Blue Cross Culls Network? Employers Customize Health Plans – An SBPPO?

 “The old model is not working,” BlueCross CEO Alphonso O’Neil-White said Wednesday .

BlueCross BlueShield of Western New York is teaming up with the region’s largest provider system to offer self-insured
employers with new tailored networks, in hopes of providing more efficient care that decreases costs.

The BlueCross and Kaleida Health initiative, which officials said is the region’s first integrated network of its kind, lets employers customize health plans, tailoring the doctors and hospitals covered under the plan, reported Business First.

“The old model is not working,” BlueCross CEO Alphonso O’Neil-White said Wednesday . “This is not the standard model where a health plan creates a product and throws it out there to the market.” See

BlueCross and Kaleida Health both admitted that the tailored networks will limit members’ choices of doctors and hospitals, but they believe the breadth and depth of services will lead to members accepting the restrictions.Although each participating employer’s health plan will differ, they will share common goals, for example, basing medical decisions on research, avoiding
unnecessary tests and procedures, tracking, using data to evaluate performance and stressing preventive care.

The initiative also could lead to BlueCross to create new provider payment systems, such as bundled payments that help cover non-reimbursed services, the insurer said.

Employer groups could begin creating their tailored plans in June and offering them to employees Jan. 1, Business

Editor’s Note: Is this is an SBPPO? – see , ,