Regence

Regence BlueShield returns $2.4 million to Medicare Advantage PPO members for financial relief amid the COVID-19 pandemic

Regence — Tue, 15 Sep 2020 17:48:45 GMT

SEATTLE – Regence BlueShield is providing $2.4 million in financial relief through a one-time premium credit to its Washington members enrolled in a Medicare Advantage (MA) PPO plan. The credit amount will either be applied to eligible members’ October premium bill or sent as a printed check in September. This follows a one-time credit totaling $35 million that Regence health plans issued in August 2020 to select fully insured group and individual customers across Washington, Oregon, Idaho and Utah.

“The communities we serve continue to experience historic levels of economic hardship, uncertainty and stress,” said Kathleen Faulk, senior vice president and general manager of government programs at Regence. “During the peak of the COVID-19 pandemic, some of our Regence Medicare members could not access care while they continued to pay premiums for their health plan coverage. As we continue to work together through these challenging times, we want to offer some relief while remaining financially strong for all our members and customers.”

In addition to premium credits, Regence health plans have taken several actions to support members, employers, providers, business partners and local communities through the COVID-19 public health crisis. These include:

Providing no-cost COVID-19 treatment to fully insured members through December 2020, as well as no-cost testing, and reaching out proactively to high-risk members
Expanding virtual care services, including primary care and behavioral health, to ensure safe health care access
Working collaboratively with providers to support them through economic challenges, including expediting claims payments and removing pre-authorizations for select services
Listening to and collaborating with our customers on solutions such as grace periods and leave-of-absence policies to enable employee coverage to continue – and providing educational events on back-to-work strategies
Helping community partners on the front lines through investments in programs that aid food security, caregivers and the health care workforce; together with its employees and corporate foundation, Regence has committed nearly $10 million in philanthropic investments to care for people affected by COVID-19.

Regence’s website, regence.com/go/covid-19, provides up-to-date information on our COVID-19 response and community support, including expanded resources for self-care as people face mental health challenges.

About Regence BlueShield
Regence BlueShield has been serving Washingtonians in select counties for over a century and now provides nearly 1.3 million members with comprehensive health insurance solutions. As a nonprofit independent licensee of the Blue Cross and Blue Shield Association, Regence is part of a family of companies dedicated to transforming health care by delivering innovative products and services that change the way consumers nationwide experience health care. For more information, please visit regence.com, facebook.com/regenceblueshieldwa or twitter.com/regencewa.

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Regence BlueCross BlueShield of Oregon returns $2 million to Medicare Advantage PPO members for financial relief amid the COVID-19 pandemic

Regence — Tue, 15 Sep 2020 15:23:00 GMT

PORTLAND, Ore. – Regence BlueCross BlueShield of Oregon is providing $2 million in financial relief through a one-time premium credit to its members enrolled in a Medicare Advantage (MA) PPO plan. The credit amount will either be applied to eligible members’ October premium bill or sent as a printed check in September. This follows a one-time credit totaling $35 million that Regence health plans issued in August 2020 to select fully insured group and individual customers across Washington, Oregon, Idaho and Utah.

Providing no-cost COVID-19 treatment to fully insured members through December 2020, as well as no-cost testing, and reaching out proactively to high-risk members
Expanding virtual care services, including primary care and behavioral health, to ensure safe health care access
Working collaboratively with providers to support them through economic challenges, including expediting claims payments and removing pre-authorizations for select services
Listening to and collaborating with our customers on solutions such as grace periods and leave-of-absence policies to enable employee coverage to continue – and providing educational events on back-to-work strategies
Helping community partners on the front lines through investments in programs that aid food security, caregivers and the health care workforce; together with its employees and corporate foundation, Regence has committed nearly $10 million in philanthropic investments to care for people affected by COVID-19.

About Regence BlueCross BlueShield of Oregon
Regence BlueCross BlueShield of Oregon, headquartered in Portland, has been serving Oregonians since 1941 and now provides approximately 935,000 members with comprehensive health insurance solutions. As a nonprofit independent licensee of the Blue Cross and Blue Shield Association, Regence is part of a family of companies dedicated to transforming health care by delivering innovative products and services that change the way consumers nationwide experience health care. For more information, please visit regence.com, facebook.com/regencebluecrossblueshield, or twitter.com/regenceoregon.

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Regence BlueCross BlueShield of Oregon commits $250,000 in community aid in wake of devastating wildfires

Regence — Fri, 11 Sep 2020 22:00:00 GMT

PORTLAND, Ore. – To help Oregonians and front-line responders battling local wildfires, Regence BlueCross BlueShield of Oregon is donating $250,000 to the American Red Cross, the United Way of Jackson County and other organizations.

Regence has more than 925,000 members across Oregon, including more than 47,000 members located in the latest evacuation zones. The health plan has a particularly close connection to Medford – a community significantly impacted by current wildfires – where 23,400 members currently reside in an evacuation zone, and approximately 200 Regence employees who work at the company’s service center at 2057 Commerce Dr.

“Regence has proudly served Oregon for almost 80 years, and we share in our state’s pain and loss,” said Angela Dowling, president of Regence BlueCross BlueShield of Oregon. “We’re making these donations to bring immediate support and resources to organizations on the front lines of the wildfire response. Oregonians are resilient, and we will continue work alongside our customers, members and community leaders through the recovery process.”

In response to the wildfires, Regence has committed these initial gifts to the following organizations:

$100,000 to the American Red Cross in Oregon, which will support relief efforts statewide.
$100,000 to organizations that support first responders and communities statewide
$50,000 to the United Way of Jackson County

Additionally, Regence has put emergency measures in place to ensure that health plan members who are affected by wildfires throughout the state can get the care they need. Those include:

Reaching out to our members in affected areas who are in our existing care management programs to ensure they have the support they need.
Waiving restrictions on most pharmacy refills and enabling members to fill needed prescriptions at any pharmacy regardless of network.
Replacing medical equipment for fully insured and Medicare members that was destroyed by fire or left behind when people evacuated.
Allowing fully insured and Medicare members who have been evacuated to get emergency medical care out of network at in-network rates.

Please visit the Regence blog for the latest updates on wildfire support for members, employers and communities.

About Regence BlueCross BlueShield of Oregon
Regence BlueCross BlueShield of Oregon, headquartered in Portland, has been providing health care solutions to Oregonians since 1941. As a tax-paying nonprofit independent licensee of the Blue Cross and Blue Shield Association, Regence is part of a family of companies dedicated to transforming health care by delivering innovative products and services that change the way consumers nationwide experience health care. For more information, please visit regence.com, facebook.com/regencebluecrossblueshield, or twitter.com/regenceoregon.

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Unpaid caregivers’ health experiencing unprecedented declines, new report reveals

Regence — Wed, 09 Sep 2020 15:55:00 GMT

PORTLAND, Ore. – Unpaid caregivers are experiencing significant health declines, due to the stress and pressure of caring for a spouse or child, according to a new study of medical claims by the Blue Cross Blue Shield Association (BCBSA).

