News

Sutter Health, Blue Shield in contract dispute

Sutter services to go out-of-network in coming months

UPDATE: The Sutter Health network of doctors and hospitals proposed Monday, Jan. 19, to extend the current transition period with Blue Shield of California through the end of this year — locking in 2014 contract rates and terms — to prevent tens of thousands of patients from being displaced from their doctors, according to a press release.

Blue Shield has not announced whether or not it is accepting the offer. The contract between Blue Shield and Sutter Health expired Dec. 31, and the health insurance company announced it will reassign members to non-Sutter physicians.

"Our proposed longer-term transition agreement would help ensure patients have continued access in 2015 to the doctors Blue Shield promised them during open enrollment," said Stephen Lockhart, Sutter Health chief medical officer, in the press release. "We believe employers and Blue Shield members deserve the network they purchased."

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Hundreds of thousands of people have been told they will need to switch doctors soon due to a contract dispute between Sutter Health and Blue Shield of California.

Notices sent to customers warn that as of Jan. 1 the health insurer canceled coverage for all hospitals and medical providers affiliated with Sutter Health.

Palo Alto Medical Foundation is part of the Sutter Health network of providers.

The cancellation affects 140,573 HMO members, who will get letters later this month warning that they will be assigned a new primary physician as of April 1, according to Blue Shield spokesman Steve Shivinsky.

In addition, letters have been sent to 4,413 PPO members who have used Sutter facilities in the past 12 months and another 139,338 PPO members living within 15 miles of a Sutter facility.

The letters inform patients that they can continue using Sutter providers until June 30, with some possible increase in out-of-pocket costs. After June 30, if no new contract is reached, Sutter will become an out-of-network provider and out-of-pocket costs will increase substantially.

The contract termination affects Sutter facilities throughout northern California, including all Palo Alto Medical Foundation locations.

Blue Shield is asking for a cut in reimbursement rates, and Sutter officials have asserted that the two sides remain "very far apart" on the financial terms of the contract.

"It's significant enough that it would have a devastating impact on Sutter Health's ability to meet our patients' needs," said Bill Gleeson, a spokesman for Sutter Health.

"This is really about a very large and powerful health-insurance company trying to cut back on the money it spends on actual patient care," Gleeson said.

Blue Shield, however, argues that Sutter's costs are well above those of other health care providers in the area and would remain so even if the company accepted the new reimbursement rates, in part due to the rapidly growing company's dominant market position in much of California.

Also at issue in the talks is a stipulation by Sutter that all unresolved disputes go to mandatory arbitration.

While Sutter officials maintain the provision was present in previous contracts, Blue Shield says the current stipulation would prevent both it and self-insured customers from suing in open court for anti-competitive business practices.

Sutter's business practices have previously been the subject of lawsuits and an investigation by the state attorney general's office.

"The new provision created by Sutter appears driven by their desire to avoid public scrutiny of business practices that have been frequently criticized by industry participants and observers," Shivinsky said in a statement.

Shivinsky said Blue Shield gave its best and final offer in the first few days of January and was happy to continue talks, but "at this time it is up to Sutter to initiate the next meeting."

Gleeson said on Tuesday, Jan. 13, that the two sides are not currently in negotiations but that Sutter has received offers from Blue Shield in the recent days. However, Gleeson said that Blue Shield has not yet offered a deal that "represents significant financial movement."

Editorial Assistant Sam Sciolla contributed reporting to this story.

— Bay City News Service

Comments

4 people like this
Posted by Anneke
a resident of Professorville
on Jan 13, 2015 at 11:58 am

Question: Will this PAMF/Sutter versus Blue Shield conflict also affect PAMF/Sutter Medicare participants who have Blue Cross/Blue Shield as their secondary insurance?

Also, please be aware that the status of Out of Network Provider is a very costly one.


8 people like this
Posted by Thoughtful
a resident of Another Palo Alto neighborhood
on Jan 13, 2015 at 7:00 pm

Thoughtful is a registered user.

I applaud PAMF directors for refusing to give in to unreasonable demands made by Blue Shield. PAMF provides a standard of care high above others found anywhere. If not for the medical attention I received there, doubtful I would be able to sit here and write this message.

The physicians I encountered have been superlative at every level from technical skills high above measure to personal caring.

In addition, I am a health care "provder" and know all too well the strategies routinely used by B.S. to avoid payment for work provided.

