Managed Care Report
• Cigna HealthCare, a subsidiary of Cigna Inter national (Philadelphia), has announced that it will restrict enrollment in its Connecticut Medicare HMO until the company catches up with a soaring membership. Membership increased from 1,078 in July to 6,800 as of Jan. 4. The company will honor new applications through Feb. 11, then not again until November when more staff is hired and trained. Also, healthcare analytic software developer, Symmetry Health Data Systems, has signed a three-year agreement with Cigna HealthCare, offering its patented ETG software. The software will help monitor the quality of healthcare delivery systems.
• A subsidiary of qmed (Laurence Harbor, NJ), Interactive Heart Management Corp., will provide its ohms/cad system for coronary artery disease management to the Tampa Bay members of Cigna HealthCare of Florida. The system uses technology to detect ambulatory myocardial ischemia and is designed to work with physicians and patients to modify coronary artery disease risk factors. It has been in place for Cigna HealthCare of Ohio’s members since July.
• Blue Cross and Blue Shield of Texas (BCBSTX; Dallas) said last week it will sell its Medicare unit to Blue Cross and Blue Shield of South Carolina (BCBSSC; Columbia, SC) after the federal government threatened to terminate its contract, reported the Dallas Morning News. The Health Care Financing Administration (Balti more) notified the company in December that its contract was in jeopardy because of its planned acquisition by Blue Cross Blue Shield of Illinois (BCBSIL; Chicago). BCBSTX and BCBSIL merged in January to form Health Care Service Corp. (Chicago). BCBSSC will take over BCBSTX’s Medicare operations in the next few months, the company said.
• Empire Blue Cross and Blue Shield (New York) has earned full accreditation from the National Committee for Quality Assurance for the five managed care plans reviewed in 1998, including Healthnet, Healthease, BlueChoice HMO, BlueChoice HMO/POS, and direct connection HMO plans.
• Blue Cross and Blue Shield of South Carolina (BCBSSC; Columbia, SC) is partnering with Franklin Health in a new program to help members with serious illnesses or injuries identify treatment options and help make the best healthcare choices. It’s the first program of its kind in South Carolina and will be available to all customers with Preferred Blue and HMO Blue coverage. The program will help patients with serious primary diagnoses such as cancer coordinate the care they receive from multiple specialists and other providers and address personal concerns ranging from disruption of family relationships to financial worries.
• RightChoice Managed Care (St. Louis) said it expects to report 4Q98 net income of between 14 cents and 18 cents per share. Rationalized market pricing of health benefit plans, controlled overhead expense, and a sequentially lower 4Q98 medical loss ratio contributed to RightChoice’s improved earnings performance in 4Q98 and for the year, officials said. For the full year, the company expects to report net income of between 28 cents and 32 cents per share. RightChoice also said it has promoted two key executives to underscore the board of directors’ commitment to further improvements in the company’s performance while pursuing the successful completion of the settlement agreement that Blue Cross and Blue Shield of Missouri (St. Louis) and RightChoice reached Sept. 20 with the Missouri Attorney General and Department of Insurance. The board promoted Sandra Van Trease to senior executive vice president/COO/CFO and Angela Fick Braly to executive vice president/general counsel/corporate secretary.