Category Archives: Individual Health

Blue Cross Blue Shield of Michigan Congratulates 39 Local Hospitals on Receiving Blue Distinction Center Designation for Quality and Efficiency


The Blue Distinction designation aids consumers and employers in choosing high-performing hospitals

Feb. 26, 2013, Taken from

DETROIT – Blue Cross Blue Shield of Michigan today recognized 39 hospitals for the Blue Distinction Centers for Specialty Care® program in the areas of Spine Surgery and Knee and Hip Replacement. Since 2006, the Blue Distinction program has identified hospitals that deliver quality care in Bariatric Surgery, Cardiac Care, Complex and Rare Cancers, Knee and Hip Replacements, Spine Surgery and Transplants.

The Blue Distinction Centers for Specialty Care program recently expanded to include new cost-efficiency measures, as well as more robust quality measures focused on improved patient health and safety. Ten facilities in Michigan are being recognized as Blue Distinction Centers for their expertise in delivering quality specialty care in Spine Surgery or Knee and Hip Replacement, and 29 are being recognized as Blue Distinction Centers+ for their expertise in quality and cost efficiency in delivering specialty care.

Quality is key: only those facilities that first meet Blue Distinction’s nationally established, objective quality measures will be considered for designation as Blue Distinction Centers+.  This is a voluntary program, and hospitals must meet minimum criteria to earn designation.  The Blue Cross and Blue Shield Association conducts the evaluation.

In Michigan, hospitals must also participate in the Michigan Blues’ Collaborative Quality Initiative programs, when applicable, in order to earn Blue Distinction designation.  These Collaborative Quality Initiative programs have resulted in rapid quality and safety improvement in some of the most common and costly medical and surgical areas of care. In fact, four of the initiatives – focusing on general surgery, cardiac surgery, bariatric surgery and angioplasty – have resulted in cost savings of more than $232 million over three years due to avoided complications and improved safety.

“Blue Distinction Center designations, together with our award-winning Collaborative Quality Initiatives, are important hallmarks of quality and safety that consumers and employers can use when deciding where to go for certain treatments and surgical procedures,” says David Share, MD,  MPH, senior vice president, Value Partnerships, Blue Cross Blue Shield of Michigan.

These newly designated Blue Distinction Centers and Blue Distinction Centers+ demonstrate better quality and improved outcomes for patients, with lower rates of complications and readmissions than their peers. Nationally, Blue Distinction Centers+ are more than 20 percent more cost-efficient. The program provides consumers with tools to help them make better informed health care decisions. These results will also enable employers, working with their local Blue Plan, to tailor benefits to meet their individual quality and cost objectives.

A list of Michigan hospitals designated in Spine Surgery and in Hip & Knee Replacement can be found below. For more information about the Blue Distinction Program, visit

Blue Cross Blue Shield of Michigan and Blue Care Network are nonprofit corporations and independent licensees of the Blue Cross and Blue Shield Association. For more company information, visit

The Blue Cross and Blue Shield Association is a national federation of 38 independent, community-based and locally operated Blue Cross and Blue Shield companies that collectively provide healthcare coverage for 100 million members – one-in-three Americans.  For more information on the Blue Cross and Blue Shield Association and its member companies, please visit  We encourage you to connect with us on Facebook, check out our videos on YouTube, follow us on Twitter and check out The BCBS Blog, for up-to-date information about BCBSA.

Blue Distinction Centers met overall quality measures for patient safety and outcomes, developed with input from the medical community. Blue Distinction Centers+ also met cost measures that address consumers’ need for affordable healthcare. Individual outcomes may vary. National criteria is displayed on  A local Blue Plan may require additional criteria for facilities located in its own service area.

To find out which services and providers (including hospital based physicians) are covered under your policy or to learn about Local Blue Plan criteria, contact your Local Blue Plan. Before making an appointment, be sure to contact your provider to verify its current Network and Blue Distinction Centers status. Each hospital’s Cost Index is calculated separately based on data from its Local Blue Plan. Hospitals in portions of California, Idaho, New York, Pennsylvania, and Washington may lie in areas served by two Local Blue Plans, resulting in two Cost Index figures; and their own Local Blue Plans decide whether all hospitals in these areas must meet Blue Distinction Centers+ national criteria for one or both Cost Index figures. Neither the Blue Cross and Blue Shield Association nor any Blue Plans are responsible for damages, losses, or non-covered charges resulting from Blue Distinction or other provider finder information or care received from Blue Distinction or other providers.  To find out more, contact your Local Blue Plan.