When a group focus is on take over of power for profit advantage-the best one can do is protect oneself.

While I fear for those insured by B.S., I am thankful to all who took a difficult stand to maintain quality in medical care. Please know it is greatly appreciated by one patient whose life was blessed by access to PAMF.


9 people like this
Posted by Blue Shaft
a resident of Old Palo Alto
on Jan 13, 2015 at 7:27 pm

Blue Shaft is what my primary care physician called them, because they were so stingy. They were also very costly to my employer, who dropped them in favor of HealthNet ( cheaper and more comprehensive)

Blue Shield has been sued successfully by the Insurance Commissioner twice in the last ten years: for not adhering to their own contract and paying out when they were required to.

Our experience with them, besides their stinginess and slowness to pay, was that they would approve a procedure or medication, then, without notice or warning, change their policy to exclude that same procedure or medication--and leave us holding the bag for 100% of the bill. On two occasions, that meant unplanned expenses of $12,000 and $20,000, respectively!


7 people like this
Posted by Anneke
a resident of Professorville
on Jan 13, 2015 at 7:41 pm

To Thoughtful: It is too bad you did not use your real name. I did and I always do.

I am happy for you that you had a wonderful experience with PAMF.

I so wished I could say the same thing. Unfortunately, I had a terribly disillusioning medical experience with PAMF over the past two plus years. It was truly frightening.


9 people like this
Posted by just a number
a resident of Meadow Park
on Jan 13, 2015 at 10:19 pm

I've been a patient at PAMF for many years and I am not impressed with the care I've received there. The visit with the doctor is incredibly rushed and very expensive. I think the doctors are really burned out by the patient load, and many of the good ones move to other practices where they can spend more time with their patients.

PAMF is in the money making business and it's all about squeezing in as many patients as possible for maximum $$$. They're big on scheduling consults every time you see a new physician, and the consult costs about $200 more than the regular visits although you mostly just sit in a chair while the doctor asks you questions without giving you a thorough exam. Highway robbery.

Perhaps if PAMF didn't charge such exorbitant prices there wouldn't be a problem with the insurance companies.


10 people like this
Posted by PAMF patient
a resident of Los Altos
on Jan 14, 2015 at 12:49 am

In comparing charges from PAMF with other providers, I have found them to be much more costly. Charges are bordering on outrageous. On the other hand, my primary care physician is the best and I have a 25 year history with her. To me, it is disturbing that Sutter has a monopoly in the Bay Area and patients have few options. This is creating a lack of competition which allows Sutter to charge what it pleases. i applaud Blue Cross for trying to hold the line on costs, but where does that leave us patients?


10 people like this
Posted by K
a resident of University South
on Jan 14, 2015 at 2:34 am

Thank you for this article. I received the letter from Blue Shield recently only several days AFTER receiving my new card for 2015. I was very happy to be able to enroll with Blue Shield in 2014 and rolled my plan over for 2015. I like PAMF because everything is under one roof, so to speak. Also, in my experience, referrals to other Physicians at the Stanford Hospital, were efficiently processed. I tried doing this on my own once and it was a logistical nightmare. I've been a patient at PAMF for over 10 years and feel I would be thrown into the wilderness, otherwise.

Here is what I did after receiving the letter from Blue Shield. I investigated most of the other insurance options for PAMF found on their website. They have a complete list with this information. I researched most policies they listed to see which one, other than Blue Shield, that I would qualify for. For me, as an individual, not yet eligible for Medicare; not eligible for a group or employee issue or a subsidy through the Exchange-- the best option I have is Health Net, Individual and Family PPO. So that's it. I'm filling out the application to Health Net for the Bronze 60 PPO plan and it's going in the mail today. I also logged onto their website today and my doctors at PAMF are listed as in-network providers on the Bronze 60 PPO. As soon as I receive a welcome letter from them, then I'm calling Blue Shield to cancel. I've read where the deadline to apply for a new plan is 2-15-2015.


