One Man's Struggle With BCBS
Story from ZDNet.com,
by Paul Greenberg

My wife and I get our health insurance from Anthem Blue Cross & Blue Shield, here in Virginia. Because my wife is a cancer survivor our insurance rates are exorbitant. Last year, we had a $500.00 deductible (each) and were paying more than $1600 a month for coverage that at best was going to get us 80% when the deductible was covered.

Toward the end of last year we made a decision to increase our deductible to $2500.00 which would not only get us 100% coverage when the deductible was done but would lower our rate to around $1279.00.

Quite the bargain (he said entirely sarcastically). But the increase in the deductible was offset by the reduction in the monthly payment so that we were swapping more upfront costs and maybe a couple of hundred dollars more for 100% coverage. Worth it to us. This began January 1, 2009.

However, little did we know what was in store. We got a notice yesterday that said our monthly rates were going up to $1576.00 as of May 1, 2009 - an increase of nearly $300.00 per month. A convenient fact, they forgot to tell us when we were changing our deductible for this year.

To add insult to financial injury this paragraph was in the letter accompanying this rate increase.

“We work hard to keep your costs down

“As health care costs continue to rise, we work hard to find ways to save on the health care services you need. For example, as the largest health insurer in Virginia, we have used our negotiating power to keep local provider and national pharmacy costs as low as possible. But even with cost-cutting initiatives like these, we’re finding it necessary to increase premiums for all members enrolled in your type of plan.”

Their idea of saving us money is to increase our premium by $3500 a year? Their cynicism is breathtaking.

The Nature of the Health Insurance Beast

One would think that with the outcry over the high costs of health insurance, the general health insurance bashing that’s going on, the bad perception as cold and uncaring that they have and the discussion of universal health care, their concerns about actual living, breathing (that of course presumes they had been able to afford health insurance when they got sick) beings - sentient creatures called, drumroll please,…………customers would be paramount.

They are not concerned. Their customers aren’t even a subject of discussion.

This came abundantly clear when I called the customer service line for Anthem and spoke to a very nice representative who was clearly hamstrung by two things a. the company b. regulation. I was absolutely astounded, not just by the magnitude of the increase (around 23 percent) but by what I was told. This was a “policy wide” increase. In other words, my actual health didn’t matter, my wife’s didn’t matter, nor did our track record in any way matter. This premium was raised whether you were a category 4 (high risk) or category 3, 2, and 1 (low risk).

This was raised regardless of any individual whatever. It was a raise whether you paid $1279 per month or $450 per month. You were raised that same nearly $300.00. Why, because it was “against the law” to treat individuals as individuals, when it came to pricing policies for specific insurance programs.

So this increase was based on the performance of the policy itself - not the customers using the policy. You can imagine that, in effect, my human health concerns are reduced to the level of an actuarial table, an algorithm or two and a policy. There is NOTHING human about that. There is NO customer differentiation - actually not even recognition by Anthem that their customers are something more than a name on a policy.

Is there a law preventing this differentiation? My customer rep told me that they have been told there is.

I checked as best as I can and I couldn’t find anything that substantiated that either nationally or in Virginia. That said, that doesn’t mean it doesn’t exist. It could.

But can insurance companies treat their customers individually if they’re blocked by law? They can’t right?

Wrong.

In the 3rd edition of CRM at the Speed of Light I covered another Blue Cross Blue Shield (this would be back in 2004). That was Blue Cross of California and their My LifePlan program which was a customer friendly program that provided a large set of online tools to help you find what you needed without much bureaucracy - be it a specialist, pharmacy or a wellness program.

