BCN: healthy alternative

If you recently received notice of rate increases for your health insurance plan, you may be wondering how to control that part of your operating budget. Is there an option you haven’t considered before?

MRA now offers Blue Cross Blue Shield of Michigan’s complete portfolio of health insurance plans. Blue Care Network (BCN), a health maintenance organization (HMO) plan, is the most affordable option in the portfolio, and may be a good choice for your business.

To learn more about Blue Care Network, Michigan Retailer sat down with three members of the BCN team: Senior Vice President and Chief Actuarial Officer David Nelson, Director of Business Development and Product Support Nancy Dewan, and Director of Underwriting Seth Crawford.

When asked why Blue Care Network is a great option, their short answer is that it combines the benefits of a managed-care system (affordability plus a focus on disease prevention and management) with all the advantages of Blue Cross Blue Shield of Michigan—its large size (and the economies of scale that brings), years of experience and understanding of the health care industry, and influence in the Michigan market.

The Q & A that follows is designed to explain the Blue Care Network plan, so that you may consider whether it might be a good fit for your business.

Contact your MRA sales representative to discuss how you might offer BCN to your employees.

Q. Is Blue Care Network available in my area?

A. BCN is available in most but not all parts of Michigan. In the Upper Peninsula, BCN is available only in Mackinac County. Consult the map to see if BCN is available in your area.

Q. Are rates going up with Blue Care Network as fast as with other plans?

A. Good news: BCN’s premium increases are starting to slow down. The premium increases for the second half of 2004 averaged around 7 percent, much lower than the double-digit increases across much of the industry. Of course there’s a lot of variation, based on the group’s makeup—a group with many older participants might see a higher increase, for example.

Q. I have store locations in Lansing, Saginaw and southeastern Michigan. Can I cover employees at all these locations with Blue Care Network?

A. BCN can cover all these employees—that means one billing system, one customer service department, one contract to deal with. As a statewide plan, BCN has a much wider coverage area than many other HMOs, which allows BCN to cover groups with employees at multiple and sometimes distant locations.

Q. How does Blue Care Network differ from other popular health plans (a traditional plan or a PPO)?

A. BCN is a health maintenance organization (HMO). From the point of view of a participant, the two fundamental differences between HMOs and other plans are the use of primary care physicians and the specialist referral system.

With BCN, each participant chooses a primary care physician (PCP) from the more than 3,000 doctors in the network. This doctor oversees the person’s overall health. Since doctors almost never work exclusively with one plan, some people may be able to choose a doctor they already see under a different plan.

For many health concerns, the primary care physician will refer the member to a specialist. This is similar to what often happens in traditional plans, but in an HMO, the specialist’s care is covered only if a referral was obtained first.

The primary care physician also arranges tests and hospitalization services for members. If you receive any follow-up services without written authorization from your primary care physician, you may be responsible for the cost.

Q. How many health care providers are part of Blue Care Network?

A. As of April 2004, our network includes 3,046 primary care physicians, 6,555 specialists and 121 hospitals.

Q. Can I change my primary care physician if I don’t like him or her?

A. Yes, members may change PCPs once a month by notifying BCN. However, once you find a PCP you like, we recommended that you stay with that provider who will know your health history and be better able to manage your care.

Q. Do I have to see my PCP before every visit to a specialist?

A. We have tried to make the specialist referral process as simple as possible. About 18 months ago, BCN went o a global referral approach. In this system, the PCP can make a referral that is valid for 30 or 60 days—or up to a year if necessary.

If you are referred to a foot doctor, for example, and are likely to need four visits over three months, your PCP can make the referral good for a three-month period, which simplifies things for you and both doctors’ offices. Only after the time period expires would you need to see the PCP again for another referral, if necessary.

Q. What if I want a referral to a particular specialist?

A. You can ask your PCP for a referral to a particular in-network specialist, or you and your PCP can decide together which in-network specialist you should see.

Q. Is an obstetrician considered a specialist?

A. A woman can get routine obstetrical services from any obstetrician within the network without a referral.

Q. What if I need medical care when I’m away from home?

A. BCN members are covered for urgent and emergency care when away from home, and that coverage is simple to understand.

BCN members have a membership card—with the BCBSM logo and a small suitcase logo, which indicates BCN participates in the Blue Cross Blue Shield Association’s BlueCard® program. Simply show this card to any BlueCard® participating health care provider in the world.

The vast majority (80 to 90 percent) of all providers in the U.S. belong to this network. Members can call a toll-free number or visit a member website to find providers anywhere in the country.