Designated Hospitals

Blue Distinction Center

Knee and Hip

  • Botsford Hospital – Farmington Hills
  • Bronson – Battle Creek
  • Chelsea Community Hospital – Chelsea
  • Henry Ford Hospital – Detroit
  • Hurley Medical Center – Flint
  • Lakeland Hospitals at Niles and St. Joseph
  • Oakwood Heritage – Taylor
  • St. John Hospital and Medical Center – Detroit
  • Sparrow Hospital – Lansing
  • William Beaumont Hospital – Grosse Pointe

Spine Surgery

  • Sparrow Hospital – Lansing
  • William Beaumont Hospital – Grosse Pointe

Blue Distinction Center+

Knee and Hip Transplants

  • Allegiance Health – Jackson
  • Borgess Medical Center – Kalamazoo
  • Bronson Methodist Hospital – Kalamazoo
  • Covenant Medical Center – Saginaw
  • Crittenton Hospital Medical Center – Rochester
  • Genesys Regional Medical Center – Grand Blanc
  • Henry Ford Macomb Hospital – Clinton Township
  • Henry Ford Wyandotte Hospital – Wyandotte
  • Holland Hospital – Holland
  • Ingham Regional Medical Center – Lansing
  • Marquette General Health System – Marquette
  • McLaren Regional Medical Center – Flint
  • McLaren Northern Michigan – Petoskey
  • MidMichigan Medical Center – Midland
  • Oakwood Hospital & Medical Center – Dearborn
  • Oakwood Southshore Medical Center – Trenton
  • Port Huron Hospital – Port Huron
  • Providence Hospital and Medical Centers – Southfield
  • St. John Macomb Oakland Hospital – Warren
  • Saint Mary’s Health Care – Grand Rapids
  • Spectrum Health Blodgett Hospital – Grand Rapids
  • Spectrum Health Butterworth Hospital – Grand Rapids
  • St. Joseph Mercy Oakland – Pontiac
  • St. Mary Mercy Hospital – Livonia
  • University of Michigan Health System – Ann Arbor
  • William Beaumont Hospital – Royal Oak
  • William Beaumont Hospital – Troy

Spine Surgery

  • Allegiance Health – Jackson
  • Borgess Medical Center – Kalamazoo
  • Bronson Methodist Hospital – Kalamazoo
  • Covenant Medical Center – Saginaw
  • Genesys Regional Medical Center – Grand Blanc
  • Henry Ford Wyandotte Hospital – Wyandotte
  • Ingham Regional Medical Center – Lansing
  • Marquette General Health System – Marquette
  • McLaren Bay Region – Bay City
  • McLaren Regional Medical Center – Flint
  • MidMichigan Medical Center–Midland
  • Port Huron Hospital – Port Huron
  • Providence Hospital and Medical Centers – Southfield
  • Saint John Hospital and Medical Center – Detroit
  • Saint John Macomb Oakland Hospital – Warren
  • Saint Mary’s Health Care – Grand Rapids
  • Spectrum Health Blodgett Hospital – Grand Rapids
  • Spectrum Health Butterworth Hospital – Grand Rapids
  • St. Joseph Mercy Hospital – Ann Arbor
  • St. Joseph Mercy Oakland – Pontiac
  • University of Michigan Health System – Ann Arbor
  • William Beaumont Hospital-Royal Oak
  • William Beaumont Hospital-Troy

Healthcare Changes Ahead: Helpful Information

Are you wondering how the health care reform law (the Affordable Care Act) will impact you or your business? I have compiled a few resources to help you learn what to expect.


