Schafer: New Blue Cross leader wants to move faster

Michael Guyette said he came to Blue Cross and Blue Shield of Minnesota as president and CEO in January of last year expecting to take over a “broken” organization.

His predecessor had lasted only six months, during which time several top-level executives left. As for market conditions, no one in the health insurance business had ever seen it so chaotic, with implementation of the sweeping Affordable Care Act reform law really getting underway.

Now, about 15 months into the job, Guyette reports that he is “having the time of my life.”

As health care delivery and how we pay for it continues to evolve, Blue Cross is clearly ambitious about its role. The vision statement on top of Guyette’s strategic plan summary reads “We will be Minnesota’s health care leader.”

Whether that describes Blue Cross right now is certainly debatable. It doesn’t have as many people enrolled in its plans as it did in 2008, although with a true statewide presence and annual revenue of $10 billion it’s not exactly an also-ran.

Among health benefits brokers and other market observers in the Twin Cities, Blue Cross is known for being a step or two slow in its marketing and plan design.

Guyette said he doesn’t disagree with that. But he also pointed out that picking up the pace of innovation and adaptation to change isn’t the only priority he’s discussed with the board. With three CEOs in three years, restoring a sense of stability also was a concern.

When Guyette started, he made a point within the first couple of months to at least shake the hand of all of Blue Cross’ more than 3,000 employees. The biggest change in its leadership team was removing the chief operating officer position.

He wanted the organization to be flatter. And to move faster.

“Decisionmaking here was focused on getting 100 percent or 110 percent of the information” before making a decision, he said. “We are instilling a culture here where we’re saying go ahead and try new things, pilot [a project], that 80 percent of the information is good enough to make a decision.

“We are trying to move faster. We are piloting more. We are partnering more. We think — we know — that will help us transform health care going forward.”

Guyette’s last job before coming to Eagan to take over at Blue Cross was as president of national accounts for Connecticut-based Aetna, a publicly held, traditional health insurer. He was responsible for the bottom line of a multi­billion-dollar health insurance business that covered about 9 million people who worked for big, ­household-name companies.

Of the “strategic pillars” built into the plan Guyette’s Blue Cross team put together, one he talks about the most is consumer focus. This may sound unremarkable for any business, but by consumer he means the individual in a Blue Cross plan, not necessarily a “customer” like the benefits manager at a big employer who picks an insurer.

More and more of the decisionmaking in health care is falling to the consumer, he said. It’s more than choosing between two different options for insurance based on annual deductibles, but also means making more informed choices for medical care.

“We know how to reach out to those members, we know how to give them information, we know how to connect to them,” he said of the role for Blue Cross. “And, we understand the actuarial risk side very well. We’ve been doing it what, 80 years? That’s not something you can just pick up off the shelf.”

The focus on the consumer is what led to the creation of what Guyette called a “war room” at Blue Cross headquarters with staffers working with providers throughout the state on finding ways to eliminate barriers to effective care. It’s everything from transportation to making sure the Blue Cross member sees the right health care professional the first time.

One example is helping Southern Prairie Community Care (SPCC), a 12-county collaborative in southwest Minnesota that is trying to improve care coordination for people on Medicaid. Blue Cross, through its HMO Blue Plus, is working with SPCC and other stakeholders in the area to identify gaps in the coordination of care in this large rural area.

Asked who is more likely to be an innovation leader in the coming years, a health plan provider like Blue Cross or an integrated clinic and hospital system like Allina Health, Guyette said, “maybe it’s together.”

Minneapolis investor and Blue Cross board chairman Vance Opperman said the executive team under Guyette “is as strong as it’s ever been, certainly as energetic as it’s ever been.” But it’s too soon to tell if the quicker Blue Cross that Guyette described is succeeding in the marketplace.

The just-announced results for 2013 demonstrated stability, and Guyette said he was “pleasantly surprised” by growth in individual plans in January. In the acutely competitive group market in the Twin Cities there was “some slippage,” although he added that those purchase decisions were mostly made last year and he’s confident going into the next cycle.