BlueCard® then handles billing. At the time of service, the member is responsible only for whatever he or she would pay at home—usually a copayment (for example, $10 for an office visit or $75 for an emergency room visit). All other charges are billed through BlueCard® and the member is not involved.

Q. I have a college-age daughter who lives away from home during the school year. How would she obtain care?

A. If she attends school in an area covered by BCN, she would simply change her PCP to one in her new area, and change it back when she’s home over the summer.

If she attends a school outside the BCN network, she will be covered for urgent care and emergency care through BlueCard®, as if she were traveling.

Q. What makes BCN different in terms of quality of health care for participants?

A. As a managed-care organization, BCN operates on the premise that participants are better served by preventing health problems and carefully managing diseases and conditions that do arise, such as asthma, diabetes and heart disease. Members stay healthier, and the organization saves money by treating health concerns before they become critical and much more costly.

BCN’s disease-management programs are some of the highest rated in the country, with more than 93,000 participants. If you do get sick, BCN’s numerous programs can help you get the best care possible.

BCN is the first commercial HMO in Michigan and the nation to receive full patient and practitioner accreditation from the National Committee for Quality Assurance (NCQA) for disease management programs in asthma, congestive heart failure and diabetes. BCN has also earned NCQA’s highest rating (Excellent: 90 or more points out of 100) for the past several years.

A new disease-management program in partnership with Accordant was implemented last year to help manage the care of people with 14 rare, complex, chronic, progressive diseases (for example, multiple sclerosis and Lou Gehrig’s disease). BCN subcontracts with Accordant to provide specialist care to participants, focusing on improving clinical outcomes, coordination of care, understanding the disease and its treatment, utilization of services and quality of life.

Only 0.4 percent of BCN participants have these 14 diseases, but we believe these patients are better served with a disease-management program. BCN is concerned with improving the health care of all participants, not just with saving money through disease-management.

Q. What does a disease-management program do for the person with the disease?

A. Here’s an example. One very effective program is for congestive heart failure, a chronic condition that sometimes results in life-threatening illness when indications of problems are missed early on. One indicator of a serious problem—which could trigger a trip to the hospital and lots of health problems—is a small weight gain.

Our disease management program encourages people with this disease to weigh themselves daily and track their weight. The program provides a small bathroom scale and the resources to contact a nurse specialist, if there is a problem or question, who is trained to understand this condition and will counsel and guide the person to the best next step.

This is just one part of a comprehensive treatment plan the program provides to help people live with their chronic illness. Patients also receive regular informative newsletters and other resources that help them learn to live well with disease.

Q. I would like to change my group plan to BCN, but I know some employees would much prefer to stay with their current BCBSM plan. Can I offer my employees a choice between BCN and another BCBSM option, having the employee make up the difference in cost?

A. Yes. Many groups devise a plan in which their employees have BCN coverage as their base plan but can upgrade to another BCBSM plan for a monthly fee. The member usually pays for the difference in cost between the base plan and more expensive plan. Discuss this possibility with your sales representative.

Delta Dental adds
life-saving benefit

Delta Dental Plan of Michigan and the MRA dental plan have introduced a new benefit that can detect and even prevent a very serious illness—oral cancer. The company has added to its standard benefits package coverage for a relatively new diagnostic test, called a brush biopsy, which uses advanced technology to identify precancerous and cancer cells in or near the mouth.

The brush biopsy is a quick, simple and painless diagnostic test. The dentist uses a small brush to gather cells from red or white spots found on the lip, tongue or other areas inside the patient’s mouth. These spots are found in about 10 percent of patients and most are benign.

The sample is sent to a laboratory for computer-assisted analysis. Pathologists combine the results with microscopic evaluation to produce a full report for the dentist.

Delta Dental conducted extensive research before adding this benefit. The company determined that the brush biopsy is one of the most cost-effective and accurate diagnostic tests available. It can save lives by identifying abnormal cells that could become cancerous or detect the disease in its earliest, most treatable stage.

Delta’s benefit programs have always covered traditional scalpel biopsies, and they continue to do so. But the brush biopsy will be used on many more patients, resulting in many more cases of oral cancer being detected earlier or even prevented.

If cancerous cells are found early, the five-year survival rate is 81 percent (compared to an average of 57 percent). Moreover, at its precancerous stage, this disease can be prevented.

The potential savings in medical costs resulting from Delta’s investment in brush biopsy could be substantial, as oral cancer is one of the most expensive cancers to treat. The average cost for treating an advanced case is $83,000.

About 30,000 Americans are diagnosed with oral cancer each year.

Risk factors for oral cancer include smoking, tobacco chewing and drinking alcohol. However, a full 25 percent of cases have no risk factors at all.