For Individuals:

is an excellent source to learn about what will be changing and when you can expect those changes to occur. Here is a breakdown of the changes ahead for 2013 and beyond, as listed on



  • Improving Preventive Health Coverage. To expand the number of Americans receiving preventive care, the law provides new funding to state Medicaid programs that choose to cover preventive services for patients at little or no cost. Effective January 1, 2013.Learn more about the law and preventive care.
  • Expanding Authority to Bundle Payments. The law establishes a national pilot program to encourage hospitals, doctors, and other providers to work together to improve the coordination and quality of patient care.  Under payment “bundling,” hospitals, doctors, and providers are paid a flat rate for an episode of care rather than the current fragmented system where each service or test or bundles of items or services are billed separately to Medicare.  For example, instead of a surgical procedure generating multiple claims from multiple providers, the entire team is compensated with a “bundled” payment that provides incentives to deliver health care services more efficiently while maintaining or improving quality of care.  It aligns the incentives of those delivering care, and savings are shared between providers and the Medicare program. Effective no later than January 1, 2013.



  • Increasing Medicaid Payments for Primary Care Doctors. As Medicaid programs and providers prepare to cover more patients in 2014, the Act requires states to pay primary care physicians no less than 100% of Medicare payment rates in 2013 and 2014 for primary care services. The increase is fully funded by the federal government. Effective January 1, 2013.Learn how the law supports and strengthens primary care providers.
  • Providing Additional Funding for the Children’s Health Insurance Program. Under the law, states will receive two more years of funding to continue coverage for children not eligible for Medicaid. Effective October 1, 2013.Learn more about CHIP.



A chain of blue paper dolls forms a circle with one orange paper doll
  • Prohibiting Discrimination Due to Pre-Existing Conditions or Gender. The law implements strong reforms that prohibit insurance companies from refusing to sell coverage or renew policies because of an individual’s pre-existing conditions. Also, in the individual and small group market, the law eliminates the ability of insurance companies to charge higher rates due to gender or health status. Effective January 1, 2014.Learn more about protecting Americans with pre-existing conditions.
  • Eliminating Annual Limits on Insurance Coverage. The law prohibits new plans and existing group plans from imposing annual dollar limits on the amount of coverage an individual may receive. Effective January 1, 2014.Learn how the law will phase out annual limits by 2014.
  • Ensuring Coverage for Individuals Participating in Clinical Trials. Insurers will be prohibited from dropping or limiting coverage because an individual chooses to participate in a clinical trial.  Applies to all clinical trials that treat cancer or other life-threatening diseases. Effective January 1, 2014. 



  • Making Care More Affordable. Tax credits to make it easier for the middle class to afford insurance will become available for people with income between 100% and 400% of the poverty line who are not eligible for other affordable coverage. (In 2010, 400% of the poverty line comes out to about $43,000 for an individual or $88,000 for a family of four.) The tax credit is advanceable, so it can lower your premium payments each month, rather than making you wait for tax time. It’s also refundable, so even moderate-income families can receive the full benefit of the credit. These individuals may also qualify for reduced cost-sharing (copayments, co-insurance, and deductibles). Effective January 1, 2014. Learn how the law will make care more affordable in 2014.
  • Establishingthe Health Insurance Marketplace. Starting in 2014 if your employer doesn’t offer insurance, you will be able to buy it directly in the Health Insurance Marketplace. Individuals and small businesses can buy affordable and qualified health benefit plans in this new transparent and competitive insurance marketplace. The Marketplace will offer you a choice of health plans that meet certain benefits and cost standards. Starting in 2014, Members of Congress will be getting their health care insurance through the Marketplace, and you will be able buy your insurance through Marketplace too. Learn more about the Health Insurance Marketplace.
  • Simple comparison of two coverage options
  • Increasing the Small Business Tax Credit. The law implements the second phase of the small business tax credit for qualified small businesses and small non-profit organizations. In this phase, the credit is up to 50% of the employer’s contribution to provide health insurance for employees.  There is also up to a 35% credit for small non-profit organizations.  Effective January 1, 2014.Learn more about the small business tax credit.