The report analyzed a data sample of caregivers and found they had, on average, 26% poorer health as compared to a benchmark population. The study’s review of health claims* identified at least 6.7 million commercially-insured Blue Cross Blue Shield (BCBS) members with a spouse or child in need of caregiver support to create the sample. Across Regence’s four-state footprint, the percent of individuals in need of caregiving was slightly below the 22% national average, representing 18% of individuals in Idaho, Oregon and Washington, and 16% of Utahns.

The report, titled “The Impact of Caregiving on Mental and Physical Health," represents the first time in the health care industry that claims data has been used to study the relationship between health status and caregiving.

“Caregivers are under an immense amount of stress right now, which has been exacerbated by COVID-19,” said Dr. Drew Oliveira, senior executive medical director at Regence. “If left unchecked, prolonged stress and anxiety can contribute to serious health problems, including high blood pressure, obesity and diabetes. This report is a wakeup call for caregivers to take proactive, meaningful action to manage stress before it compounds into a more serious health event.”

Compared to the benchmark population, caregivers in the Millennial age group – those born between 1981 and 1996 – are the most likely generation to experience additional stress-related conditions.

Additionally, the health impacts associated with caregiving seem to be more pronounced for this group, compared to the benchmark population, with the following conditions being more prevalent:

82% increase in hypertension
60% increase in anxiety
64% increase in major depression
74% increase in obesity
59% higher rate of hospitalization; 33% higher rate of ER visits

ARCHANGELS study finds caregivers are turning to negative coping mechanisms

To better understand these alarming health trends, BCBSA collaborated with ARCHANGELS, an independent national movement and platform that is reframing how caregivers are seen, honored and supported using a combination of data and stories.

According to an ARCHANGELS study conducted early in the pandemic, caregivers were turning to a variety of negative coping mechanisms, including:

Alcohol (14%)
Medication (18%)
Food (50%)

“Wherever you are right now, look to your left, look to your right. One of you is a caregiver. Being a caregiver is one of the most important jobs many of us will ever do. It’s also one of the hardest, with profound physical and mental health impacts,” said Alexandra Drane, co-founder and CEO at ARCHANGELS. “The first and most important step we all need to take is to check in on ourselves and our loved ones.”

Regence supports caregivers and those they care for

Regence and its corporate parent are committed to recognizing, understanding and supporting caregivers by changing perceptions, influencing policy change and creating solutions that address the needs of today’s caregivers.

Regence’s Personalized Care Support program helps members and their caregivers navigate the challenges that come with serious illness, by offering one-on-one support at no extra cost. The program’s in-house clinicians and social workers provide care coordination, member advocacy, social support, connections to community resources and advance care planning. Offering one of the most comprehensive palliative care benefits in the industry, the program’s member-centric approach helps those living with serious illness, and their caregivers, live as well as possible for as long as possible. The plan’s benefit also provides reimbursement for advance care planning and includes additional coverage for home health visits and psycho-social support services, such as family counseling.

In light of additional stressors brought on by the COVID-19 pandemic, Regence has also partnered with local nonprofits to provide caregivers and other vulnerable populations with technology to keep them connected and address the negative impacts of isolation.

*This is the 33rd study of the Blue Cross Blue Shield, The Health of America Report^® series, which examined data from commercially-insured members in the BCBS claims database, alongside data and support from ARCHANGELS, the National Opinion Research Center (NORC) at the University of Chicago, The Centers for Disease Control and Prevention (CDC), the Center to Advance Palliative Care (CAPC) and U.S. Census data.

All company names and brands are the property of their respective owners and used for identification purposes only and are in no way associated or affiliated with the Blue Cross Blue Shield Association. Use of these names and brands does not imply endorsement.

About Regence
Regence serves 3.1 million members through its Regence health plans in Idaho, Oregon, Utah and Washington. Each Regence health plan is a nonprofit independent licensee of the Blue Cross and Blue Shield Association. Regence is part of a family of companies dedicated to transforming health care by delivering innovative products and services that change the way consumers nationwide experience health care. For more information, please visit regence.com.

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Regence welcomes Brent Hess as new director of Medicare sales

Regence — Tue, 01 Sep 2020 15:00:00 GMT

PORTLAND, Ore. – Regence has hired Brent Hess as its director of Medicare sales, effective August 3. In this role, Hess leads a team of sales professionals dedicated to business development for prospective Medicare customers and employer retiree groups. This includes supporting prospects and brokers as they work together throughout the year to find Medicare solutions that best suit their needs.

Hess, a seasoned leader with over 15 years working in health care, is responsible for Medicare sales across the regional health plan’s four-state footprint, which includes Idaho, Oregon, Utah and Washington.

“At Regence, we’re dedicated to building a better health care experience,” said Kathleen Faulk, senior vice president and general manager of government programs at Regence. “Brent embodies Regence’s commitment to put our customers at the center of what we do. His deep-rooted knowledge of the industry, coupled with a sincere passion for providing consumers with high-quality, cost-effective health plan options, make him a perfect fit for this role.”

Hess was drawn to Regence’s focus on meeting Medicare consumers on their health care journeys by offering a wide range of plan options to meet diverse health care needs and budgets. He looks forward to applying his industry experience and perspective to help Regence build on its health plan offerings and differentiate in the marketplace.

“The relationships we forge with our members and brokers matter immensely,” said Hess. “I’m thrilled to join a not-for-profit health plan that prioritizes a people-first mentality and takes a dedicated approach to helping individuals navigate their health care journeys.”

Prior to joining Regence, Hess served as director of government sales for a large health care system in Utah, Idaho and Nevada, managing product strategy and distribution. He also previously served as a regional sales manager with a national carrier, covering the Utah, Idaho and Nevada markets. In his new role, Hess reports to Dara Smith, who oversees Regence’s Medicare product and sales.

Hess earned his bachelor’s degree in Business Administration with a minor in HR Management from California State University of Fullerton. He also completed his MBA at Western Governors University.

“The challenges today’s Medicare consumers face are more complex and diverse than ever before,” said Hess. “Through exceptional plan offerings and new benefits for 2021 coverage, Regence is poised to deliver solutions that meet the unique needs of our members.”

*Those enrolled in Medicare can sign up or switch to a Medicare Advantage plan during Medicare’s annual election period (AEP) that runs Oct. 15 through Dec. 7 each year with a Jan. 1 coverage effective date.

Regence is an HMO/PPO/PDP plan with a Medicare contract. Enrollment in Regence depends on contract renewal. Other providers are available in our network.

