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.

The Amish Health Care Plan

An article on FierceHealthFinance.com reminds us that not all health plans are insurance plans. The article titled, “The Amish way of healthcare finance,” explains that the Amish have legally opted out of participating in the Affordable Care Act, but that does not mean they are doing without a plan for taking care of their member’s health care needs..

The article says that various Amish communities have negotiated prices with local hospitals for its members in exchange for quick cash payments. The communities then use a combination of church aid and benefit auctions to raise money for any member who is unable to pay their bill, according to Reuters.

“We have our own healthcare,” an anonymous Amish community member told Reuters. “They [hospitals] give you a bill,” he said. “If you can’t pay it, your church will.”

See the full story at: FierceHealthFinance.com

BCBSM Refocusing Welcome Centers to Help Consumers Navigate ACA Marketplace Changes

Blue Cross Blue Shield of Michigan (BCBSM) has announced that it is re-focusing its 10 welcome centers located across the state of Michigan to help consumers understand and navigate ACA marketplace changes.

The walk-in centers allow consumers to talk directly with a health plan advisor or licensed Blue Cross agent.

“Of the many questions consumers have, the most common include cost, being able to determine subsidy eligibility and understanding the difference between products,” said Terry Burke, vice president for individual business, BCBSM.

In addition to the walk-in centers, Blue Cross Blue Shield of Michigan is hosting a number of community education sessions throughout the month of October

See the full story at BCBSM.com.

 

Insurers Targeting Younger, Healthier Consumers With Mobile

Insurers that are offering plans through the Affordable Care Act’s health insurance exchanges increasingly are turning to mobile applications to reach younger, healthier consumers, according to a PricewaterhouseCoopers Health Research Institute reportU.S. News & World Report reports.

The report’s authors suggested that insurers “build out data analytics and mobile strategies” that will target consumers ages 18 to 24. They added that “mobile apps will help customers gain access to important medical and cost information” (Slabodkin, FierceMobileHealthcare, 10/1).

See the full story at ihealthbeat.org.

Survey: Big Business May Shift Retirees, Part-Timers To Insurance Exchanges

Corporate America is taking a hard look at moving retirees and part-time workers into health insurance marketplaces created by the Affordable Care Act, suggests a survey by the National Business Group on Health.

To a lesser extent large companies also expect coverage for their full-time workers employee spouses to shift to the online, state-based marketplaces known as exchanges, according to the annual survey published Wednesday.

Read the full story at KaiserHealthNews.org

 

EveryMove 100 Health Insurance Index Launches

SEATTLE, WA — August 27, 2013 — EveryMove, Inc., an innovator in health rewards-based marketing and incentives, today introduced the EveryMove 100 Health Insurance IndexTM, the first ranking of the top 100 health insurance companies in the U.S. based on how they engage with and empower consumers to manage their own health. The EveryMove 100 can be found online https://everymove.org/everymove-100 including detail information about each company.

With a huge impending influx of consumers to the federal and state health insurance exchanges stemming from the implementation of the Affordable Care Act, the need for comparative information about health insurance companies is greater than ever. The EveryMove 100 evaluates plans using more than 50 metrics to arrive at an aggregate score that indicates how well they meet consumer needs for accessibility, motivation, community activism and overall satisfaction.

For more information go to EveryMove.org

 

Employer Mandate Delay will Drive Consumers into Exchanges, Experts Say

Insurers likely will see even more consumers shopping for coverage on the health insurance exchanges after the Obama administration delayed the reform law’s employer mandate.

The move could drive “a few million” more consumers to the online marketplaces, Larry Levitt, senior vice president for the Kaiser Family Foundation, told Bloomberg.

That’s because employees who would otherwise have received health coverage through their companies will be newly in the market for insurance.

Subscribe at FierceHealthPayer

Read more: FierceHealthPayer

 

 

CodeBaby Intelligent Virtual Assistant Becoming Important Tool For Healthcare Exchanges

CodeBaby, an intelligent virtual assistant  (IVA) technology provider is quickly becoming an important tool for healthcare exchanges interested in offering self-service and customer engagement solutions to help consumers select the appropriate health plan for their medical needs.

