Managed Care Report
• CCN (San Diego) has formed a long-term alliance with Unicare (Thousand Oaks, CA) that will bring a significant amount of group health business into the company’s PPO and managed care system. The alliance, which became effective Jan. 1, will provide better access to more physicians and hospitals, said Unicare Senior Vice President Max Brown. The integration "means we can administer these services and claims with improved accuracy and faster turnaround times," he said.
• A safeguard initiated by Blue Cross and Blue Shield of North Carolina (BCBSNC; Chapel Hill, NC) has saved the Medicare program nearly $134 million for FY98. The guard is designed to detect and correct overcharges, bookkeeping errors, duplicate payments, and fraud cases, said BCBSNC Vice President of Medicare Operations Brown Gardner. It saved $155 million in 1997. The largest savings of two-thirds were from coordinating claims with other insurance companies, when Medicare pays for the beneficiary without knowing the person is already covered. BCBSNC follows up on these cases and reimburses Medicare for them.
• Continuum Healthcare (Springfield, PA) said last week that it acquired Health Examinetics (San Diego). The acquisition will enable Continuum to offer occupational health testing and evaluation services on-site or through contracted providers, said President/CEO Peter Hotz.
• A Broward County, FL, Circuit court judge has decided that Humana’s (Louisville, KY) Florida health plan members may continue to receive care in facilities owned by Columbia/HCA Healthcare (Nashville, TN). Humana filed suit against Columbia on Jan. 8 after the hospital chain refused to treat several Humana health plan members. The companies had a contract that expired Dec. 31, but it allowed for a three-month run-off period so plan members could make a smooth transition to other hospitals. Since Dec. 31, Columbia withheld hospital care in at least 27 cases. Circuit Judge John T. Luzzo decided Columbia hospitals must continue to treat Humana’s members until the contract’s run-off period expires March 31. Humana will hold its annual meeting of stockholders at 10 a.m. May 6 on the 25th floor of its corporate headquarters in Louisville. It has also changed its transfer agent from the Bank of Louisville to National City Bank (Cleveland), effective March 31.
• Cigna International (Philadelphia) has acquired a 45% stake in a Mexican managed care company and hopes to become a "national presence" within three years. The acquisition came about a week after Cigna sold its property/casualty operations for $3.45 billion to Bermuda-based Ace. Cigna bought the stake in Planes de Salud Integral S.A. de C.V. (Guadalajara, Mexico). The company had $2.2 million in revenues in FY98 and has about 14,000 members.