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Home / News & IndustryManaged Care Insight and Analysis
Updated: August 25, 2009
BCBS Companies Highlight Successful Private Market Strategies For Improving Health

Chronic care management programs, integrated health management solutions, and prevention and wellness programs are some of the successful innovations by Blue Cross and Blue Shield (BCBS) companies that are helping to reform healthcare and deliver improved outcomes and lower consumers’ and employers’ costs.

As policymakers work to develop comprehensive healthcare reform legislation, the chief executive officers from BCBS companies in Michigan, New Jersey and Kansas City shared examples of how their health plans are transforming the delivery system today in ways that cannot be replicated by the public sector, said Scott P. Serota, president and CEO of the Blue Cross and Blue Shield (BCBS) Association.

"Provider incentives to promote the best care, working with employers to craft custom-designed benefit programs instead of a one-size-fits-all approach, and programs that empower patients, providers and employers with tools that are leading to improved outcomes and savings are examples of healthcare reform available only through private innovation," said Serota.

"Government-run programs, such as Medicare, face enormous political pressures and are simply unable to implement these key improvements," he said.

In New Jersey, for example, a patient-centered medical home pilot program led by Horizon BCBSNJ is improving the quality of care, while simultaneously lowering healthcare costs for 1,300 enrolled members by 12 percent between January 2007 and January 2008.

The program has since been expanded to include another 6,000 participants.

The patient-centered medical home, where a patient’s personal physician directs a team of healthcare providers in the comprehensive planning and treatment of a patient, proved particularly successful increasing the number of patients with diabetes receiving critical screenings. Prior to the start of the program in January 2007, only 33 percent of the patients with diabetes had taken an LDL diabetic blood test, which measures cholesterol. By January 2008, 88 percent of the patients had taken the test.

"Making sure that diabetic patients get their required testing reduces costs, but more importantly keeps them healthy and improves their outcomes," said Bill Marino, president and CEO of Horizon BCBSNJ.

"Having the personal physician responsible for arranging appropriate, evidenced-based care at the practice level and involving the patient in the treatment planning process is particularly useful for patients with chronic illnesses."

BCBS of Kansas City is working with more than 200 large employer groups representing 120,000 individual employees in it’s "A Healthier You," a turnkey health and wellness program that is encouraging healthy lifestyle decisions that reduce medical costs and increase employee productivity.

Emergency room visits – and their costs – by A Healthier You participating companies are down, while ER visits by non-participating companies have increased by 17 percent. Overall wellness scores of participants are up, blood pressure and cholesterol levels are down, and overall medical costs have grown at a slower rate – growing 10 percent – for those participating in the program versus a 17 percent increase in overall medical costs among non-participating companies.

"The statistics are startling – nationwide nearly 70 percent of all healthcare costs are the direct result of the lifestyle choices we make," said Tom Bowser, president and CEO of BCBS of Kansas City. He noted that the rate of obesity among adults has doubled in the past 25 years to more than 30 percent of the adult population and that childhood obesity has tripled over the past 40 years.

"The future of healthcare cost containment lies in disease prevention and increased member accountability for lifestyle behaviors," Bowser said.

Blue Cross Blue Shield of Michigan’s (BCBSM) "BlueHealthConnection" (BHC) offers members a full suite of wellness and care management services such as a 24/7 nurse call line and an e-health portal, which features resources including online health assessment tools and self-care guides that allows for proactive, integrated approach to total well-being of the whole person. It connects with members across entire continuum of healthcare needs, from low-risk/wellness to existing chronic conditions and catastrophic conditions. Combined with claims experience, BCBSM is able to use the wellness/care management program to effectively model risk and intervene, disrupting and reversing the flow of risk from low to high. Without intervention, annual medical costs for high-risk individuals are nearly 44 percent more than cost of low-risk individuals.

Since its launch in 2002, BHC has shown overall savings of over $30 million in annual benefit cost savings per year.

More than 1,000 physicians have also been designated as part of BCBSM Patient-Centered Medical Home (PCMH) program, making it the largest PCMH initiative in the nation with 300 primary care practices located in 40 Michigan counties.

"Health and wellness programs offer real value and real results – BHC has shown overall savings ofover $30 million in annual benefit cost savings per year since it was launched in 2002. A majority of members report that the program has improved their interactions with their providers, resulting in actions that have significantly improved their health," said Daniel J. Loepp, president and CEO of BCBSM.

Address: Blue Cross Blue Shield Association, 225 N . Michigan Ave., Chicago, IL 60601; (312) 297-6000,

  This article was taken from:
The Executive Report on Managed Care

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