More germane was this:

“It is in the interest of the insurance company to see that a diabetic customer has regular checkups for blood sugar. Consequently, by institutionalizing CRM processes, the alert will show on an agent’s or other appropriate CSR’s screen that diabetic customer A should take advantage of a free test being given in his area over the next month. Aside from any humanitarian concerns that the insurance may (or may not) have, keeping that diabetic customer healthy is in the insurance company’s interest, simply because if the diabetic is healthy, no one collects and premiums are paid for a longer time. The insurance vendors can also track whether the diabetic took advantage of the free blood sugar test. The response can create the need to adjust the level of risk associated with the diabetic. This is a step better than even the thought-leadership that CRM-driven insurers can provide and is a major step to reducing risk without the cold-blooded approach characterized by State Farm.”

As of 2009, you can substitute Anthem for State Farm. No wait. Add “and Anthem.”

This approach would be aimed at preventing recurrences which benefits the insurance company that doesn’t have to pay out the dollars. Second it would make a policyholder feel like the insurance company gave a crap beyond the money we’re feeding them each month so that we don’t have a catastrophe that we can’t afford to pay for. In other words, this would be a way to treat a customer like an individual that mattered to the company.

Has Anthem ever sent us a notification of something related to preventing a recurrence of my wife’s cancer - either through an email or a direct mail piece?

Noooooo.

All we ever have gotten in the nearly a year we’ve been with them is notices of bills and notices of things that might become bills. And the monthly invoice. And now the notification of the premium increase. I mean this literally. Not metaphorically.

Sure, look, I get the fact that they are a business but if the customer in the highly sensitive area of health is nothing more than an actuarial table and a policy performance tied by an algorithm, then their business doesn’t deserve to survive, much less prosper.

Whether you believe in universal health care or not (I do), I would presume you would see that this is not just an inhumane approach, it is a cold blooded model implemented by heartless creatures who have no concern for their actual policyholders. They are concerned that a. you pay and b. you don’t use the insurance ever.

My wife and I are stuck with this company for awhile. Because of her past condition, it isn’t that easy to guarantee coverage, so the cost of moving is perilous for us. But from a CRM lesson learned here, it should be clear that not only is this a company that should never have its practices emulated, even with nice CSRs, but it should be seen as a model of what not to do when your customers are more engaged and more concerned than ever.

BCBS of Michigan Says It's Losing Money,
Seeks Bailout From Customers
Story from the Detroit News

Robert Boys is 73 years old, lives on a fixed income, and worries he'll soon have to shell out another $33.20 a month on health premiums.

His insurer, Blue Cross Blue Shield of Michigan, is seeking to raise the rates on his Medigap policy by 31 percent, to $140.29 a month, as part of a broader proposal to increase rates on its entire line of individual insurance plans -- policies for people who buy their own medical coverage. Blue Cross says it needs to raise rates to stem growing losses incurred in the individual market.

"They are hitting the people that can least afford it," said Boys, who lives in Brighton. "I'm trying to live on Social Security right now. What do I cut now?"

Boys is not alone in his worries. Many Blue Cross members are troubled by the insurer's proposed rate increases, which are now under review by state insurance regulators. They say the increases are too extreme and ill-timed with the state's unemployment rate in the double-digits -- the highest in decades.

On Monday, state regulators deemed the Blue Cross rate filing complete and will now go about notifying Blue Cross members, as well as other industry stakeholders and the state's attorney general, of the insurer's request. Once those steps are complete, members will have a chance to weigh in by requesting a rate hearing to challenge the increases.

The rate hikes are among the highest proposed by Blue Cross in the last five years and will affect about 400,000 Blue Cross members, including 209,000 seniors who buy their supplemental Medicare plans, known as Medigap.

Depending on the insurance plan, the proposed increases range from a few percentage points to as much as 72 percent for some of the insurer's age-rated plans, such as Individual Care Blue. Blue Cross's Medigap enrollees will see increases of 31 percent, but the hike won't affect Medicare Advantage members.

Blue Cross says the increases are necessary to stanch red ink flowing from its individual health plans and come as part of several cost-cutting moves announced in January by the insurer, including a work force reduction of about 1,000 positions.

