BLUES FIND SOME COMMON GROUNDPosted On: Jan. 28, 1996 12:00 AM CST
STAMFORD, Conn.-Multistate employers that have feared dealing with a plethora of Blue Cross/Blue Shield plans may be encouraged by a new initiative: a group of Blues plans that are now following common guidelines on thorny technical and medical matters.
So far nine of the nation's 60-plus Blues plans have joined the compact, which is being promoted by the Stamford, Conn.-based National Account Consortium Inc. That company, founded in 1994 by several plans, is trying to persuade Blues plans that to win multistate managed care contracts they will need standardized operating procedures, utilization review rules and marketing strategies.
Twelve other plans are discussing joining the compact, said Timothy F. Ray, NAC senior vp for marketing. And because multistate companies often have workers only in a handful of contiguous states, it won't be necessary to sign up Blues throughout the country in order to start offering unified, consistent health plans to many of them, Mr. Ray said.
"We don't need 50 Blue Cross/Blue Shields in the consortium to generate national accounts," he said. "We need 20."
Blues plans historically have had great success attracting plan sponsors in local and state markets but have resorted to patchwork coverage for national clients, said Dr. Alex R. Rodriguez, vp and medical director of the NAC.
The new organization is targeting companies with 500 to 10,000 insured workers and dependents, especially those with point-of-service plans, who can be persuaded that more consistency between states will lead to better care overall.
Many Blues plans have expressed a need for common standards that would allow for quick decisions on issues such as the use of sophisticated diagnostic equipment, Dr. Rodriguez said. Such decisions have at times varied greatly among plans.
The guidelines also cover some routine procedures, such as how often women should have Pap smears, for example, and what doctors should do as a follow-up procedure based on the test result. The guidelines were based on the consensus of medical experts, not by the Blue Cross/Blue Shield Assn. or the NAC, Dr. Rodriguez said.
"It's not just a cost issue," he said. "It has to do with safety and efficiency."
The consortium will make the guidelines available on computer diskette for incorporation into individual Blues plans' utilization review and billing systems. Member plans have agreed to abide by the guidelines, and the consortium believes several other Blues plans will consult the guidelines as well on an unofficial basis.
The Blues plans that have signed contracts with the NAC, representing some 20 million group members, are Blue Cross & Blue Shield plans in Connecticut, Illinois, Massachusetts, Michigan, Ohio and Texas; Blue Shield of California; Blue Cross of Western Pennsylvania; and Pennsylvania Blue Shield.
The coalition does not want to eliminate the uniqueness of individual Blues and create a unified Blue for all Americans, Mr. Ray said. "The intention is always to keep the individual plans as individual plans," he said. "But by knitting them together in a more seamless, back-office way, we believe we can have the benefits of both."