Category Archives: Managed Care

Capital BlueCross, PinnacleHealth System Team Up to Bring Employers a New Health Insurance Option

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HARRISBURG, Pa., Jan. 13, 2014 /PRNewswire/ — Capital BlueCross and PinnacleHealth System are teaming up to offer businesses a unique new health insurance plan for their employees. Marketed as CareConnect Point of Service (CareConnect), this plan connects the benefits and services of Capital BlueCross with the physicians and facilities of PinnacleHealth. It is powered by the two-year-old accountable care arrangement between the two companies.

“It is incumbent upon insurers and health care providers to find innovative ways to help employers achieve workforce health goals and lower costs,” said Gary D. St. Hilaire, Capital BlueCross president & CEO. “CareConnect offers this service and PinnacleHealth’s reputation as a trusted provider makes this plan really attractive to businesses seeking the best possible care for their employees.”  Continue reading →

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Horizon BCBSNJ Launches Patient-Centered Pediatric Program that Puts Focus on Improving the Health of Children and Families

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Newark, NJ (PRWEB) – Horizon Blue Cross Blue Shield of New Jersey has announced that it is launching a new, family-focused program to improve the health of children. This is Horizon BCBSNJ’s first patient-centered program dedicated to pediatric care.

Horizon BCBSNJ says its new Patient-Centered Pediatric Program will initially benefit more than 100,000 pediatric members. More than 630 pediatricians and family practice doctors at over 110 practice locations throughout New Jersey will be participating in the initiative, which launches on January 1, 2014.

According to a company release, this program was developed over the past year in close collaboration with pediatricians, family practice physicians, practice managers and leadership of the New Jersey Chapter, American Academy of Pediatrics.

The health plan describes the initiative as a “value-based program” that reinforces the role of pediatricians and family doctors to effectively coordinate all the health care needs of their patients so that children and their families receive the highest quality of care, in the right setting and at the right time. – See more at HorizonBlue.com

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PwC’s Health Research Institute Identifies the Top 10 Health Industry Issues for 2014

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NEW YORK, /PRNewswire/ — Implementation of the Affordable Care Act (ACA) is only one of the factors forcing a rapid reshaping of the $2.8 trillion U.S. healthcare industry in 2014 according to PwC’s Health Research Institute (HRI). In its annual report on the Top Health Industry Issues for 2014, PwC’s HRI identifies the top 10 issues facing the U.S. health sector this year, including the need to adjust to empowered consumers, rapid innovation, and increasing competition from non-traditional players. The report includes the results of a survey of 1,000 U.S. consumers and interviews with health industry leaders that provide insights into the emerging new health economy.

The report notes that much of the health industry has accepted that reform is here to stay – and forward-looking executives are making decisions based on a post-ACA landscape that has altered the provision of insurance and the delivery of care. Continue reading →

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ReAdmission Solutions Launches Pilot with Independence Blue Cross to Prevent Hospital Readmissions

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PHILADELPHIA and NEW YORK, Dec. 16, 2013 /PRNewswire/ — Independence Blue Cross (IBC) and ReAdmission Solutions, LLC (RAS) today announced they have signed a letter of agreement to implement a pilot program to prevent hospital readmissions. RAS will conduct the pilot for IBC Keystone 65 and Personal Choice 65 Medicare Advantage members.

According to a joint statement, the objective of the pilot is to prevent hospital readmissions for members regardless of the patient’s diagnosis or the hospital where they treated. It is expected that the first phase of the pilot will run 90-120 days and include 180 hospitalized IBC Medicare Advantage members, which is considered a statistically valid sample to determine effectiveness.

The statement noted that ReAdmission Solutions will provide a registered nurse clinical coordinator to coordinate discharge planning and post acute care with hospital staff and other healthcare professionals. – See more details at PRNewswire.com.

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Cigna ACO Showing Higher Quality, Lower Costs in First Year

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CONCORD, N.H. & BLOOMFIELD, Conn., December 11, 2013 – Cigna today is reporting on the first-year results from its collaborative accountable care initiative with Granite Healthcare Network (GHN), a partnership among five independent charitable health care organizations in New Hampshire.

According to a Cigna release, the program is making strides toward achieving its goals of improved health, affordability and patient experience.They also say the initiative has helped GHN deliver a higher level of care in New Hampshire while controlling total medical costs for its 30,000 patients who are covered by a Cigna health plan.

