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WellPoint Pilot Program May Have Unintended Costs and Create Regulatory Backlash

November 19, 2008

Analysis of:WellPoint Pilot Program Will Provide Coverage For Members To Travel To India For Certain Non-Emergency Procedures | www.medicalnewstoday.com

The WellPoint program may not reduce overall costs and could very well trigger regulatory backlash, particularly if bundled with existing products. Providers will likely pursue cost shifting from other product lines to compensate for losses from lucrative elective procedures that have moved off-shore. Specialty physicians can also be expected to play tough in negotiations to protect market share. Delivery of services off-shore also creates significant challenges for continuity of care and malpractice risk. Off-shore services present regulators with crucial policy challenges beyond those of quality and outcomes, including: 1) the need to protect volume in essential facilities; 2) potential impacts that lost volume might have on quality for non-commercial patients; 3) Issues of network adequacy; and 4) implications of a two-tiered system of care. Separately packaging and selling these services may be required.

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