, intended for the underprivileged and disabled. Nevertheless, Massachusetts’ Blue Cross Blue Shield, the largest health insurer in the state, stated it won’t significantly raise its reimbursement rates.

CEO Sarah Iselin explained in July that Blue Cross Blue Shield had notified providers that any price hikes would remain below the state’s 3.6% benchmark.

David E. Williams, president of a Boston consulting firm, observed that MGB seems willing to let go of nearly 19,000 Medicare Advantage patients, as they’re already struggling to meet existing primary care demand.

If reimbursement rates requested by MGB were opposed by insurers, it’s likely that the health system felt they could afford to disengage.

“MGB is already distanced from the patient,” stated Williams.

While Massachusetts boasts some world-renowned doctors, the landscape for primary care seems quite broken for both patients and physicians, according to a report released earlier this year by the state Health Policy Board.

Many patients report significant difficulties in locating a doctor, while physicians are burdened by overwhelming workloads. The primary care provider workforce is aging, and the medical education system isn’t adequately producing enough new doctors to fill the gap.

The balance between compensation and work-life balance is a vital consideration, making primary care less appealing to many younger doctors. Generally, primary care physicians earn less than specialists, often work lengthy hours, examine lab results, respond to patients’ inquiries through calls or portals, and negotiate with insurance providers.

The shortage of primary care physicians is a nationwide dilemma, but it is especially acute in Massachusetts. A recent report by AMN Healthcare highlighted that Boston has the longest wait times for patients to see primary care doctors among the top 15 metropolitan areas in the country—averaging 69 days compared to locations like Atlanta and Washington, DC.