Managed Care Report
Managed Care Report
• SelectCare (Detroit) has named James Forshee senior vice president and chief medical officer. In his new position, Forshee will be responsible for the overall leadership of SelectCare’s medical administration and quality management activities. Prior to joining SelectCare, Forshee was medical director for clinical affairs at Blue Care Network of Michigan.
• Merck-Medco Managed Care (Montvale, NJ) has launched the Optimal Health Inspirations Asthma Management Program. The company hopes, with the new program, to help people ages 6 and above with asthma manage their disease and the events that occur because of it. The program now has 16,000 plan members enrolled. Program interventions include questionnaires to assess current asthma therapy, symptom control and tolerance to the patient’s prescribed regimen, newsletters, refill reminders, and peak-flow meters for monitoring. The Inspirations program is based on the 1997 Guidelines for the Diagnosis and Management of Asthma established by the National Asthma Education and Prevention Program.
• PacifiCare Health Systems’ (Santa Ana, CA) foundation has awarded grants totaling more than $1 million to 118 charitable organizations in the United States and Guam. These grants bring the PacifiCare Foundation’s donations for 1998 to $2.5 million. PacifiCare of California, which covers more than 50% of the HMO’s total membership, awarded 69 grants totaling more than $600,000. Four organizations in Oklahoma shared more than $34,000, and in Oregon, grants totaling $51,000 were awarded to seven groups. Nine additional Texas organizations were rewarded with more than $79,000, and in Washington, about $50,000 in grants were awarded to six organizations.
• Blue Cross and Blue Shield of Massachusetts (BCBSMA; Boston) has agreed to pay the federal government $4.75 million to settle demands by the U.S. Department of Health and Human Services (HHS; Washington) that BCBSMA reimburse the federal government for Medicare overpayments. The claims relate to reimbursement of Medicare payments for healthcare services provided to Medicare beneficiaries whose expenses should have been paid by group health plans insured or administered by BCBSMA. The company also agreed to furnish information to the Health Care Financing Administration (HCFA; Baltimore) that would identify instances where healthcare providers may have been reimbursed both by Medicare and private insurers; to maintain procedures that would insure the company properly pays Medicare Secondary Payer claims in the future; and to inform HCFA of situations where the company was the primary payer for Medicare beneficiaries.
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