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.

Tags: bcbsil, Blue Cross Blue Shield, Blue Cross Blue Shield of Illinois, health care, health insurance, illinois health insurance

The Treasury Department and Internal Revenue Service recently released 2009 guidelines for maximum contribution levels for Health Savings Accounts (HSAs) and out-of-pocket spending limits for high deductible health plans (HDHPs) that must be used in conjunction with HSAs. The 2009 IRS requirements are:

Minimum Deductible: $1,150 single plan; $2,300 family plan
Maximum Out-of-Pocket: $5800 single plan; $11,600 family plan
Contribution Maximum: $3,000 single plan; $5950 family plan

New Annual Contribution Levels for HSAs

• The maximum annual HSA contribution for an eligible individual with self-only coverage is $3,000.

• For family coverage, the maximum annual HSA contribution is $5,950.

• Catch-up contribution for individuals who are 55 or older is increased to $1,000 for 2009 and all
years going forward.

• Individuals who are eligible individuals on the first day of the last month of the taxable year (December 1 for most taxpayers) are allowed to make the full annual contribution (plus catch up
contribution, if 55 or older by year end), regardless of the number of months the individual was an eligible individual in the year. For individuals who do not maintain eligibility for the 13-month
testing period following that date, both the HSA contribution and catch-up contribution should be prorated based on the number of months of the year a taxpayer was an eligible individual. New Amounts for Out-of-Pocket Spending on HSA-Compatible HDHPs

• The maximum annual out-of-pocket amount for HDHP self-coverage increases to $5,800. The maximum annual out-of-pocket amount for HDHP family coverage is twice that at $11,600. Minimum Deductible Amounts for HSA-Compatible HDHPs

• The minimum deductible for HDHPs increases to $1,150 for self-only coverage and $2,300 for family coverage. In addition, a fiscal year plan that satisfies the requirements for an HDHP on the first day of the first month of its fiscal year may apply that deductible for the entire fiscal year.

Tags: health insurance, Health Savings Accounts, hsa, irs, irs insurance

The Assurant Health MaxPlan, CoreMed, and OneDeductible now include TelaDoc, a service that offers physician access—24 hours a day, 7 days a week, and 365 days a year. When members need non-emergency medical care, they can call TelaDoc from anywhere and let the doctor come to
them by phone, and, in most cases, in less than an hour.

Members with the MaxPlax and CoreMed plans designed without an office visit copay will receive 3 free telephone consultations per person each year and additional consultations are only $35 each.

Members with the OneDeductible plan will be charged $35 for each consultation, and are covered, subject to deductible and coinsurance. New members will receive registration information with their new policy welcome packets.

Tags: 24/7 physician access, Assurant, health insurance, phone consultation, phone physician, teladoc

NEW YORK (Reuters) – UnitedHealth Group Inc on Tuesday reported a 72 percent drop in quarterly profit on a big charge from a legal settlement and challenges in its businesses serving seniors and employers, although its results surpassed previously lowered expectations.

The largest U.S. health insurer by market value said second-quarter net earnings fell to $337 million, or 27 cents per share, from $1.23 billion, or 89 cents per share, a year earlier.

Excluding items, UnitedHealth earned 67 cents per share, 2 cents ahead of the analysts’ average forecast, according to Reuters Estimates.

Earlier this month, UnitedHealth estimated earnings for the quarter at 64 cents to 66 cents per share, excluding special items, far below analysts’ forecasts at the time.

Second-quarter revenue rose 6.7 percent to $20.3 billion.

Earnings from operations at its main health-care benefits unit fell 35 percent to $1.14 billion.

Pressure in its commercial business serving employers — where the company has cited tough competition — hurt margins and enrollment. Membership in the company’s plans for which it assumes full insurance risk fell by 95,000 from the first quarter to about 10.5 million members.

Profitability in the company’s Medicare business for seniors also was under pressure, as the company offered overly attractive benefits to those with special-needs plans.

The company’s consolidated medical care ratio, which measures the portion of premiums spent on medical costs, worsened to 83.2 percent from 80.3 percent a year ago.

Overall, the Minneapolis-based company provided medical benefits to 32.68 million members at the end of the quarter.

The company said it still expected full-year adjusted earnings per share of $2.95 to $3.05. UnitedHealth lowered the outlook earlier this month, marking the second such reduction to initial 2008 expectations.

UnitedHealth shares have fallen 59 percent so far this year, worse than the 44 percent drop for the Morgan Stanley Healthcare Payor index , amid setbacks for its commercial business for employers and Medicare plans for seniors.

The company earlier this month agreed to pay more than $900 million to settle lawsuits related to past stock options practices. The legal settlements brought it closer to moving past a scandal over the manipulation of stock option dates that led to the departure of William McGuire as chief executive.

Tags: health insurance, health insurance carriers, insurance companies, insurance settlement, lawsuit, stock market, stocks, United Health, United Healthcare

(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.”

