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Need to Know: April 2014


Industry updates in business and health management



Blue Cross of North-eastern Pennsylvania (BCNEPA) and Highmark Inc. reached a definitive agreement, bringing together two not-for-profit health insurers to serve nearly 5 million members in 62 of Pennsylvania’s 67 counties, as well as in Delaware and West Virginia. Under the terms of the merger agreement, which builds on the two organizations’ longstanding collaboration, BCNEPA’s local operations will be merged with Highmark, and Highmark will become the Blue Cross and Blue Shield Association affiliate for BCNEPA’s 13-county service area. The agreement also contains provisions that are designed to preserve BCNEPA’s historical presence, operations and workforce in northeastern and north central Pennsylvania.


Blue Cross Blue Shield of Michigan’s value-based hospital reimbursement model has now been embraced by seven leading Michigan health systems. Rather than paying hospitals for each service performed, these new reimbursement agreements evolve the focus of hospital payments toward improving the quality of care and patient outcomes, eliminating overuse of care and preventing unnecessary re-hospitalizations. The participating hospitals will also work with their provider partners in the community to implement an infrastructure plan that promotes coordination of care among all providers who treat the same patient, resulting in more efficient and effective care for Michiganders at lower costs.


Regence Health Insurance Services is launching Regence Marketplace, a new private exchange health insurance option for select businesses in Idaho, Oregon, Utah and Washington. This model provides mid-and large-sized businesses with a customizable private exchange containing multiple Regence coverage options for safe, affordable and effective quality care. Similar to a 401(k) retirement contribution, Regence Marketplace supports defined contribution which allows employers to contribute a set amount to their employees’ accounts. Employees can then shop for Regence health insurance on the online Regence Marketplace. Employers are increasingly turning to private exchange solutions incorporating defined contribution. Consultant Bain & Co. estimates that as many as 80 million people will receive their health insurance through private exchanges by 2018.

Health management

Optum Labs, the collaborative research and innovation center founded by Optum and Mayo Clinic, have added seven new charter partners in order to help improve healthcare delivery and patient outcomes: American Medical Group Association, Alexandria, Va.; Boston University School of Public Health, Boston; Lehigh Valley Health Network, Allentown, Pa.; Pfizer Inc., New York; Rensselaer Polytechnic Institute (RPI), Troy, N.Y.; Tufts Medical Center, Boston; and the University of Minnesota School of Nursing, Minneapolis. More than 20 major research initiatives are currently under way at Optum Labs, including studies that compare results from randomized clinical trials. 


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