The Blues Anti-Fraud Unit Recouped More Than $270 Million

Blue Cross Blue Shield of Michigan’s health care fraud investigation unit, the oldest and most successful health plan operation of its kind in the U.S., saved or recovered nearly $277 million since it first began operation nearly 30 years ago.

During 2009 the BCBSM anti-fraud unit acted on 2,300 tips involving suspected fraud. Its investigations led to 149 arrests and 94 convictions, and resulted in nearly $15 million saved or recovered in 2009 alone. Health care fraud constitutes nearly 3 percent of all health care spending, according to the National Health Care Anti-fraud Association.

“Our anti-fraud activities help ensure that critical health care dollars are being spent appropriately,” said Daniel J. Loepp, BCBSM president and CEO.

Telephone calls to BCBSM’s toll-free, anti-fraud hot line are the starting point for most investigations, with explanation of benefits statements to Blues’ members prompting approximately 70 percent of all hot line calls when members notice irregularities on their statements. BCBSM also has an online method of reporting fraud through its website

The unit’s members have law enforcement backgrounds in surveillance, undercover work, credit card fraud and narcotics, while others come from inside the company with experience in auditing, security and nursing.

If you or anyone you know has information about suspected health care fraud in Michigan please call the BCBSM toll-free, anti-fraud hotline at 800-482-3787, between 8:30 a.m. and 4 p.m. Monday through Friday. Click here to learn more about The Blues’ anti-fraud efforts.

Alternative medicine partnership’s a natural for members

If you’re a Michigan Blue Cross member interested in alternative approaches to health care, we’re working to better serve your needs. Through our Blue365 partnership, we’ve teamed with Healthyroads, Inc.TM, a health improvement and wellness subsidiary of American Specialty Health Incorporated.

Healthyroads offers savings on products and services in the areas of:

  • Chiropractic
  • Exercise and movement
  • Massage and bodywork
  • Wellness and fitness centers
  • Mind and body relaxation techniques
  • Diet and supplement advisors
  • Vitamins and supplements
  • Acupuncture (under development)

To participate in the program, members pay an annual $25 fee to receive discounts of up to 25 percent with 25,000 complementary and alternative medicine providers nationwide. Or, members can pay an annual $25 fee to get discounts or best pricing at participating affinity fitness club and exercise centers.

Want both? You pay only $40 to receive discounts at alternative providers and participating fitness clubs.

The new Healthyroads program augments our array of other member discount programs, including Healthy Blue XtrasSM and Blue365.

To access Healthyroads, Log into the member secured portal and go to Blue365 (Health and Wellness tab). From there, Healthyroads can be found under the Healthy Choices tab (Wellness).

About Our Request to Increase Individual Product Premiums

On May 21, 2010, BCBSM requested approval for premium increases for our health plans for individual consumers under age 65.

The mere fact that BCBSM requested approval is important.

We are the only health plan in Michigan that must obtain regulatory approval for new premiums in the individual market – and we are the only health plan that is transparent to the public with individual market rate requests.

Many Michigan consumers are struggling, no doubt. The economy is challenging. In fact, many people who obtain individual health coverage from BCBSM need it because their jobs have been lost, or their employers have stopped offering coverage. We recognize and respect these personal struggles.

But BCBSM – by law – must run a self-sustaining health insurance business. We lost $94 million on these individual products in 2009.

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Imagine Having 250 Nurses at Your Fingertips – With BlueHealthConnection® You Can

BlueHealthConnection is a collection of health management programs that give Blues members access to health education, support, and health and wellness resources to help them take charge of their health.

BlueHealthConnection offers several programs that are supported by licensed, registered nurse health coaches and case managers. These experienced professionals assist members in their efforts to stay healthy, get healthier or manage illness. Available programs supported by registered nurse health coaches include:

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Stay Out! Hospitals partner with Blues to lower readmissions

This week, Blue Cross Blue Shield of Michigan announced 15 physician organizations and hospitals across the state that will be collaborating with the Blues to reduce the incidence of preventable ER visits and preventable readmissions to the hospital.
A preventable readmission is when a patient is readmitted to the hospital within 30 days of being discharged, for the same diagnosis or a complication of that diagnosis, which could have been prevented with proper care management and coordination.
Lowering the readmission rates will have a positive impact on thousands of Michigan lives.  Not only will it improve safety, but it will save costs.  In 2008, Blue Cross Blue Shield of Michigan spent $75 million on preventable readmissions – roughly $11,490 for each patient whose readmission could have been prevented.
This 15-site initiative is a long-term effort that will improve communication and coordination among hospital-based physicians and nurses and doctors in private practice.  The participating hospitals and physician organizations will share their learnings with each other, in a collective effort to improve patient safety and clinical quality.