The technology features a 3D virtual assistant  named “Chloe”  designed to enhance individual enrollment tools already made available by the health plan or the exchange,  and to enhance member self-service capabilities.

Two exchanges have recently announced that they were adding CodeBaby to their platforms. CareFirst BlueCross BlueShield (CareFirst), the largest health insurer in the mid-Atlantic region, and Benefitfocus, a leading provider of cloud-based benefits software solutions for consumers, employers, insurance carriers and brokers. have signed on to use the CodeBaby technology.

Codebaby offers self-service and customer engagement solutions that enable the benefits health insurance and healthcare provider industries to increase online customer engagement, drive conversion objectives, and improve online self-service. Its benefits advisor solution, based in the cloud, guides and engages consumers and employees towards decisions on health exchanges and benefits platforms using a combination of interactive web elements, decision support tools, and emotionally expressive 3D intelligent virtual assistants.

For more information visit: http://www.codebaby.com/

Highmark Direct health insurance store to open in Erie, PA

PITTSBURGH (June 21, 2012) — Highmark Inc. announced today that it will open a Highmark Direct retail health insurance store in Erie, Pa. The store will be the ninth location in Pennsylvania.

“Across other parts of the state, the Highmark Direct stores have helped customers better understand health insurance and make more informed decisions about their health,” said Matt Fidler, Highmark vice president of consumerism and retail marketing. “With the addition of the Erie store, we’ll be able to reach even more Pennsylvanians who need health insurance support.”

Highmark opened its first two Highmark Direct stores in March 2009, added four stores in 2010 and two additional stores in 2011. Since inception, the stores have seen more than 144,000 visitors and provided health insurance to thousands of individuals and their families.

The Highmark Direct Erie store is scheduled to open in August and will be located at 5753 Peach Street in Kingswood Plaza. Eight additional employees will be hired as staff for the new store location.

Highmark Direct offers consumers in Highmark’s service area the opportunity to meet one-on-one with a health insurance specialist to discuss their health insurance options and their benefits as a Highmark member. The stores sell health insurance plans to individuals, seniors and small businesses, as well as ancillary products such as dental insurance, critical illness and accident insurance as well as a personalized genetic health program.

About Highmark
Highmark Inc., based in Pittsburgh, is an independent licensee of the Blue Cross and Blue Shield Association, an association of independent Blue Cross and Blue Shield plans. Highmark serves 4.9 million members in Pennsylvania, West Virginia and Delaware through the company’s health care benefits business and is one of the largest Blue plans in the nation. Highmark has 20,000 employees across the country and provides a broad range of health and wellness related services through subsidiary and affiliate companies. For more information, visit www.highmark.com.

 

Competing to Win: TriZetto Suggests Healthcare Payer Strategies for Growth in Emerging Retail Market

DENVER–(BUSINESS WIRE)–According to The TriZetto Group, as payers continue to make the necessary business changes to comply with reform, increase administrative efficiency, and improve the cost and quality of care, these organizations will face an additional challenge—competing to win in an emerging retail market.

“Rep. Eric Cantor says 10,000 baby boomers a day are becoming eligible for benefits”

To compete effectively, it is imperative that payers stand out from the crowd and differentiate themselves with new products that drive value, increase transparency, and create opportunities for collaboration with providers and other healthcare stakeholders.

Markets for Expansion and Growth

A winning strategy involves optimizing enterprise platforms, including core administration, network management and care managementsystems, through integration. The integration of these systems can help strengthen key lines of business that are poised for rapid growth in the wake of health reform. TriZetto has identified four major markets where expansion opens new opportunities for payers:

  • Individual market
  • Ancillary services
  • Medicaid managed care
  • Medicare managed care

Prepare for Newly Insured Individuals

Beginning in 2014, 24 million people are expected to enroll in health plans via exchanges.i Payers that invest in scalable, flexible enterprise systems that can be configured to respond to changing needs will have the agility to participate in a wide variety of new opportunities related to the burgeoning exchange market.

With integrated systems, payers can use clinical analytic tools to harness the rich data in their applications to strategically address the individual market, segment populations and proactively help high-risk members manage their own health effectively. System integration also helps optimize the enrollment, eligibility, renewal and billing/collection processes.