Regence complies with applicable Federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, or sex. ATENCIÓN: si habla español, tiene a su disposición servicios gratuitos de asistencia lingüística. Llame al 1-800-541-8981 (TTY: 711). 注意：如果您使用繁體中文，您可以免費獲得語言援助服務。請致電 1-800-541-8981（TTY: 711).

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Regence returns $35 million to customers for financial relief amid the COVID-19 pandemic

Regence — Thu, 06 Aug 2020 14:00:00 GMT

PORTLAND, Ore. – Regence is providing up to $35 million in financial relief to commercial health plan customers in its four-state footprint through a premium credit. Select fully insured group and individual Regence health plan customers across Idaho, Oregon, Utah and Washington will receive a credit for a portion of their health care premium on upcoming bills.

“Our communities have faced unprecedented stress and widespread economic hardship these past few months because of COVID-19,” said Jared Short, president and chief operating officer. “During this time, some of our members have paid for coverage for care that they were not able to fully access. While much uncertainty remains, we believe offering relief for our members, customers and communities is the right thing to do, and we appreciate the support of our regulators in being able to provide it.”

The premium credits are the latest among a number of steps the health plan has taken to support members, employers, providers, business partners and local communities through the COVID-19 public health crisis.

Throughout the pandemic, Regence has announced a series of significant initiatives to support members, business partners and communities. These include:

Providing no-cost COVID-19 treatment to fully insured members through December 2020, as well as no-cost testing, and reaching out proactively to high-risk members
Expanding virtual care services, including primary care and behavioral health, to ensure safe health care access
Working collaboratively with providers to support them through economic challenges, including expediting claims payments and removing pre-authorizations for select services
Listening to and collaborating with our customers on solutions such as grace periods and leave-of-absence policies to enable employee coverage to continue – and providing educational events on back-to-work strategies
Helping community partners on the front lines through investments in programs that aid food security, caregivers and the health care workforce; together with its employees and corporate foundation, Regence has committed nearly $10 million in philanthropic investments to care for people affected by COVID-19.

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Regence’s first-in-the-nation health care collaboration improves medication safety

Regence — Tue, 28 Jul 2020 15:00:00 GMT

PORTLAND, Ore. – In a first-in-the-nation health care collaboration, Regence members will experience more efficient, effective and affordable care through innovative data-sharing arrangements between the health insurer and two providers, MultiCare and Oregon Health & Science University (OHSU).

These initiatives are part of the HL7® Da Vinci Project, which helps organizations deliver better outcomes on clinical quality, cost and care management. Collaborating with these health systems, Regence is shifting to a value-based care approach powered by seamless data exchange, or “interoperability,” a process that delivers more coordinated care between members and their health care providers.

Accelerating value-based care with focus on medication safety

During one initiative last year, Regence and MultiCare Connected Care—the Accountable Care Organization that is a wholly owned subsidiary of MultiCare Health System—teamed up on a first-in-the-nation Da Vinci Project use case based on HL7® FHIR® (Fast Healthcare Interoperability Resources) as the standard for value-based care data exchange.

Medication reconciliation is the process by which a patient’s medication history is verified to ensure there are no discrepancies when considering medication changes. This reconciliation is often conducted during transfers of care as an important value-based care quality and patient safety measure. This specific partnership enabled MultiCare to send proof that a patient’s medication history had been verified upon hospital discharge. This data is submitted daily and directly to Regence, reducing administrative burden, costs and improving quality.

“Our partnership with Regence has been instrumental to streamlining the clinical workflow and ensuring patient safety,” said Anna Taylor, director of operations, MultiCare Connected Care. “By working together, we were able to quickly reduce labor-intensive administrative work so that our providers can dedicate more time to caring for patients.”

Reducing decision turnaround times

In another initiative, Regence is working with OHSU to expedite and simplify decisions on the most appropriate care for members. The current prior authorization process can be time-consuming for patients, providers and payers, and a costly administrative burden that potentially delays care. Providers need real-time access to health plan coverage requirements to efficiently deliver more informed and timely treatment decisions.

Collaborating with OHSU, Regence is integrating prior authorization tools directly in the electronic health record (EHR), including delivering automatic coverage decisions. Treatment decisions at the point of service help ensure patients receive the right care when they need it most, reducing disruptions to care and improving outcomes.

Enabling success for value-based care programs

In value-based care programs, providers take additional accountability for their patients’ outcomes, experience and affordability. To do this, providers need access to easy-to-understand and actionable patient data. However, the industry currently lacks standards for sharing this data between payers and providers.

Regence is working with MultiCare Connected Care to implement a FHIR-based approach to share key information needed for member attribution in value-based arrangements. As part of this work, Regence’s corporate parent is sponsoring and leading the development of one of the Da Vinci Project’s implementation guides, which will provide a standard, consistent process for providers and payers to share key information needed for members in value-based arrangements.

The goal of all Da Vinci Project use cases is to expand their use to additional providers and payers, establishing new standards for improving data sharing across the industry.

“The more we are able to simplify provider workflows and lighten the administrative load, the more quickly we can accelerate successful value-based care programs for patients, providers and payers alike,” said Kristie Putnam, Regence’s VP of provider partnership innovation. “These innovative partnerships are offering a more complete view of patient history, resulting in a better outcome and more affordable care for patients and increased efficiency overall.”

“Founding members of Da Vinci Project, Regence and its corporate parent provide deep thought leadership, a wealth of subject matter expertise and real-world implementation experience back to the emerging FHIR community across focus areas,” shared Jocelyn Keegan, program manager, Da Vinci Project. “Regence and its partners are demonstrating the power of standards and FHIR to reduce burden and improve outcomes for patients, providers and payers.”

About Regence
Regence serves approximately 3.1 million members through Regence BlueShield of Idaho, Regence BlueCross BlueShield of Oregon, Regence BlueCross BlueShield of Utah and Regence BlueShield (select counties in Washington). Each health plan is a nonprofit independent licensee of the Blue Cross and Blue Shield Association. Regence is part of a family of companies dedicated to transforming health care by delivering innovative products and services that change the way consumers nationwide experience health care. For more information, please visit Regence.com.

About the HL7 Da Vinci Project
As an HL7 FHIR Accelerator, the Da Vinci Project is a private sector initiative comprised of industry leaders and health information technology technical experts who are working together to accelerate the adoption of HL7® FHIR® as the standard to support and integrate value-based care (VBC) data exchange across communities. The Da Vinci Project focuses on minimizing the development and deployment of one-off solutions between partners with a goal to help all clinicians and health plans to better deliver clinical quality, value and care management outcomes. The core focus of phase one of the project is to deliver implementation guides and reference software implementations to the public for data exchange and workflows necessary to support providers and payers entering and managing VBC contracts and relationships. To learn more about the Da Vinci Project, visit www.HL7.me/davinci.

