Tag Archives: Blue Cross Blue Shield

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

BCBSM

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

Feb. 26, 2013, Taken from http://www.bcbsm.com/content/microsites/blue-cross-blue-shield-of-michigan-news/en/index/news-releases/2013/february-2013/bcbsm-blue-distinction-center.html

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 www.bcbs.com/bluedistinction.

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 bcbsm.com.

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 www.BCBS.com.  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 www.bcbs.com.  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

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, www.medicare.gov 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.

http://news.bcbsm.com/news/2012/news_2012-10-18-11174.shtml

http://www.priorityhealth.com/about-us/press-room/releases/2012/medicare-2013-expansion

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.

http://www.freep.com/article/20121018/NEWS15/310180372/State-Senate-approves-overhaul-Blue-Cross

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.