Blue Cross Blue Shield Plan News Roundup: December 2023

The following Blue Cross Blue Shield announcements are just a few of the company activities from this month.


AMI offers continuing market research services to clients on Blue Cross Blue Shield Plans as well as publishing an annual Blue Cross Blue Shield Plans Report that provides comprehensive profiles on each of the 34 BSBS plans as well as the BCBSA organization.


 Two Little Rock, Ark.-based ASCs are seeking potentially millions of dollars in unpaid reimbursements from Arkansas Blue Cross and Blue Shield for procedures performed during the COVID-19 pandemic, Arkansas Business reported Dec. 11.  The ASCs — Freeway Surgery Center and Centerview Surgery Center — became temporary hospitals during the public health emergency. They allege that they should have been reimbursed for procedures as hospitals instead of at the lower rate for ASCs. Nearly all of the commercial insurance companies agreed to increase their free schedules to reflect the hospital classification, but Arkansas Blue Cross and Blue Shield of Little Rock and HMO Partners Inc., the joint venture between Little Rock-based Baptist Health and Arkansas BCBS that does business as Health Advantage, allegedly did not agree to raise their fee schedules, according to the report.


Blue Shield of California and Adventist Health have reached a new agreement that provides Blue Shield members in-network access to Adventist hospitals. The arrangement includes all 18 Adventist hospitals across California and is effective December 1, 2023. Blue Shield serves more than 4.8 million members in California through network relationships with about 350 hospitals and more than 122,000 providers across the state.


Wellstar Health System and Anthem Blue Cross and Blue Shield of Georgia reached a multi-year agreement providing Anthem members with continued access to affordable, high-quality care at all 11 Wellstar hospitals, more than 325 medical offices, 35 imaging centers, 11 cancer centers, 91 rehab centers, 18 urgent cares, nine pediatric centers and five health parks. There are more than 3,900 medical staff members and 30,000 Wellstar team members serving people throughout Georgia. The four-year agreement impacts over 350,000 Georgia Anthem members in the metro-Atlanta area and throughout north and middle Georgia.


Highmark announced its first ever Affordable Care Act (ACA) health insurance products in Southeastern Pennsylvania for 2024, offering individuals and families high-quality, low-cost and convenient health coverage options to help them be at their best. Highmark will offer broad-network my Blue Access PPO ACA products in the five Southeastern Pennsylvania counties for 2024. In total, consumers in these counties will have 14 plan options from Highmark to choose from, including five that include adult dental and vision benefits, in additional to robust medical and pharmacy benefits. My Blue Access PPO includes in-network access to Highmark’s broadest local provider network as well as access to over 97 percent of hospitals nationwide through the BlueCard® program, including providers in bordering states and throughout Pennsylvania.


Blue Cross and Blue Shield of Illinois announced its continued commitment to expanding access to quality, cost-effective health care, offering individual and family plans in every county in Illinois. Marketplace open enrollment began Nov. 1 and runs through Jan. 15, 2024.


Starting January 1, 2024, Independence Blue Cross (Independence) members will have access to new virtual care services through Teladoc Health** (Teladoc), the global leader in whole-person virtual care. Independence selected Teladoc as its vendor of choice for virtual services* including urgent care, mental health care, and dermatology.


A new policy from Blue Cross Blue Shield Massachusetts, starting Jan. 1, will restrict coverage of monitored anesthesia care (MAC) for patients undergoing endoscopic procedures like colonoscopies. Patients classified as American Society of Anesthesiologist class I or class II will no longer receive coverage. These patients usually do not have accompanying comorbidities. The coverage restriction also applies to bronchoscopy and certain pain procedures. The decision has been decried by national groups — including the American College of Gastroenterology, the American Society for Gastrointestinal Endoscopy and the American Gastroenterology Association —as they warn it will lead to less safe clinical conditions for patients and a lower overall quality of care.


 Blue Cross Blue Shield of Michigan’s value-based care partnership program is one of the largest and most impactful value-based initiatives in the nation, with one million members now receiving care from a physician who participates in its Blueprint for Affordability program. The Blueprint for Affordability (Blueprint) program is a partnership model that aligns provider incentives, financial accountability, and enhanced data and analytics to drive better outcomes for members. Recent results indicate that Blueprint physicians have achieved $93 million in lower costs and higher HEDIS® and Medicare Star quality performance over a three-year period. Since the program launched in 2020, 25 physician organizations have entered into Blueprint agreements for their Blue Cross Commercial PPO, Medicare Advantage PPO and Blue Care Network Medicare Advantage plans. Currently, 70% of Medicare Advantage members and 57% of commercial PPO primary care-engaged members in Michigan receive care from a Blueprint provider.


Valley Health and Anthem Blue Cross and Blue Shield of Virginia announced a new agreement that will keep Valley Health physicians and hospitals in Anthem’s provider networks. The new agreement provides Anthem customers uninterrupted, in-network access to Valley Health caregivers and services through 2028; additional details of the new agreement were not disclosed. Anthem is the largest health insurer in Virginia, and it was essential that Valley Health reach an agreement to serve thousands of community members who rely on Anthem or other Blue Cross and Blue Shield affiliates for their health care.


Anthem Blue Cross and Blue Shield in Virginia and Aledade, the nation’s largest network of independent primary care, announced the latest step in their effort to expand access to high quality primary care across Virginia, especially in communities facing challenges accessing care. Anthem and Aledade’s collaboration in Medicaid now means that more than 150,000 Anthem members in the Commonwealth of Virginia will have easier access to high-quality primary care, including preventive care and screenings. This partnership will impact more than 80 practices, 15 health centers and 25 rural health clinics across Virginia and covers Medicare Advantage, commercially insured, or Medicaid members.