About MultiCare Connected Care
MultiCare Connected Care (MCC) is an independent Accountable Care Organization (ACO) established in 2014 as a wholly owned subsidiary of MultiCare Health System and operates as an independent entity. MCC has established a comprehensive Clinically Integrated Network (CIN) comprised of doctors and other health care providers, as well as hospitals, clinics and other health care services, such as imaging, labs and pharmacies. The CIN includes independent health care professionals in the community, as well as MultiCare providers totaling over 3,600 clinicians providing services across the continuum of care.

MCC is a physician-led organization with its own governing board and offers a commercial health benefit plan focus plus Medicare Shared Savings Program (MSSP) and is fast becoming the population health engine representing MultiCare Health System and its independent partners, in transforming health care in our region with 16 Value Based Contracts and serving over 120,000 lives. multicareconnectedcare.com

About OHSU
OHSU is the only academic health center in Oregon and is nationally distinguished as a research university dedicated solely to advancing health sciences. This singular purpose allows us to focus on discoveries that prevent and cure disease, on education that prepares physicians, dentists, nurses and other health professionals for the evolving health care environment, and on patient care that incorporates the latest advances. Based in Portland, we are one of Oregon’s largest employers, operate the top-ranked adult and children’s hospitals in the state, and secure competitive research funding of more than $486 million. As a public organization, we also provide services for the most vulnerable Oregonians and outreach to improve health in communities across the state.

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New Regence full funding health plan solutions help employers reduce risk, boost predictability in challenging economic times

Regence — Tue, 30 Jun 2020 16:00:00 GMT

PORTLAND, Ore. – Today Regence announced a new level-funded benefits offering, Regence LevelBlue^SM, that is now available with health plans in Idaho, Oregon, Utah and Washington. With Regence LevelBlue and its fully insured equivalent Regence SharePlan^SM, Regence now provides a full range of funding solutions to help mid-sized employers (those with 51+ employees) better manage through challenging economic times. Both Regence LevelBlue and Regence SharePlan can be paired with the health plan’s full suite of products and best-in-class network.

“With employers facing unprecedented economic uncertainties, Regence’s full spectrum of health plan solutions offers flexibility and customization from a trusted and stable market leader,” said Bill Bradley, vice president of product development for Regence. “Regence LevelBlue and Regence SharePlan pairs our deep expertise in managing self-funded and fully insured plans with an unmatched provider network and our award-winning customer service.”

Regence LevelBlue and Regence SharePlan provide opportunities to receive cash back at the end of year if actual claims are less than expected. Both solutions include reporting with an easy-to-use interface, clear visibility into how claims dollars are being spent, and identified opportunities for additional savings. Regence LevelBlue integrates pharmacy, stop-loss and administration into one comprehensive offering on a single bill, while Regence SharePlan includes all the options and added stability that employers receive on their fully insured plans.

Regence’s full portfolio of funding solutions are paired with the Blue Cross and Blue Shield Association network, delivering access to 95% of doctors and 96% of hospitals throughout the United States. For more information, please visit www.regence.com.

About Regence
Regence serves approximately 3.1 million members through its Regence health plans in Idaho, Oregon, Utah and Washington. Each Regence health plan is a nonprofit independent licensee of the Blue Cross and Blue Shield Association. Regence is part of a family of companies dedicated to transforming health care by delivering innovative products and services that change the way consumers nationwide experience health care. For more information, please visit regence.com.

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Regence and Habitat for Humanity partner to build safe, affordable housing for Oregonians impacted by health and socioeconomic disparities

Regence — Wed, 17 Jun 2020 15:00:00 GMT

Portland, Ore. – Regence BlueCross BlueShield of Oregon today announced an investment in Habitat for Humanity Portland/Metro East to build safe, affordable homes for Oregonians impacted by health and socioeconomic disparities.

Regence’s most recent $75,000 investment, made over the next two years, will support crucial Habitat for Humanity programs:

Inspired by the community’s response to Habitat for Humanity’s Safety of Home campaign, Regence will meet an immediate need for affordable homeownership by committing $37,500 to the completion of 42 homes in North Portland. This will provide safe, stable housing for 200 Oregonians.
An additional $37,500 will support Habitat’s 10-home community in the Cully neighborhood of Northeast Portland.

This multi-faceted investment reflects Regence’s commitment to address immediate local needs and disparities exposed by the COVID-19 pandemic, while also supporting the long-term recovery and resiliency of local communities.

Since 1976, Habitat for Humanity, a global nonprofit working in local communities across all 50 U.S. states and in more than 70 countries, has provided homeownership opportunities to communities of color, promoting equity and addressing a legacy of displacement and marginalization. Over the course of their valued partnership, Regence, its employees, and corporate foundation have contributed over $260K and 4,300 hours of volunteer support to Habitat for Humanity Portland/Metro East.

“The COVID-19 pandemic has magnified the gaps and disparities that exist within our health and social care system,” said Peggy Maguire, Regence’s senior vice president of corporate social responsibility and palliative care solutions. “Guided by the core beliefs that health disparities are not inevitable and that access to safe, stable and affordable housing is a key social determinant of health, Regence is proud to partner with Habitat for Humanity to improve overall individual, neighborhood and community health.”

A Habitat for Humanity study found that 79% of families experiencing asthma and other housing-related respiratory illnesses reported no longer having symptoms after moving into their new Habitat homes. “Having a safe, healthy home is critical now more than ever,” said Steve Messinetti, CEO of Habitat for Humanity Portland/Metro East. “Many families apply to Habitat for Humanity while experiencing unhealthy living conditions. Thanks to the incredible support of partners like Regence, more people will have the opportunity to experience the safety and stability of a healthy home.”

Initial Regence funding will support the development of affordable homes in North Portland. These homes will provide homeownership opportunities for people who have generational ties to historically African American neighborhoods, but have been displaced due to gentrification and systematic racism.

As Oregon’s largest health insurer, Regence is committed to supporting the health and wellbeing of its members and the community it serves. To learn more, visit news.regence.com.

About Habitat for Humanity Portland/Metro East
Habitat for Humanity Portland/Metro East believes that everyone deserves a decent, affordable place to live. Habitat homebuyers help build their own homes alongside volunteers and pay an affordable mortgage. Through financial support, volunteering or adding a voice to support affordable homeownership, everyone can help people achieve the strength, stability and self-reliance they need to build better lives for themselves and their families. Learn more at habitatportlandmetro.org.

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Regence ensures members continue access to mental health care through telehealth during COVID-19

Regence — Tue, 16 Jun 2020 15:00:00 GMT

PORTLAND, Ore. – Eighty-five percent of Regence members continued their behavioral health care during the COVID-19 pandemic. The statistic illustrates how Regence has collaborated with providers and rapidly pivoted to meet increased member demand for telehealth and virtual care solutions in the face of COVID-19.

