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Affordable Care Act Forges Partnership Between Blue Care, Mercy Health

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GRAND RAPIDS — Starting Oct. 1, residents of Kent, Muskegon and Oceana counties who don’t receive employer-sponsored health insurance, or who are Medicare-eligible, will have the ability to select new health insurance products from Blue Care Network of Michigan.

The Blues say the new products will be affordably priced and provide access to quality health care services through Mercy Health’s more than 700 local doctors and four local hospitals.

The health insurance product for individuals under age 65 is priced to appeal to people in the three counties who seek affordable health insurance and care coordinated through local hospitals and doctors affiliated with Mercy Health. 

Pending final approval from state and federal regulators, it will be offered for sale when the new Health Insurance Marketplace opens for the first-ever federal open enrollment period October 1, with coverage effective Jan. 1, 2014.  It also will be offered for sale directly from Blue Cross Blue Shield of Michigan, as a Blue Care Network product, and indirectly through independent agents. The product for the Medicare market also will become available starting Oct. 1.

“Health care reform is driving significant changes in the marketplace, and the price of insurance products has become paramount to consumers,” said Jeff Connolly, BCBSM president of West Michigan Operations and Managed Care. “Many people will be looking to trade broad network access for a quality local network and a lower-cost insurance premium. We applaud our partners at Mercy Health for their energy and ingenuity in working with the Blues to develop these new, affordable health insurance options for people in west Michigan.”

“Insurance products that provide quality health care, coordinated through local networks of physicians and hospitals, are a real solution for people who lack access to affordable health coverage today,” said Kevin Sears, vice president for payer and product innovation at CHE Trinity Health. “There are more than 100,000 uninsured people in these three counties, and thousands more who want an affordable health plan option. These people will benefit immediately from these products that we have jointly developed with the Blues.” 

Sears noted that these two products will be among the first of similar products to come in other markets served by CHE Trinity Health.

To ensure that quality health care services are delivered efficiently, insurance subscribers will have their care coordinated through the offices of Mercy Health’s regional clinical integration network of more than 700 local physicians. Services outside the doctor’s office will be delivered at any of Mercy Health’s four regional hospital facilities. Patients will be able to access services within Blue Care Network’s statewide network if Mercy Health cannot provide them.

Mercy Health will begin a months-long process of orienting its physicians to their new role in successfully guiding health insurance product subscribers through their relationship between doctor and hospital.

“Mercy Health physicians work every day with their patients to focus on how medical care, self-management of chronic conditions and nutrition and exercise all work together to keep people healthy,” said David Blair, M.D., medical director of Mercy Health Clinical Integration Network. “Now our physicians will work to help people understand how to manage their health successfully, and provide the guidance their patients need to ensure a smooth and successful journey through their individual health care experience, whatever it may be.”

These efforts to coordinate care successfully extend work already underway at Mercy Health to lower health costs through greater efficiency.  This is the basis for CHE Trinity-Michigan Health System’s value-based reimbursement arrangement with BCBSM.  Announced earlier this year, this is the first such contract between a hospital system and BCBSM.

“These new localized products are a natural extension of a trusted relationship between a hospital and Blue Cross where quality and value — not volume — are rewarded through reimbursement,” said Kevin Klobucar, CEO of Blue Care Network. “These products are not directly connected to our reimbursement arrangement with CHE Trinity, but the approach behind it — delivering successful patient outcomes through effective and coordinated management of care — is foundational to our ability to partner. Hospitals that embrace their role in effectively managing health care costs and delivering the best patient outcomes are the types of partners the Blues will be seeking for future localized insurance product offerings in Michigan.”

Mercy Health is a multi-campus health care system serving West Michigan and the lakeshore with five hospital campuses, 58 physician offices, more than 1,300 medical staff physicians, more than 800 hospital beds and 7,200 associates. Mercy Health Physician Partners, its multi-specialty physician network, employs a total of 491 providers: 275 physicians and advanced practice professionals in Grand Rapids and 216 physicians and advanced practice professionals in Muskegon and the lakeshore. The system includes leading teaching hospitals, and renowned clinical leadership in oncology, cardiology, orthopedics, and neurology.

Mercy Health is a regional health ministry of Livonia-based CHE Trinity Health, one of the largest multi-institutional Catholic health care delivery systems in the nation. It serves people and communities in 21 states from coast to coast with 82 hospitals, 89 continuing care facilities and home health and hospice programs that provide nearly 2.8 million visits annually.

More at http://mercyhealth.com or http://mercyhealthphysicianpartners.com.

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