Blue Cross and Blue Shield Association

December 8, 2014 Jeff Herring What is the organization’s current focus? What are the organization’s overarching goals? The current focus of Blue Cross Blue Shields is to provide the best quality insurance to their members. Also, it is time for an open enrollment period for their current members, or trying to get new members to come to Blue Cross Blue Shields. The organizations overarching goals are to provide its members with the lowest premium cost, but providing the most insurance coverage…

offered by Blue Cross/ Blue Shield (BC/BS), after doing business with them for several years, this insurance company continues to be a sound investment for our commercial employer-based healthcare needs. I have been tasked to research any significant developments of BC/BS, and the impact and trends regarding healthcare quality, access, technology, and reimbursement. In essence, give my concerns about the health insurance they offer and what the future of the company should be. As we know Blue…

Horizon Blue Cross Blue Shield understands this and have taken some very aggressive, pro-active measures to combat fraud and abuse. In 2015, Horizon Blue Cross Blue Shield’s Special Investigations Unit (SIU) -- generated $43.2 million in savings -- identified as a combination of monies recovered and losses avoided – and opened 988 new…

United States, in an attempt to keep the industry’s greed at bay and force it to remain customer-focused by implementing federal regulations, a lawsuit was filed and won by the United States Supreme Court against the South-Eastern Underwriters Association. After ninety plus years of free reign the Supreme Court agreed with lawmakers and found the availability of health insurance to be a fundamental right to United States citizens, and as such, was subject to federal regulation as per the United…

Manage care organizations (MCOs) are types of health insurance that involve the creation of provider networks as well as prevention benefits, utilization review for medical necessity and standards of care, and often care management (Kongstvedt, 2013; Medline Plus, 2014). The beginnings of managed care in the United States reaches back to the early twentieth century and continue to thrive, but managed care has not been born from a single force or entity but from many sources seeking differing…

First example, Valdivia (2007), who is a manager, in Blue Cross and Blue Shield of Kansas, he recognizes that when hiring, interpersonal skills are one of the primary job condition for new employees, especially the listening skill. Nonetheless, he realizes that good listeners can express their ideas and build implicit…

Public Opinion in Healthcare Several sources such as media including social media, and news media can have an impact on health policy. The population’s views can be swayed with the opinions of the public lobbyist, and even media. The Affordable Care Act is one big initiative that some of the public is wary about. Consequently, many individuals do not know how to interpret it, and some may not be able to determine how it will affect them, or if it will affect them at all. Several news sources…

On December 8, 2003 began a historical day for which President George W. Bush signed the Medicare Prescription Drug, Improvement, and Modernization Act. The main provision of this legislative act was allowing Medicare coverage for outpatient prescription drugs. This was a well overdue benefit for Senior’s who spend an average of $2,322 per year on prescription drugs. President Bush proposal was to initiate private sector’s capacity to expand health care coverage while delivering quality medical…

Urgent care is a $16 billion a year industry and is expected to grow about 3.5 percent a year for the next decade, making it one of the fastest-growing segments of the health care system, according to IBIS World, a market research firm. What is the difference between Urgent care and Emergency care that is making Urgent care a fast-growing industry? Could it be that Urgent Care is a happy median between your practical doctor and an emergency room or its wide accessibility? Urgent care is a…

The purpose of this paper is to reflect upon the information I have learned in module three as well as to introduce the topic of nursing unions. Important topics to be discussed are policy and politics in nursing professional associations, organizations and unions, and nurses being advocates of change regarding issues in the workplace. I will first summarize the information I have learned throughout my readings in module three. In module three, I was able to further my knowledge on how policy…