Subscribe to The Pulse

Health Costs

State workers, Blue Cross await coverage change

Blue Cross and Blue Shield of Georgia is gearing up to handle the transition of the State Health Benefit Plan (SHBP) to a co-pay system next month.

Teachers, state employees and other members of the SHBP will get new ID cards, said Morgan Kendrick, president of Blue Cross, the state’s largest health insurer, in an interview with GHN.

clipboardConsumers may get a rebate or credit on their previous health care transactions for this year, as a result of the switch to a co-pay system. Currently, patients are operating with a co-insurance model, where they pay a percentage of the costs of a health service.

The change to co-pays will occur by March 14, but will be retroactive to the beginning of the year. State officials said the transition should relieve financial stress for many SHBP members.

Some patients may end up owing money if they have received care in 2014 and had first-dollar coverage with their health reimbursement arrangement. The Department of Community Health is expected to give more guidance on the co-pay transition this week.

The SHBP has been in a state of flux in recent weeks. Effective Jan. 1, it changed over to a single vendor, Blue Cross, and a single type of health plan. But after a flood of complaints from SHBP members about how the new arrangement was working, the board of Community Health called a special meeting and approved the transition to co-pays. full story

Critics of new health plan send message to state

Jan. 1 rang in a major change for more than 650,000 members of the state employees’ health plan.

And on Jan. 2, the wife of a Cherokee County teacher started a Facebook page to voice complaints about the 2014 changes to the State Health Benefit Plan.

In just days, the Facebook page has exploded, with thousands joining the group.  The governor’s office has been deluged with phone calls. Preparations are under way for a rally against the new plan.

State employees’ leading complaint is the lack of choice of health plan providers, said Ashley Cline, creator of the Facebook group, called TRAGIC, or “Teachers Rally Against Georgia Insurance Changes.’’

Ashley Cline and her family

Ashley Cline and her family

A single vendor, Blue Cross and Blue Shield of Georgia, is providing medical care for the plan, which covers public school teachers in the state.

Cline told GHN on Wednesday that the family’s cost for occupational therapy for her 4-year-old daughter has soared to $130 a week under the plan. The deductibles and premiums are high as well, she said.

“I get upset and angry about our situation,’’ Cline said. “People always had options in health care.’’ full story

Following the money in fight against tobacco

Fifteen years ago, Georgia and other states settled lawsuits against the nation’s major tobacco companies to recover tobacco-related health costs. Total payments for the states were huge –– estimated at $246 billion over the first 25 years.

Cigarette BurningThis fiscal year, Georgia will receive $347 million in tobacco settlement funds and the state’s tobacco taxes, according to a recent report released by the Robert Wood Johnson Foundation.

But the state will spend less than 1 percent of that amount on programs to prevent smoking, the report said.

Georgia ranks 43rd in the country in the amount it spends on tobacco prevention –– $2.2 million –– as compared to the funding level recommended by the CDC, according to the report.

Still, Georgia spending on tobacco prevention is not dramatically low relative to other states.

The states will collect $25 billion in revenue from the tobacco settlement and tobacco taxes in fiscal 2014, but will spend only 1.9 percent of it –– $481.2 million –– on tobacco prevention programs, the report said. full story

Is Stratus alliance the wave of the future?

Stratus Healthcare billed itself as the largest hospital alliance in the Southeast when it was formed this summer.

hospital-road-signSince then, health industry officials have wondered: What is this new collection of independent hospitals all about?

If nothing else, Stratus is growing. The number of its hospitals has risen in a few months from 23 to 29. They are spread across Middle and South Georgia, and many are smaller, rural facilities.

Ninfa Saunders, president and CEO of Central Georgia Health System in Macon, and one of the leaders of Stratus, told GHN recently that member hospitals meet monthly to discuss collaboration on clinical services, information technology, and ways to better manage the health of area residents.

Saunders said member hospitals may eventually go beyond a loose alignment of interests and conclude management agreements, joint ventures or even joint operating agreements. full story

Mayo Clinic may ramp up presence in Georgia

Mayo Clinic’s recently announced collaboration with a Columbus hospital may signal other Georgia ventures for the renowned Minnesota-based health system.

St. Francis hospital becomes the first Georgia organization to join the Mayo Clinic Care Network. Under the agreement, its physicians will be able to connect with Mayo specialists on questions of complex care using an electronic consulting technique. Mayo will supply other informational tools as well.

St. Francis hospital in Columbus

St. Francis hospital in Columbus

Last year, Mayo Clinic acquired a health system in Waycross that included a hospital and two nursing homes. But future Mayo alliances in the South won’t be ownership deals but will be more like the St. Francis agreement, Mayo Clinic spokesman Kevin Punsky told GHN last week.

“We’re looking at a number of hospitals in Georgia and the Southeast,’’ Punsky said. Mayo Clinic already has a main campus in Jacksonville, Fla., roughly 80 miles from Waycross.

All across Georgia and the nation, hospitals are scrambling to forge alliances to survive the rapid changes shaking the health care business. full story

  • Sign up for our mailing list.