Anthem Blue Cross And Blue Shield

P4P program pays doctors for patients' performance

Anne Zieger — Thu, 16 Oct 2008 10:25:41 -0400

Anthem Blue Cross and Blue Shield of Indiana is rolling out an interesting pay-for-performance program that pays doctors for their patients' performance. Doctors will be rated on how many of their patients are or are not taking medications as prescribed, or are getting medical tests or screenings that the doctor recommended.

The goal, obviously, is to encourage doctors to follow up with patients, making sure that they are getting their recommended care and taking medications as prescribed. And some see it as an ideal way to do just that. However, some doctors are concerned that if they serve lower-income patients, they will be penalized because their patients can't afford to get the care that is recommended.

If they can avoid information overload, however, doctors who participate will be receiving a lot more information on the compliance of their patients. Anthem will be sending doctors reports on which of their patients have gotten the recommended tests. So if doctors can work it into their practice, they will know which patients need to be cajoled into getting that mammogram or taking their medication as prescribed.

Currently, the program has only been rolled out to primary care doctors, including family practice, internal medicine, pediatrics, and obstetrics and gynecology. Time will tell how well the program will work to achieve its goals for better patient care and cooperation.

To learn more about the program:
- Read this IndyStar piece

CA governor vetoes bill banning some health policy cancellations

Anne Zieger — Wed, 01 Oct 2008 13:20:06 -0400

After years of controversy, in which the California's Department of Managed Health Care has struggled to stop health plans from retroactively canceling policies, Gov. Arnold Schwarzenegger (R) has vetoed a bill cracking down on this practice. This comes after the DMHC imposed multiple million-dollar fines on insurers that have canceled individual policies inappropriately, most recently in a $13 million settlement detail with Anthem Blue Cross and Blue Shield that forced the plan to reinstate thousands of people who had lost their coverage.

The new bill would have created an independent review process to examine each case of "rescission," as these cancellations are known. Under this new system, policies could be rescinded only if the health plans could prove consumers deliberately misrepresented the state of their health on their application.

Schwarzenegger said he vetoed the bill because it didn't include certain consumer protections and would benefit attorneys who wrote it. The governor wanted six other protections included in the text, including a rule demanding that insurers continue coverage for family members of someone whose policy had been dropped. However, a provision offering just this protection is included in a separate bill that the governor has already approved.

To learn more about the bill:
- read this Associated Press piece

Related Articles:
PacifiCare faces $1.33B fine
BC of California fined $1M for cancellations
Kaiser forced to reinstate coverage
CA agency mulls review of policy cancellations

CA Blue plans will pay $13M in fines over cancellations

Anne Zieger — Fri, 18 Jul 2008 11:06:18 -0400

Two of the state of California's largest health plans have agreed to pay a combined total of $13 million in fines related to their practice of rescinding policies for members after those members became sick. The fines are the largest yet imposed by the state Department of Managed Health Care, which has been focused of late on stopping health plans from reviewing patient applications and canceling policies after the patient begins incurring large medical bills. In addition to the fines, the agreements will require the two plans, Anthem Blue Cross and Blue Shield, to offer new coverage to more than 2,200 beneficiaries. However, the two are not admitting any wrongdoing.

WellPoint-owned Blue Cross will pay a record $10 million fine, and will offer no-strings-attached coverage to 1,770 members whose policies were canceled since 2004. Competitor Blue Shield, meanwhile, will pay $43 million and offer new policies to 450 people whose policies were discontinued during the same period. Both health plans have agreed to set up a process to help ex-members recover medical bills paid out of pocket after they were dropped, as well as collect other damages, such as reimbursement for homes or business lost because unpaid medical bills ruined the patients' credit. The agreements follow on similar settlements with Kaiser Permanente, Health Net and PacifiCare.

To learn more about the agreements:
- read this Los Angeles Times piece

Related Articles:
WellPoint pays hospitals $11.8M to settle bills from rescissions
BC of California fined $1M for cancellations
Kaiser forced to reinstate coverage
Blue Cross of CA settles plan-cancellation suits