In brief

HHS seeks input on improving care coordination

On Dec. 12, 2018, the U.S. Department of Health and Human Services Office for Civil Rights issued a request for information, seeking input from the public on how the Health Insurance Portability and Accountability Act of 1996 rules could be modified to further the HHS secretary’s goal of promoting coordinated, value-based health care. HHS developed the HIPAA rules to protect the privacy of individuals’ health information while permitting information sharing needed for important purposes. However, in recent years, the OCR has heard calls to revisit aspects of the rules that may limit or discourage information sharing needed for coordinated care or to facilitate the transformation to value-based health care.

Public comments on the RFI are be due by Feb. 11, 2019. For more information or to download the RFI, go to federalregister.gov/public-inspection.*

Program rewards cost-effectiveness

Blue Cross Rewards^SM, which kicks off this month, will give fully insured Blue Cross Blue Shield of Michigan PPO group members the chance to earn e-gift cards ranging from $25 to $75 for visiting a cost-effective health care provider location for select, non-emergency procedures.

How do we determine if a service is cost effective? For purposes of this program, it’s considered cost effective if the cost falls within the lowest 30 percent cost range of all claims submitted for a service during the previous year. For more details, see the December Record article, “Blue Cross Rewards program will help members compare costs while earning e-gift cards.”

How to complete and submit wellness qualification forms

This year, you’ll probably see patients with wellness plans who ask you to complete and return their 2019 Blue Cross Blue Shield of Michigan qualification forms. We’re instructing members to work with their doctor to complete and submit the qualification form. We’re asking you to submit the qualification form electronically for your convenience and to help improve processing time.

For more information, read the January Record article, “Blue Cross qualification forms should be submitted electronically.”

We’re making changes to PGIP allocation

Starting Jan. 1, 2019, the 7 percent Physician Group Incentive Program allocation is being divided as follows:

Blue Cross Blue Shield of Michigan is directing 2 percent to fund the 2019 PGIP Risk-Bearing OSC program. This new program rewards OSCs for managing the benefit cost trend of their attributed Blue Cross PPO patient population and is the first step in our pathway to risk strategy.
The remaining 5 percent continues to reward eligible physician organizations and OSCs for improving the quality of patient care, system and practice transformation, and reducing costs.

To read more about other PGIP allocation changes, check out the January Record article, “Reminder: Changes to the PGIP allocation will support Organized Systems of Care efforts.”

Online visits now a benefit for MA plans

Blue Cross Online Visits^SM is now available to our Medicare Plus Blue^SM and BCN Advantage^SM members. This was effective Jan. 1, 2019. Commercial Blue Cross PPO and Blue Care Network HMO members already have this benefit, while the Michigan Public School Employees Retirement System group opted out of this benefit for 2019.

To read more about this benefit, check out the December 2018 Record article, “Online health services available to Medicare Plus Blue PPO members, starting Jan. 1.”

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Blue Cross Blue Shield of Michigan and Blue Care Network are nonprofit corporations and independent licensees of the Blue Cross and Blue Shield Association.