How Texas’ Largest Insurer Changed Its Offerings For This Period Of Open Enrollment

There are dates in history that are seared in our national consciousness and which changed our country’s destiny. In regard to public health, few dates will be as momentous as March 23, 2010, the day when the long made promise of broader access to our world class health system began to have an unprecedented impact on millions of Americans.

We are now five years into the journey. As both a doctor and an insurance executive, I have lain awake many nights considering the different perspectives of those involved. How are the uninsured impacted? How are current patients impacted? How are employers impacted? How are independent doctors and hospital systems impacted?

We still don’t know the full impact of the healthcare law. This new age of healthcare has only begun, and it will continue to evolve. Likewise, Blue Cross and Blue Shield of Texas (BCBSTX) is increasing our flexibility so that we can adapt to the new environment as well.

Part of this natural evolution includes modifying insurance offerings as we adjust to the new marketplace that the Affordable Care Act created. With that in mind, BCBSTX will be discontinuing our Preferred Provider Organization (PPO) plan for individuals in 2016. Fortunately, the vast majority of BCBSTX members will not be affected by this 2016 change. PPO plans will still be available for employers and government programs such as Medicare and Medicaid. Individuals with “grandfathered” plans–plans that existed when the Affordable Care Act became law–will remain the same as well.

When the Health Insurance Marketplace opened, we went “all in,” making a calculated risk to offer individual PPO and HMO products in all 254 counties–a commitment that no other Texas insurer was willing to make. While we know the discontinuance of our PPO product for individuals will be disruptive, it is clear that keeping the individual PPO policies would limit our ability to provide sustainable coverage to all of our members over time.

We lost $400 million last year, a loss that naturally creates challenges in providing sustainable healthcare coverage. But there’s no need to worry. As an insurer that has been around for 85 years–since the very beginnings of health insurance–we have literally seen it all. We have every intention of offering healthcare coverage to Texans for another 85 years and beyond, and we stick by our goal of increasing access and affordability of healthcare to our members and the communities we serve.

We will again offer our Blue Advantage HMO in every county across the state. We are also adding a new HMO with point-of-service coverage, the Blue Advantage HMO Plus plan. For our individual members currently in our PPO plan, we will be transitioning them to Blue Advantage HMO Plus, so that they are not without coverage at any time. They can change their selection during Open Enrollment. To help add ease to this transition for our members with complex conditions, we will be working closely with them and their doctors to create personalized transition plans.

With changes like these, it’s more important than ever for patients and doctors to stay informed and educated. Healthcare is complicated, and many newly insured patients are still trying to wrap their minds around their coverage. As insurance products transform, it becomes even more critical for patient eligibility and benefits to be confirmed prior to every scheduled appointment. It’s in the best interest of both the patient and the provider. This includes health plan membership status, coverage status, applicable copayments, coinsurance and deductible amounts. When services are not covered, it’s important for providers to clarify with their patients what their financial responsibility will be for the health services, before they are given.

While we are adapting to the evolving landscape, some things will inevitably change. However, I will personally vouch for BCBSTX’s commitment to remain a firm supporter of physician-coordinated care. We believe our members get the best and most affordable care when it’s supervised by accountable doctors.

The health insurance market has many needs, and we all have a role to play. As the market evolves, we must all be prepared to adapt and evolve – as patients, as employers, as doctors and as hospitals. While it won’t happen overnight, our industry is moving confidently toward providing the right care, at the right place, at the right time.

So this is my challenge to you: Consider 3/23/10. What is your unique role in this healthcare revolution? What healthcare solutions will you bring to the table on behalf of the Dallas community?

Dr. Dan McCoy is vice president and chief medical officer of Blue Cross and Blue Shield of Texas.


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