Tags: Blue Cross Blue Shield, health insurance, wellness

WASHINGTON (CNN) — Congress voted to halt planned cuts in Medicare payments to doctors Tuesday, overriding President Bush’s veto in a battle that pitted health insurers against physicians.
President Bush says he objects to the bill because it takes choices “away from seniors to pay physicians.”

President Bush says he objects to the bill because it takes choices “away from seniors to pay physicians.”

The new law stops a 10.6 percent cut in Medicare payments to doctors, part of a scheduled cost-saving formula that went into effect July 1.

The money for the doctors will be taken from the government-subsidized Medicare Advantage program, which the Bush administration strongly supports.

Bush spiked the bill Tuesday, telling lawmakers they would be “taking choices away from seniors to pay physicians.”

“I urge the Congress to send me a bill that reduces the growth in Medicare spending, increases competition and efficiency, implements principles of value-driven health care and appropriately offsets increases in physician spending,” he said in his veto message.

The Senate voted 70-26 to enact the law over Bush’s objections, the third time in his presidency that Congress has overridden his veto. The margin in the House of Representatives was a lopsided 383-41, well beyond the two-thirds majority needed.

The American Medical Association lobbied heavily for the bill, warning that its members could be forced to curtail seeing Medicare patients if the cuts went into effect. But insurers, which receive government subsidies to offer Medicare Advantage plans, warned that 2 million seniors could lose health benefits if it passed.
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A total of 21 Senate Republicans joined 47 Democrats and two independents in the override vote.

Supporters broke a GOP-led filibuster of the bill last week, aided by the dramatic return of Sen. Edward Kennedy of Massachusetts. Kennedy’s vote came in his first appearance on the Senate floor since surgery to remove a brain tumor in early June.

Though he did not vote Tuesday, Kennedy praised his colleagues for overriding the “misguided” veto.

“It’s a great vote, and a great day for America’s seniors,” he said in a written statement.

Those Republicans who opposed the bill argued that it would roll back many of the changes made to Medicare in 2003, when Congress created privately run, government-subsidized prescription drug coverage and expanded the role of private insurers in other coverage.

“These are not pro-patient policies,” said Sen. Jon Kyl, R-Arizona. “Rather, the bill reduces access, benefits and choices for Medicare beneficiaries.”

But critics of the 2003 reforms say Medicare Advantage subsidies end up costing more than the government would pay to cover the same people through regular Medicare, the federal health insurance program for seniors. The Congressional Budget Office estimates that the bill will reduce federal spending by $12.5 billion by 2013, largely by reducing Medicare Advantage enrollment.

Sen. Patty Murray, D-Washington, said the bill also made “vital improvements” by supporting rural health care and lowering fees for mental health care.

“Today, we can stand up for Medicare,” she said. “We did it last week, when we came together and voted for this measure by a veto-proof margin, and I believe we can do it today by overriding that veto.”

Congress had passed only two bills over Bush’s objections: a $23 billion water-project legislation that the president vetoed in 2007 and a $300 billion farm bill he spiked in May.

The Medicare system pays for the health care of roughly 40 million elderly Americans. Rising health care costs have made Medicare a growing part of the federal budget, and the stress on the system is increasing as more baby boomers reach retirement age.

While the debate was raging over the bill, the AMA said the cuts could lead to a “meltdown” of the government’s health care system for the elderly.

A recent survey by the group found that 60 percent of physicians will be forced to limit the number of new Medicare patients they can take on if the cuts go into effect.

“We stand at the brink of a Medicare meltdown. … For doctors, this is not a partisan issue; it’s a patient access issue,” AMA President Nancy Nielsen said in a statement after last week’s Senate vote.

The AMA ran radio and TV ads over the July Fourth congressional recess targeting 10 Republican senators, seven of whom are up for re-election.

The AARP, the nation’s largest organization of retired people, and other groups also are weighing in against the cuts.
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Gerald Harmon, a family physician who practices in Pawleys Island, South Carolina, said the cuts could lead to doctors taking fewer Medicare patients, making it difficult for the program’s elderly patients to get the care they need.

“This Medicare access problem is a real issue, not just a political football,” said Harmon, who said 35 percent of his patients were eligible for Medicare. “It affects your dad when he’s sick. It affects my patients in my practice. This has to be addressed.”

Tags: Congress, health insurance, healthcare, Medicare, President Bush, veto

Assurant Health is lowering rates up to 15% on their Short Term Medical plans with effective dates of July 1, 2008 or later. The rate reduction will be especially beneficial for recent college graduates. Most plans specify that individuals are no longer eligible dependents under their parent’s plan after graduation and have to pay expensive COBRA premiums to continue coverage.

A short term insurance plan may offer more cost-effective temporary health insurance coverage than COBRA until they are covered under employer group coverage. If need help to decide whether to choose employer-offered COBRA coverage or an alternative, short term medical insurance policy, visit our page on Short Term Medical. Assurant is the #1 underwriter of short-term medical plans in the United States and even offer better benefit plans and rates than BlueCross BlueShield of Illinois. Short Term Medical policies cover a wide variety of needs, from 30 to 365 days, and it allows you to use your own doctors and hospitals. Click here to get get a quote

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Democrats back governor on health care

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