15 people like this
Posted by Broken Health Care in the US
a resident of Palo Verde
on Jan 14, 2015 at 7:37 am

I am a self employed photographer w/Blue Cross Covered California insurance. Me and my family have been going to PAMF for over 20 years. I have always looked at the PAMF website to see which Covered California insurance packages they covered and now, it appears that there are none.... Web Link on their list. I noted this year that they were in negotiations w/Blue Cross and feared this would happen. I have already spent hours on the phone w/Blue Cross to get this years policy correct..... I now need to try to change again but not sure if there is any Covered California package Sutter/PAMF will take. Ever since I left the corporate world to pursue my passion, Heath Care has been the most difficult part of that transition and I welcomed the Affordable Care Act with open arms since it helped individuals who needed to purchase insurance. Now it is clear that the system is creating a two tier health care system in the US.... this is really disheartening..... there is greed on both sides here..... PAMF/Sutter and Blue Cross Blue Shield.... and the consumers once again are getting screwed.... this isn't the America we were brought up being proud of....


Like this comment
Posted by Midlander
a resident of Midtown
on Jan 14, 2015 at 8:24 am

PAMF have published a FAQ at Web Link describing the state of the Blue Shield negotiations and trying to answer common questions about what it means for patients.


13 people like this
Posted by Cman
a resident of Menlo Park
on Jan 14, 2015 at 9:37 am

There are no saints in this business. I moved from PAMF to Stanford health care which is covered by Blue Shield at least as of now and having had to move from Blue Cross to Blue Shield earlier since it had neither. Without PAMF and Stanford, it is difficult to get health care in this area.

While there are good doctors in all networks and one might be thankful for what they may have done for us in the past, they are all operating in a broken system that has no incentive to bring costs down. The insurance companies, frighteningly enough, as they are also pressured by their own business model is the only force available now to reduce costs and wastage.

PAMF is notorious for bad billing practices in the area. Check out the Yelp reviews. My primary care doctor at PAMF wouldn't even look at me to talk for a medical checkup, he was busy typing on a screen that came pre-filled with patient description, so he could finish up in 20 minutes or less. My subsequent doctor raised his eyebrows on all the tests that had been ordered at PAMF when I showed him my previous medical records.

While one is thankful that there are Doctors who may save your life one day, it shouldn't make us blind to the broken system where no one is incentivized to provide decent care that most can afford. It is a myth that the escalating infrastructure costs at hospitals are increasing the quality of care, it is also increasing the use of equipment for more billable services whether necessary or not.

Covered CA started with a good intent but has been disappointing because their charter is to increase enrollment for political reasons, not ensuring quality of service or availability of healthcare. They couldn't care less if the health insurance you purchased from them cannot really be used. The head of Covered CA, Peter Lee, appears to spend more time in photo ops with politicians than ensuring his site works and is promoting better health coverage rather than more enrollment numbers. A good example that good intentions aren't enough for good results when politics and greed takes precedence over competence.


8 people like this
Posted by bill kelly
a resident of Barron Park
on Jan 14, 2015 at 9:42 am

We are witnessing an elaborate game of chicken played with people health concerns. Shame on both parties. Settle soon or help destroy the little good will that exists,


5 people like this
Posted by Mr.Recycle
a resident of Duveneck/St. Francis
on Jan 14, 2015 at 10:45 am

@K - Interesting that Health Net no longer sells their PPO on Covered CA, they only are selling a much more limited EPO, which isn't listed on the PAMF accepted policies. You have to buy the PPO directly from Health Net, no subsidies available.

I like the convenience of PAMF, but is incredibly overpriced, and wouldn't be surprised to see Health Net follow in the footsteps of Blue Cross, and now Blue Shield, and drop them next.


4 people like this
Posted by Same boat
a resident of Barron Park
on Jan 14, 2015 at 10:59 am

I fully agree with the comments by K. I was in the exact same boat last year with Anthem Blue Cross. We are self employed husband and wife with two children. We purchase our own insurance. We had Anthem Blue Cross for many years. When the Affordable Care act came around, we continued with Anthem at the start of 2014. I checked their web site and all our doctors were listed. Turns out this information was wrong and none of our doctors would be covered. Most of our doctors are through PAMF.

We ended up switching to HealthNet. Been very happy and haven't looked back.


10 people like this
Posted by J. Smith
a resident of Evergreen Park
on Jan 14, 2015 at 11:06 am

From the Sutter FAQs:
I called Blue Shield’s customer service to ask them what the issues are regarding the contract and they said that Sutter Health wants large increases that they cannot afford to pay. Is that true?
That is not true. Blue Shield is seeking significant rate reductions from Sutter Health and contract terms that Sutter Health can’t accept. We can also tell you we have been working hard to reduce our costs while striving to provide value and deliver the exceptional, high-quality care our patients expect and deserve. These commitments are reflected in our proposal to Blue Shield.