  • Increasing Access to Medicaid. Americans who earn less than 133% of the poverty level (approximately $14,000 for an individual and $29,000 for a family of four) will be eligible to enroll in Medicaid. States will receive 100% federal funding for the first three years to support this expanded coverage, phasing to 90% federal funding in subsequent years. Effective January 1, 2014.Learn more about Medicaid.
  • Promoting Individual Responsibility. Under the law, most individuals who can afford it will be required to obtain basic health insurance coverage or pay a fee to help offset the costs of caring for uninsured Americans.  If affordable coverage is not available to an individual, he or she will be eligible for an exemption. Effective January 1, 2014.Learn more about individual responsibility and the law.



  • Paying Physicians Based on Value Not Volume. A new provision will tie physician payments to the quality of care they provide. Physicians will see their payments modified so that those who provide higher value care will receive higher payments than those who provide lower quality care. Effective January 1, 2015.


For Businesses:

The U.S. Small Business Administration is launching a new series to explain the basics of the law, what you need to do to comply, and how your business can benefit from new incentives. The first article in the series, written by Meredith Olafson, highlights three big things every small business owner should know about the Affordable Care Act.

About the Author

Meredith Olafson is Senior Policy Advisor for the U.S. Small Business Administration where she oversees the agency’s education and outreach efforts around health care and the Affordable Care Act.

The Affordable Care Act will help small businesses by lowering premium cost growth and increasing access to quality, affordable health insurance.   Depending on whether you’re a small employer or a larger employer, different provisions of the Affordable Care Act may apply to you as described below.

1.  Businesses with Fewer than 25 Employees- Small Business Tax Credits

The Affordable Care Act does not require that businesses provide health insurance, but it offers tax credits for eligible small businesses that choose to provide insurance to their employees.  To qualify for a small business tax credit of up to 35% (up to 25% for non-profits), you must have:

  • Fewer than 25 full-time equivalent employees
  • Pay average annual wages below $50,000
  • Contribute 50% or more toward employee health insurance premiums

Beginning in 2014, this tax credit goes up to 50% (35% for non-profits) and is available to qualified small businesses who participate in the Small Business Health Options Program (SHOP) Exchanges.

2.   Businesses with 50 or Fewer Employees- Affordable Insurance Marketplaces

The Affordable Care Act does not require that businesses provide health insurance, but beginning in 2014, small businesses with generally 50 or fewer employees will be able to purchase coverage through SHOP , competitive marketplaces where small employers can go to find health coverage from a selection of providers.  The SHOP Marketplaces and Individual Marketplaces for those who are self-employed open on January 1, 2014. Open enrollment begins on October 1, 2013.  SHOP will offer small businesses increased purchasing power similar to that of large businesses.

3.  Businesses with 50 or More Employees- Employer Shared Responsibility Provisions

Under the Affordable Care Act, the Federal government, State governments, insurers, employers, and individuals share the responsibility to reform and improve the availability, quality, and affordability of health insurance coverage in the United States. Employers are not required to provide coverage to their employees under the Affordable Care Act.   However, beginning in 2014, businesses with 50 or more full-time employees (or full-time equivalents) that do not offer affordable health insurance that provides a minimum level of coverage to substantially all of their full-time employees (and their dependents) may be subject to an employer shared responsibility payment if at least one of their full-time employees receives a premium tax credit to purchase coverage in an insurance Marketplace.  A full-time employee is generally one who is employed an average of 30 or more hours per week.

If you meet or are close to this threshold level of full-time employees, it’s important to understand how these rules may apply to you and how the employer shared responsibility payments could be triggered.   For more guidance on the employer shared responsibility payments, refer to this FAQ from the IRS.

Check back with the Reno Agency blog for more updates about the Affordable Health Care Act as they become available.

President Obama’s Health Care Overhaul is in a Sprint to the Finish Line

Whether you are for or against President Barack Obama’s health care overhaul, the main question now is not “Will it happen,” but “How will they make it happen.” There are 11 months left before millions of uninsured Americans are able to get health care coverage, but there are still many questions about how the President will execute those plans. Here is an article from that provides an update to where we are now, and what has to be done over the next several months to implement a successful transition.

