Health care exec focuses on wellness, prevention

Health care exec focuses on wellness, prevention

Recently, associate editor Sherri Dauskurdas interviewed Karen Atwood, senior vice president for National Accounts at Blue Cross and Blue Shield of Illinois, to discuss trends in health insurance, the influence of the present economy, and future challenges in the industry. Here are some excerpts of that interview:

Q. In recent months, many people have lost benefits for their families or lost jobs completely. What is Blue Cross doing to help out folks who may now need to purchase their own coverage, typically a very expensive proposition?

A: We have a variety of individual health and dental plans for those who need to purchase insurance on their own. There are several PPO plans available with a deductibles ranging from $250 to $10,000.

Q. Small businesses make up such a large portion of today’s economy, yet many are still unable to offer employee healthcare benefits. What does Blue Cross see as its responsibility to help small business owners cover their staff?

A: We have many small businesses that want to continue to offer health insurance to employees, and have asked us to work with them to offer affordable plans. Two years ago, we submitted a legislative proposal to the state asking for more affordable insurance for small businesses. As the legislature passes mandates for additional services for medical conditions, such as autism spectrum disorders, these mandates have an impact on the cost of coverage for all groups.

Q. On a similar topic, more patients are subject to high deductible health plans, a trend that surely will increase as businesses look to curb health premiums. There is currently no reliable way to find out how much tests and treatments cost. What will Blue Cross do to encourage transparency?

A. As part of the latest push toward consumerism in the healthcare industry, we encourage information transparency, based on the belief that consumers need access to reliable cost and quality information in order to make the best and most cost-conscious decisions about their health. We offer our members online decision-support tools that provide cost and quality information. These tools come in many forms such as comparison tools and star ratings, which can be found on our website.

Also, the Blue Star Hospital Report provides performance information on Illinois hospitals. The report summarizes the results of quality and safety performance measures. Our treatment cost advisor helps members obtain cost information for common health care services based on demographic and geographic information.

Q. Whether we adopt a form of socialized health care or not, there will no doubt be a need for dramatic cost-cutting. What will Blue Cross do to encourage cost-saving measures at participating providers?

A: We negotiate with these physicians and hospital networks to make health care more affordable for our members. We produce a Blue Star hospital report, available online, to help our members make better choices on where to spend their healthcare dollars based on reported outcomes from accrediting entities. We report on hospital utilization and administrative efficiency, both which result in cost-savings measures. We encourage hospitals to submit claims electronically, reducing additional staffing resources. We also fund a computerized physician order entry program, called “ePrescribe,” which reduces errors and promotes safe practices on behalf of the patient.

Q. There is a well-known primary care physician shortage in the country. With so many patients already waiting months for an appointment and often crowding emergency rooms at local hospitals, how does this problem affect insurance providers?

A: We are concerned about patients not being able to be seen by their primary care physician and opting to go to the emergency room for services. For our Blue Cross and Blue Shield of Illinois members, we offer benefit coverage for retail clinic services and urgent care centers where they can receive immediate medical attention. We would like all our members to establish a relationship with a primary care physician who can direct their care and help them manage their lifestyle.

Q. What is on the horizon for wellness programs and lifestyle incentives? How is Blue Cross working with physicians and companies to promote the prevention of illness?

A. We offer integrated tools and resources designed to promote health, wellness, and productivity. These include health assessment and health planning tools; educational resources; lifestyle management programs; worksite wellness initiatives; and motivational and incentive programs.

We start with health risk assessments, which help participants evaluate and better understand their health status. Based on their input, HRAs produce personalized reports, which highlight areas of health risk. Using the reports, members can develop health goals and plans for improvement that address fitness, nutrition and a host of related issues. In addition, members can enroll in lifestyle management programs covering topics ranging from tobacco cessation to weight management.

The wellness tools also incorporate a number of worksite wellness modules, including webinars on health and wellness topics, onsite health fairs, and screenings.

In addition, we provide “wellness campaigns in a box" spanning a range of topics, from walking programs to weight management contests. We incorporate educational components, such as pre-written articles and an online health encyclopedia, drug index and interactive symptom checker. Participating members have access to nurses by phone, 24 hours a day, seven days a week, as well as e-mail access to dietitians, life coaches and trainers. In addition, we offer discounts on memberships to a variety of health clubs and weight management programs. Our members can receive discounts on a variety of alternative and complementary health care products and services, ranging from vitamins and herbal supplements to acupuncture, meditation, yoga and mind and body therapies.

Q. The ICD-10 code conversion promises providers and payers more data on which to document diagnosis, decisions and reimbursement. But the process is burdensome and costly. What will be the effects on providers, and how will that translate to those covered by your plans?

A. ICD-10 is the updated version of the standard codes that must be used to describe all inpatient diagnoses and procedures and all outpatient diagnoses. These 207,000 new codes replace the approximately 24,000 current ICD-9 codes. Almost all other developed countries (99) use ICD-10, including Australia and Canada.

The World Health Organization is pushing for adoption of ICD-10 because it will enable much more meaningful understanding of the world-wide health care landscape. This could include things like tracking SARS, antibiotic-resistant bacteria, or HIV. It captures more granular health care detail in terms of diagnosis and procedure coding. Other benefits include more precise reimbursement, improved benchmarking and quality management, enhanced pay-for-performance initiatives and improved health reporting and health services research.

Similar to past large compliance issues, we will work with the provider community to educate and train them on new ICD-10 codes and transition to ICD-10. We will enhance provider education and training tools for reduction of coding errors. It will be a daunting job even for the largest players in health care as it will be extremely expensive, technically difficult and resource-intensive.

Q. What will be the most significant issue to your insurance providers in the coming year(s)?

A. The most significant issues will be the economy, the uninsured and our continuing goal to address the needs of our communities. Focusing on our members and on the communities in which we do business allows us to develop more effective health care solutions. Investments in technology, wellness, disease management programs and quality improvement initiatives are made with the goal of benefiting our members and improving the entire health care system.

Posted on Monday, January 12, 2009 (Archive on Monday, January 19, 2009)
Posted by jstoltz Contributed by jstoltz

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