The Affordable Care Act brought many changes to the health care industry — for consumers and health insurance companies.
Roy Vaughn, vice president for corporate communications for BlueCross BlueShield of Tennessee, highlighted how the insurance giant has navigated the changes during his talk at the Rotary Club of Cleveland Tuesday.
He describes the changes as challenging.
“We didn’t oppose the law itself. Although we have been universally thought to have opposed it, we were for the concept of access. Access improves people’s health. We know that,” Vaughn said. “We were for the concept, but there are still some issues about how it’s done.”
He said from Jan. 1, 2013, to March 31, 2014, there were 40 policy regulation changes in the Affordable Care Act. The company worked through each change looking to comply with the new law and provide feedback.
“We did have grave concerns about healthcare.gov on the front end. We shared those on the front end as well,” Vaughn said.
BCBST had the lowest prices in the state on the health care marketplace, Vaughn said.
At this point the company “is losing money on the marketplace plans. So we filed for an increase for those plans, only to get us to a break-even point.”
“Because of our financial strength, we can take a loss for a year or two, but we are trying not to do that,” Vaughn said. “We are a not-for-profit business, (but) we have to make some margin.”
Vaughn said the company’s model has it switching to a “pay for performance” model.
“It’s not just pay for volume anymore, it’s what did you achieve on behalf of our members?” Vaughn said.
“We have essentially about 6,500 members in a pilot where primary care physicians serve as the quarterback, essentially, for the care of members. They are coordinating among all specialists, coordinating all prescriptions, coordinating all levels of care.”
BCBST has also partnered in a surgery program that has brought a decrease in infections and saved money.
“We are really focused on ‘How can we work with physicians in hospitals in improving care?’” Vaughn said.
The format of healthcare.gov created some confusion for those looking for coverage. Network E created an issue for BCBST when people realized the limited number of providers available.
“As you (apply), you are prompted to go look at the directory on our website. A lot of people, for whatever reason, didn’t do that,” Vaughn said. “We switched about 5,000 from Network E who had an issue related to that.
“Now what happens is if we have a member who expresses that dissatisfaction … the only way to (change) is to appeal to HHS (Department of Health and Human Services) and get that approved. We assist with that,” Vaughn said.
Network E had the most savings and was built around the major health provider in a given area. Other networks have a higher cost but have more options for care. Vaughn said even the “broadest network delivers value.”
BCBST was started in 1945 by the late Roy McDonald.
“There were a couple of reasons why plans were being started. One was to save people from catastrophic financial debt related to health services … at the same time many hospitals were having problems collecting for the services that they rendered,” Vaughn said.
“Not only did he want to protect individuals, he wanted to protect hospitals, because he knew them to be a community asset.”
Vaughn said the goal of the company is the same today.