Medicare Open Enrollment is Now Through December 7

Are you turning 65 soon and need help finding a Medicare plan? Are you 65+ and want to see if you can save money by switching Medicare plans? Or do you have a disability that qualifies you for Medicare? Open enrollment for Medicare is now through December 7, and if you have questions, the Reno Agency is here to assist. Call us today at 269.792.2232 to schedule your appointment.

In the meantime, is an excellent place to start if you have questions.

In Michigan, both Blue Cross Blue Shield and Priority Health have expanded their Medicare products. Read the full articles here to find out more information.

Blue Cross Blue Shield of Michigan may be one step closer to an overhaul of its corporate structure

The state Senate approved an overhaul of Blue Cross Blue Shield-MI’s corporate structure in efforts to modernize the company and level the playing field between the non-profit and its competitors. Read the full story here.

National Insurers Face New Scrutiny Over Price Hikes

U.S. health insurance companies that want to increase premiums by 10 percent or more next year would face tougher government scrutiny under new rules proposed Tuesday.

The rules, called for under the sweeping healthcare law passed in March, would require insurers with price increases of 10 percent or more in 2011 to submit data justifying the higher rates for states or, in some cases, the federal government to assess.

While regulators cannot set health insurance rates, they can determine whether proposed increases are “unreasonable.”

The rules put further pressure on health insurers such as Aetna Inc., UnitedHealth Group Inc. and WellPoint Inc., which suffered bad press and drew closer scrutiny by Congress and regulators this year when prices for some individual plans in certain areas rose more than 30 percent.

Tuesday’s proposal offers Wall Street and insurers more details on the rules, which analysts said were better than expected and lifted some uncertainty hanging over the industry.

Shares of insurers, represented by the S&P Managed Health Care Index, rose 1.5 percent after the proposal was announced, but later pared their gains and were up 0.5 percent, in line with the overall market.

The rule is “not as bad as it could have been,” Capital Alpha Partners analyst Kim Monk told Reuters. With its emphasis on the states’ role, less federal oversight is likely over time and the U.S. Department of Health and Human Services (HHS) ”will get out of the rate review business entirely, with this just being a stopgap.”

The proposal also pushes back implementation until July, which gives companies more time to seek possible changes, she added.

Health insurers largely fought Democrats’ healthcare overhaul but have since said they will work to implement it. Republicans, who are set to take over the House of Representatives next month, have vowed to repeal the law.

Karen Ignagni, head of the healthcare industry lobbying group America’s Health Insurance Plans, said the 10 percent threshold does not adequately account for all the factors insurers face when setting rates and that overall higher healthcare costs are a major factor.

“The public policy discussion on healthcare costs has focused on health insurance premiums while ignoring the root causes that are driving up the cost of coverage,” said Ignagni.

Jay Angoff, head of the Office of Consumer Information and Insurance Oversight at HHS, said the proposed rule “strikes the right balance” between companies and consumers as well as state and federal roles.

“We believe that it maximizes consumer protection and transparency without unduly burdening the industry,” he told a news conference.

Under the draft, healthcare insurance plans for large groups, such as those offered by many big employers, are not subject to the review.

Still, insurers would have to submit a host of data to regulators about how they set their higher prices, including a three-year history of rate increases for the specific insurance plan, details on the plan’s medical-loss-ratio spending, and data on employee and executive compensation.

The requirements are likely to add to health insurers’ paperwork burden, Monk said.

Various consumer groups applauded the proposal, which they said would help rein in skyrocketing health plan prices and give buyers better information, although some advocates said the rules could be stronger.

“No longer will the insurance industry be able to operate in a wild, wild West through unreasonable premium increases without any accountability for their actions,” Ron Pollack, executive director of Families USA, said in a statement.

After a rate review, federal officials would post the findings on the HHS website. If a rate hike was deemed too high, insurance companies would also have to post the verdict on their own websites.

States with their own health insurance review systems would evaluate companies’ rates, with HHS stepping in to assess proposed increases in states without such systems.

Different state-by-state thresholds — rather than the blanket 10 percent one next year — would be set after 2011, officials said.

The proposal, online at, will be finalized after a 60-day public comment period.

