Blue Cross Blue Shield of Illinois loses contract with Wal-Mart

Blue Cross and Blue Shield of Illinois, the state’s largest health insurer, soon will no longer administer claims and provide customer service to employees of Wal-Mart Stores Inc., the world’s largest retailer, losing the business to another Blue Cross plan in Arkansas.

Starting in January 2010, Illinois Blue Cross won’t be performing administrative functions, such as staffing customer-service call centers, for employees of Wal-Mart, the health plan confirmed. Wal-Mart employees in the state still should be able to access benefits through Illinois Blue Cross because the new contract is largely related to behind-the-scenes work, the insurer said.

Such administrative tasks will begin in 2010 to transition over to Arkansas Blue Cross and Blue Shield, Illinois Blue Cross said.

Illinois Blue Cross would not disclose the financial impact of this change. Bentonville, Ark.-based Wal-Mart has more than 1.4 million U.S. employees and is known for its clout in negotiating with its many vendors.

“The membership in our four states will still be captured as part of our market share,” Illinois Blue Cross spokesman Jack Segalsaid of its parent, Chicago-based Health Care Service Corp., which also operates three other Blue Cross plans in Oklahoma, Texas and New Mexico.

In its new role, Health Care Service’s four Blue Cross providers will “become what’s known as ‘host plans’ for Wal-Mart’s approximately 200,000 members that live in our four states,” Segal said. “As host plans, we’ll provide our [medical-care provider] networks and our discounts, continue to reimburse providers and continue to determine claims pricing.”

As a home plan, Illinois Blue Cross has 445,000 members at Wal-Mart.

Wal-Mart would not confirm the change in the contract or financial terms of its relationships with any of the Blue Cross plans that process its health care.

“We regularly assess the quality and costs of the health-care plans offered by our providers, including those plans owned by Health Care Service Corp., and we don’t have any changes to those plans to announce at this time,” said Greg Rossiter, spokesman for Wal-Mart.

But Illinois Blue Cross said, “Wal-Mart was looking to consolidate into a single platform, so Arkansas [Blue Cross] decided to take this on and become the single home plan or administrator.”

Until the transition, Illinois Blue Cross will continue to share administrative duties with the Arkansas Blue Cross plan and Blue Cross and Blue Shield of Alabama.

Health Care Service had $865 million in net income last year on $14.3 billion in premium revenue. The nation’s fourth-largest insurer, the Chicago company has 12.4 million members, including 7.4 million in Illinois.

Blue Cross and Blue Shield of Illinois Announces Its Intent Not to Pay for Additional Costs Resulting From ‘Never Events’

CHICAGO, Aug. 11 — Blue Cross and Blue Shield of Illinois (BCBSIL) announced today its intent not to pay for costs resulting from hospital-based preventable medical errors known as “serious hospital acquired conditions” and “never events” (errors in patient care that can and should be prevented). BCBSIL said it will work with hospitals in its networks to put this new approach into operation and ensure that members are held harmless financially when these events occur.

In addition, BCBSIL reiterated its longstanding commitment to collaborating with contracted network providers to prevent medical errors before they occur.

“Blue Cross’ goal for years has been to work to prevent medical errors, which often go undetected. To this end, Blue Cross has and will continue to collaborate with hospitals and physicians in our communities to promote quality and safety and prevent medical errors before they threaten patients’ health and add to the cost of care,” Scott Sarran, MD, BCBSIL’s chief medical officer, said.

For years, BCBSIL has participated in initiatives designed to prevent medical errors. In 2001, for example, BCBSIL began an outcomes-based reimbursement program that provides incentives to hospitals when they provide care without complications. Designed to enhance quality and safety, this approach can reduce employer groups’ claims costs if hospitals’ services do not meet established quality criteria.

