Jersey City Medical Center, Horizon BCBSNJ to Collaborate on Lowering Patient Costs, Improving Care

The Jersey City Medical Center and a major insurance carrier have entered into an agreement to work together improve care and lower patient costs, the hospital announced.

“We look forward to successfully developing a patient-centered program with Jersey City Medical Center to help ensure our members receive high-quality, efficient health care services,” said Jim Albano, vice president of network management and Horizon healthcare innovations at Horizon BCBSNJ.

“Rather than becoming an insurance company, we want to collaborate with an insurance company to provide the most efficient patient career,” said Joe Scott, President and CEO of Jersey City Medical Center.

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Study: Market Power Drives up Hospital Prices

Hospital costs for those who are privately insured vary widely and are much higher than Medicare payment rates, a new study by the Center for Studying Health System Change (HSC) found.

Within the communities studied, hospital prices for privately-insured patients were found to be approximately one-and-a-half times the Medicare rates for inpatient care, and twice what Medicare pays for outpatient services.

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Coventry Health Care of Illinois and St. John’s Hospital Collaborate to Form High-Performance Network

SPRINGFIELD, Ill.–(BUSINESS WIRE)–Coventry Health Care of Illinois and St. John’s Hospital are pleased to announced a new high-performance network in Springfield, IL. A high-performance network collaboration consists of a group of health care providers who assume responsibility for the quality and cost of care for a group of patients.

The new product, Carelink from Coventry: A St. John’s Hospital Partnership, is effective September 1, 2013. The goal of this collaboration is to improve quality of care and lower overall health care costs in the Springfield community. The partnership demonstrates a commitment to deliver more value to the patient, no matter what his or her health care needs may be.

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How Ideas Become Innovations: Roundtable With Healthcare Innovation Leaders From UCLA, Ohio State

Innovation is increasingly becoming an important discipline for many of the country’s hospitals and health systems. Leaders are dually tasked to build a culture that promotes the sharing of ideas and a willingness to learn, but they must also ensure the creative process is formalized and methodical. Here, four leaders from two of the top academic medical centers in the country share their approach to innovation.

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Regence and MultiCare Health System Announce New Collaborative Care Initiatives

SEATTLE, Aug. 27, 2013 /PRNewswire/ — Regence BlueShield in Washington and MultiCare Health System today announced that they have taken an important step in advancing the Triple Aim goals of improving the health of patients and their care experience, and lowering costs, through a new payment model. Additionally, the two organizations are collaborating on innovative new networks and health insurance products to further enhance care and bend the medical cost curve for people in the south Puget Sound region.

The initiative will include a shared incentive reimbursement arrangement for services at MultiCare hospitals and clinics which will be aligned with increased focus on quality and patient care goals that are mutually agreed to by Regence and MultiCare.

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Hospitals, Health Systems Quicken Pace to Own Insurers, Full-Risk Health Plans

Nationwide, about 100 provider-sponsored health plans are owned by hospitals or health systems, says Joe Damore, vice president of population health management for the Premier healthcare alliance. Moreover, he tells HPW that approximately 20 more health systems are in the process of getting licensed to offer their own plans. These likely will be implemented within the next 18 months or so for at least a 20% increase over that time period, says Damore.

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Coventry Health Care Expands Partnership with UnityPoint Health

DES MOINES, Iowa–(BUSINESS WIRE)–Coventry Health Care and UnityPoint Health on August 23,  announced the expansion of their partnership providing high-performance network plans in the state of Iowa.

Coventry’s “Carelink” high-performance network plans will now give more Iowans affordable access to care through the clinics, hospitals and home care services of UnityPoint Health – the nation’s fourth largest nondenominational health system.

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WellPoint’s Affiliated Health Plans Enhance Newborn Support by Incorporating CareNex Expertise into Maternity Benefits Coverage

INDIANAPOLIS–(BUSINESS WIRE)–Aug. 19, 2013– According to the Centers for Disease Control and Prevention (CDC), nearly half a million babies in the United States – that’s one in nine – are born prematurely, before 37 weeks of gestation, resulting in potentially serious and ongoing health complications.

As part of its effort to address the problem with industry-leading, quality- and outcomes-driven maternity and newborn support, WellPoint, Inc., (NYSE: WLP) today announced it will start using CareNex’s expertise in neonatal support internally, in connection with WellPoint’s care management services.

