BCBSNC, UNC Health Care Announce Partnership To Launch Novel Patient-Centered Practice

CHAPEL HILL – The state’s leading health insurer and the state’s health care system will collaborate to develop a completely new type of medical practice in which patients – not just their symptoms – are the focus of care. This advanced medical practice will extend beyond what is currently called the ‘medical home’ and will enable teams of health care providers to work collaboratively with patients and families in delivering high quality, coordinated care. BCBSNC and UNC Health Care expect the new practice, which will likely be located in Orange or Durham county, to open in the fourth quarter of 2011.

This venture would be the first product of what BCBSNC and UNC Health Care expect will be an ongoing collaboration in which they work together to enhance health care quality, improve efficiency and effectiveness, and reduce healthcare costs.

“The team approach to care emphasizes patient involvement and allows more time for clinical interaction and patient education and support,” said BCBSNC President and CEO Brad Wilson. “We believe this approach will result in improved health and fewer complications – both of which will help control rising health care costs.”

“We’re in an era of change in health care, so let’s work together to make positive change,” said Dr. William L. Roper, CEO of UNC Health Care.  “This innovative approach with education, patient support and self-management is one important step toward making health care less mysterious and more effective.”

The practice will care for 5,000 BCBSNC members focusing on patients with chronic conditions, including coronary artery disease, hypertension, diabetes, obstructive lung disease, major depression, and asthma. 

The new practice will provide continuity by coordinating care across a variety of settings and provider types. The practice is designed to enable more effective patient-provider interactions, which should result in better patient satisfaction and improved health. Additionally, this practice will provide an expanded set of services and greatly enhanced access to these services including:

  • Non-traditional visit formats (e-visits, televisits, home monitoring)
  • On-site mental health
  • On-site nutritionist
  • On-site pharmacy and medication management
  • On-site laboratory
  • Case management and coordination of care for patients requiring hospitalization
  • Group and educational visits
  • Extended weekday and weekend hours
  • State-of-the-art information technology

About BCBSNC: 
Blue Cross and Blue Shield of North Carolina is a leader in delivering innovative health care products, services and information to more than 3.7 million members, including approximately 900,000 served on behalf of other Blue Plans. For 77 years, the company has served its customers by offering health insurance at a competitive price and has served the people of North Carolina through support of community organizations, programs and events that promote good health. Blue Cross and Blue Shield of North Carolina is an independent licensee of the Blue Cross and Blue Shield Association. Access BCBSNC online at http://www.bcbsnc.com.

About UNC Health Care:
The UNC Health Care System is a not-for-profit integrated health care system owned by the state of North Carolina and based in Chapel Hill. It exists to further the teaching mission of the University of North Carolina and to provide state-of-the-art patient care. UNC Health Care is comprised of UNC Hospitals, ranked consistently among the best medical centers in the country; the UNC School of Medicine, a nationally eminent research institution; community practices; home health and hospice services in seven central North Carolina counties; and Rex Healthcare and its provider network in Wake County. Although this new practice will only provide care for BCBSNC members, UNC Health Care’s other physician offices, hospitals and facilities will continue to provide care for patients with all types of insurance and those without insurance.

PA Hospitals Blame Consumer-driven Health Plans for Financial, Health Woes.

A group of hospital officials in Pennsylvania came out this week with statements saying that consumer-driven health plans are making people sicker, not healthier, and hurting the financial health of hospitals.

According to a news story that originally appeared in The Patriot-News, Carolyn F. Scanlan, the president and CEO of the Hospital and Healthsystem Association of Pennsylvania, along with executives of PinnacleHealth System and Penn State Milton S. Hershey Medical Center, had met with the paper’s editorial board to discuss the impact of the nation’s economic crisis on hospitals.

The paper reported that a major concern of the group was the impact of consumer-driven health plans. Such plans typically have high deductibles and co-pays, making patients responsible for larger portions of bills than under traditional plans.

A goal of the plans is to motivate consumers to spend more carefully, and give them a financial incentive to take better care of themselves so they don’t need as much health care.

But, the story noted, Pinnacle and Hershey Medical Center officials said the plans are causing people to avoid health care.

They cited declines in preventive care such as mammograms, and elective surgeries such as hip and knee replacements that might not be medically necessary, but improve patients’ lives.

The hospital officials reportedly told the newspaper that patients with consumer-directed plans often don’t realize how large their shares of bills will be and that it’s common for patients to cancel procedures upon learning how much they will have to pay.

Another concern of the hospitals is rising charity care and bad debt, the paper reported. Hershey Medical Center has spent $13 million on charity care during the fiscal year that ends in June. Bill Pugh, the chief financial officer at Pinnacle, said bad debt rose 25 percent there in 2008.

There is little doubt that the recession is causing health coverage issues for many Americans, but to blame consumer-driven health plans is simply short-sighted on the part of the hospitals.

The plans that carry higher deductibles may cause people to think twice about seeking elective surgeries – that is what they are intended to do. But there should not be an impact on prevention as most consumer-driven plans pay 100% for preventative services. In fact, the Blue Cross Blue Shield Association and others with considerable statistical data to back them up say that persons with consumer-driven plans are taking better care of themselves than do those with more traditional plans.