In addition to payment methodologies, BCBSIL participates in a variety of initiatives designed to help prevent medical errors, including:

* — Rewarding BCBSIL PPO and HMO physicians who complete the American Board of Medical Specialties’ Patient Safety Improvement Program, which addresses a host of inpatient and outpatient safety issues;
* — Encouraging hospitals (through letters, personal meetings, Blue Cross’ “Hospital Profile” scoring, and public reporting) to comply with and make public information about their progress towards meeting The Leapfrog Group’s patient safety standards. The Leapfrog Group’s goal is to reduce preventable medical errors and improve the quality and affordability of health care;
* — Measuring and reporting diverse indicators of hospital quality and patient safety. For the past six years, the results from the BCBSIL profile have been sent to hospital CEOs, and receive the attention of senior management;
* — Annually collecting data from Illinois hospitals on their participation in state and national patient safety and quality improvement programs and their procedures for addressing “near misses;”
* — Making information about hospital quality and safety available to members via our Blue Star Hospital Report, which is available at http://www.bcbsil.com; and
* — Starting up and providing the first $1 million in funding for a statewide e-prescribing system, which is open to network physicians, health insurance carriers, pharmacies, technology providers, professional societies, and others. Since its inception in April 2007, participating physicians have written approximately 467,500 electronic prescriptions – 41,573 in June 2008 alone. Moreover, in June, the system, which is designed to help prevent medication errors, detected more than 4,500 potential negative drug interactions, of which nearly 19% resulted in a change or cancellation of the proposed prescription. In addition, in June, the system detected more than 700 potential allergic reactions. As a result, physicians changed or cancelled more than 8% of prescriptions.

Blue Cross Blue Shield of Illinois reducing EOB mailings

Effective July 13, 2008, Blue Cross Blue Shield of Illinois will no longer print and mail Explanation of Benefits (EOBs) that relate to all patient share zero liability claims. Zero liability claims are those claims that are covered and paid for by Blue Cross and Blue Shield of Illinois and do not require any additional payment by members. Zero liability claims can still be viewed and downloaded online through Blue Access® for Members at www.bcbsil.com/members.

In mid-December, 2008, Blue Cross Blue Shield of Illinois will begin to bundle all EOBs into one envelope on a weekly basis. However, any EOB accompanied by a check will be excluded from the bundling process and instead will be immediately mailed.

Blue Cross Blue Shield Companies report Wellness Programs have Financial, Health Benefits

(BestWire Services Via Acquire Media NewsEdge)
An increasing number of employers are participating in employee health and wellness programs in a bid to reduce health care costs due to chronic illnesses, officials from Blue Cross Blue Shield companies and the National Business Group on Health announced. The Blue Cross Blue Shield Association of America also released a new report finding that workplace education efforts can increase worker participation in wellness programs by 21% or more.

Joined by participating companies, the insurers were in the nation’s capital to lobby Congress on the benefits of wellness programs.

With chronic conditions such as heart disease, diabetes, obesity and smoking accounting for approximately 75% of health care costs, employers have a strong incentive to utilize workplace wellness programs, panelists said at the National Press Club. Blues’ representatives did not provide national statistics on how many companies and employees have joined such plans.

Dr. Douglas Woll, senior vice president and chief medical officer for the Blue Cross Network of Michigan, said the nonprofit insurer gave participating member companies an up-front 10% discount on health insurance premiums in exchange for enacting health and wellness programs. In less than two years, 575 employers with 75,000 employees have signed up, a figure that is growing by about 1,000 employees monthly.

Insurers began offering wellness, disease management programs and pharmacy benefit management services over the past decade because they learned that employers were willing to pay for them, according to Edward Kaplan, national health practice leader with the Segal Co., a New York-based employee benefits consulting firm. These programs also are helping insurers boost revenue in an environment where they?re struggling to grow membership, he said (BestWire, June 16, 2008).

While anecdotal and qualitative findings show increased participation by employers and employees, Blue Cross and Blue Shield of North Carolina Vice President and Chief Medical Officer Don Bradley said insurers have to show hard numbers verifying cost savings from wellness programs.

Otherwise, he said, “I’ll be polishing up my resume.”

Blue Cross Blue Shield of Illinois and Advocate Health Care renew contract through 2010

Effective June 19, 2008, Blue Cross and Blue Shield of Illinois and Advocate Health Care have announced they have reached an agreement that renews all of their contractual relationships through 2010. The newly signed contract will include all of the Advocate hospitals and expand to include Libertyville’s Condell Medical Center when its expected integration into Advocate Health Care is approved by federal and state agencies later this year.