WellPoint has had a relationship with CareNex Health Services, a California-based company that provides URAC-accredited neonatal medical management services, since 2009. WellPoint became the sole owner of CareNex inDecember 2012. Since then, WellPoint has worked to leverage CareNex’s proficiency in newborn management while accessing its clinical data repository and nationally recognized Physician Advisory Board.

“Historically, across the health care delivery system, care for high-risk newborns has been far too fragmented and costly,” said Gail Borgatti Croall, MD, senior vice president of care management with WellPoint. “We believe integrating CareNex’s approach to coordinating care for the highest risk newborns as part of our goal to improve maternity-related care will offer our affiliated health plan members greater access to the support they need, when and where they need it most.”

“Ensuring that clinically complex infants and women with high-risk pregnancies have access to timely, quality health care has been CareNex’s priority. We are pleased that our collaboration with WellPoint will further enable mothers and babies to have access to personalized and thoughtfully coordinated medical resources and benefits,” said Pedram Salimpour, MD, president and co-founder of CareNex Health Services.

Integrating CareNex’s capabilities into WellPoint’s overall maternity and infant care management strategy among its affiliated health plans will enable WellPoint to continue building more robust pre- and post-natal, consumer-centered benefits and benefits management services. This integration also underscores WellPoint’s commitment to promoting patient-centered care and improving the coordination of care across the health-care spectrum.

“We believe we can be even more successful in fostering healthier outcomes by leveraging CareNex’s assets coupled with our own care management services and maternity-related resources that focus on care for high-risk newborns and offer vital support for their families,” said WellPoint’s Croall.


Wellmark and Genesis Health System enter into Accountable Care Organization

Today, Wellmark Blue Cross and Blue Shield of Iowa officially announced a collaboration with Genesis Health System in Davenport to create an Accountable Care Organization (ACO). The new ACO will focus on coordinating patient care to improve quality, provide greater value, and slow increases in health care costs.

Genesis Health System President and CEO, Doug Cropper, said he looks forward to seeing improvements in the quality and reductions in the cost of care, adding, “This collaboration is the next important step of a process that began for Genesis two years ago when we made the commitment to participate in the transformation of health care. Wellmark and Genesis have a long, shared collaboration of serving our customers and patients with a high quality of care and a high level of efficiency.”

In an ACO, providers assume responsibility for managing a population of patients, both who are healthy and those who are in need of care, no matter where in the system the patients receive care. Wellmark offers the providers financial rewards if they reach established quality goals and slow the rate in increase in health care spend in caring for these patients. At the same time, providers will not earn their financial incentive if their quality declines or their costs run higher than expected.

John Forsyth, Wellmark chairman and CEO said, “Wellmark is pleased to enter into this ACO agreement with Genesis Health System, to improve the health care experience, and to help slow the rate of cost increases. This ACO was created to keep healthy people well and improve outcomes for our members when they need care.”

The ACO will enhance Wellmark members’ care in a variety of ways:

  • Providers encouraging their patients to take an active role in their health care.
  • Continued freedom to see the doctors of their choice.
  • Seamless customer experience when setting up an appointment, seeing multiple doctors, and receiving follow up care.
  • A reduction of redundant care and services.

“This has been an extensive and rewarding process,” said William Langley, M.D., executive director of the Genesis Accountable Care Organization. “Since Genesis made the commitment to form an ACO two years ago, we have advanced to the point that it’s now a reality. We are looking forward to collaborating with Wellmark to keep the population we serve healthy.”


About Wellmark

Wellmark, Inc. ( does business as Wellmark Blue Cross and Blue Shield of Iowa. Wellmark and its subsidiaries and affiliated companies, including Wellmark Blue Cross and Blue Shield of South Dakota and Wellmark Health Plan of Iowa, Inc., insure or pay health benefit claims for more than 2 million members in Iowa and South Dakota. Wellmark Blue Cross and Blue Shield of Iowa, Wellmark Blue Cross and Blue Shield of South Dakota, and Wellmark Health Plan of Iowa, Inc. are independent licensees of the Blue Cross and Blue Shield Association.  Contact: Courney Greene, 515-988-0918,


About Genesis Health System

Genesis Health System, its affiliates and partners offer a full continuum of health care services for a 12-county region of Eastern Iowa and Western Illinois. Genesis hospital affiliates include: Acute and tertiary hospital care at Genesis Medical Center, Davenport and DeWitt, Iowa and at the Illini Campus in Silvis, Illinois. Genesis also manages hospitals in Maquoketa, Iowa and Aledo, Ill.  Genesis also offers home health and hospice services through Genesis VNA and Hospice; Genesis Workplace Services; Clarissa C. Cook Hospice House; senior living facilities offering rehabilitation and long-term care; Genesis Health Group, with more nearly 170 primary care physicians and specialists; the Genesis Quad Cities  Family Practice Residency program. For more information, visit our Web site at www.genesishealth.comContact: Craig Cooper, 563-421-9263,