This kind of collaboration is the heart of what we call our Value Partnershipsa collection of initiatives that focus in improving health care quality and safety for Michigan residents.  It’s how the Blues are working to lead Michigan to a healthier future.

National Nurses Week is here

We celebrate National Nurses Week from May 6 through May 12. This is a time to honor those gracious health care professionals who are dedicated to the wellbeing of patients.
If you think National Nurses Week was created without any roadblocks, you are mistaken. In 1953, Dorothy Sutherland began fighting to have the government officially designate a day to honor nurses across the country. It wasn’t until almost 30 years later that President Reagan declared that May 6 would be “National Recognition Day for Nurses”. From there, the day was extended to a week.
If you talk to a friend, a neighbor or a family member, chances are they have a positive story to tell you about an experience they had with a nurse. At times when people are sick, stuck in a hospital bed, or in need of some health related guidance, nurses are there for support.
At the Michigan Blues, there are over 250 nurses that play an integral role within the company. Customers have direct access to nurses, dieticians, case managers and more via the Blue Health Connection program.
Terry Muse had an especially wonderful experience with a case manager at BCBSM. This story illustrates the added value of the Michigan Blues’ insurance.

So, think back this week about those nurses that have had a positive impact on your life and thank them again if you get a chance.

The Physician Group Incentive Program

Blue Cross Blue Shield of Michigan spearheads a number of statewide initiatives focused on improving health care quality. Check out this brief update from our recent Physician Group Incentive Program conference in Lansing.

Blues build social media leadership as Shannon Paul joins our team

Have you clicked your way to lately?  Or Jodi Davis’ blog?  Or our Facebook page?  Or our Twitter profile?
Or this?

Or this

Or even this blog? In a short time, Blue Cross Blue Shield of Michigan has certainly established our belief that interactive online communications channels hold value in this new era of communication. But anyone who knows “social media” will tell you that having a lot of channels doesn’t necessarily make you a leader.  It’s how those channels support your overall business strategy and stakeholder needs.

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Blue Cross Blue Shield of Michigan surprises students with Matthew Stafford on ACES Day

What were children across the world doing at 10:00 a.m. on Wednesday, May 5? Exercising!  That’s because it was ACES (All Children Exercise Simultaneously) Day, a program that encourages students to exercise and engage in physical activity.  And, Blue Cross Blue Shield of Michigan made ACES Day extra special for one school in Michigan.
 Matthew Stafford poses with students during ACES Day.
Students at Martin Luther King, Jr. Academy in Mount Clemens were surprised when Matthew Stafford, quarterback of the Detroit Lions, showed up to exercise along with them. He spoke to the more than 300 students and staff about the importance of eating healthy and exercising. Six students had the chance to ask Stafford questions about his exercise and healthy eating habits, while six others got to participate in a HOPSports activity with him. Stafford then lead everyone in a walk around the school and spent time visiting with students at activity stations where he helped kids jump rope, threw football passes and challenged students to pull-up contests.
In 2009, Matthew Stafford and BCBSM announced their partnership to combat childhood obesity in Michigan through the promotion of preventive measures that foster healthy lifestyles. This partnership was truly witnessed at MLK Academy in Mount Clemens on ACES Day.      
Stafford challenges student pull-up contest on Fitness Center funded by BCBSM grants.

 Stafford talks to Michael Patrick Shiels of WJIM-AM, while Ken Dallafior looks on.

Blues poised to thrive, lead in a post-reform world

Discussions of how to fix our country’s broken health care system have dominated political discourse over the past year. Now that national health care reform legislation has been signed into law, our work has not ended. In fact, as BCBSM President and CEO Dan Loepp said in a statement March 22, the passage of the legislation “is just the beginning.”

The Michigan Blues are well-positioned to operate in a post-reform world since we have been pursuing health care reform in myriad ways for the past several years. In fact, many of our initiatives could serve as a national model for continuing reform. Here are two examples:
  • Our patient-centered medical home program, the largest of its kind in the country, is placing renewed focus on the role of the primary care doctor. The primary care physician’s practice serves as a patient’s medical home, helping to coordinate every aspect of the patient’s care. One report showed that if every American had a medical home, it would result in savings of more than $100 billion per year and improved health care quality.
  • Our Collaborative Quality Initiatives bring together physician groups and hospitals across the state to analyze clinical data, share best practices and implement changes that improve health care quality and lower costs in such areas as angioplasty, surgery and oncology. These efforts have saved hundreds of millions of dollars and many lives.
A new booklet, the 2010 Partners in Health Care Report, takes an in-depth look at these initiatives, illustrating how Michigan could lead the nation in health care reform. Check it out and let us know what you think.