CareFirst BlueCross BlueShield announced yesterday that it will spend $8.7 million more this year for community programs as part of a $92 million plan aimed at fulfilling its nonprofit mission -- dollar figures that a key Maryland lawmaker immediately derided as "completely inadequate."
The region's largest health insurer, under pressure to significantly increase its charitable spending, declared "CareFirst Commitment" a major expansion of its focus on community needs. The plan will include at least $60 million to slow the rate of premium increases, plus the $24 million currently directed to low-cost drug programs for Maryland seniors and through coverage of hard-to-insure District residents.
But skepticism over the biggest chunk of that commitment surfaced during legislative briefings in Annapolis, where lawmakers questioned whether the decision to keep premiums lower was mainly competitive strategy. CareFirst board Chairman Michael Merson said it was truly designed to help keep coverage affordable for all.
"It means we will be satisfied with making less money," he told the House Health and Government Operations Committee. Pressed a few minutes later on whether the board could do more, he promised, "We will not be driven as much by the bottom line."
Merson failed to persuade committee Chairman John A. Hurson (D-Montgomery), who still intends to sponsor bills that would force the nonprofit firm to divert a certain amount or percentage of its earnings to public initiatives. "There's a lot of things they could do that I don't see in this," the lawmaker said.
Nor did Merson sway the Washington advocacy organization that last month released a thick legal and economic analysis of whether CareFirst's District-based affiliate lives up to its nonprofit responsibilities. The study by the D.C. Appleseed Center for Law and Justice concluded that the affiliate should on its own be spending at least $40 million annually on community activities, not less than $1.5 million, as calculated for 2004.
"They say they're going to slow the rate of increase," noted Appleseed Executive Director Walter Smith. "For exactly which employees, which subscribers, which products? Unless you scrutinize exactly where the money is going, you can't begin to determine whether it's a competitive move or an attempt to really help people with trouble affording insurance."
Yesterday's briefings in Annapolis, like the D.C. Appleseed study, flowed from the aftermath of CareFirst's unsuccessful 2001 bid to convert to for-profit status. Maryland's insurance commissioner denied the request in part because of the huge bonuses top executives would have received through the sale. The legislature followed by prohibiting another for-profit move for five years and giving itself oversight authority.
Merson alluded to the scrutiny the company continues to face inside and outside government. "There are people in this world who will have unrealistic expectations about what a single company can do," he said. "We are a health insurer. We are not the equivalent of the United Way."
With the $8.7 million announced for new community initiatives, CareFirst will concentrate on strengthening hospital intensive care, working with local groups and addressing health disparities among certain racial and ethnic populations. The first identified are cardiovascular disease in blacks, diabetes among Latinos and cervical cancer in Asian women.
In addition, the company will target physician error and quality care through an initiative called Raising the Bar that will pay doctors who undergo a comprehensive safety certification process. Those who meet the criteria will receive $50 more per patient, up to $20,000 a year.
CareFirst's medical director of quality improvement touted the project, to be advanced in partnership with the national organization Bridges to Excellence, as breaking ground. "This is innovative, and we're putting money where we really think it will make a difference," Jon Shematek said.
Through its three regional affiliates, CareFirst has about 3.2 million members in the District, Northern Virginia, Maryland and Delaware. |
