Ruseas Blue Cross-Blue Shield

In 2000 Mr. D’Ablemont turned seventy years of age. Normally, he would receive an end of year bonus but, did not since he reached seventy. Subsequently, he wrote a letter in December 2000 to Kelley Drye & Warren’s chairman John Callagy, in reference to the end of the year bonus, which he felt he was entitled to. When Mr.

First implemented in 1985 by Aetna (previously U.S. Healthcare), P4P programs were used to reward top performers and improve outcomes (Bruno, 2012). The incentives were meant to improve the quality of patient care by basing incentives on patient outcomes. Conversely, fee-for-service reimbursements are based on the treatments and set limits on the amount reimbursed for services. Because of these limits, incentives for use of pharmaceuticals and non-invasive procedures can impact how physicians practice.

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!

2. San Diego Business Journal  Best Places to work and HR Professional Of The Year Awards Supplement, August 20, 2012 v33 i34 pS29(1)

ACO, another 3 letter health care organization consisting of integrated groups of providers, comes along promising the elusive goal of reducing health care cost, improving population health, and bolstering custom satisfaction. Sounds like a perpetual remake of a 70s movie called HMO that went through several reiterations over the past decades which gave us PPO, PSO, IDS, and the different flavors of MCOs. ACO’s hype is credited to the Affordable Care Act as it sought to reduce health care costs is by encouraging doctors, hospitals and other health care providers to form networks that coordinate patient care and become eligible for bonuses when they deliver that care more efficiently. Bottom line, providers are promised to make more if they

To attract Medicare patients, hospital must be contracted with Medicare. Hospital must also be contracted with private health insurance companies that provide Medicare Part A or Part B benefits. As per Kaiser Family Foundation, there are more than 55.5 million Medicare beneficiaries in the U.S. and Texas has more than 3 million. Hospital should have regular contact with senior citizens and can be made attractive to Medicare patients by offering sessions about healthy life style choices. Also offer regular disease management sessions, exercise group and organize social activities such as trips to mall, museums. Seniors should also be encouraged to take tour of the hospital.

One of these examples is the Meridian Health Accountable Care Organization. “In January 2013, Meridian was selected by the Centers for Medicare &Medicaid Services (CMS) to participate as a Medicare Accountable Care Organization (Meridianhealth.com). When a system is selected to become an Accountable Care Organization it can choose one of three routes. They are Medicare Shared Savings Program, Advanced Payment ACO Model, and Pioneer ACO Model. Meridian Health chose the shared savings program. This program goals include better care for individuals, better health for populations and lowering growth in expenditures. The Shared savings program also rewards “ACOs that lower growth in health care costs while meeting performance standards on quality of care and putting patients first” (CMS.gov). The next type of ACO is the Advanced Payment Model. This model is “designed for physician-based and rural providers who have come together voluntarily to give coordinated high quality care to the Medicare patient they serve… selected participants will receive upfront monthly payments”(CMS.gov). This form of ACO is for systems that do not meet the requirements for Shared Savings because they are too small in size and they do not have access to capital so that they can invest in upgrading their system. So far there are 35 ACO using this model and so that they can

Does your employer support employees who are engaged in community and civic activities? Blue Cross Blue Shield is a big advocate when it comes to giving back to the community so much so that we are allotted time off for special events in addition to the moral support of the company.

As we know the IN HHW/ Anthem BCBS plan will go live as of 01/01/2017. As we all know this is one of many new plans and I just wanted to point out some key points. When you are looking for benefits before the official ORM is posted please refer to KQ. They will be listed as

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.

Key Point: The deductibles for prescription medications are a great way to lower your premiums.

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

By partnering with Providers and implementing Payment Innovation Models, Anthem as part of its Enhance Personal Health Care Program is empowering them with tools, information, resources and choices. This allows the providers to focus on the most important aspect– “overall health of the patients”.

Today’s market demands organizations to have a strategic plan. The purpose of the strategic plan describes where the organization wants their organization to go. A strategic plan is a document used to communicate goals, and the actions needed to achieve those goals. In order to remain competitive every organization needs to innovate to stay ahead of the competition. They need to develop new products and services with increasing frequency. The design of these new products and services must meet, or exceed, customer expectations and at the same time, they must generate an acceptable financial return for the organization. However, any business that does not realize the importance of developing new products will not last very long as a consequence

Pacific Medical Supply Company was a prominent supplier in the southern California region. They used to supply medical instruments and all other itineraries using a distribution channel consisting of sales commission based Sales force. Jim Shine, the owner of Pacific Medical, started off his career with a background of a salesman at a beach application store. His first venture into the medical supplies business commenced in a garage and slowly climbed up to be a fully fledged business covering Southern California meaning