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

August 12, 2008

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; 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

July 16, 2008

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

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

July 16, 2008

(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.”

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

June 23, 2008

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

June 23, 2008

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

Blue Cross Blue Shield of Illinois Increasing Individual Rates!

May 8, 2008

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)