“We should talk again in a year or two,” he said. “I’d love to know what you are hearing about us then.”

http://www.startribune.com/business/253853181.html?page=all&prepage=1&c=y#continue

32 Recently Announced ACOs

The following accountable care organizations or value-based care delivery arrangements were covered by Becker's Hospital Review within the past month.

1. Humana struck up three new accountable care agreements.

• One is with Miramont Family Medicine, a medical group practice based in Denver. It covers Humana's Medicare Advantage HMO members in the area. 
• Another is with Edgewood, Ky.-based St. Elizabeth Healthcare.
• The third new agreement was formed with The Christ Hospital Health Network in Cincinnati.

2. Cigna was also very active, partnering with several provider organizations for collaborative accountable care initiatives, the payer's version of ACOs.

• One agreement is with Baton Rouge (La.) Clinic, a multispecialty group with about 90 physicians.
• The partnership between the payer and Springdale, Ark.-based PremierCare Northwest, a provider-owned network and collaborative effort between physicians and Northwest Health System, covers roughly 5,000 Cigna members.
• A third CAC initiative is with Brewer, Maine-based Beacon Health, a subsidiary of Eastern Maine Healthcare Systems, which covers 7,000 Cigna beneficiaries.

3. Anthem Blue Cross and Blue Shield in Missouri partnered with Esse Health, a St. Louis-based independent physician group, for an accountable care model.

4. LHS Health Network, which includes physician practices, hospitals and other providers and is affiliated with Camden, N.J.-based Lourdes Health System, partnered with Horizon Blue Cross Blue Shield of New Jersey for anACO.

5. Blue Cross Blue Shield of Michigan expanded its pay-for-performance initiative by signing value-based reimbursement contracts with 24 hospitals.

http://www.beckershospitalreview.com/accountable-care-organizations/32-recently-announced-acos-0314.html

Highmark eyes deal with Blue Cross company in northeast Pa.

Health giant Highmark Inc. is eyeing opportunities to grow outside of Western Pennsylvania as it prepares for the possibility of losing customers in the region when its contract with rival UPMC expires.

Highmark said on Tuesday that it is talking with Blue Cross of Northeastern Pennsylvania about creating a “stronger affiliation” between two of the state's four nonprofit Blue Cross companies.

Highmark, the state's largest health insurer with about 5 million members, purchased Blue Cross companies in Delaware and West Virginia in recent years, adding about 600,000 members.

If talks between Highmark and the much smaller Blue Cross of Northeastern Pennsylvania lead to a takeover, Highmark would gain about 545,000 members in 13 counties.

With about 60 percent of the health insurance market in Western Pennsylvania, Highmark is the dominant carrier. That could change if UPMC's insurance division and several national companies persuade employers to leave Highmark for health plans that will keep in-network access to UPMC's hospitals and doctors after 2014.

UPMC refused to negotiate a reimbursement contract with Highmark because the insurer bought West Penn Allegheny Health System and converted itself into UPMC's chief competitor for medical services and health insurance. Without a contract, Highmark members will pay more expensive out-of-network rates at UPMC starting Jan. 1, 2015.

Highmark “could be faced with losing market share” if the UPMC contract expires, said Tom Tomczyk, a principal in the practice of Buck Consultants, a Downtown benefits consulting firm. That means growth could come only from outside the region, he said.

“Highmark branched out into other states to expand their business,” he said. “Highmark's ongoing business plan is to continue to grow.”

Highmark tried to merge with another of the state's Blue Cross companies. But in 2009, Highmark and Independence Blue Cross in Philadelphia dropped their proposed merger, citing conditions that state regulators wanted to place on the deal to maintain a competitive insurance market.

The state Insurance Department declined to comment on the talks between Highmark and Blue Cross of Northeastern Pennsylvania. Spokeswoman Melissa Fox said neither company filed documents with the regulator regarding an acquisition or merger.

Mark Pauly, a professor of health care management at the University of Pennsylvania's Wharton School, said it is unlikely that state regulators would object to Highmark's absorbing the Wilkes-Barre-based Blue Cross company because the markets don't overlap.

It's more likely the smaller Blue Cross wants the protection of a larger company as implementation of the Affordable Care Act creates uncertainty for insurers, he said: “They believe there's safety in numbers and safety in size.”

