Blue Shield Launches New Contractual Program with Hospitals.SAN FRANCISCO--(BUSINESS WIRE)--Sept. 5, 1995--Responding to increased competitive pressures in the health care marketplace, Blue Shield of California Blue Shield of California is a not-for-profit health insurance provider headquartered in San Francisco, California. An independent licensee of the Blue Cross and Blue Shield Association, Blue Shield of California is an incorporated, wholly owned subsidiary of California Physicians' has announced it will initiate a new contractual program with its statewide network of 293 HMO HMO health maintenance organization. HMO n. A corporation that is financed by insurance premiums and has member physicians and professional staff who provide curative and preventive medicine within certain financial, and PPO PPO abbr. preferred provider organization PPO Managed care Preferred provider organization, see there Infectious disease Pleuropneumonia-like organism, see there hospitals. As one of the state's leading managed care companies, the nonprofit health plan will begin meeting next week with hospitals, on a regional basis, to present a new "request for proposal" strategy aimed at reducing costs while assuring continued access to quality hospital care services for Blue Shield's 1.5 million members. "The goal of the program is to identify hospitals who are willing to partner with Blue Shield Blue Shield A US not-for-profit health care insurer that is a reimbursement intermediary for physicians. Cf Blue Cross. in a select network serving the majority of our members. Those who do not meet qualifying criteria will become part of a secondary network, while others may assume out-of-network status," said Blue Shield President and CEO (1) (Chief Executive Officer) The highest individual in command of an organization. Typically the president of the company, the CEO reports to the Chairman of the Board. Wayne Moon. "Under the request for proposal strategy, we are asking each hospital to propose rates for inpatient and outpatient services outpatient services Hospital-based services Managed care Medical and other services provided, to a nonadmitted Pt, by a hospital or other qualified facility–eg, mental health clinic, rural health clinic, mobile X-ray unit, free-standing dialysis unit Examples and to provide information about the facility's quality and utilization management Utilization management is the evaluation of the appropriateness, medical need and efficiency of health care services procedures and facilities according to established criteria or guidelines and under the provisions of an applicable health benefits plan. programs. Our ultimate objective is to develop collaborative relationships with hospitals in responding to growing demands from health care purchasers and consumers for high quality care and superior service at cost-effective prices," said Moon. Subsequent to meetings with hospitals, Blue Shield is asking that requests for proposals be submitted within 30 days of receipt. The new contracting program will also be offered to hospitals not currently in the Blue Shield network. Decisions concerning the structuring of the health plan's statewide hospital network will be announced in late November. New contractual agreements will become effective in January 1996. Meantime, Blue Shield has set up a special telephone inquiry service number for hospitals to call, should they require further assistance or information. The new contracting program and its implementation was discussed earlier this year in consultation with California's three regional hospital councils representing all of the facilities in the Blue Shield network. Blue Shield of California operates one of the state's fastest growing HMOs, as well as the largest statewide PPO network. The San Francisco-based organization -- with Bay Area, Central and Southern Regional operations -- annually pays more than $1.6 billion in health care benefits for members enrolled in a range of individual and group HMO, PPO and traditional health plans. CONTACT: Blue Shield of California, San Francisco San Francisco (săn frănsĭs`kō), city (1990 pop. 723,959), coextensive with San Francisco co., W Calif., on the tip of a peninsula between the Pacific Ocean and San Francisco Bay, which are connected by the strait known as the Golden Mike Odom, 415/445-5281 |
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