(Reporting by Susan Heavey; Editing by Dave Zimmerman, Matthew Lewis and John Wallace)

Read more:

Blue Cross adjusting rates of individual health plans

The state Office of Financial and Insurance Regulation (OFIR) has formally approved a new rate structure and benefits for all of BCBSM’s nongroup and group conversion products (closed and Plus products) for those under 65.
Beginning January 1, 2011, BCBSM MyBlueSM members will see many enhancements to their benefits. Here are some of these changes, required by the Patient Protection and Affordable Care Act (Health Care Reform):

  • Ensuring there are no exclusions or waiting periods for members under age 19 with pre-existing conditions
  • Extending coverage for dependents (by birth, adoption or legal guardianship) up to age 26
  • Eliminating lifetime maximum dollar limits that would prevent members from being able to access care when the cost of their care reaches a certain lifetime dollar amount
  • Providing preventive services and immunizations to members with no cost sharing

As a result of the additional benefits, the approval allows BCBSM to adjust premiums on their rate structure of their coverage. Instead of a family contract and a percent some members will receive higher-than-average adjustments while others will see smaller adjustments.
BCBSM has sent letters to affected members in “closed” and “Plus” products and enclosed a flier outlining preventive benefits that are now included with all MyBlue plans. Those experiencing a rate adjustment recently received a letter via U.S. mail. The new rates will become effective January 1, 2011.

BCBSM will proactively call members experiencing a higher-than-average adjustment to discuss more affordable options.
If a member is concerned about the increase he or she is incurring, we have additional MyBlue products to fit their needs and budget. Plans include Young Adult BlueSM, Individual Care Blue PlusSM, Flexible Blue IISM and OneBlueSM. You can check current rates for these plans by using the “Life, Health, and Benefits” page on our website.  Then look for the link Click here to apply for permanent health coverage.

 Additional information

A small number of members (460 contracts) will receive a higher premium adjustment.  The larger increase for this small subset of individual members results from a change in  how BCBSM is now able to rate dependents.

  • Previously, dependents over age 19 were covered under a Family Continuation rider.
  • Under the rider, BCBSM charged different rates for dependents based on age, which is no longer permissible under national health reform legislation. All dependents (0 to 26 years old) must be charged at the same rate.
  • Therefore, BCBSM is discontinuing the FC rider, effective Jan. 1, 2011.
  • As a result, individual members who had dependents over 19 will see a change in their rate structure of their coverage. Instead of a family contract and a separate family continuation rate for their over age 19 dependent, their new rate will reflect a family contract where all family members are grouped together.
  • The affected family can opt to move the over-19 dependent to a Young Adult Blue product. If they do so, they could experience an overall decrease in their premium. The one-person family premium, combined with the Young Adult Blue premiumwill, in many cases, be lower than what they were previously paying for coverage.
  • BCBSM will be making outbound calls to these members to explain how they can lower their costs.

Rate Adjustment Enrollment Period

We’ve set up a rate adjustment enrollment period for MyBlue members interested in changing coverage options. The enrollment period only applies to MyBlue members affected by the rate adjustment. If a group isn’t affected by the rate adjustment, normal processing rules apply. Excluded groups include all Medigap/St. John, Chrysler Bridge, Michigan Farm Bureau and personal dental contracts.

Enrollment processing guidelines

  • The special enrollment period for option changes is Dec. 1, 2010, to Jan. 15, 2011.
  • Requested option changes will take effect no earlier than Jan. 1, 2011,
    regardless of the bill cycle.
  • During this time period, option change requests will be honored regardless of how long a member has had their coverage or if they have made a change in the past 12 months.
  • Requests received after Jan. 15, 2011, will be processed per the normal underwriting policy.

Rate Adjustment Effective Dates

  • The rate adjustment will take effect with Jan. 1, 2011, premium bills.
  • Members will receive the rate adjustment effective Jan. 1, 2011, regardless of their bill cycle.
    • Example 1: Billed from Jan. 15, 2011, to Feb. 14, 2011, the system will automatically make the rate adjustment back to Jan. 1, 2011.
    • Example 2: Billed from Dec. 15, 2010, to Jan. 14, 2011, the system will split the rate adjustment.