Michael Reese Physician Group no longer participating in BCBS of Illinois’ HMO Illinois or Blue Advantage HMO

Effective October 1, 2008 the Michael Reese Physicians Group MG-189 will no longer participate in HMO Illinois or Blue Advantage HMO networks. There are approximately 6,000 members and 63 physicians impacted as a result of this medical group closing.

Letters will be sent to these members and their employers by end of June, and will inform members of the medical group closing along with the option to select a new physician group. If a member does not select a new physician group by Friday, August 22, Blue Cross Blue Shield of Illinois will automatically reassign them to a new medical group for an effective date of 10/1/08.

Cape Radiology Group Terminates PPO Contract with Blue Cross Blue Shield of Illinois

Cape Radiology Group of Southern Illinois has terminated their PPO contract with BCBSIL. Cape Radiology Group is a group of radiologists that are on staff at the following Southern Illinois PPO Hospitals:
• Memorial Hospital – Carbondale
• Carbondale Clinic – Carbondale (This is a professional provider satellite of Memorial Hospital)
• Herrin Hospital – Herrin
• St. Joseph Hospital – Murphysboro
• Union County Hospital – Anna

Because Cape Radiology is the exclusive radiology group contracted with the above facilities, all inpatient and outpatient radiological services are subject to non-PPO benefits. The member may be responsible for the balance billing above the amount covered under their group benefit plan. Notification letters went out last week to all group and individual market members who reside in the service areas of the above hospitals. Letters are also going to all employer groups affected by their employees residency in the service areas. To find a radiologist in the BCBS IL PPO network, use the Provider Finder on www.bcbsil.com.

Additional Blue Cross Blue Shield of Illinois Vision Program changes effective July 1st, 2008

As part of our BlueExtras discount program, Blue Cross Blue Shield of Illinois has arranged a vision discount program that offers all group members discounts on eye exams, contact lenses, frames, lenses and lens add-ons.

In addition, as part of their health care benefits, HMO members have a vision benefit that provides coverage for one eye exam every 12 months for the cost of their PCP copayment, when they visit a network provider. All HMO members are eligible to receive this vision benefit, independent of any vision benefit (materials allowance) your company may have elected to provide for your employees. Effective July 1, 2008, both the HMO vision discount program and vision benefit will be administered by Davis Vision, Inc. Davis Vision began administering the vision discount program for non-HMO groups on January 1, 2008.

All group members also have access to discounts on laser vision correction through Davis Vision, featuring the TruVision network (Yes, the network Tiger Woods endorses). Members can receive discounted pricing on disposable contact lenses through Davis Vision’s Lens 1 2 3 Mail Order Contact Lens Replacement Program.

Blue Cross Blue Shield of Illinois Increasing Individual Rates!

Effective July 1, 2008, Blue Cross® and Blue Shield® of Illinois will be raising rates on their individual health insurance plans. If you are planning to get a new BCBS of IL policy, apply online ASAP to get new business rates and avoid the price increases. The plans will be increasing as follows:

* HSA Products (9.0% increase)
o BlueEdge Individual HSA
o BlueEdge Individual HSA 5000

* Series 3 Affordable Products (9.0% increase)
o SelectBlue Advantage
o BlueValue Advantage
o BlueChoice Select
o BlueChoice Value

* Series 3 Products (12.6% increase)
o Select Blue
o Basic Blue
o BlueValue
o Traditional Blue

* Select TEMP (11.7% increase)

Blue Cross Blue Shield of Illinois Adds New $3,500 Deductible Plans Added to the Small Group (2-150) Portfolio

Effective July 1, 2008, for small group (2-150) new business and thereafter for renewing accounts, Blue Cross and Blue Shield of Illinois will introduce 17 new $3,500 deductible benefit plans to the Standard Products portfolio. The plans will be available with the following products:

• BlueChoice Select ® – 2 new plans
• BlueAdvantageSM Entrepreneur PPO (BAE) – 4 new plans
• BluePrint PPO – 10 new plans
• PPO Value Choice – 1 new plan

On average the new plan options will offer a 5 percent savings groups that have the $2,500 deductible plan with the same benefit design and will be available for quoting in mid-April.