Diversify by Growing Ancillary Services

Health plans can differentiate their brands by growing ancillary services and extending these offerings to individuals who enter exchanges and to those who have only medical coverage. Research published in 2009 by the U.S. Bureau of Labor Statistics indicated that 71 percent of workers in private industry had access to medical care benefits, 46 percent had access to dental care benefits and 27 percent had access to vision care benefits.ii A major goal of growing ancillary services such as vision and dental is to capitalize on high-growth margins by providing coverage for services typically excluded or only partially reimbursed by health plans today.

To respond quickly to these new opportunities, payers need an enterprise-wide core administration system that maximizes efficiencies through greater automation and enables seamless transactions among providers, members and payers. In addition, integrated network management systems can help payers efficiently and accurately pay claims across multiple services and providers.

Prepare for Medicaid’s Shift to Managed Care

According to the Kaiser Family Foundation, about 70 percent of new Medicaid enrollees will enter managed care organizations.iii This shift from traditional fee-for-service Medicaid coverage creates opportunities for payers to enhance services that help manage care and control costs for a vulnerable population, as well as increase the number of those served under new and existing Medicaid managed care plans.

There are two key areas where IT investments may help drive payer success in the Medicaid market. First, healthcare analytics can help payers and providers identify high-risk populations and proactively manage care for these members. Analytics also can help payers model and compare the value and costs of clinical and incentive-based programs.

Second, technology for value-based insurance design, which incents members to manage their own care more effectively, also supports payer goals in the Medicaid market. By proactively engaging members with personalized wellness, support and educational programs through web portals, e-mail and other automated communications, payers can help improve member health and control costs.

Invest in the Growing Senior Market

With more than 10,000 people a day (i.e., approximately 3.5 million annually) becoming eligible for Medicare, the senior market cannot be ignored.iv Despite less favorable reimbursement rules, the shift from traditional Medicare fee-for-service to managed care continues to create opportunities for payers and providers to work collaboratively toward improving the cost and quality of care for seniors. These opportunities include:

  • Developing innovative payment structures such as pre-approved bundling of all provider services for an agreed-upon amount
  • Creating methodologies for sharing risk in collaborative care settings
  • Aligning incentives based on provider adherence to clinical protocols
  • Profiling segments of members to find new ways to attract seniors who expect retail-type
  • services and personalized care
  • Managing seniors collectively who have both commercial and Medicare coverage

The emerging retail market presents compelling opportunities for profitable growth. Watch for healthcare payer organizations to leverage technology-enabled business solutions to compete and win in this new, evolving market.

About TriZetto

TriZetto provides world-class healthcare IT software and service solutions that drive administrative efficiency, improve the cost and quality of care, and increase payer and provider collaboration and connectivity. TriZetto solutions, many of which are patented or patent-pending, touch half the U.S. insured population and reach more than 21,000 physician practices. TriZetto’s payer offerings include enterprise and component softwaremanaged application services, managed business services and consulting services. Provider offerings, delivered through TriZetto’s Gateway EDI wholly owned subsidiary, include tools and services that monitor, catch and fix claims issues before they can impact a practice. TriZetto’s integrated payer-provider platform will enable deployment of promising new models of post-reform healthcare. For information, visit www.trizetto.com.

Footnotes

i. Pear, Robert, “Heath Care Overhaul Depends on States’ Insurance Exchanges,” The New York Times, Oct. 23, 2010
ii. U.S. Bureau of Labor Statistics, “Spotlight on Statistics,” November 2009. http://www.bls.gov/spotlight/2009/health_care/
iii. Kaiser Family Foundation, “Medicaid and Managed Care: Key Data, Trends, and Issues,” The Kaiser Commission on Medicaid and the Uninsured. February 2010. http://www.kff.org/medicaid/upload/8046.pdf
iv. PolitiFact.com, “Rep. Eric Cantor says 10,000 baby boomers a day are becoming eligible for benefits,” Richmond Times Dispatch, May 4, 2011.http://www.politifact.com/virginia/statements/2011/may/04/eric-cantor/rep-eric-cantor-says-10000-baby-boomers-day-are-be/

 

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