I'm so upset about this-- I've been with PAMF since the '50s, and love the level of care I receive there. My employer just switched from Blue Cross to Blue Shield, and suddenly 1000s of us are left in the lurch. What a TRAVESTY, and stupidity. WHY OH WHY don't we have a comprehensive federal health plan that would negate this kind of jockeying, at the expense of citizens? Covered CA is a step in the right direction, but the overall plan doesn't go far enough to eliminate this kind of problem... I just want to stay with my doctors at PAMF... why is it so hard...


4 people like this
Posted by bb
a resident of Midtown
on Jan 14, 2015 at 11:34 am

I was emailed a list of covered providers in the area from Blue Shield after getting my letter. The list included Quest diagnostics, a few endoscopy centers, a dialysis center, a start up oncology diagnostic company in Palo Alto out east Embarcadero Rd.,what appears to be a veterinarian, a sleep clinic, and two doctors in Fremont and Novato!! There were one or two independent doctors actually in the area (Menlo Park, Redwood City) listed. So thanks to those who researched for me which networks are still ok - will switch over by the deadline. PAMF not perfect, but one stop shopping, and long term relationships with docs is a good thing.


4 people like this
Posted by member, too
a resident of Duveneck/St. Francis
on Jan 14, 2015 at 3:09 pm

This forum actually has some useful information! Thanks to all for participating. It is so difficult to get straight-up information on this maddening dilemma. I think both parties are at fault here. I would love to blame just the insurance company because they have been astoundingly evil and incompetent. One small example out of dozens I can personally site: they simply cancelled our policy mid-way through last year. I thought they weren't aloud to do that any more. It wasn't for lack of paying - we have always paid on time. It was just "a mistake". One in a long line. And then they charge so much money for their lousy service. PAMF could be a lot better, too. It wouldn't be so hard for them to find ways to lower costs some. Fewer unnecessary tests for example. Quality of care there doesn't seem to be what it used to be which is sad but probably to be expected from an institution that has grown so huge.That's not an insurance issue, though.
I support the affordable care act. It is essential to try to get to a more reasonable health care system. We now have some more protections than before but it doesn't go far enough. I don't think these cost issues will get better until there is a single payer system. Until then I fear we will be doing this stupid dance with the companies every year. And we will still be paying ridiculous prices for health care.


7 people like this
Posted by palo alto resident
a resident of Crescent Park
on Jan 14, 2015 at 3:51 pm

Our insurance is Blue Shield, I just logged into their site, they are still showing all the PAMF doctors as accepting their insurance. I have NOT received any information from Blue Shield about coverage changes. Unfortunately, although the Covered California enrollment is still open, the ability to change insurance at work is not. We can't change our insurance plan until next fall...


3 people like this
Posted by GAil
a resident of Charleston Meadows
on Jan 14, 2015 at 4:33 pm

I have been self employed for many years and have had Blue Cross and then added Blue Shield for many years. Every few years one or both were cancelled for awhile but after negotiations, they were usually valid again. Of not also, after changes due to the ACA my I had to switch my son to Healthnet Bronze PPO. Be aware with that policy covers only one Doctor visit a year. All else you pay full price until the deductible is met. Furthermore, midway through the year Health et switched to am EPO and I don't think PAMF is in that network. I could be wrong. I have since cancelled the policy. I do want to say, as a healthcare provider I know that Blue Shield reimburses twice what Blue Cross does (premiums are triple that of Blue Cross), secondly, PAMF physicians work only 4 days a week and are paid substantially more that other area physicians. Lastly, I remember that I had Blue Cross and Blue Shield when my son had an emergency hospitalization, Blue Shield paid the hospital three times what Blue Cross did. I believe PAMF is trying to maintain its super high physician salaries, unfortunately, that is likely a losing game. I wish patients were not caught in the middle as I am tired if trying to switch to a plan that is "participating."


3 people like this
Posted by neighbor
a resident of Greenmeadow
on Jan 15, 2015 at 6:11 am

I don't believe it is accurate that PAMF physicians work only 4 days each week -- that certainly isn't true for those I see. Some do move around, however, working at one location for several days, and then other PAMF clinics on other days. Services at the clinic haven't been perfect, but for me they have been excellent over the last 20+ years. That Blue Shield reimburses at a higher rate for PAMF only tells me that they reimburse at horrendous rates for other providers. Blue Shield (BS) continues to charge higher and higher premiums for coverage while lowering reimbursement rates whenever they think they can get away with it. I applaud PAMF for hanging in there.


