Blue Shield Case Study

After a brief review of this discussion lecture. I learned the BlueCross and BlueShield also offer Medicare benefits. BlueShield plans only covers physician’s charges and BlueCross only covers hospital charges. Although Medicare benefits are offered from BlueCross and BlueShield its only offered to people that are 65 years and old and to those who are under 65 years of age but suffers from disabilities like renal disease that requires long term care such as dialysis or a kidney transplant.

Anthem Blue Cross of California: Advantage HMO, Advantage PPO, Anthem Blue Cross, HMO, also sometimes known as California Care or Rural Cal Care (includes Cal PERS Traditional HMO), Anthem Blue Cross, HMO/POS (California Care Plus), Anthem Blue Cross, Individual HMO as known as California Care,Anthem Blue Cross Plus (POS), Anthem Blue Cross Small Group HMO as known as California Care (California Pacific Medical Center, 2015). More insurances are Behavioral Health Program, Blue Cross PPO, Prudent Buyer Plan, includes PERS Care and PERS Choice, Blue Cross Senior Advantage Care Plan, Blue Cross Senior Classic Plans; Classic A through L Blue Cross Senior Smart Choice, Preferred and Plus Plans, Blue Card Cal PERS EPO, Del Norte County, EPO Federal

BlueCross BlueShield doesn’t have any other Managed Care Organizations that it truly competes against. There are only three MCO’s in the state of Tennessee who were awarded the contract to implement and administer the CHOICES program in 2010. BlueCross BlueShield (BCBST), AmeriGroup (Group) and United Healthcare (UHC) are all three actively managing care of the members in the program at this point. Upon review of the website of both of the other MCO’s, I found that they are all set up surprisingly similar and all three have a very comparable appearance. UHC’s site (www.uhc.com) presented the “locate a provider” feature more obviously than the other two websites; making it easier to find active providers that are participants in their network.

The Trojans and Greeks fought a frivolous war that began with a golden apple and a trio of precarious goddesses. It initiated when Prince Paris was given an apple from the “evil goddess of Discord, Eris,” and told him to choose the fairest goddess between three. Paris ludicrously chose the goddess who offered him the most beautiful woman. This woman was Helen, queen of Sparta. But Paris stole her from her husband and refused to give her back to Menelaus.

The implementation of the Affordable Care Act (ACA) will propel changes that were on the horizon for pharmaceutical and biotechnology firms. Pharmaceutical and biotechnology industries knew there was going to be some type of healthcare reform so they began to take the necessary precautions to prepare. The ACA had key provisions related to the pharmaceutical and biotechnology industry affecting Medicare and Medicaid. Legislation in the ACA will reduce cost for brand name prescriptions (Rx); this will reduce drug cost for patients, but increase rebates and discounts for pharmaceutical and biotechnology firms, therefore, imposing cost on the firms. The pharmaceutical and biotech industry was key in creating legislation for the ACA, according to CMS (2009), “despite

The Affordable Care Act includes a requirement that all citizens must have some level of health coverage. The primary method through which the mandate is attempting to create 100% coverage in health care is by instilling fear into the minds of hardworking citizens as those who ignore the rule will have to pay a hefty fine. This mandate, unconstitutional according to the law, will deteriorate the quality of health care, hamper economic growth and cause spikes in insurance premiums. The hope of universal health care may or may not arise under the mandate but new dilemmas and hardships on U.S. citizens will undoubtedly surface.