Anthem Blue Cross Emergency Room Interventions Using Google Maps and Education, Empower Consumers to Choose ER Alternatives for Non-Emergency Conditions

WOODLAND HILLS, Calif., July 8, 2011 /PRNewswire/ — Anthem Blue Cross has launched an emergency room education campaign incorporating Google Maps to make it easier for consumers to find and use retail health clinics and urgent care centers for non-emergency conditions when their regular physicians are not available.

“When your five-year-old is crying with a fever at 7 p.m. on a Friday because she has a sore throat or an ear ache, what do you do?” said Kurt Tamaru, MD, Anthem medical director.  “It’s important people know that they have options for less serious ailments other than an ER, such as retail health clinics and urgent care centers that provide quality care and cost them significantly less.”

For example, emergency rooms that contract with Anthem Blue Cross generally charge an average $641 to treat strep throat compared with $70 at urgent care centers and $27 at retail health clinics. Consumers can save out-of-pocket expenses because ER copays cost about $150, compared with $10 to $40 for retail health clinics and urgent care centers.

“Not only were the ER program’s online tools developed to be easy to use—but they are available to everyone,” said Pam Kehaly, president, Anthem Blue Cross. “All you have to do is go to Google, Yahoo! or Bing, and type in ‘Anthem and urgent care’ and our educational site will pop up with a link to help you find ER alternatives. The link will also provide information on when it’s appropriate to use these alternatives.”

“We see in our data that the highest rates of avoidable ER use are among people 34 and younger—those who are less likely to have a primary care physician but more likely to be technology consumers,” Tamaru said. “We chose to develop Google Maps and create online links because that’s where many consumers go for information today.”

About 17 percent of all visits to hospital emergency departments nationally could potentially be treated at retail medical clinics or urgent care centers for an estimated savings of $4.4 billion, according to a RAND Corp. study published in the September 2010 edition of Health Affairs. ER visits also are getting longer, with California ranked 40th nationally in the length of its ER waits—274 minutes, according to the Emergency Department Pulse Report, Press Ganey Associates, 2010.

Research performed by HealthCore Inc., which conducts research for health plans and others, showed that a pilot program with a commercially insured population in Virginia, which included member education via e-mails and online advertising, in addition to financial incentives and a Google map finder for retail health clinics and urgent care centers, assisted in members’ decisions to use ER alternatives for non-emergency care.

The study showed that ER use for conditions that could be treated at retail health or urgent care clinics decreased in 2010 from 2009 for all populations studied.  Specifically, HealthCore reported a 14 percent decrease in ER visits for those who participated in the program compared with those who did not. The decrease in visits covered minor sicknesses or conditions that could be treated elsewhere.

“This program demonstrates that by empowering members with information on appropriate resources, they can get the care they need while helping to control health care costs and reduce their out of pocket expenses,” added Kehaly.

After the intervention period, the group participating in the program was more than twice as likely to seek treatment for non-emergency conditions at retail health clinics than those who did not participate.

The ER program includes:

  • Links on Google, Yahoo! and Bing that drive visitors to an educational site explaining when it’s appropriate to use ER alternatives, such as retail health clinics and urgent care centers.


  • A Google map, available to everyone, that provides the location of ER alternatives in Anthem’s network throughout the state so that consumers can easily find them.
  • Automated calls to educate members whose recent ER visits were potentially avoidable, and e-mails to members interested in learning more information.
  • Educational pieces mailed explaining the type of conditions that could be treated at ER alternatives and potential differences in cost.

About Anthem Blue Cross:

Anthem Blue Cross is the trade name of Blue Cross of California.  Anthem Blue Cross Partnership Plan is the trade name of Blue Cross of California Partnership Plan. Anthem Blue Cross and Anthem Blue Cross Partnership Plan are independent licensees of the Blue Cross Association. ® ANTHEM is a registered trademark of Anthem Insurance Companies, Inc.  The Blue Cross names and symbols are registered marks of the Blue Cross Association. Additional information about Anthem Blue Cross is available at Also, follow us on Twitter at, on Facebook, , or visit our YouTube channel at


SOURCE Anthem Blue Cross