As the state's insurer of last resort -- a responsibility tied to its tax-exempt status -- Blue Cross must cover all Michigan residents, regardless of their medical history. But that arrangement, Blue Cross officials say, leaves them with the state's costliest members because those customers are routinely rejected by other private insurers because of pre-existing medical conditions.

"The need for the increases is driven by a broken regulatory system in the individual insurance market that has not changed in nearly 30 years," Blue Cross spokeswoman Helen Stojic said.

Millions in losses claimed

Blue Cross has spent more than a year pushing for legislation changes to give the insurer more leeway in raising monthly rates, an effort that fizzled last December when state lawmakers let the measure die.

Blue Cross now says its losses in the individual market -- expected to increase in 2009 to $210 million -- could jeopardize the organization's long-term financial health.

Some Blue Cross critics, including the Michigan Attorney General Mike Cox, aren't so sure and have questioned the way the insurer is calculating those losses, saying they aren't as large as Blue Cross claims.

Lidia Abate of Farmington Hills is one Blue Cross subscriber eager to voice her opposition.

At age 59, Abate said she pays $286 a month for her Flexible Blue PPO. Her 89-year-old mother also spends another $107.09 a month for her Blue Cross Medigap policy. Under the proposed rate increase, her monthly premiums will rise only 3 percent but her mother's will go up 31 percent to about $140 a month.

"Luckily, she has us lending her a hand with her rent. Can you imagine how many older people will be in trouble if this happens?" said Abate, who lost her job at a physical therapy firm last year. Any increase to her policy will also strain the family's budget, Abate said. "We do have a mortgage and cars and bills and the 401(k) is in the toilet," she added.

Rate increase OK'd in 2008

Blue Cross received state approval last year to raise rates on about 20,000 members enrolled in individual plans, a hike that ranged from 40.6 percent for the high option to 22.49 percent or the moderate-level plans. The final increases approved by the insurance commission were lower than Blue Cross had requested, but still too high for member Ghada Abraham, who challenged the rate hikes before their approval by the insurance commissioner and continues to fight them on appeal.

"Blue Cross was created to make coverage affordable, yet the opposite is happening," said Joseph Aoun, an Ann Arbor attorney representing Abraham, who has the moderate option of Blue Basic and saw her monthly rates increase from $459 to $562 last year. Now, Blue Cross's request could send their premiums up another 63 percent to $917 a month.

"These increases, on top of the large increase they have received in years past, put coverage beyond the reach of the average resident," Aoun said.

Blue Cross said it sympathizes with its individual members, particularly those on fixed incomes or who have lost their jobs.

"Blue Cross wants to continue providing coverage to the vulnerable. But we need a regulatory system that works," Stojic said, adding that the market for individual policies has grown rapidly, saddling the Blues with a greater financial burden than their private-sector competitors.

Blue Cross expects to add another 76,000 individual members in 2009 and its actuaries project losses of up to $1 billion on its individual policies over the next three years. Financial information released in March by Blue Cross shows the insurer lost about $133.2 million on its individual policies in 2008 -- a slight improvement from the previous year's losses of $134 million. Still, Blue Cross says, the losses incurred on individual insurance dragged down the insurer's bottom line last year, contributing to a net loss of $144.9 million for 2008.

Subsidies For Private Medicare Plans
On The Chopping Block
Story from the Wall Street Journal

The government late Monday is expected to set in stone the 2010 rates it will pay health insurers to run private Medicare plans. Most signs suggest that cuts are coming in the subsidies that the industry got during the Bush administration.

Stocks of health insurers were sucked into a surprise tailspin in February after Medicare officials signaled they planned an effective 5% cut in those payments after formula adjustments. Insurers, medical societies and others have had six weeks to give regulators their arguments before the payment rates become final for next year.

Their arguments, plus an effort by 17 senators from both parties who on Friday urged Medicare to reconsider the way it calculated the effective cuts, could sway the Centers for Medicare and Medicaid Services to compromise on the new payment rates, as the federal agency has in previous years. But its new management hasn't given any hint of letting up on efforts to rein in federal subsidies for the private-sector Medicare plans.

