Blue Cross of California

Another California health plan is making headlines after wrangles with state regulators. In this case, the state has ordered Kaiser Foundation Health Plan to reinstate the coverage of a woman whose policy it says was illegally canceled. The woman, who lives in Northern California and has been a Kaiser beneficiary for more than 20 years, is undergoing treatment for kidney stones. Recently, Kaiser had canceled her policy, claiming that she left out key information from her application when …

Blue Cross of California has settled a group of 70-odd lawsuits and claims filed by patients who alleged that the health plan canceled their insurance after they got sick. The settlement comes in response to pressure from state regulators, which already fined the health plan $200,000 for canceling one California woman's policy, according to the Los Angeles Times. While the dollar …

Blue Cross of California (BCC) has kicked off a $40 million project offering bond-backed financing to providers serving low-income urban or rural areas. The program will be administered by the California Statewide Communities Development Authority, which will offer guide applicants and issue funds to providers. The program will finance bond offerings of $1 million to $7 million, at rates these providers would otherwise be unlikely to obtain, the insurer said. The bond financing initiative …

Responding to a rebuke from the state's Department of Managed Health Care (DMHC), Blue Cross of California has agreed to discontinue its policy of paying physicians a higher fee for performing certain endoscopy procedures in ambulatory surgical centers. The California Hospital Association had filed a suit challenging the policy. After reviewing the policy, the DMHC concluded that Blue Cross should have sought prior regulatory approval first, as the financial incentive policy constituted a …

The Integrated Healthcare Association, a California-based group including health plans, medical groups and health systems, has released a list of the top-performing medical groups among the 228 medical practices participating in its pay-for-performance program. The IHA named 46 groups, or 20 percent, as meeting top standards for quality, patient satisfaction and appropriate use of information technology. The ratings come from an analysis of 2005 measurement year, and included data from …

Blue Cross of California said that it will revise some of its practices when it comes to canceling individual insurance policies. The insurer has recently faced several lawsuits for retroactively canceling customers' coverage after a policyholder required high-cost medical care. Blue Cross will change the patient appeals process for when they are denied a claim and will also create an ombudsman. But critics say that that the new measures don't address the fact that the insurer is …

In a Web exclusive, Dr. Michael Belman, staff VP and Medical Director with WellPoint division Blue Cross of California, discusses how his company developed its pay-for-performance program. Dr. Belman says that the P4P program came about as Blue Cross realized that it could do more to manage chronic disease, improve care and cut costs. The insurer worked with the Integrated Healthcare Association to develop a report card based on HEDIS measures. The report card, which is also used …

Throwing fuel into the CDHP fire, WellPoint announced that it will make all of its CDHP products available in all markets to both employers and individuals beginning on January 1, 2007. Execs say that consumer interest in CDHPs led the insurer to make the plans more accessible and estimates that it could save patients up to $400 dollars a year over traditional plans. "More informed consumers can make better health care decisions and improve their health, which can help to …

The $66 million dollar question: How to make pay for performance work
Dr. Michael Belman, staff VP and Medical Director with WellPoint division Blue Cross of California, discusses how his company developed its pay-for-performance program, which recently awarded its contracted medical groups $66 million in incentive pay.
How long has your current pay for performance program been in the works?
First, bear in mind that 99 percent of our HMO network is through our delegated medical groups.  We give the group a full capitation for the professional risk, though the hospital risk stays with us.
Anyway, we had a program in the 90s aimed at our HMO product which offered a small incentive related to how doctors managed chronic disease, health, and how they managed grievances and appeals.  But the money wasn’t very much.

California Medical Association (CMA), the state's largest physician group, has released a report ranking the state's insurers by the percentage of their budget spent on healthcare in 2005. The ranking is part of the group's campaign to get insurance companies to spend more money on medical costs--including doctor's reimbursements--and less on profits and overhead. Blue Cross of California (California's largest insurer) ranked the lowest. The insurer spent 78.9 percent of their revenue on …