Blue Cross Blue Shield of Michigan to Provide Low-Cost Individual Health Plans

DETROIT – Blue Cross Blue Shield of Michigan, four southeast Michigan hospital systems, four independent community hospitals and more than 4,700 doctors will partner in 2015 to provide low-cost insurance coverage and health care services to local residents.

The localized network – called an Exclusive Provider Organization (EPO) – is coming together following responses to a comprehensive RFP issued by Blue Cross last year to hospitals asking for participation. Physicians – totaling 4,789 on Jan. 13 – are still coming aboard.

“In a region where hundreds of thousands of people are without health insurance coverage, the Affordable Care Act gives insurers and providers new opportunities to work together to provide people with affordable access to coverage and care,” said Susan Barkell, BCBSM senior vice president for Health Care Value. “Local hospitals and doctors are committed to providing quality care and keeping it affordable. Blue Cross is very pleased to join with local healthcare leaders to offer a quality, localized and low-cost insurance product to meet the needs of people not covered at work.”

For more news and information go to bcbsm.com/news and mibluesperspectives.com.

Florida Blue and Orlando Health Create Accountable Care Arrangement

JACKSONVILLE and ORLANDO, Fla., Dec. 10, 2013 /PRNewswire/ — Florida Blue and Orlando Health Physician Partners have announced the execution of an accountable care agreement, which aims to improve the quality and efficiency of patient care in the Orlando area.

Starting on Jan. 1, 2014, the accountable care program will utilize a value-based compensation structure that i s intended to decrease medical costs and increase quality outcomes by rewarding the right combination of goals, including transparency, care coordination, consumer empowerment and lack of redundancy. – See more details at PR Newswire.com.

CMS to Providers Looking to Support ACA Premiums: Not so Fast!

On November 4, 2013, the Department of Health & Human Services, Centers for Medicare & Medicaid Services issued a Q&A warning hospitals, other healthcare providers, and other commercial entities that it had “significant concerns” about those entities  supporting premium payments and cost-sharing obligations with respect to qualified health plans purchased by patients in the Marketplaces.

The guidance stated that HHS has significant concerns with this practice because it could skew the insurance risk pool and create an unlevel field in the Marketplaces. HHS said it discourages this practice and encourages issuers to reject such third party payments. The agency said it intends to monitor this practice and to take appropriate action, if necessary. – See the Q&A at cms.gov.

Narrow-Network Plans Spark Lawsuits and Renewed Debate

Carriers are increasingly turning to narrow-network plans help lower premiums to attract cost-conscious consumers to thier products offered through insurance exchanges .

This trend is getting pushback from some hospitals in the form of lawsuits and has renewed the debate over what is “reasonable access.”

AISHealth examines this issue in their featured Health Business Daily story found here.

Should Health Care Systems Become Insurers?

A new article published in the Journal of the American Medical Association (JAMA) asks the question: Should Health Care Systems Become Insurers?

An introduction to the article explains that incentives under the Affordable Care Act (ACA) are spurring increasing numbers of health care systems to assume the risk of paying for patient care, blurring the boundaries between care delivery organizations and insurers. New arrangements such as bundled payments, value-based purchasing, and accountable care organizations (ACOs) transfer financial risk from payers to health care systems. The union of payer and care delivery functions may engender opportunities for health systems to invest in prevention and more comprehensive, coordinated, patient-centered care.

The entire article is available at JAMANetwork.com and is available to registered members.

CAQH CORE, the Quiet Side of the Affordable Care Act

With health care exchanges dominating the news with regard to the Affordable Care Act (ACA), another piece of the health care reform legislation that will affect more people than the individual mandate or the public exchanges is being implemented with much less fanfare and media attention.

Those are the sections of the law that require administrative simplification and the development of standards for financial and administrative transactions. Sections 1104 and 10109 of ACA will impact nearly everyone who uses, pays for or delivers health care.

Essentially these sections of the law are aimed at bringing the health care industry (hospitals, health plans and other stakeholders) to a place that the financial services industry has been for years. That is having universal standards in place that allow financial institutions to communicate with one another in the same electronic language. It is what allows someone to use an ATM at a bank branch or at a gas station.  Continue reading

BCBSM to Compare Michigan Hospitals Costs and Care

DETROIT—Blue Cross Blue Shield of Michigan, Blue Care Network, and the University of Michigan Health System have launched the Michigan Value Collaborative, an initiative aimed at helping hospitals across the state understand their practice patterns compared with their peers, better manage costs and improve outcomes for patients.

“This new initiative uses health care claims data to enable hospitals to see how they compare on the resources they use to deliver care to patients,” said David Share, M.D., M.P.H., senior vice president, Value Partnerships, Blue Cross Blue Shield of Michigan. “This initiative is unique in that it allows participating hospitals to see how they compare with other hospitals, and use that data to better connect their care practices and costs with outcomes. Hospitals will be able to adjust their practice patterns to benefit patients and the overall efficiency of our health care system.”

See the full story at BCBSM.com.

Trading Access for Price in Healthcare Exchanges

To add a follow up the the previous post about Independence Blue Cross (IBC) offering state exchange consumers “tiered networks,” Fierce Health News is reporting that hospitals are pushing back on limited health exchange networks.

A story on the FierceHealthcare website notes that Seattle Children’s Hospital has sued Washington state’s Office of the Insurance Commissioner, claiming the health insurance exchange will prevent some patients from receiving care at the hospital,

The article also points out that most plans sold through health insurance exchanges limit patient choice of doctors and hospitals, believing consumers will trade provider choice and access for lower premiums.

The questions is, do the people buying these plans know they are giving up access for a lower price, and do they care?

What do you think? Comment below.

See the full story at FierceHealthcare.com

Consumer Groups Criticize Anthem’s Narrow Network In Missouri’s Obamacare Marketplace

Patient advocates say the exclusion of one of Missouri’s top hospital systems from policies offered by the region’s biggest insurer under the Affordable Care Act could hinder treatment for some patients and force others to switch doctors.

The network for the Anthem BlueCross BlueShield plans, which will be sold through Missouri’s “Obamacare” marketplace, does not include BJC HealthCare and its 13 hospitals — among them Barnes-Jewish Hospital, the area’s premier academic medical center, and St. Louis Children’s Hospital.

See the full story at KaiserHealthNews.com

 

Healthcare Leaders take ‘American Idol’ Approach to Innovation

Taking a cue from American Idol, leading healthcare professionals pitched innovative ideas at a recent Boston University-hosted event. Eight teams had two minutes each to describe their innovation projects and their importance. They also had to select $12,500, $7,500 or $2,500 as the project’s funding cost.

The innovation teams that won the American Idol-like competition received a $12,500 prize to build an online network for healthcare professionals to exchange solutions to complex medical problems, $7,500 to introduce e-cigarettes to wean the homeless off tobacco, and $2,500 to recreate a program that addresses patients’ basic resource needs as a quality care standard

See the full story at  FierceHealthcare