There is also no reason to suspect that these types of plans are increasing bad debt to the degree that the hospitals are witnessing. Again, while most consumer-driven health plans carry a little higher deductible, they also include features like Health Reimbursement Arrangements (HRAs) and Health Savings Accounts (HSAs) that help members fund the deductibles with pre-tax dollars, in many cases some or all of these dollars are furnished by the employer. Furthermore, once the deductible is reached these plans usually pay for 100% of covered services as opposed to traditional plans that have long co-payment corridors where the cost of care continues to be shared by the patient long after the deductible has been satisfied.

No, the health plans are not to blame for the woes of the hospitals. Instead, I would suggest that it’s the hospital’s dependence on a system where there is no pricing transparency and where rich benefit plans provide no incentives for the hospitals to become more efficient.

Here’s a news flash: The money is running out. There will be no more first-dollar plans that completely insulate the patient from the cost of the service.

Instead, these facilities need to embrace the change and become more consumer-focused. Lasicks eye surgery is a great example of an elective procedure that is not typically covered by health insurance. Over the years the price has come down considerably and the quality has improved.

Rather than blame a health plan design for their troubles, perhaps these hospitals should spend some time with the Geisinger Health System just down the road from them. As was noted recently in this blog, Geisinger, located in the coal country of Pennsylvania, offers a 90-day warranty on elective heart surgery, promising to get it right the first time, for a flat fee.

Not only does the health system guarantee its work, but heart patients have fared measurably better, and the health system has cut its bypass surgery costs by 15 percent. Today, Geisinger has extended the program to half a dozen other procedures.

As I pointed out in my post about Geisinger, it is disappointing to learn that “best practices” like those being demonstrated at Geisinger are not being embraced by the health care industry.

Visa Pre-Paid Forum will Address use of Stored-Value Cards in Health Care

pjLater this afternoon I will be making my way to Phoenix for the annual Visa Prepaid Forum. This is the event hosted yearly by the people at Visa who work to bring us those stored value cards like the gift cards that look and operate pretty much like a bank debit card. The Forum will attract banks, merchants, card processors, and others involved in making pre-paid cards work.

Among this group will be a smaller subset of health care people who will break out after the General Sessions to focus on the use of stored value cards to facilitate the use of various account-based health plans including Health Reimbursement Arrangements (HRAs) and Flexible Spending Accounts (FSAs).

The big topic of discussion over the past couple of years, and the one likely to dominate the discussion this year as well, is how to make these cards compliant with IRS guidelines. As of January 1, 2008, the IRS required ‘non-healthcare’ retailers, such as supermarkets, grocery stores, discount stores, warehouse clubs, and mail-order merchants, that sell medical goods and services to maintain a point-of-sale system that effectively identifies eligible transactions when consumers use flexible spending account (FSA) and health reimbursement arrangement (HRA) debit cards.

Fort the past couple of years, the Special Interest Group for IIAS Standards (SIGIS), has worked to develop its a voluntary industry standard solution to meet IRS requirements for operating an inventory information approval system (an “IIAS”). IIAS-compliant transactions enable real-time, auto-substantiation for eligible medical items purchased with an FSA/HRA payment card. For more information see: http://www.sig-is.org/en/index.asp.

Visa Healthcare has been a driving force in the development of the IIAS Standards and will no doubt have new information to present during the forum.

Time permitting; I will be blogging from the conference, so check here for updates.

New Study Shows Lower Costs in Account-Based Health Plans: HSAs & HRAs

It is great to see another study that confirms that market forces combined with transparency in pricing and quality measures can produce lower prices and better quality — just as they have in every other industry where they have been applied.

On Tuesday, HealthPartners, the largest consumer-governed, nonprofit health care organization in the nation confirmed the findings of reported last week by CIGNA that Consumer-Driven Health Care is effective in lowering medical costs and better engaging consumers to seek out more cost effective care.

A press release issued by the health plan stated that the analysis showed that even when adjusted for illness burden, health care costs were 4.4 percent lower for HealthPartners members in these consumer directed health plans compared to members in traditional plans. Researchers found the lower costs were driven by CDHP members receiving care from lower cost providers and that providers used fewer resources such as diagnostic imaging and other procedures.

Proponents of consumer-driven health care have long argued that given incentives and proper tools, persons will take an active role in making health care purchasing decisions just as they do with purchases of other goods and services. The HeathPartners study bears out this theory in that researchers also found that members with CDHPs were more likely to use Web-based tools that provide information on health care costs and quality. The study found members with consumer-directed plans were twice as likely to access HealthPartners Medical Cost Calculator which has cost information for 93 high frequency procedures or conditions from ear infection to coronary artery bypass surgery.

Finally, the study, that examined the experience of members in both HRAs and HSAs*, provided evidence that members, including those with chronic illness, are getting care they need.

HealthPartners, based in Bloomington, MN, was founded in 1957 and has more than 640,000 members in Minnesota, western Wisconsin, North and South Dakota and Iowa.

*As defined by the report:

Health savings account (HSA). An account into which either or both the employer and the individual can make tax-free contributions up to an IRS defined annual maximum. Participants must be enrolled in a high deductible health plan (HDHP) to contribute to an HSA. Any money left over at the end of the calendar year is rolled over to the next year. Funds belong to the individual and are portable through employment changes.
Health Reimbursement Arrangements are set up by the employer for the employees benefit and are typically paired with a deductible health plan. Only employers can make contributions into an HRA. The account belongs to the employer and is not portable through employment changes. Employers may allow access to HRA funds for medical expenses post employment, but in typical plan designs funds revert back to the employer upon termination.

Read the study summary.

tag: , ,