“The communities we serve are facing unprecedented stress due to the pandemic, economic fallout and social determinants of health,” said Dr. Cheryl Pegus, president of consumer health solutions and chief medical officer for Regence. “Maintaining access to behavioral health care for current users and members who now need access remains our priority. We are partnering with providers and innovative e-health solutions to meet the needs of all the communities we serve.”

Members across Regence’s four-state region who received behavioral health care before the pandemic successfully switched to virtual care options to ensure their continued care from the earliest days of physical distancing. This included 87 percent of members in Washington, 85 percent in Oregon, 85 percent in Idaho, and 82 percent in Utah, averaging to 85 percent across the four states.

Regence expanded members’ access to all provider specialties through telephone, video, text and other options to help them get the care they need during the pandemic while allowing them to maintain physical distancing. These virtual services included both routine preventive services and COVID-19-related care.

Other areas aside from behavioral telehealth have also experienced increases. Regence’s telehealth claims are up 4900 percent during the pandemic. In January, Regence saw an average of 1,000 telehealth visits a week. In May, that average was more than 50,000 visits a week. Primary and specialty care are making up half of all telehealth utilization for Regence members, up from about 20 percent in January.

Expanded access through virtual care is one of the ways Regence is supporting its members, business partners, employees and communities during the pandemic. In addition to telehealth, Regence is:

Providing no-cost COVID-19 treatment to fully insured members through December 2020, as well as no-cost diagnostic testing when recommended by a doctor, and reaching out proactively to high-risk members
Working collaboratively with providers, including expediting claims payments
Listening to and collaborating with our customers on solutions, such as grace periods and leave of absence, to achieve continuation of employee coverage—and providing educational events around back-to-work strategies
Supporting community partners on the front lines through investments in programs that aid food security and caregivers
Protecting the safety and well-being of its employees through remote work and enhanced home health programs for mindfulness and exercise

Regence’s website, regence.com/go/covid-19, is regularly updated with the latest information, including expanded resources for self-care as people face mental health challenges.

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Regence and Healthmap Solutions partner to provide Kidney Health Management program to members

Regence — Thu, 11 Jun 2020 13:00:00 GMT

PORTLAND, Ore. – Regence today announced a new partnership with Healthmap Solutions—a growing national Population Health Management company with a flagship Kidney Health Management (KHM) program—to improve care and outcomes for Regence members with Chronic Kidney Disease (CKD) and End Stage Renal Disease (ESRD). Effective July 1, Healthmap Solutions’ innovative national KHM program will be available to eligible Regence fully insured and Medicare Advantage members. Regence is a family of health plans in Oregon, Idaho, Utah and select counties in Washington, each an independent licensee of the Blue Cross and Blue Shield Association dedicated to making health care better, simpler and more affordable.

“Regence is committed to helping people on their health care journeys—especially our most vulnerable populations in these extraordinarily challenging times—with innovations that deliver better outcomes,” said Dr. Cheryl Pegus, Regence’s president of consumer health solutions and chief medical officer. "This solution provides compassionate, quality, person-focused care for patients facing the complex challenges of kidney disease, and helps aid providers facing unprecedented stresses from the COVID-19 pandemic.”

Patients with kidney disease have an impaired immune response and multiple co-morbid chronic diseases, putting them at a high risk for COVID-19. This risk is exacerbated by the need to maintain safe and life-sustaining access to critically important and ongoing treatments such as dialysis, further emphasizing the importance of patient support to maintain good health.

The Healthmap Solutions program enhances the physician-to-patient relationship and makes health care more affordable by ensuring a seamless transition between stages of kidney care and preemptively intervening to avoid adverse health care events. In contrast, Medicare alone spent $144 billion in 2016 on patients diagnosed with CKD and ESRD,[1] according to the National Kidney Foundation. Early detection, proper care and treatment are the most effective means of treating the disease, delaying its progression and enabling the patient to live better, longer lives.

“Healthmap Solutions is excited to partner with Regence in bringing our kidney health program to its members. We know that when people are engaged in their health care, empowered with information, and a physician has more time to spend with their patients, quality of care and outcomes improve, and costs go down," said Joe Vattamattam, chief executive officer of Healthmap Solutions. “Our high-tech/right-touch approach to kidney health management aligns well with Regence's innovative and people-driven approach to making health care economically sustainable while helping to coordinate and protect those living with kidney disease.”

The National Kidney Foundation has identified CKD as the under-recognized public health care crisis.[2] According the Centers for Disease Control and Prevention:

37 million people in the United States live with CKD, 15% of US adults,
9 out of 10 adults are unaware they have CKD until the disease progresses to its more serious stage, ESRD,[3]
An estimated 726,000 people live with ESRD and tens of thousands are newly diagnosed each year.

Healthmap Solutions' KHM program uses clinical big-data resources, machine learning, Artificial Intelligence, and proactive person-centered care management to identify people with CKD. The company then stratifies each person into the appropriate CKD stage to maximize effective clinical management, improving the person’s quality of care and life, and through predictive analytics preemptively identifies and intervenes with patients at risk of an adverse health care event. Working with providers and specialists, coordinated care provides support and information to guide the patient, ensuring a seamless transition to the next and most appropriate stage of care – from in-center or in-home dialysis to kidney transplants.

About Healthmap Solutions
Healthmap Solutions is a specialty population health management company with a specific Kidney Health Management (KHM) solution for patients with kidney disease, serving health plans, as well as accountable care organizations (ACOs) and provider groups seeking value-based solutions that improve the clinical care and financial performance for high-risk, high-cost kidney patient populations. The company has a rich history forged in data and analytics, having begun as a healthcare data clearinghouse, adding robust healthcare analytics expertise. Today Healthmap Solutions uses that experience to power a complex Kidney Health Management program with its clinical experts. Healthmap Solutions, which is a separate and independent company from Regence, also provides similar integrated programs across a full range of specialty population health management. For more information: healthmapsolutions.com.

[1] https://www.kidney.org/news/newsroom/factsheets/KidneyDiseaseBasics
[2] Ibid
[3] https://www.cdc.gov/kidneydisease/pdf/2019_National-Chronic-Kidney-Disease-Fact-Sheet.pdf

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Regence health plans extend no-cost COVID-19 treatment for members through December 2020

Regence — Wed, 10 Jun 2020 15:35:00 GMT

PORTLAND, Ore. – To support people and communities facing unprecedented challenges, Regence health plans announced today an extension of coverage for coronavirus (COVID-19) treatment without any out-of-pocket costs for fully insured members through December 31, 2020. This extends the previously announced coverage period through June 30, 2020.

In addition, Regence will continue paying providers for virtual care services at the same rate as in-person visits through September 2020 to help ease member access and support providers experiencing financial challenges. Diagnostic testing also remains covered at no cost to members. Regence has provided these benefits for members and providers since March 1.

“In these historic times, we are taking action to ensure our members aren’t deterred from receiving critical care for COVID-19,” said Jared Short, President of Regence. “We will continue to work closely with our employers, providers and community partners to enable safe and effective care and help aid our region’s economic recovery.”

