Blue Cross CEO says providers must control costs, or else

Dreyfus, who once worked in state government and for the Massachusetts Hospital Association, said Blue Cross Blue Shield will take a hard line in negotiations with hospitals and doctors that don’t agree to accept global payments. “Fee-for-service payment rates cannot continue to rise if we are to meet the community’s goal of affordable care,’’ he wrote. “Ultimately, we must continue our work to identify ways to reduce the level of payments.’’

Blue Cross, which insures nearly 3 million state residents, has an outsized influence on employers and health care providers. Dreyfus’s letter acts as “both a threat and a promise,’’ said Stuart H. Altman, health policy professor at Brandeis University. “He’s saying to the hospitals, you can do better under global payments. But he’s also saying, if you don’t want to do it, if you’re more comfortable with the fee-for-service system, forget it, we’re going to come down on you.’’

Massachusetts employers have long chafed at annual double-digit premium increases, with most blaming Blue Cross and other insurers for the relentless trend that crimps hiring by raising employee costs.

At the same time, nonprofit hospitals are being financially squeezed by cuts in Medicaid and other government payments. Community hospitals and smaller academic medical centers say they can’t command the same reimbursement rates granted by insurers to dominant market players such as Partners HealthCare System and Children’s Hospital Boston.

But officials at hospitals large and small agree that Dreyfus has sent a wake-up call.

“What Blue Cross is basically saying is it’s not going to be about (market power) any more,’’ said Ken Hanover, chief executive of Northeast Hospital Corp., which owns Beverly Hospital and Addison Gilbert Hospital in Gloucester. “It’s going to be about quality and managing the cost of care. This is going to require a significant restructuring of the Massachusetts health care delivery system.’’