Reimbursement

Blue Cross Blue Shield of Oklahoma (BCBSOK) is launching its patient-centered medical home (PCMH) in early 2010. With Oklahoma's growing primary care physician shortage and its bottom five national ranking of their ratio per capita, the payer is looking for ways to impact quality of care while expanding its provider footprint.

Independence Blue Cross' healthcare information technology capabilities helped the company land a new health benefits contract with Lincoln Financial Group, IBC executives announced Thursday.

Physicians in Maine are piloting electronic visits with their patients as part of a program developed between Eastern Maine Healthcare Systems (EMHS) and Anthem Blue Cross and Blue Shield in Maine.

Genetic testing and electronic medical records are top of the ECRI Institute's 2010 technology watch list for health plans.

Compared to other stakeholders in the healthcare ecosystem, payers are late adopters of Health 2.0 technology. While many payers are beginning to invest, a panel at the Health 2.0 Conference in San Francisco in October demonstrated how they are leading the pack. Kaiser Permanente's electronic health record system is well known in the industry. The healthcare organization is putting the finishing touches to its EHR throughout the enterprise, said Christopher Ohman, senior vice president of health plan operations outside California for Kaiser.

In a move to drive more transparency in the healthcare insurance market, the Oregon legislature has mandated health plans to provide the cost of 35 different treatments to consumers. PacificSource has delivered nearly 1,000 estimates for its members since it deployed TriZetto's Treatment Cost Navigator in July, said CIO Erick Doolan.

Although healthcare reform dominates the payer world, payers need to start working on a game plan for the major transition to ICD-10, industry consultants said. "The biggest mistake payers can make is not addressing the impact assessment quickly," said Pamela Ruebelmann, vice president of healthcare solutions for HighPoint Solutions. An assessment, which provides a full understanding of all the impacted components of people, process and technology, will help payers develop a multi-year, organization-wide roadmap, she said.

In an effort to boost healthcare delivery, physicians at Children's Hospital Boston are partnering with Massachusetts' major health plans to develop new technologies and integrated care models.

The Centers for Medicare and Medicaid Services has announced a 2 percent market basket update to Medicare's calendar year 2010 home health prospective payment system rates and modifications to the home health outlier policy.

The U.S. Department of Health and Human Services has issued an interim final rule to strengthen enforcement and increase penalties for violations of the Health Insurance Portability and Accountability Act, known as HIPAA. The Health Information Technology for Economic and Clinical Health (HITECH) Act, which was enacted as part of the American Recovery and Reinvestment Act of 2009, modified the penalties that the HHS could impose for violations of the HIPAA rules.