3 people like this
Posted by Summer
a resident of Old Palo Alto
on Jan 15, 2015 at 10:04 am

Someone said that there is no saints here. And there isn't, but the culprits are the pharma and hospitals--their greed continue to drive health care prices up. Their lobbysts continue to prevent comprehensive health care insurance, similar to other countries like Germany, France, Canada, etc. If we did have real, real universal health care, we would not be in this boat, but voters, and you know who you are, continue to be mislead into beleiving that we have the "best" insurance we can have, but no one in the rest of the world would go bankrupt because of a catastrophic health care issue--only in this country. When are voters going to learn?


6 people like this
Posted by Mike
a resident of Crescent Park
on Jan 15, 2015 at 10:31 am

Having been born and raised in Palo Alto I was a long time patient with the PAMF. What was once a great institution with "patient care" being the primary objective, it now seems that $$$$ are the main objective. Overbook and under deliver seems to be the theme now. "Appointment" wait times are a joke with the overbooking and resulting in Doc's rushing patients in and out as though they are just herding cattle.

Some are expressing disdain at what they perceive as the big bad insurance companies, PAMF is no better with their exorbitant charges for services.

Really fed up with both insurance companies and PAMF.


12 people like this
Posted by grandmakk
a resident of Midtown
on Jan 15, 2015 at 10:52 am

THIS is one of the many reasons we need a one-payer universal health care system, NOW.


6 people like this
Posted by Cman
a resident of Menlo Park
on Jan 15, 2015 at 1:00 pm

Clearly, there is a PR battle going on between Sutter and BlueShield like what happens with Comcast/DishTV and content owners every time a contract comes up for renewal. Lot of misinformation and obfuscation on all sides to influence low-information customers to take sides and pressure the other. This is just sickening to me.

No hospital or doctor gets respect from me for their business practice until they post their prices publicly. Mandating this is what health care reform should have started with as the minimum and the basis of any free market solution.

For all the people taking side with PAMF, do you know what the charges from PAMF are for various procedures to judge if they are reasonable or not. Do you know if the health care premiums are sufficient to pay such prices? This is a fundamental problem with the health system when people want insurance companies to pay whatever with no idea of what it costs the insurance company.

Sutter, put your prices up on your website for each hospital for each treatment code for all to see before you do your propaganda against insurance companies. Let your charges for various procedures and reasons for procesures be audited by third parties without divulging patient info. If you don't want to do so, then don't claim a free market system, ask for a single payer system. Hypocrites.

Of course, insurance companies have been egregious in their practices which is why they don't get any sympathy either. At least ACA has reigned in some of the unethical and immoral practices like recession, etc. There are controls now on how much of premiums have to be spent on patient care.

But even if they totally stop being predatory, the math still has to work and it won't unless costs are reigned in.

Single payer system won't work in this country not because some side or the other won't allow it but because the culture of accountability and competence is not present enough for that single payer to do a good job. Look at how healthcare.gov and coveredCA have been managed. Even the sides that supported them have been disgusted by their poor management and incompetence focusing only on enrollment numbers not quality of care. Why would anyone trust them?

The solution is regulations that promote competition in health industry with transoarency and rewards for results. But one side doesn't want any regulations, the other side thinks they can regulate all problems away. Start with forcing hospitals to post prices and see how quickly things change.

The problem isn't pharma or hospitals or insurance companies, it is us who don't elect true leaders and give them a chance to execute but rather wallow in ideological or low information talking points to prevent solutions and don't hold anyone accountable.

Meanwhile people die from lack of health care in the richest country in the world while disputes like this only contribute to it and don't solve it even after an agreement is reached which only determines whether someone buys a Mercedes or a Maserati.


2 people like this
Posted by Gunn Parent
a resident of Gunn High School
on Jan 15, 2015 at 2:41 pm

I have one word for you all - Kaiser! Excellent care, low copays, reasonable wait times, professional staff and many services provided by phone.


