Blue Plans Designing Special Products for Uninsured Consumers; Better Management of Inpatient Costs for Uninsured Leads to Affordable Products

9/29/2003

From: Christopher Hamrick of BCBSA, 312-297-5954; e-mail: chris.hamrick@bcbsa.com

CHICAGO, Sept. 29 -- Increased enrollment in existing public programs, such as Medicaid and SCHIP, and innovative private health insurance programs could reduce the number of the uninsured as much as 30 percent or more. A recent Blue Cross and Blue Shield Association (BCBSA) analysis shows that the uninsured Americans are not a homogeneous group. In fact, more than 14 million -- or about one-third -- uninsured children and adults are eligible, but not enrolled in, government-sponsored programs. In addition, more than 13 million uninsured Americans have income levels in excess above $50,000, with the fastest-growing income segment of these earning more than $75,000 a year.

In an effort to help reduce the number of uninsured, Blue Cross and Blue Shield companies across the country are reaching out to these and other populations with new products and innovative programs. For example:

-- Blue Cross and Blue Shield of Montana offers a product that provides enrollees with up to $10,000 in coverage per year, including six office visits, out patient care, emergency room care, and limited pharmaceuticals and which is priced at 40 to 50 percent of the average premium. The product is the output of a statewide coalition of physicians, hospitals and the Plan to provide insurance to the low-income uninsured in Montana. In order to be able to offer the product at affordable rates, physicians and hospitals agreed to the deep discounts.

-- Blue Cross and Blue Shield of Alabama's Child Caring Program helps uninsured children, 18 and under, that are not eligible for governmental coverage. The plan is offered free for enrolled children with no premium contribution, deductibles or co-insurance. Services covered under the program include all outpatient visits and procedures, immunizations, emergency medical care, vision care, and drugs administered in the outpatient setting. The Plan matches donations from public and private organizations dollar-for-dollar and also covers all administrative expenses so that 100 percent of the funds go to provide healthcare. The program has enrolled more than 43,000 children since its inception, with more than 7,000 currently enrolled.

-- Blue Cross and Blue Shield of Massachusetts (BCBSMA) created the Blue Cross and Blue Shield of Massachusetts Foundation in 2001, with an initial endowment of $55 million to be funded over a four-year period. The Foundation recently awarded $1.56 million in grants to 48 Massachusetts organizations to strengthen services for uninsured and low-income residents. The Foundation's grant awards will help to support 19 models of coordinated care for the uninsured, 16 programs to help connect low-income consumers -- particularly new MassHealth (formerly Medicaid) members -- with healthcare services and 12 organizations working to increase citizen participation in healthcare advocacy and policy initiatives.

A recent study conducted for BCBSA by Richard Siegrist, Jr., Adjunct Professor of Management at the Harvard School of Public Health, found that inpatient costs for the uninsured are 12.3 percent higher than costs for patients with private insurance. Further, uninsured patients with manageable health conditions or chronic illnesses like diabetes or asthma impacted these costs significantly.

"Blue Cross and Blue Shield companies have found that the real value in reaching out to the uninsured is twofold," said Scott P. Serota, president and CEO of the Blue Cross and Blue Shield Association (BCBSA). "First, having healthcare coverage provides piece of mind that encourages consumers -- especially those with chronic illnesses -- to seek out preventive care and treatment at the early stages of an illness. Second, having access to affordable healthcare improves the quality of care a patient receives and lowers healthcare costs for everyone."

"One of the main reasons inpatient hospital costs are higher among the uninsured is that they put off regularly scheduled treatments and check-ups because they can't afford them," Serota said.

The Siegrist research underscores efforts by Blue Cross and Blue Shield companies to create affordable new products for middle-income individuals, families and small businesses. "Covering the uninsured must be done in a way that promotes better health and affordability for consumers," Serota continued. "This research shows it is vital that we encourage people to take better care of themselves, promote quality relationships with their physicians and help them understand the importance of prevention and care management."

According to the Siegrist research, a lack of participation in appropriate preventive and health management programs causes inpatient admissions for uninsured patients with diabetes or asthma to be up to twice as high as those with private insurance. Patients with chronic illnesses had longer lengths of stay and typically required more intensive treatments compared to patients with private coverage, according to the study.

For more information about products offered for the uninsured through your local Blue Cross and Blue Shield company, go to BCBS.com and select the "Get Insurance Purchase Information" option in the main page.

The Blue Cross and Blue Shield Association is comprised of 42 independent, locally operated Blue Cross and Blue Shield plans that collectively provide healthcare coverage for more than 88.3 million - nearly one-in-three - Americans. For more information on the Blue Cross and Blue Shield Association and its Plans, visit http://www.bcbs.com.