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BLUE CROSS EXPANDS MANAGED CARE BASE WITH REGIONAL NETWORKS

 PITTSBURGH, July 8 /PRNewswire/ -- To expand its managed care base, Blue Cross of Western Pennsylvania has announced that it will selectively contract with area hospitals to continue building its integrated delivery programs that set standards for high-quality care at competitive costs.
 The networks will add another dimension to the complete line of health care products developed by Blue Cross over the years to provide medical management and cost control. These products include: traditional/fee-for-service, point of service (POS), preferred provider organizations (PPO) and health maintenance organizations (HMO).
 "There has been an increasing number of employers who have asked us to find a way to help them reduce health care costs for their employees and to make those costs more predictable on an annual basis," said William M. Lowry, president of Blue Cross of Western Pennsylvania.
 This process will result in the formation by Blue Cross of three regional networks of hospitals, physicians and other health care providers who will exercise a high degree of focused medical management and cost-conscious practices. Blue Cross, Blue Shield and Keystone Health Plan West will work closely together to maximize use of the network.
 Initially, Blue Cross plans to organize the Western Pennsylvania network in the following regions: northwest, southwest and eastern. Each network will consist of one or more lead hospitals, which are the major referral centers offering tertiary care services to the region. Hospitals that are selected for the network must meet a variety of criteria which include case load or volume requirements, as well as defined quality, cost-control and physician-credentialling measures, which are based on medical guidelines and national performance standards.
 An initial request for proposal (RFP) was issued on July 7 to potential lead hospitals throughout western Pennsylvania. A second RFP will be issued to all other western Pennsylvania hospitals later this year. The RFP process is being conducted in two stages to allow for a fair comparison among similar types of hospitals.
 "With the anticipated national health care reform proposal, we are entering a new and challenging era. An important element of the evolving health care environment is expanding network-based delivery systems with physicians, hospitals and other types of health care providers, that is value driven to best meet the needs of employers and consumers in western Pennsylvania. Trends in health care policy point to a larger role in the future for managed care networks," Lowry said.
 Blue Cross network subscribers will have easy access to Centers of Excellence for the most complex medical treatment. These centers will be located at network hospitals with the highest volume, best clinical outcomes and most reasonable prices for these specialty services. Blue Cross subscribers will be encouraged to seek primary care services at local community network hospitals.
 Within the network, health services will either be provided or directed by primary care physicians or specialists as determined by the patient's primary care physician. Health services will be delivered in the most appropriate setting: in outpatient facilities, through home care or in a local network hospital.
 Blue Cross will continue to contract with all hospitals in western Pennsylvania. Each hospital that signs the basic Blue Cross agreement will have an opportunity to respond to the RFP for participation in the networks being created for Blue Cross' managed care products.
 In addition to ensuring quality through clinical criteria, the network will include a community accountability component. These goals will help the network be responsive to community medical needs by:
 -- establishing programs that encourage subscribers to obtain care when it is needed from network physicians in the most appropriate setting;
 -- promoting a patient-based quality-of-care philosophy that controls costs by ensuring that the right care is obtained the first time treatment is provided;
 -- providing incentives to encourage subscribers to take responsibility for their own health by becoming physically and emotionally fit, and learning how to use health care services wisely;
 -- communicating information to the general public on the cost of network operations, utilization patterns of members, availability and accessibility of network services and member satisfaction.
 As part of its community service mission, Blue Cross offers coverage to everyone, regardless of medical history, age or occupation.
 "Other insurers have abandoned this practice and engage in cherry- picking, or selling coverage to only those individuals and groups expected to use the fewest health care services," Lowry said.
 "Our goal is to provide true cost-control options and price predictability to our customers, while at the same time protecting the quality of care our subscribers receive and the viability of the community health care system in western Pennsylvania. Our longstanding commitment to serve the needs of the community, first and foremost, will not change," he noted.
 -0- 7/8/93
 /EDITORS: Spokespersons are available for interviews by calling the contact. A fact sheet follows.
 BLUE CROSS OF WESTERN PENNSYLVANIA
 NETWORK FACT SHEET
 -- Blue Cross of Western Pennsylvania has issued an initial request for proposal (RFP) to potential lead hospitals. Other hospitals will receive RFPs later this year.
 -- Potential lead hospitals are: Allegheny General Hospital (Pittsburgh), Altoona Hospital, Children's Hospital (Pittsburgh) Conemaugh Valley Memorial Hospital (Johnstown, Pa.), Hamot Medical Center (Erie, Pa.), Magee-Womens Hospital (Pittsburgh), Mercy Hospital (Pittsburgh), Shadyside Hospital (Pittsburgh), St. Francis Medical Center (Pittsburgh), St. Vincent Health Center (Erie), University of Pittsburgh Medical Center and West Penn Hospital (Pittsburgh).
 -- To be eligible for network participation, lead hospitals must sign the basic Blue Cross hospital reimbursement contract, and return the signed network RFP by Aug. 16. Network lead hospitals will be selected based on these responses around mid-September.
 -- The initial network regions are: southwest-area, northwest-area and eastern-area.
 -- The goals of selectively contracting with health care providers in the network are to improve quality control, reduce administrative costs, maximize economies of scale and eliminate expenditures for health services and overhead which are not necessary for delivery of high quality, convenient and cost-effective care to Blue Cross subscribers.
 -- All health care providers selected for inclusion in the network must meet the following terms and conditions of the RFP: I. Coordination and Integration of Care
 -- Health services will either be provided and directed by primary care physicians or provided and directed by a specialist determined by the patient's primary care physician. Health care services provided through the network will include, but not necessarily be limited to, those covered services furnished by outpatient facilities and programs, community hospitals, referral hospitals, an outpatient pharmacy/supply/durable medical equipment distribution system, home care services, physicians and organized access to nursing homes and other assisted living facilities. Health care providers within the network, including but limited to hospitals, will be obligated to make referrals within the network.
 -- Network participants must adopt a unified medical record that is accessible to all components of the network, but assure patient confidentiality in accordance with federal and state law. A common patient registration system must also be utilized.
 -- To the extent possible, network subscribers will have free choice of primary care physicians (family practice, internal medicine, pediatrics, obstetrics/gynecology and emergency medicine) within the network. II. Public Accountability
 -- The network will develop and implement a community health status improvement process and provide an effective procedure for developing, compiling, evaluating and reporting performance standards, statistics and other information to the general public, including patterns of utilization of services.
 -- Clinical guidelines will be implemented in the provision of health services by the network and a credentialling process will be developed and implemented for network providers and practitioners.
 -- The network will not expel or refuse to enroll any applicant or Blue Cross subscriber, or limit coverage of services based on age, sex, race, health status or usage of health services.
 -- The network will develop and implement a process for coordinating network capacity, planning and capital acquisition and allocation, and publicly report decisions regarding such plans./
 /CONTACT: Diane Wuycheck of Blue Cross of Western Pennsylvania, 412-255-7697/


CO: Blue Cross of Western Pennsylvania ST: Pennsylvania IN: HEA INS SU: PDT

KC-CC -- PG002 -- 9279 07/08/93 05:01 EDT
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