HJNO Jan/Feb 2024

Editor’s Note: So, I am sitting at my desk one day, phone rings, Henry Kinney, Esq., introduces himself to me in that old-school New Orleans accent I hope never disappears. He clearly wants to share his bewilderment of the Blue Cross and Blue Shield of Louisiana proposed buyout with the Journal. Kinney begins the hour-long colloquy stating that he has nothing financially to gain from this, “zero, no fee, zero.” Kinney just thinks, after looking at the agreement, that it is wrong for Louisiana and the members of BCBSLA but ironically absolutely beneficial for the board of directors who stand to make over a million dollars each, either by moving forward with the new company or being part of a newly proposed $3 billion foundation that, he is clear to state, will have no accountability from members after the buyout and was originally set up in Delaware, not Louisiana. If a buyout were to happen, which Kinney argues against, he feels the money from the sale, at minimum, should be held in a trust and paid out annually to members, if not given back to them outright. He certainly had my interest, and when he came up for air, I asked him, “Henry, can you write? I think you should tell your side, then we will ask BCBSLA for theirs.” He loved that idea, and BCBSLA’s spokesperson was appreciative to have Journal space to directly share their opinion of the buyout that was taken off the table last fall. Many say the buyout was pulled for “political reasons” and would be resubmitted after the new governor was elected, which it was in late December. Journal sources say BCBSLA was surprised at the pushback it has gotten about the takeover. Louisiana State Medical Society president Richard Paddock told the Journal, “Since our last public comments dated September 18, we’ve continued to talk to physician colleagues in other states, our board met with Elevance leadership, and we are reviewing the updated filing. At present, our concerns remain unaddressed, and we still urge caution. It remains our intent as a policy owner to vote ‘no.’” Concerns are also coming from the Louisiana Hospital Association about Elevance’s market behavior in other states. The American Hospital Association has stated Elevance Health, previously known as Anthem, has faced sanctions for creating un- necessary coverage and access barriers for U.S. patients and healthcare providers. These barriers include: • Full or partial coverage denials of emergency services, which potentially violate federal law. • Delays in patient care resulting from excessive prior authorization requirements. • Multiple requests for medical records even after hospitals have sent the records with signature confirmation and therefore know they have been received. • Failure to pay claims in a timely manner, which have totaled hundreds of millions of dollars for several systems. • Attempts to steer patients away from their trusted providers to receive certain physician-administered drugs, like chemo- therapy infusions. • Mid-year changes to Anthem enrollees’ coverage, limiting where they can get certain services after they enroll in their health plan. These mid-year policy changes have been described as “bait-and-switch on consumers.” Critics contend that “enrollees should be assured that the policy they bought provides the services and network it promised.” Some Louisiana stakeholders have urged state leaders to “undertake an extensive market conduct evaluation” of the com- pany to determine whether the proposed acquisition of Blue Cross and Blue Shield of Louisiana would protect consumers and benefit Louisiana’s businesses, patients, and healthcare providers. Whatever the outcome, the words you will read from BCBSLA’s president keep ringing in my ears: “Rather than accept this as our status quo, we should strive to improve the health of the people in our state. “Almost two million Louisianians count on us for their health insurance coverage. They deserve better. They look to our company not just for access to healthcare that is affordable, they want us to help them lead their best lives. “It has been made clear to us over the last year that our members trust us and they trust our mission, which is at the heart of everything we do — to improve the health and lives of Louisianians. So, we ask them now to trust us in breaking the status quo. We know that we need to create change in a bold way to improve the health of Louisianians.” With all due respect, Louisiana deserves better health statistics than last place. Perhaps since the leadership of BCBSLA seems to have conceded that Louisiana’s top health insurer requires “bold change,” the members of BCBSLA should retain control and seek new leadership to implement that change using the billions of dollars in reserve — new leaders who comprehend that “palliative care” isn’t a new “top offering” and who aren’t seeking to depart with golden parachutes. HEALTHCARE JOURNAL OF NEW ORLEANS I  JAN / FEB 2024 9