Cigna noted that when the program started last year, it evaluated how well GHN followed nationally recognized evidence based medicine guidelines (a measure of quality) and Continue reading →

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Aetna, PinnacleHealth System Form Accountable Care Relationship

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Aetna and PinnacleHealth System recently announced a new accountable care agreement that is designed to improve the quality of care and lower overall health care costs for Aetna commercial plan members in the Harrisburg, Pa., area.

According to a release issued by Aetna, the collaboration will use PinnacleHealth’s comprehensive, integrated system of physicians, hospitals and ambulatory services to give area employers better health care options for their employees by:

  • Creating a more coordinated patient experience;
  • Saving employees money when they use providers aligned with PinnacleHealth; and
  • Improving health care outcomes.

Aetna says it will introduce both fully insured and self-insured health plans in Central Pennsylvania that will use PinnacleHealth’s community-based systems of care and its network of highly respected physicians. The first product, for groups of more than 51 employees, will be available on April 1, 2014. A small-group product for groups of between two and 50 employees will be introduced July 1, 2014. – See aetna.com for more details.

 

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Will ACOs Usher in a New Era of HMO-Style Managed Care?

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Amber May has published an article on BenefitsPro.com that recalls a time in the 1990s when HMOs were the biggest thing in health care. She points out that the most obvious benefit of an HMO system is the coordination of care the organizations facilitate and how, since 1995, the National Health Insurance Law in Israel made participation in one of the four Israeli HMOs compulsory for all Israeli citizens.

May points out that once again the United States is experimenting with managed care. She notes that the Patient Protection and Affordable Care Act (PPACA) is attempting to address the lack of care coordination that’s developed in the American health care system by creating provisions for accountable care organizations (ACOS), coordinated groups of health care providers that provide care for specific populations of patients and are accountable for the quality, cost and outcomes of that care.

She notes that through PPACA, ACOs are tied to Medicare and speculates that a universal managed care system similar to Israel’s may be a long way off for the U.S. – To learn more see benefitspro.com.

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National Network of Post-Acute Care Providers Formed to Serve ACOs

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As Accountable Care Organizations (ACOs) begin to change the patient care model nationwide, coordination of care between acute and post-acute care providers is an important component for ACO success.

ACOs will need to partner with  Long Term Care (LTC) pharmacies, Home Infusion and Specialty pharmacies, HME and Respiratory providers, and Long Term Care facilities including Skilled Nursing, Assisted Living and Rehabilitation facilities.

To address this issue, Managed Health Care Associates, Inc. (MHA), a health care services and technology company focused on alternate site health care providers, has announced the formation of the MHA ACO Network. MHA says that by working with both Commercial and Medicare Accountable Care Organizations (ACOs), the MHA ACO Network will provide access to the largest national network of alternate site post-acute care providers in the country. – For more information, visit www.mhainc.com.

 

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Blue Cross Blue Shield of Michigan and Munson Healthcare Embrace New Approach to Reimbursement

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Nov. 12, 2013 – TRAVERSE CITY, Mich. — Munson Healthcare and Blue Cross Blue Shield of Michigan say they are launching a new value-based hospital reimbursement agreement in northern Michigan designed to improve patient care and medical outcomes while also enhancing efficiency and holding down the cost of care.

According to a press release posted on BCSCM.com, their agreement provides a fair base-rate increase in reimbursement from BCBSM to the hospital. In addition Blue Cross will reward the hospitals with a share of the savings achieved when hospitals and physicians coordinate the delivery of efficient and effective care, eliminate reuse and overuse of care, and prevent re-hospitalizations. Continue reading →

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New Horizon Blue Cross Blue Shield of New Jersey Product Brings Innovative Accountable Care Model to Employers

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Newark, NJ – November 7, 2013) – Horizon Blue Cross Blue Shield of New Jersey (BCBSNJ), which has been leading an effort with physicians, hospitals and health care leaders throughout the state to transform how health care is delivered, has developed a new product for employers to encourage employees to use physicians focused on improving the value of care patients receive, rather than the volume of care. The goal of the new product is to increase the number of Horizon BCBSNJ members who will seek care in patient-centered practices to improve patient outcomes and reduce overall health care costs.

The new product – the Horizon Patient-Centered Advantage EPO Plan – is now being offered to fully-insured employer groups for coverage that becomes effective on January 1, 2014.

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