14 people like this
Posted by RHK
a resident of Professorville
on Jan 15, 2015 at 2:46 pm

I am fortunate to be able to get a portion of my health care paid for by a local employer. During open enrollment in late October the employer switched from one HMO/PPO provider to Blue Shield. During open enrollment Blue Shield and Sutter/ PAMF did not reveal they were in a contract dispute or that their contract was terminating at the end of 2014, so many of us enrolled in Blue Shield thinking they could continue to use Sutter/PAMF services. Only after we paid our premiums did we find out that the services we thought we were paying for were no longer going to be available to us. We, the healthcare consumer are stuck in a yearlong contract while the insurance company is free to significantly change its product/provider base the first day the contract begins. This is all completely legal unless laws are changed to compel insurance companies to reveal their contract status with large providers during open enrollment. (Transparency) Another law should prohibit insurance companies from significantly altering their provider base during the course of the yearlong contract they hold with employer groups and individual subscribers. (Good Faith) I urge people to contact their elected representatives to change healthcare law to require Transparency and Good Faith and also to lodge a complaint against Blue Shield with the California Department of Managed Care. I was told by an employee there that Blue Shield filed the first of its transition plans to move customers out of PAMF/Sutter and assign them to other providers on October 1st, well before most open enrollment periods even began.


5 people like this
Posted by John Allured
a resident of Barron Park
on Jan 16, 2015 at 4:35 pm

Your article states that "Blue Shield is asking for a cut in reimbursement rates," which seems to imply that Blue Shield is the party attempting to change the terms of the relationship. However, stories in other news sources, including KQED, suggest that Sutter is also attempting to change terms, such as those relating to arbitration of disputes. Moreover, you quote Sutter's spokesperson, but don't provide any comment from Blue Shield's counterpart. I'm not sure what the real dynamics of the dispute are, but your piece (which is admittedly just a very brief summary) appears to be less balanced than it might be. Nonetheless, I appreciate the story and would welcome more detailed coverage.


1 person likes this
Posted by Resident
a resident of Woodland Ave. area (East Palo Alto)
on Jan 17, 2015 at 10:26 am

Nothing but a bunch of crooks.


3 people like this
Posted by hsum
a resident of another community
on Jan 17, 2015 at 12:07 pm

I live in Santa Cruz, CA, but we aren't even listed in the choices of neighborhoods. Our community will be heavily impacted by the loss of Palo Alto Medical Clinic physicians. These doctors are the most efficent, caring and competent doctors here in this county of Santa Cruz. I suffer from Osteoporosis and my last doctor with another medical group was not helpful at all. I couldn't take the previous doctor's prescribed pills for this condition. My new physician at Palo Alto Medical Clinic immediately took me off another debilitating medication that was making my bones worse and sent me to a Rhumatologist who now has to correct the damage. These Palo Alto Medical Physicians listen and follow up on all their care. If need be I would be willing to pay a little more out-of-pocket for this type of care instead of having to deal with other medical group doctors who don't take the time to really solve the problem.


Like this comment
Posted by Broken System
a resident of Palo Verde
on Jan 17, 2015 at 4:33 pm

This is a big deal. I appreciate the Weekly keeping the board visible although there isn't much we can do but exposure the issue and put pressure on both sides to realize the impact (as if they care) and make a prudent decision that takes into account the welfare of their constituencies. Blue Cross is a not for profit, the PAMF represents those who have taken a Hippocratic Oath to help individuals.... seems like all of this is getting lost for a bigger piece of the pie.... I once worked for a not for profit company whose CFO told me we are actually a "Not for too much profit" organization.... simple answer..... Single-payer healthcare system. Is that what you guys really want?


3 people like this
Posted by slew
a resident of Old Palo Alto
on Jan 18, 2015 at 7:41 pm

I don’t have enough information to know whether Blue Shield or Sutter is more responsible for this unfortunate situation but I do know a few things about Sutter and PAMF.

First, the PAMF culture we all knew and loved for decades no longer exists. Prior to 2010 or so, PAMF had a very special home grown culture and provided excellent health care. PAMF was a Sutter affiliate but Sutter had a hands off approach. In the last 5-7 years, Sutter has methodically taken control of every aspect of PAMF’s operations. PAMF exists in name only now, because Sutter has used the PAMF name very liberally in recent years for branding purposes. I’ve lost count of the number of local medical practices Sutter has acquired and given the PAMF brand name. This year for the first time, the Sutter name is on top and the PAMF name is underneath on the logo. I suspect the PAMF name will disappear relatively soon.