More than 10 million beneficiaries get their medical and drug coverage through so-called Medicare Advantage plans, which the Bush administration promoted with extra benefits for seniors and by providing subsidies to insurers that offer them. President Barack Obama wants to finance a good chunk of his health-care agenda by cutting those payments over time to the level of traditional Medicare's per-patient outlays. But the rates signaled in February by the new administration caught insurers -- and Wall Street -- off guard by cutting payments so soon.

The stock performance of big Medicare Advantage players on Friday suggested that many investors "don't believe it will be a positive surprise," said Matthew Borsch, analyst at Goldman Sachs. Humana Inc., already down 30% for the year, shed $1.54, or 5.7%, to $25.46 on Friday.

If the payment cuts remain or change little from those proposed, insurers may raise premiums or cost-sharing amounts, such as copayments The Blue Cross Blue Shield Association argues that the cuts could translate into premium increases or benefit reductions of between $50 and $80 a month for seniors. That could slow enrollment in a business that has been critical to many health insurers' profit growth in recent years.

Medicare Advantage wraps physician and hospital services in one. Unlike traditional Medicare, the government doesn't pay providers directly but instead pays insurance plans to manage care.

The Obama administration argues it wants to make sure the plans aren't overpaid while not providing value or better care. Last week, it took steps to tighten screws on the private plans on another front, setting new caps on what insurers can charge sick seniors and ordering them to be more upfront about what they cover.

Governor Doyle of Wisconsin Discusses Health Care Leadership
Story from NBC26 WGBA

Governor Jim Doyle will discuss his leadership in health care and moderate the first Regional White House Forum on Health Reform on Thursday, March 12, 2009 at 2:00 EDT at the Ford Conference and Event Center in Dearborn, Michigan. Governor Doyle will join Michigan Governor Jennifer Granholm and Melody Barnes, director of the White House Domestic Policy Council.

Governor Doyle has made Wisconsin a national leader in providing access to affordable health care. In a time when many states are cutting back on health care programs, Governor Doyle is moving forward on a bold plan to insure 98 percent of Wisconsin residents through simple, accessible, and affordable plans. Since February 2008, all kids in Wisconsin have been able to get the health care they need at a price their families can afford through BadgerCare Plus. Nearly 70,000 children have enrolled in the program since 2008.

Governor Doyle is also moving forward the state's efforts to provide low-costs prescription drugs to Wisconsin seniors through SeniorCare. SeniorCare is cheaper, easier to apply for and provides better drug coverage than Medicare Part D. The program saves taxpayers and the federal government over $90 million a year, and provides prescriptions to 90,000 Wisconsin seniors.

Wisconsin is making strides in many areas of health care, including long-term care. The state's pilot program, Family Care, serves elders and people with disabilities with a need for a nursing home level of care with a flexible, community-based approach. It saves the Wisconsin Medicaid program an average of $450 per month per person.

Forum participants will include doctors, patients, providers, insurers, policy experts and health care advocates of all kinds - both Democrats and Republicans - who will discuss the urgent need to curb skyrocketing health care costs that are draining our federal and state budgets, devastating families and small businesses and undermining our long-term economic prosperity. People across the country can also visit www.healthreform.gov to submit their questions and ideas and join the debate.

There is Job Security - If You Enjoy Working With the Elderly
Story from KansasCity.com

Do you want almost slam-dunk-guaranteed job security over the next 10 years?

Take a look at job projections from the U.S. Bureau of Labor Statistics and demographic trends which show — no surprise here — that the big baby boom generation is getting old.

People who provide care for seniors, especially those who require extended care, will be needed in droves.

Look especially for growth in demand for in-home care providers.

Because the cost of nursing home or life-care facilities is comparatively high, many Americans are opting for in-home care, sometimes round-the-clock.