Some insurers worry they'll lose business from individuals with chronic illnesses who previously could buy coverage only from Blue Cross companies. Under the law, dubbed Obamacare, those individuals can buy insurance through a government website where a number of insurers offer plans. Other customers, who may buy insurance for the first time because their illnesses made them costly to cover, might flock to these same insurers and increase the companies' risk.

Health insurers “are going to need money to deal with negative selection and losses,” said James McTiernan, a health care consultant with Triad Gallagher, a Downtown benefits consulting company.

Pennsylvania is unusual among states for having four nonprofit Blue Cross companies. Only five other states have more than one; there are 37 Blue Cross companies across the country. Several companies, most notably Anthem Blue Cross, are building multi-state companies through consolidation.

“There are not going to be a lot of niche players left,” McTiernan said.

Highmark and Blue Cross of Northeastern Pennsylvania have existing partnerships, officials said. Blue Cross of Northeastern Pennsylvania uses Highmark's information technology systems for claims processing, spokesman Aaron Billger said. The companies jointly own First Priority Health, an insurance subsidiary that sells group health plans to companies in northeastern Pennsylvania. They partner on Medicare Advantage plans sold to seniors there.

Highmark views that region “as very important to the community,” William Winkenwerder, Highmark CEO, said in a statement. His counterpart, CEO Denise S. Cesare, said the discussions are meant to “best serve the long-term needs of the residents” in 13 northeastern counties.

Blue Cross of Northeastern Pennsylvania's revenue averaged $750 million per year in 2011 and 2012, the company told the Tribune-Review this year. Highmark's annual revenue in 2012 was $15.2 billion.

Alex Nixon is a Trib Total Media staff writer. Read More:  http://triblive.com/mobile/5055230-96/blue-cross-highmark

Blue Cross Blue Shield of Texas Creates New Accountable Care Organization Alliance

Richardson-based Blue Cross and Blue Shield of Texas announced a new strategic alliance Thursday that it hopes will deliver improved, sustainable patient care while better managing healthcare costs, beginning in mid-2014.

The partnership—with Memorial Hermann Accountable Care Organization—is aiming to improve patients’ health while reducing costs through avoiding unnecessary hospital admissions, readmissions, emergency room visits, and duplication of services.

“This is a paradigm shift in paying for medical services,” Shara McClure, BCBSTX vice president for network management, said in a statement. ”The arrangement begins to move reimbursement away from fee for service to fee for value. In addition, the arrangement enables MHACO to harness clinical data to help drive medical care decision-making, enhance patient safety, and improve quality of care—all supporting the goals of better health and improved outcomes for BCBSTX members.”

The ACO model of healthcare delivery is designed to improve outcomes in three  categories: quality of care, patient experience and satisfaction, and cost efficiency. BlueCross will reach those goals by pursuing:

— Early identification of disease and illness through coordination of patient care

— Use of advanced technology and support services to make more informed decisions and facilitate transitions in care

— the implementation of an alternative or non-fee-for-service payment arrangement

— lower cost trends by increasing coordination among payers and providers

“Our relationship with Blue Cross Blue Shield of Texas around accountable care activities is consistent with Memorial Hermann’s commitment to quality outcomes and cost management,” said Chris Lloyd, CEO of MHACO. “The efforts we will undertake together will continue to advance the health of the populations we serve.”

BCBSTX is entering the ACO game just as another prominent North Texas healthcare organization is leaving it. Plus ACO—the accountable care organization comprised of Texas Health Resources and North Texas Specialty Physician— indicated to CMS in July that it intended to withdraw from the Pioneer ACO program, due to unmet financial goals.

“We look forward to working with CMS in other areas, and we will continue to support the accountable care framework’s fundamental components—reducing costs, improving patient outcomes through enhanced quality of care and care coordination across the continuum,” THR spokesman Wendell Watson said in an email to D Healthcare Daily in July.

Watson said Plus ACO was on track to save $10 million annually, yet was anticipating that it could be liable for a penalty between $6 million and $9 million at the end of the year. Watson said the group will continue to work with commercial plans to implement accountable care programs.

http://healthcare.dmagazine.com/2013/09/06/blue-cross-blue-shield-of-texas-creates-new-accountable-care-organization-alliance/