The harder-line approach comes after two years of warnings by the administration of Governor Deval Patrick to rein in premiums that were crippling businesses and working families, and as state lawmakers prepare to take up a cost-control bill that would overhaul how health providers are paid.
In addition to their tougher negotiating stances, insurers have been prodding providers, including more expensive hospitals such as Massachusetts General and Brigham and Women’s, into global payment plans that give them a budget for all of a patient’s medical services rather than pay a separate fee for each visit and procedure.
Insurance companies also are offering customers, including employers and government groups, new programs ranging from wellness incentives at Tufts Health Plan to a Harvard Pilgrim Health Care service that rewards members for getting tests at lower-cost providers. Most important has been the growth of limited network plans that restrict where patients can get care and tiered networks higher payments for costlier providers.
“If you can choose a physician who is tops in quality and good on cost, it’s a good choice,’’ said James Roosevelt Jr., chief executive of Tufts Health Plan in Watertown, where every employee, including Roosevelt, will switch to a tiered plan Jan. 1.
But critics say the moves do not go far enough to ease the burden on cash-strapped small businesses and municipalities, which struggle to pay health insurance premiums that have climbed at double-digit rates for most of the past decade. They also say this year’s more modest reimbursement increases were largely driven by a decline in the use of medical care, and to employers shifting some insurance costs to their workers through higher copayments and deductibles.
