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Minn. Blues to shrink exchange role


Blue Cross and Blue Shield of Minnesota will reduce its role  in the state’s Affordable Care Act insurance exchange next year after losing nearly $300 million in the individual market in 2015.

The company will push people toward its narrower HMO option — — Blue Plus — according to the (Minneapolis) Star Tribune.

Plans with more limited  provider networks  usually offer cheaper monthly premiums but they have also created some confusion for members unfamiliar with the insurance, including the surprise of how smaller their choices of providers  can become.

Actions like the Minnesota Blues’ are being seen around America.

To read the Star-Tribune’s article, please hit this link.

The comeback of the HMO


The much maligned (and over-maligned) health maintenance organization (HMO) is making a comeback, under  pressure from private and public payers to save money while seeking better medical outcomes, The New York Times reports.

The Times notes that “A  defining feature of an HMO is  the restriction placed over which doctor or hospital a patient can use, which was a primary reason so many floundered in the 1990s. Doctors and patients complained about their lack of choices. Critics also accused the plans of denying patients tests and procedures to save money, and many plans were seen as offering low-quality care.”

But, The Times reports: “Despite the stigma and many failed efforts, insurers say they are eager to push a revamped version that revives many of the same features that restrict choices as a way of lowering costs. Insurers are already promoting HMO’s on the state exchanges created under the federal health law, and many are trying to persuade more companies and their employees to sign up.”

Putting more patients into narrower provider networks is  crucial to bringing America’s astronomical health care under contr0l.

Study cites a Calif. house-call program’s success


A recent study in HealthAffairs says that house calls can help reduce the number of emergency room visits and hospital readmissions.

It looks at  how since 2009 Torrance, Calif.-based HealthCare Partners Affiliates Medical Group has provided its House Calls program to recently discharged high-risk, frail and psychosocially compromised patients.  The idea is to provide and manage care for the group’s Medicare Advantage and commercially insured HMO patients.

The study says that  after being involved with the program for three months, patients were admitted to the hospital less often–and per-month use and spending continued to decrease.

Nurse practitioners  are the key to the program: They develop patients’ care plans while monitoring them and  sending updates to primary-care physicians. Meanwhile, social workers assess patients in their home environments. There, they identify  such potential issues such as fall risks, medication organization, social isolation and financial concerns and provide nutrition coaching.







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