Empire Blue Cross Blue Shield Case Study

This week I began my 6-week internship at Blue Cross Blue Shield of Nebraska (BCBSNE). The first day was a common orientation for all new employees, internally denoted to as the “onboarding process” where all employees are told they matter. This full-day session communicates the core mission, vision and goals of BCBSNE, organizational structure, operating objectives, and workplace culture. BCBSNE is a not-for-profit health insurance company that is focused on collaboration to find the best solution for their customers; in other words, they are customer-focused. Since the implementation of the Affordable Care Act (ACA), many changes to the health insurance market required a change in the organizational structure and culture of BCBSNE. Through partnerships with providers, the goals of BCBSNE are to be responsive, accountable, minimize errors, and decrease costs – all components of the ACA. BCBSNE has strategically aligned their goals to those of the government-mandated goals, and implemented them at all levels of the organization, making them competitive in the health insurance market. I found this very fascinating: I was very excited after day one!

Poor nutrition in the United States is indeed a scary factor that continues to lead our citizens to chronic healthcare conditions. The article notes “Health People 2020 states the most affected are non-White, Hispanic adult populations are disproportionately affected by obesity” (Kaiser Foundation Hospital, 2014, p. 6)

HealthSouth Corporation was incorporated in January 1984 in Birmingham, Alabma by the founder Richard M. Scrushy. HealthSouth Corporation is the leading provider of medical rehabilitation health care and outpatient surgery services in the United States. Richard M. Scrushy was the former CEO& Founder of HealthSouth Corporation, and there were 5 CFO which were Aaron Beam, Weston, Smith, Bill Owens, Michael Martin and Tadd Mcvay.

The development of new technologies, the rapid increase in the number of Internet users signal to the insurance business about the opportunities for expanding the client audience and building a new channel - online sales. The Blue Cross and Blue Shield (BCBS) a national family of health benefits companies currently actively use digital marketing. It allows the most recognizable provider in the healthcare insurance industry to hold positions. This Association unities 39 independent Blue Cross and Blue Shield companies, which together cover more than half of all commercially insured persons in the United States.

Established in the 1930s by Henry J. Kaiser and Dr. Sidney as a health care program for construction, shipyard, and steel mill employees, in 1945 Kaiser Permanente (KP) opened enrollment to the public (Our History, 2016). Despite many challenges and setbacks, KP has grown to become one of the largest leading healthcare providers (SPEC Associates, 2011; "Labor Management," n.d.). However, is KP ready to meet the health care needs of citizens in the next decade? This paper will delve into KP to assess their readiness as well as their strategic plans regarding network growth, adequately staffing nurses, managing resources, and maintaining patient satisfaction.

Currently I work for Blue Cross Blue Shield of Tennessee which is one part of a complex health care system that has a lot of stakeholders. The four most visible stakeholders first would be patients, who seek medical services and advice (“The Modern Health Care Maze,” 2009).Second stakeholder would be providers of services and products, including hospitals, doctors, nurses and durable medical equipment. Third stakeholder would be payers such as private insurance companies, Medicaid and Medicare government programs and their employees. The fourth stakeholder would be employers, who purchase for their employees health insurance, then the federal government gives the employers a tax liability break allowing them to deduct this purchase on their

California Association of Health Plans (CAHP) represents statewide trade association with 46 full-service healthcare plans, which provide coverage to millions of California residents. Most member programs are introduced through group and individual markets to Californians. CAHP are dedicated to providing accessible, high quality and affordable health plans. All health plans through Covered California are members of CAHP. Their goal is to serve their members by providing and sustaining opportunities that allow them to grow and maintain viability as organizations. An organization like Kaiser Permanente, Anthem Blue Cross, Delta Dental, Bayer Healthcare LLC and Crowell & Moring are members of CAHP.

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.

Crystal is well informed of the changing DSDS policy and procedures, and implements them with no reminders. She is able to quickly identify participants who are eligible for HCB Medicaid and make the appropriate referrals. Crystal continues to show that she understands the importance of confidentiality and HIPAA. She is able to identify eligible adults for HCBS through using the InterRAI assessment tool. Crystal continues to consult with her supervisor on challenges that may come up on cases. She works with other agencies to ensure that participants unmet needs are

I just spoke with Mrs. Hornsby's regarding her issues. Her main concern was locating a Blue Advantage Plus Silver HMO Primary Care Physician who is accepting new patients. I walked Mrs. Hornsby's through our Provider Finder and we were able to locate multiple PCP's listed as accepting new patients with 25 miles of her home. She stated she would call them next week and see if she can get an appointment with any of them. She stated she has plenty of medication but simply needs to establish as a new patient with a PCP as her Specialist has advised her she needs to start having services rendered by a PCP. She asked if we have any PPO network plans and I explained to her that the Blue Advantage HMO is the only network available for the Individual

Leading this team was an incredible opportunity that has shaped my entire approach to fostering community collaboration. I continue to co-chair the advisory board of this grant, and since I have supported additional grant advisory boards, coalition meetings, and integrated resource teams to serve our local community and ensure that we are investing our dollars and time to right areas. The most important lesson I have learned when leading a team and building partnerships, is that the focus must be on collaboration not coordination.

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.

Blue Shield is a private insurance broker in California and they were billed four hundred and eight dollars by Torrance Memorial Medical Center and apart from the insurance claim the patient had to pay nearly three hundred dollars for their medical expense. The patient enquired about this expense to the insurer and they said that the cost for a simple blood test was charged around eighty dollars, the patient cross verified the information with the billing department of the hospital and was informed that they would have paid less if they had no insurance plan. But the actual cost for a simple blood test was only around fifteen dollars.

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.