Regence is supporting its members, business partners and local communities through the following actions:

Expanded access through virtual care
Members can reach their providers – including primary care and behavioral health -- through telephone, video, text and other options to help them get the care they need for routine preventive services and COVID-19-related concerns.

Proactive outreach to high-risk members
Since late January, Regence has been proactively contacting high-risk members in its care management program to ensure they have the care they need.

Helping doctors, specialists and other providers care for patients
In addition to increasing member access to virtual visits to help alleviate pressure on in-person providers, Regence is expediting provider payments of claims, supporting discharge needs to accommodate care for critical patients, expediting credentialing to help meet emerging demands, and more as detailed here.

Standing beside our employers
Regence is listening to and collaborating with our customers facing unprecedented challenges on solutions such as grace periods and leave of absence to achieve continuation of employee coverage. Regence is also working with our customers to help them understand the full array of federal and state financial resources that are available.

Supporting community partners on the front lines
Regence, together with its employees and corporate foundation, has committed nearly $10 million in philanthropic investments to care for people affected by COVID-19, including patients, families, unpaid caregivers and the health care workforce on the front lines of this public health crisis.

Regence’s website, regence.com/go/covid-19, is being regularly updated with the latest information, including how to prevent the spread of disease and a new page of self-care resources for members. Regence has been highly engaged with provider partners and local, state and federal public health officials to offer help and resources in responding to community needs and ensure out-of-pocket costs are not a barrier to people seeking testing for, and treatment of, COVID-19.

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Regence and TRHC partner on COVID-19 virtual clinical trial to assess proposed treatment risks

Regence — Tue, 09 Jun 2020 15:00:00 GMT

PORTLAND, Ore. – Regence and Tabula Rasa HealthCare® (NASDAQ: TRHC) announced today that the companies have partnered on a virtual clinical trial to assess the risk of adverse drug events (ADEs) associated with drugs repurposed for the treatment of COVID-19. The trial examines de-identified medical information for approximately 500,000 Regence health plan members across multiple lines of business.

Regence is a family of health plans in Oregon, Idaho, Utah and select counties in Washington, each an independent licensee of the Blue Cross and Blue Shield Association dedicated to making health care better, simpler and more affordable. TRHC is a separate and independent health care technology company advancing the field of medication safety.

In conducting the study, the TRHC Precision Pharmacotherapy Research and Development Institute utilizes the MedWise™ proprietary, accumulative multi-drug interaction technology solution to determine each patient’s MedWise Risk Score™ (MRS), which is used as a predictive tool for ADEs. A recent study found that each MRS unit results in more than $1,000 in medical expenditures, including three additional hospitalizations and two emergency department visits per 100 members.¹ In this study, through medication risk stratification, TRHC researchers will simulate the impact of multiple potential repurposed drugs for COVID-19 to assess their safety for Regence members.

“Connecting members to care and supporting them through the COVID-19 pandemic is our highest priority,” said Julie Lindberg, Regence’s vice president of clinical services. “Through this partnership, we can help contribute to a long-term recovery plan that prioritizes health and safety, while transparently sharing results that can aid other researchers working on strategies to combat COVID.”

“Partnering with Regence on this novel, virtual clinical trial supports TRHC’s commitment to provide the medical community with validated safety information on COVID-19 repurposed drugs,” stated TRHC Chairman and CEO Calvin H. Knowlton, PhD. “Our study will analyze the impact to members of adding each repurposed therapy – without exposing them to these drugs – and identify who is at increased risk for adverse drug events, further demonstrating the value of our MedWise technology across a large and diverse population including commercial and Medicare lives.”

This study will also examine the combined risk of increased ADEs for drug regimens with COVID-19 repurposed adjuvants, especially drug-induced Long QT Syndrome, a disorder that occurs in the heart that can potentially cause fast, chaotic heartbeats, triggering a sudden fainting spell, seizure or in some cases death. The results of this study should be completed and ready for publication within 60 days to add important COVID-19 medication safety treatment information to the literature.

About Tabula Rasa HealthCare
Tabula Rasa HealthCare (TRHC) is a leader in providing patient-specific, data-driven technology and solutions that enable healthcare organizations to optimize performance to improve patient outcomes, reduce hospitalizations, lower healthcare costs and manage risk. Medication risk management is TRHC’s lead offering, and its cloud-based software applications provide solutions for a range of payers, providers and other healthcare organizations. For more information, visit TRHC.com.

Forward-Looking Statement
This press release includes forward-looking statements that we believe to be reasonable as of today’s date. Such statements are identified by use of the words “anticipates,” “believes,” “estimates,” “expects,” “intends,” “plans,” “predicts,” “projects,” “should,” and similar expressions. These forward-looking statements are based on management’s expectations and assumptions as of the date of this press release. These forward-looking statements include, among other things, our goals and expectations regarding the combined company and the integration of PW into TRHC, the expected synergies from the combined company and the expected financial and operating performance of TRHC following the completion of the acquisition. Actual results might differ materially from those explicit or implicit in the forward-looking statements. Important factors that could cause actual results to differ materially include: the risk that we may not be able to achieve our expectations for the combined companies due to challenges in integration and inability to retain key employees; fluctuations in our financial results; the acceptance and use of our products and services by PACE organizations and pharmacies; the need to innovate and provide useful products and services; risks related to changing healthcare and other applicable regulations; our ability to maintain relationships with a specified drug wholesaler; increasing consolidation in the healthcare industry; managing our growth effectively; our ability to adequately protect our intellectual property; the requirements of being a public company; our ability to recognize the expected benefits from acquisitions on a timely basis or at all; and the other risk factors set forth from time to time in our filings with the Securities and Exchange Commission (“SEC”), including those factors discussed under the caption “Risk Factors” in our most recent annual report on Form 10-K, filed with the SEC on March 2, 2020, and in subsequent reports filed with or furnished to the SEC, copies of which are available free of charge within the Investor Relations section of the TRHC website ir.trhc.com or upon request from our Investor Relations Department. TRHC assumes no obligation and does not intend to update these forward-looking statements, except as required by law, to reflect events or circumstances occurring after today’s date.

^{^[1]} Bankes, David L., et al. “Association of a Novel Medication Risk Score with Adverse Drug Events and Other Pertinent Outcomes Among Participants of the Programs of All-Inclusive Care for the Elderly.” Pharmacy, vol. 8, no. 2, 2020, p. 87., doi:10.3390/pharmacy8020087.

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Regence health plans offer members virtual mental health resources through myStrength at no cost

Regence — Wed, 27 May 2020 15:00:00 GMT

PORTLAND, Ore. – As part of a continued effort to support members’ health and well-being, Regence is offering health plan members free access to COVID-19 and Mental Wellness resources powered by myStrength, a digital behavioral health app, through the end of the year.