It is still possible to get reasonable quality health care at PAMF branded Sutter facilities. But that is not the trend, and the health care provided is very assembly line these days. My husband and I have had some scary and life threatening experiences at PAMF Palo Alto in recent years due to neglect. Appointment times have been shortened, doctors are burned out and there has been tremendous cost cutting going on internally. Sutter has instituted an internal charm offensive called PAMFCares and an external marketing campaign called “We Plus You” to try to camouflage these changes. All or nearly all ancillary functions have been outsourced (mail, security, housekeeping) or have been relocated to Sacramento (HR, IT, etc.). PAMF was a place employees wanted to stay for their entire working lives. Sutter is a place where job insecurity is the norm. Internally, Sutter’s stated goal is to become more like Kaiser. Ironically, Kaiser appears to have improved dramatically whereas Sutter has reduced quality.

At Sutter Palo Alto, is difficult to get accepted by a good doctor because their practices are full. Many of the good experienced ones have left due to retirement or because they don’t find working at Sutter satisfying. Morale is a problem. Many doctors and employees wish that PAMF and Sutter would divorce, similar to Marin General Hospital’s disconnect from Sutter.

It may surprise some to learn that Sutter is also an insurance provider to its own employees. Sutter employees have only one choice for their health insurance - Sutter Select. Sutter Select uses many of the same hard ball practices as better known health insurance carriers, such as denying and delaying benefits incurred by employees at non Sutter facilities while on vacation requiring emergency health care, denying payment for medications Sutter’s “experts” have deemed unnecessary etc. Sutter is readying plans to provide Sutter insurance to the general public.

I think that Kamala Harris should be keeping an eye on these health care giants for antitrust investigation purposes. And it would be great if the San Jose Mercury or the Weekly would provide more investigative coverage of this health care giant and the effects of its policies on the quality and availability of local health care.


4 people like this
Posted by slew
a resident of Old Palo Alto
on Jan 18, 2015 at 7:41 pm

I don’t have enough information to know whether Blue Shield or Sutter is more responsible for this unfortunate situation but I do know a few things about Sutter and PAMF.

First, the PAMF culture we all knew and loved for decades no longer exists. Prior to 2010 or so, PAMF had a very special home grown culture and provided excellent health care. PAMF was a Sutter affiliate but Sutter had a hands off approach. In the last 5-7 years, Sutter has methodically taken control of every aspect of PAMF’s operations. PAMF exists in name only now, because Sutter has used the PAMF name very liberally in recent years for branding purposes. I’ve lost count of the number of local medical practices Sutter has acquired and given the PAMF brand name. This year for the first time, the Sutter name is on top and the PAMF name is underneath on the logo. I suspect the PAMF name will disappear relatively soon.

It is still possible to get reasonable quality health care at PAMF branded Sutter facilities. But that is not the trend, and the health care provided is very assembly line these days. My husband and I have had some scary and life threatening experiences at PAMF Palo Alto in recent years due to neglect. Appointment times have been shortened, doctors are burned out and there has been tremendous cost cutting going on internally. Sutter has instituted an internal charm offensive called PAMFCares and an external marketing campaign called “We Plus You” to try to camouflage these changes. All or nearly all ancillary functions have been outsourced (mail, security, housekeeping) or have been relocated to Sacramento (HR, IT, etc.). PAMF was a place employees wanted to stay for their entire working lives. Sutter is a place where job insecurity is the norm. Internally, Sutter’s stated goal is to become more like Kaiser. Ironically, Kaiser appears to have improved dramatically whereas Sutter has reduced quality.

At Sutter Palo Alto, is difficult to get accepted by a good doctor because their practices are full. Many of the good experienced ones have left due to retirement or because they don’t find working at Sutter satisfying. Morale is a problem. Many doctors and employees wish that PAMF and Sutter would divorce, similar to Marin General Hospital’s disconnect from Sutter.

It may surprise some to learn that Sutter is also an insurance provider to its own employees. Sutter employees have only one choice for their health insurance - Sutter Select. Sutter Select uses many of the same hard ball practices as better known health insurance carriers, such as denying and delaying benefits incurred by employees at non Sutter facilities while on vacation requiring emergency health care, denying payment for medications Sutter’s “experts” have deemed unnecessary etc. Sutter is readying plans to provide Sutter insurance to the general public.

I think that Kamala Harris should be keeping an eye on these health care giants for antitrust investigation purposes. And it would be great if the San Jose Mercury or the Weekly would provide more investigative coverage of this health care giant and the effects of its policies on the quality and availability of local health care.