The passage of the Affordable Care Act in 2010 allowed for comprehensive health insurance reform that shifted the imperative for care delivery and reimbursement from a volume to a value-based approach. The Center for Medicare and Medicaid Innovation (CMMI) under CMS has been at the forefront of developing and testing innovative payment models that would support the premise of expanding access to beneficiaries and achieving better quality outcomes while lowering exorbitant spending. One such model, named the Independence at Home (IAH) Demonstration, was deployed through ACA section 3024, with the aim of transforming the way primary care is delivered. This demonstration project builds on the success of the Veteran’s Administration Home-Based

The Basic Health program could be structure in several ways. It could expand programs such as Medicaid and CHIP and contract with managed care plans on behalf of its Medicaid and CHIP beneficiaries outside the private insurance market. These changes would allow both programs to continue as a "separate program with a separate financing mechanism and risk pool from that of Medicaid and CHIP, but would leverage the state's existing infrastructure for information technology, contracting, rate setting, and other function" (Angeles, 2012). Alternatively, a state could expand the Medicaid managed care by increasing the number and types of service through different network of providers, other than those that serve Medicaid and CHIP beneficiaries (Angeles,

You bring up an excellent point of social justice in relation to this case. As given by Pierce and Randels (2010), justice is provided by distributing benefits or burdens across society in a fair manner. It is shocking to me, that Blue Cross/Blue Shield felt they were being just in their determination of denying this coverage. Insurance companies are supposed to aim towards providing help for individuals. Without insurance, obtaining health care would be an absurd out of pocket expense for many in society. The areas of coverage, or lack of, can significantly progress the potential for health disparities on people. As Patel and Rushefsky (2014) examined, one of the greatest problems within health care is the access to health insurance, as well as the cost of merely having insurance (p. 203-234). Those who are able to have insurance and afford it, expect to be covered for health issues. The very purpose of having insurance was undermined by Blue

The United States Department of Veterans Affairs (VA) is a government-run military veteran benefit system that provides essential financial and medical assistance to veterans and their families that are located all over the world. (www.va.gov) As the country and the military’s needs change, the VA needs to continue to evolve and grow. With this thought in mind, it is necessary to understand how the department is coping with the many different challenges that they are currently facing to effectively address the current issues and policy pitfalls. The most critical issues presently facing the VA, is the concern over long increasing wait-times and backlogs for services, which have emerged since 9/11 and are primarily the result of the growing

I am a firm believer in the fact that everyone deserves healthcare. Although the affordable healthcare act does promote health and does cover more screenings so that people can avoid delaying health problems, there are public policy implications that will affect the future of Medicare, Social Security and aging services. The Affordable Health Care Act requires every American to have health insurance and unless exempted, they must pay a penalty when they file their taxes. Businesses are cutting employees hours to avoid covering employees. Insurance companies cannot deny someone because of pre-existing health problems. Companies will have to pay up to cover health care costs and they cannot put a set dollar limit on coverage, which has caused

Universal health care is not impossible to achieve, but takes lots of planning and strategy to make it work. As President Obama campaigned, he strongly emphasized the importance of universal health care. With a great team and planning, the Affordable Care Act, also know as Obama Care, was passed. The ACA should be kept because it covers health disorders, businesses with employees have to have insurance, and allows parents to add their children to their plan up to the age of 26.

When the Patient Protection and Affordable Care Act (PPACA) was signed into law it attempted to address issues associated with transitional care and improving the quality of healthcare, while decreasing the cost of healthcare (Segal, 2010). The PPACA has expanded coverage for children, the elderly, and those experiencing poverty. As previously stated in other discussion boards, the PPACA has also set provisions and restrictions for insurance companies.

It was in 1977 that the United Healthcare United Health group was founded by Richard Burke. The headquarters of the company are in Minnetonka, Minnesota. This organization works towards the betterment of people's health, it help them in living a healthy life by providing them with the kind of health care that would be best for them. The main focus of United Healthcare which is a major division of the United Health group is to provide the people with better health benefits and coverage.

The Omega Ultrasound System would be the best choice to green light for the Healthymagination initiative. After assessing all the potential products, we determined that the lack of concrete metrics, difficulty or uncertainty in measuring outcomes, or clinical relevance to the Healthymagination goal rendered the TEEMax, UltraLipo, and HepEcho unfit for launch. We’ve outlined justification for this decision in (Figure 1.), but we believe the Omega system provides the greatest opportunity for meeting Healthymagination standards with the best chance of obtaining definitive evidence to support the certification.