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Blue Cross Praised and/or Rewarded Employees Who Dropped Expensive Patients

Posted Jun 16 2009 6:09pm

  There may not be a policy, but I’ll bet there are algorithms that calculate this, so what good does a policy do when the algorithms rule?   Wall Street may have lacked policies too, but the algorithms ran 24/7.   It’s all about business intelligence software that provides the data on the screen for decision making processes.  We really don’t know what goes on as transparency is not a priority with the business unless someone happens to secure some documents that show otherwise. image

There’s a real breakdown here with the insurance business not only in the area of consumer perception, but some good reality stories that have been in the news over the years.  In a recent item I posted we went back to Blue Cross buying computers for doctors in southern California with the hopes they would e-prescribe, well that didn’t work, so it tends to just still show the disconnected levels of better health care being able to successfully partner with insurers. 

Blue Cross Blue Shield defends bonuses in Michigan

The 2 New Hot Words in Healthcare: Algorithms and Whistleblowers

I just don’t seem to get it, why be deceptive and come to the table clean, admit and take action to change a business plan instead of a continued path of denial.  We ask and encourage doctors to say they are sorry and make amends, so would that not work here?  If this has been a practice, there’s going to be a whistleblower that leaks it out sooner or later, and the more we see of this, credibility falls one step lower.  BD

Blue Cross of California encouraged employees through performance evaluations to cancel the health insurance policies of individuals with expensive illnesses, Rep. Bart Stupak (D-Mich.) charged at the start of a congressional hearing today on the controversial practice known as rescission.
The state's largest for-profit health insurer told The Times 18 months ago that it did not tie employee performance evaluations to rescission activity. And executives with Blue Cross parent company WellPoint Inc. reiterated that position today.

The documents show, for instance, that one Blue Cross employee earned a perfect score of "5" for "exceptional performance" on an evaluation that noted the employee's role in dropping thousands of policyholders and avoiding nearly $10 million worth of medical care.
WellPoint's Blue Cross of California subsidiary and two other insurers saved more than $300 million in medical claims by canceling more than 20,000 sick policyholders over a five-year period, the House committee said.

The documents show, for instance, that one Blue Cross employee earned a perfect score of "5" for "exceptional performance" on an evaluation that noted the employee's role in dropping thousands of policyholders and avoiding nearly $10 million worth of medical care.
WellPoint's Blue Cross of California subsidiary and two other insurers saved more than $300 million in medical claims by canceling more than 20,000 sick policyholders over a five-year period, the House committee said.

Blue Cross praised employees who dropped sick policyholders, lawmaker says - Los Angeles Times

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