Nationally, that means the personal and home care aide category is expected to grow by more than 50 percent — from 767,000 in 2006 to 1.15 million in 2016.

In Missouri, projections are for a 28 percent growth in the demand for home care aides, from 21,000 jobs in 2006 to 26,920 in 2016. A separate projection calls for demand in Kansas to grow by 35 percent, from 11,400 jobs in 2004 to 15,340 by 2014.

One supplier of such workers, Home Instead Senior Care, says the demand for senior care givers will outplace supply. It expects to have to double its workforce in just three years to handle incoming business.

Now here’s an important note of caution for anyone thinking of jumping into the growing, nearly recession-proof occupation:

Caring for seniors is not for everyone.

To help find out if you have the interest, aptitude or attitude for the profession, you can take a career self-assessment test.

In-home caregivers may be trained nurses, nurse assistants, physical therapists, cooks, housekeepers, errand-runners and companions.

Doug Kisgen, owner of Home Instead, points out that in-home care giving can be a mid-life career change as well as a part-time job opportunity.

If you like old people, if you have some experience as a care giver, or if you have a giving personality, you might consider the field.

NOAA Weather-Alert Radios Available Free to
Day Care, Adult Foster Care Homes In Ludington Area
Story from Ludington Daily News

Tuesday, March 31, 2009

This week is Severe Weather Awareness Week and a good time to remind state licensed day cares and adult foster care facilities they may receive a free NOAA weather-alert radio.

“It provides a good warning for people who may not have their TVs or radios on,” Elizabeth Reimink, Mason County Emergency Management coordinator, said about the radios.

They are small, about the size of a hand, Reimink said, but loud and are designed to wake people if a warning comes at night.

“They’re programmed to receive alerts from the National Weather Service,” she said, adding that the warnings will start with a tone and then relay messages about potential storms to affected areas. Those messages will include information about the storm, the area that may be affected and the storm’s duration.

Reimink said she received grant money and bought several of the radios and has tried to contact area day care and adult foster care facilities.

“But I want to make sure no one’s missed,” she said, adding they can contact her at 408 Resseguie St., Suite 100, 845-5911.

Key Choices For Seniors
Story from Ohio.com

While Trying to Save Money, Ohio Seeks to Bridge Gap Between Nursing-Home Care and Assisted Living Care

As a former businessman and member of President Richard Nixon's administration, Fred Rouse is used to being in charge.

But when the 82-year-old lived in the nursing-home section of St. Luke Lutheran Community in North Canton, he couldn't even set his own thermostat.

Thanks to a special state program that lets some low-income seniors use Medicaid to pay for assisted living, Rouse recently moved into the assisted-living portion of St. Luke's after recovering from intestinal surgery and completing therapy.

Now he can set his own schedule — and his own thermostat — while saving the government money.

Assisted-living costs an average of $2,106 per month, compared with $4,231 for nursing-home care, according to the Ohio Department of Aging.

''I'm a conservative, and I don't like wasting money,'' Rouse said. ''And I don't see wasting people's talents to come in and blow my nose.''

Faced with an aging population and rising costs to provide care, the state is trying to expand the options between home care and nursing homes for Ohio's seniors.

The Ohio Department of Aging has been working to enhance its existing community-based programs and develop new options for long-term care, Director Barbara Riley said.

Among the choices that could be added or expanded in the coming years:

• Enhanced community-living programs, which would allow Medicaid recipients in subsidized senior houses to get on-site help 24 hours if needed, similar to assisted-living facilities.

• Adult foster care, which would bring together a small number of seniors who need help with the tasks of daily living to live in a home with 24-hour care available.

• The ''Choices'' waiver program, which allows Medicaid recipients to hire their home-care providers, who could be trained relatives. The program is only available on a limited basis in central and southern Ohio.

• PACE (Program of All-Inclusive Care for the Elderly), which allows one provider to coordinate a recipient's medical care, home care and, if needed, adult day care. There are two approved sites statewide, in Cleveland Heights and Cincinnati.