MyStrength from Livongo for Behavioral Health provides interactive, activity-based modules designed to manage heightened stress and feelings of social isolation stemming from the current pandemic. Through year-end, Regence’s fully-insured and self-funded members will have complementary access to myStrength’s COVID-19 and Mental Wellness resources, which include stress-management strategies, tips for parenting during challenging times, ideas to manage feelings of social isolation, and other emotional support tools.

“In times of stress and uncertainty, it is incredibly important to attend to your mental health in addition to your physical well-being,” said Dr. Jim Polo, Regence executive medical director. “Offering our members free access to myStrength’s platform is just one of the ways we’re helping our community remain resilient through the pandemic with additional support and tools to better manage stress.”

Regence members can get started by visiting their plan’s myStrength website and creating a free account:

Idaho: bh.mystrength.com/regence-id
Oregon: bh.mystrength.com/regence-or
Utah: bh.mystrength.com/regence-ut
Washington: bh.mystrength.com/regence-wa

“Throughout the COVID-19 pandemic, we are seeing behavioral health challenges amplified, and access to mental health professionals limited,” said Livongo Chief Medical Officer Dr. Bimal Shah. “Since launching COVID-19 specific modules in April, utilization has significantly increased across our platform. We are excited to offer personalized, digital behavioral health resources to Regence members that support their mental health and wellness during these challenging times.”

In addition, all Regence members can access COVID-19 resources free-of-charge through Regence Empower, a well-being platform that includes self-guided programs on managing stress, building resilience, and boosting nutrition. Members can also access a specialized behavioral health Customer Service call queue, trained in Mental Health First Aid.

In a continued effort to support the health of the communities it serves, Regence is also offering an interactive COVID-19 symptoms checker that helps individuals assess their health and determine the best course of action if they exhibit signs of coronavirus. The symptom tracker is available to the public and can be found on Regence.com.

Regence’s holistic response to the COVID-19 pandemic also includes proactive outreach to at-risk members, increased access to telehealth, provider community support, and philanthropic investments in local organizations serving those in need. To learn more about what Regence is doing to support its members, providers and local communities, please visit regence.com/go/covid-19.

Livongo is a separate and independent company that provides behavioral health services but does not provide Blue Cross Blue Shield products or services and is solely responsible for its products or services.

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Regence value-based care provider arrangements improve member health, lower costs

Regence — Tue, 12 May 2020 15:00:00 GMT

PORTLAND, Ore. – Regence launched its value-based arrangement (VBA) provider networks in 2013 with the goal of improving member health, lowering overall costs and driving greater provider collaboration to achieve more efficient and effective care. The latest data from across the health plan’s four-state footprint demonstrates the gains accomplished through these innovative provider arrangements.

At least 40% of Regence health plan member claims currently flow through almost 120 value-based arrangements with provider partners, according to the latest 2018 year-end data. Results demonstrate significant improvements in care outcomes and savings over more traditional models, including:

6% lower costs
200% higher patient satisfaction scores, as judged by net promoter scores (NPS) among members in VBAs vs non-VBA arrangements
17% higher quality care gaps closed
33% lower catastrophic spend
14% lower opioid scripts filled

Regence’s VBA approach ties provider payments to quality versus quantity of care. For 2018, the health plan paid more than $15.8 million in total provider payments (including Medicare Advantage) linked to specific quality measures that address gaps in care, encourage clinical best practices and promote important preventive screenings. More information about Regence’s VBA approach can be found in a new white paper “Where collaboration meets innovation.”

“Our success achieving better outcomes at lower costs for our members in partnership with providers, and the long history with value-based arrangements reinforce our leading position as a company dedicated to transforming care,” said Dr. Cheryl Pegus, Regence’s president of consumer health solutions and chief medical officer. “As we look to the future, we are continuing to prioritize collaborative arrangements with providers who embrace data-driven approaches to improving the quality, safety and affordability of patient care.”

Regence’s value-based programs range from an inclusive care management model called Total Care, to value-based networks that create a deeper engagement between the patient and the provider. In November of 2019, the health plan announced a new program called Episodes of Care, the first to focus specifically on clinical procedures. Episodes of Care compensates providers for delivering improved patient outcomes and lower costs over a patient’s “episode of care” for a procedure or condition – such as a knee replacement or cardiac procedure – over a defined period of time.

Regence is committed to supporting health care professionals during the COVID-19 pandemic. Steps taken include expanding virtual care access, expediting provider payments and credentialing to help meet emerging demands, advocating for providers to receive additional federal aid, and more here.

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Regence and Option Care Health partner to provide options for high-risk patients who rely on infusion therapy

Regence — Wed, 22 Apr 2020 14:00:00 GMT

Portland, Ore. – Regence and Option Care Health, Inc. (“Option Care Health”) (NASDAQ: OPCH) today announced an expanded partnership to ease access to care and provide additional options for high-risk patients who rely on infusion therapy. This collaboration enables Regence Health Plan members who currently receive their infusion therapy services in a hospital outpatient setting the ability to transition care to their home or an Option Care Health Infusion Suite.

Regence is committed to helping ease the burden on hospitals during the COVID-19 pandemic and ensuring its members and their families have the clinical care support they need, provided in the comfort, convenience and safety of a preferred location. Regence is a family of health plans in Oregon, Idaho, Utah and select counties in Washington, each an independent licensee of the Blue Cross and Blue Shield Association dedicated to making health care better, simpler and more affordable.

“Ensuring our members have convenient access to care in a safe and affordable setting is our top priority,” said Kerry Bendel, Regence’s chief pharmacy officer. “Option Care Health’s 40-years of experience focused solely on infusion therapy makes them the right partner to help protect the health and safety of our members, their families and our community during the unprecedented challenges created by the COVID-19 crisis.”

The partnership – which builds on Regence’s existing Site of Care program – helps address changing needs during the COVID-19 pandemic, allowing for greater flexibility for hospitals, physicians and patients who rely on infusion therapies for a wide variety of acute and chronic needs, from nutrition support and immune disorders to infections and neurologic conditions.

“Infusion provided safely and effectively at home or an infusion suite is more vital to our nation’s health system and patients than ever before,” said John C. Rademacher, president and chief executive officer of Option Care Health. “As we face this public health crisis, it is critical that we work together to continue delivering trusted clinical care that expands the overall capacity of our healthcare system.”

Option Care Health follows rigorous guidelines from the Centers for Disease Control and Prevention (CDC) to ensure the safety of patients and staff. These measures include comprehensive training of employees, strict protocols for infection control at home and infusion suites, screening of staff and patients for COVID-19 symptoms, ongoing virus-specific updates and education and the use of personal protection equipment (PPE). Employees can call the Option Care Health COVID-19 hotline 24/7 to address questions regarding their health or a patient’s health.

