From Health Plan Week - The board of Covered California on April 7 approved a measure requiring participating health insurers to identify and exclude poorly performing hospitals from their networks by 2019. Experts say this is a “leading policy” that indicates where the industry is headed in its drive to cut cost and improve quality. In Attachment 7 to Covered California’s contract with Qualified Health Plans, insurers will be required to work with the exchange “to identify areas of ‘outlier poor performance’ based on variation analysis. Read more
From The AIS Report on Blue Cross and Blue Shield Plans - Instead of rushing patients to the emergency room, two Albuquerque paramedic companies are working with Blue Cross Blue Shield of New Mexico to keep Medicaid members out of their ambulances. The pilot project, dubbed Community Paramedicine, began operating in January with a goal of reducing 911 calls and hospital readmissions. The New Mexico Blues plan is one of five Blues plans operated by Health Care Service Corp. (HCSC). The New Mexico… Read more
From The AIS Report on Blue Cross and Blue Shield Plans - Mia Finkelston, M.D., a primary care physician in rural Maryland, works out of an office in the basement of her home. It’s St. Patrick’s Day, and she’s seated in front of a white screen adorned with large paper shamrocks. She’s wearing a green sweater beneath her white lab coat. Before each appointment begins, patients enter basic information about themselves and the reason for their visit. They also key-in their health… Read more
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