4 people like this
Posted by Neighbor
a resident of Leland Manor/Garland Drive
on Jan 19, 2015 at 1:15 pm

Write to: Paul Markovitch, CEO Blue Shield of California, 50 Beale Street, San Francisco CA 94105-1808-to voice your concerns/complaints about Blue Shield's absolute lack of concern for the public who subscribe(d) to the Blue Shield health plans. It does not matter who is largely at fault,PAMF or Blue Shield, what matters is that this enormously rich "health" insurer where the CEO makes about $4,000,000/year cannot manage to do its job which is to ensure its paid-up subscribers get the very care for which they are paying with the medical providers of their choosing. Have you noticed that we-the general public-here in Silicon Valley the home of the 1 "perecnt-ers" have fewer choices from medical care to internet providers. Pretty soon Sutter will own Comcast/ATT, or it might be the other way around. The 1% have NO problems at all. They will always get what they want.


1 person likes this
Posted by Craig Laughton
a resident of College Terrace
on Jan 19, 2015 at 4:30 pm

>do its job which is to ensure its paid-up subscribers get the very care for which they are paying with the medical providers of their choosing.

Obama promised, "you can keep your doctor, your plan...AND save money", under Obamacare. It was a lie, and he knew it. He and his gang developed a strategy to blame the insurance companies. You are carrying his water.

Blue Shield is trying to contain costs...an uphill, but honorable battle on its part. At least it is not lying about it.


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Posted by M.Rubin
a resident of Mountain View
on Jan 21, 2015 at 10:11 pm

The following email received from Sutter this evening:

This week, Sutter Health proposed a solution that would allow you to keep your doctor through 2015. We simply proposed to extend the transition period through the end of this year— at the same contract rates and terms we had in place with Blue Shield in 2014. Unfortunately, Blue Shield has not accepted our offer.

This is despite the facts that:

- Blue Shield sold health plan products during open-enrollment that featured the doctors and hospitals of Sutter Health; and then just days into the New Year abruptly announced plans to reassign members to non-Sutter doctors.

- Blue Shield continues to collect rate increases from its members and employers this year of up to 23 percent.

It had been our sincere hope to reach a new contract with Blue Shield. At Sutter Health, we believe employers and Blue Shield members deserve the network they purchased, and our patients deserve time to consider alternative health plan options for 2016. If you have questions about Blue Shield’s contract termination with Sutter Health and your medical care, you can speak with a PAMF customer service representative by calling 1-844-729-2833 between 8 a.m. and 5 p.m., Monday through Friday

While I'm certainly not happy with Blue Shied I'm equally unhappy with Sutter's negative propaganda campaign. That said, next open enrollment I'll go with Kaiser.


2 people like this
Posted by kris Rothgery
a resident of another community
on Jan 21, 2015 at 10:50 pm

I have always had very good experiences at PAMF. The doctors I've seen have been great, and I've never had any problems.

What bothers me about this whole thing is that Blue Shield sold us a package which included Sutter Health, and now, after we have signed up with them, they decide we can't see the doctors that we want to. I like being part of Sutter Health.

I don't understand why BS won't sign the contract now that Sutter Health has agreed to the same contract that they had in 2014.


1 person likes this
Posted by palo alto resident
a resident of Crescent Park
on Jan 22, 2015 at 8:21 am

Interestingly enough, I just searched for Blue Shield providers on their website and PAMF is still listed. So they continue to market themselves as covering PAMF. Seems like they should have to take that off their site...


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Posted by Eve in Mountain View
a resident of Mountain View
on Jan 28, 2015 at 11:42 am

Thanks all for the interesting and informative discussion. Just called Blue Shield of California (which covers doctor visits and the majority of my claims from PAMF) and asked when PAMF would be preferred provider. Was told that they have a contract extension until June 30, that negotiations continue, and that they are optimistic that they will find a way to settle the contract. That was good to hear. I asked about ways to voice discontent with BC/BS (particularly the bait and switch days after the open enrollment window closes), and he said one could write a letter and send to the same address claims go to (Blue Shield of California, P.O. Box 272510, Chico, CA), and that such letters would be noted. My family and I have gotten very good health care from PAMF for about 10 years. Not perfect, but better than most. My teenage son's doctor is the most competent and caring I have ever seen. PAMF's use of medical records and capacity to communicate with doctors and staff electronically (including prescription and appointment requests) make getting medical care much easier than with most health care organizations.


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