''We haven't done what we're doing now, which is make a full-force public education effort to help people understand what choices are available and to make sure we have the choices available that people want,'' Riley said.

Burden on Medicaid

Most of the burden for providing long-term care to the state's elderly and disabled population falls on Medicaid, a state-run health insurance program for the poor and disabled that is supported with state and federal tax dollars.

About 74 percent of Ohio residents who received long-term care through Medicaid in 2004 lived in nursing facilities, compared with 61 percent nationwide, according to the most recent estimates available.

Ohio's population is graying — and that's expected to cost the state a lot more green. Each month, about 12,000 Ohio residents turn 60, according to the Ohio Department of Aging.

''The big picture is there's a huge problem and it's getting worse,'' said Joseph L. Ruby, president and chief executive of the Greater Akron-Canton Area Agency on Aging.

The agency coordinates Medicaid long-term care services for residents of Summit, Stark, Portage and Wayne counties.

''The best way to address the long-term care issue is to provide long-term care options,'' he said.

Oregon, for example, has developed a system that provides seniors and disabled residents covered by Medicaid a variety of options outside nursing homes for care, said Barry Donenfeld, executive director of the NorthWest Senior Area Agency on Aging in Oregon.

Donenfeld was among several state and national speakers during a recent seminar in Fairlawn organized by the Greater Akron-Canton Area Agency on Aging.

Oregon residents can get care while living in assisted-living facilities, their own homes, foster-care homes and even with relatives, who can get paid to provide the care, Donenfeld said.

As a result, Oregon ranked second in the nation in 2007 for the percentage of Medicaid dollars spent on community-based services (almost 73 percent) compared with nursing homes, according to data from the U.S. Centers for Medicare & Medicaid Services.

Levels of care

''What Ohio would need to do is make a commitment to developing this middle of the continuum,'' Donenfeld said. ''Just because you leave home doesn't necessarily mean that the next stop is the nursing home. There are other levels of care that allow someone a much more home-like setting.''

Ohio could save about $900 million a year in Medicaid costs if the state could achieve the average balance seen nationally between patients in nursing homes versus home and community settings for long-term care, according to estimates by the Ohio Business Roundtable.

Ohio's skilled nursing facilities ''are supportive of the continuum of long-term care and the ability of consumers to make choices from different settings of care, depending on what their needs are,'' said Peter Van Runkle, executive director of the Ohio Health Care Association, which represents nursing homes and assisted-living facilities statewide.

However, he said, nursing homes need to be appropriately funded, because they will continue to be the right choice for many consumers.

Riley said the state already is taking steps to provide more options beyond nursing homes.

In recent years, the state has eliminated waiting lists for PASSPORT, a program that lets Medicaid recipients who otherwise would require nursing-home care to get services in their homes.

In addition, Ohio is making efforts to sign up more facilities for the assisted-living Medicaid waiver program, Riley said.

In Rouse's case, the former chairman of the Great Lakes Basin Commission under President Nixon got strong enough to move out of the nursing home but still needs help.

He said he has been very satisfied with the care he received in the nursing-home section when needed and now in the assisted-living area.

''I'm in good health, but I need help,'' he said from his new assisted-living room, which soon will be equipped with a recliner chair and personal-sized refrigerator and freezer.

His wife of 58 years, Barbara, has Alzheimer's disease and lives in the nursing-home portion of the facility.

''I want to stay here,'' he said. ''This is where I want to be.''

By later this year, the state also might approve more PACE sites. Participating programs get a set amount of money from Medicare and Medicaid each month to provide and coordinate all the medical care and home assistance that enrollees need.

Summa Health System in Akron is considering establishing a PACE program, possibly tied to its adult day-care program at Cuyahoga Falls General Hospital, said Patricia L. Troyer, Summa's executive director of post acute and senior services.

''Clearly,'' she said, ''people like to get services at home.''