Featured Health Business Daily Story, Dec. 30, 2016

Blues Plans Wrap Insurance Products Around Value-Based Networks

Reprinted from THE AIS REPORT ON BLUE CROSS AND BLUE SHIELD PLANS, a hard-hitting independent monthly newsletter on new products, market share, management strategies, profitability, strategic alliances and executive compensation of BC/BS plans. (Not affiliated with the Blue Cross and Blue Shield Association or its member companies.) Sign up for a $72 two-month trial subscription today.

By Jill Brown, Executive Editor
January 2017Volume 16Issue 1

Just as Blue Cross and Blue Shield plans are continuing to invest in value-based care models, they also are wrapping insurance products around networks built on the foundations of these programs.

“Consumers and health providers alike understand that as health care costs continue to grow, programs that deliver on the triple aim represent the best way to ensure that we can provide high quality coverage at an affordable cost,” Horizon Blue Cross Blue Shield of New Jersey Chairman, President and CEO Bob Marino tells The AIS Report. “In 2016, the OMNIA Health Alliance, a collaboration with some of New Jersey’s top health care organizations, began to build on those models and accelerate the transformation of New Jersey’s health care system to one more focused on value and quality.”

The AIS Report on Blue Cross and Blue Shield Plans

Horizon last month said it expanded OMNIA’s 2017 benefit designs available on New Jersey’s health insurance exchange, with gym membership reimbursements, behavior therapy and coaching, and dedicated customer service reps. The insurer is offering Bronze, Silver and Gold plans, along with a Silver product tied to a health savings account (HSA), and three other exchange products. The OMNIA products have 280,000 members.

The insurer estimates that OMNIA enrollees save an average of 20% of premiums compared with Horizon’s broad-network plans. The OMNIA product features a tiered provider network, with lower out-of-pocket costs for members who use one of the insurer’s 26,000 Tier 1 doctors or hospitals.

Similarly, Blue Cross Blue Shield of Michigan recently launched the Blue Cross Personal Choice PPO for small and mid-sized businesses. The product is built on the insurer’s longstanding program of patient-centered medical homes, which together with specialists and hospitals are formed into “Organized Systems of Care” (OSCs). The PPO product has 38 OSCs with more than 4,300 primary care physicians, 11,630 specialists and 118 hospitals. Enrollees who use providers in their OSC have lower out-of-pocket costs.


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