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Health Plans Focus on Collaboration to Lower Costs

BY KEN WOOD – Health plans have experienced a dramatic growth in Medicaid and Medicare membership since 2013, when eligibility requirements expanded under the Affordable Care Act.

Nearly 11.2 million Americans joined the ranks of Medicaid and the Children’s Health Insurance Program (CHIP) between the summer of 2013 and January 2015, according to recent CMS data. Most of this growth was in large states in the West that implemented the Medicaid expansion.

In order to best serve this growing population of low-income Americans, health plans are investing in coordinated care models to deliver programs that increase access to high-quality, high-value care for members, while reducing the healthcare cost trend in California.

Coordinated care management is essential to ensuring that patients get the right treatment, at the right time, in the right setting and for the right duration. Effective use of care management reduces overuse of services and ensures that patients are involved in care decisions and given tools to manage their conditions.

Marilyn Tavenner, the new president and CEO of industry trade group America’s Health Insurance Plans, has made it a focus of the association to strengthen Medicaid and Medicare programs, and she encourages plans to continue leading the collaborative efforts to reform payment and deliver options.

“Through greater collaboration and information sharing between the public and private sectors, we will create a 21st Century health care system with payment and deliver models that better meet the changing needs of the patients we serve,” Tavenner said in a blog post.

In October, Blue Shield acquired Care1st, marking the company’s entry into Medicaid, a population that the company has been actively seeking the opportunity to serve. It also increases the company’s Medicare membership and furthers Blue Shield’s mission to ensure all Californians have access to high-quality, affordable care.

Additionally, Blue Shield helped launch Cal INDEX, a next-generation health information exchange, that allows physicians, nurses and hospitals throughout the state to share patients’ health information, and give their patients the safest, coordinated highest-quality care possible.

We will continue to invest in our coordinated care efforts to improve affordability and access to care for all Americans, including the underserved Medicaid and Medicare populations.

Ken Wood is senior vice president of consumer and senior markets at Blue Shield of California