Care managers and clinicians will contact high-risk Regence members to ensure they know about the option to receive infusion therapy care in an alternate setting. Option Care Health clinical teams will coordinate transitions of care and customize treatment plans to suit the specific needs of each patient, with an assigned nurse and pharmacist to monitor treatment. Experienced clinicians and nurses are available 24 hours a day, seven days a week, 365 days a year to answer questions and provide support for patients, families and providers.

For more information on the Option Care Health and Regence response to the COVID-19 pandemic, visit optioncarehealth.com/coronavirus and regence.com/member/health-lifestyle/coronavirus-covid-19.

About Option Care Health
Option Care Health is the nation’s largest independent provider of home and alternate site infusion services. With over 5,000 teammates, including 2,900 clinicians, we work compassionately to elevate standards of care for patients with acute and chronic conditions in all 50 states. Through our clinical leadership, expertise and national scale, Option Care Health is re-imagining the infusion care experience for patients, customers and employees. To learn more, please visit our website at OptionCareHealth.com.

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Regence BlueShield of Idaho announces Maureen Hamilton as its new Director of Community and Business Relations

Regence — Tue, 21 Apr 2020 16:00:00 GMT

BOISE, Idaho – Regence BlueShield of Idaho is announcing the selection of Maureen Hamilton as its new Director of Community and Business Relations, effective immediately. In her expanded role, Maureen serves as a brand ambassador for Regence BlueShield of Idaho, strategically positioning the company’s executive leadership, partnering with the sales team to cultivate opportunities and serve existing customers, and representing the company in the business community by serving on local boards and community organizations that support Regence’s goals.

“Maureen brings exceptional creativity and drive to everything she does,” said Regence BlueShield of Idaho Government Affairs Vice President Jayson Ronk. “The broad and deep relationships she has with individuals and community-facing organizations across the state will serve us and our customers well in the years to come.”

"I could not be prouder to represent Regence BlueShield of Idaho as Director of Community and Business Relations or more excited to continue the great tradition of our company supporting our valued customers and trusted community partners,” said Hamilton. “Our team is so well positioned to make a difference for our business and community partners in all corners of the state.”

Hamilton brings great familiarity with Regence to her new role, having been with the company for more than 18 years. She served most recently as corporate social responsibility manager. In that capacity, she was accountable for strengthening communities by strategically managing internal and external corporate philanthropy and marketing initiatives. Her responsibilities included cultivating relationships with nonprofit partners in Idaho, leading cross-functional sustainability efforts (including green business practices, employee engagement and corporate citizenship), matching employees with community board leadership opportunities, and driving volunteerism and philanthropic giving.

Hamilton takes on the newly amended director position from Gary Smith, who recently retired after eight years with Regence. Prior to his time with Regence, Smith was a senior vice president with Travelers Insurance Companies and was director of the Idaho Department of Insurance. “We wish Gary the best as he launches into new adventures in retirement,” said Regence BlueShield of Idaho President Sean Robbins. “I’m grateful to have someone of Maureen’s caliber and character now take the baton and lead our community and business relations efforts boldly into the future.”

Hamilton reports to Ronk and is based in Boise.

About Regence BlueShield of Idaho
Regence BlueShield of Idaho, based in Lewiston, has been serving Idahoans for 74 years with comprehensive health insurance solutions. As a nonprofit mutual insurance company and independent licensee of the Blue Cross and Blue Shield Association, Regence is part of a family of companies dedicated to transforming health care by delivering innovative products and services that change the way consumers in Idaho and nationwide experience health care. For more information, please visit regence.com, facebook.com/regenceblueshieldofidaho or twitter.com/regenceidaho.

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Regence health plans, Prime Therapeutics study shows significant improvements when integrating pharmacy and medical benefits

Tue, 14 Apr 2020 15:00:00 GMT

EAGAN, Minn. and PORTLAND, Ore. – Regence and Prime Therapeutics LLC (Prime) today released a peer-reviewed study demonstrating more evidence of associated cost savings and potential health benefits from integrating pharmacy benefits with medical benefits.

Referred to as “carve-in”, this model combines pharmacy and medical benefits under one plan offering, allowing for greater insights into total costs of care. The Journal of Managed Care & Specialty Pharmacy (JMCP), a peer-reviewed journal of the Academy of Managed Care Pharmacy, published the co-authored study titled "Medical Costs and Healthcare Utilization Among Self-insured Members with Carve-in versus Carve-out Pharmacy Benefits” online, and it will appear in a future print issue. Regence health plans operate in Oregon, Idaho, Utah and select counties in Washington, each an independent licensee of the Blue Cross and Blue Shield Association dedicated to making health care better, simpler and more affordable.

The study examined medical costs over 2017 and 2018 for Regence members whose pharmacy benefit services were either managed as carve-in or carve-out. These industry terms describe when an employer chooses to have prescription benefits managed by a pharmacy benefit manager (PBM) that is separate from and not affiliated with the health plan administering medical benefits (carve-out) or chooses an integrated solution with prescription benefits managed in conjunction with medical benefits provided by the health plan (carve-in).

Key results from the study regarding the benefits of carve-in vs carve-out found that an integrated approach resulted in:

Fifteen percent less likely that members would be hospitalized and seven percent less likely to have an emergency room visit than members with a separate PBM.
Four percent lower annual medical costs, with an associated average medical costs savings of $148 per member per year, specifically $3,601 with carve-in versus $3,749 with carve-out or a separate pharmacy benefit.^{^[1]}

The study also examined the total medical cost for members with certain chronic conditions, including asthma, depression, diabetes, chronic obstructive pulmonary disease (COPD) and coronary artery disease (CAD). It found 12% to 17% lower associated total costs for members with integrated, carve-in plans across all of these conditions. Additionally, the study found that members with integrated benefits had an associated 22% to 36% lower odds of hospitalization and 16% to 20% lower odds of an emergency room visit across the five chronic conditions. Additional findings and analysis are detailed in a new white paper from Regence.

“This study proves what we’ve long known: to most effectively support members on the road to good health, we need to have a full picture of their care and medications,” said Dr. Cheryl Pegus, Regence’s president of consumer health solutions and chief medical officer. “Regence’s experience and data demonstrates that when employers take a holistic approach and keep medical and pharmacy benefits with the same company, they save money and their employees benefit with better health outcomes.”

"The associated overall lower medical costs and events (i.e., hospitalizations and emergency department visits) found in this study are similar to other study findings, including the Blue Cross and Blue Shield Association study we conducted. In addition, the Regence study found associated lower medical costs and events in five common chronic conditions for which medications are integral to treatment (asthma, chronic obstructive pulmonary disease, coronary artery disease, diabetes mellitus, and depression) adding to our understanding of value from integrating pharmacy and medical benefits ,” said Pat Gleason, PharmD, assistant vice president of Health Outcomes at Prime.

Gleason added, “As pharmaceutical spending becomes a bigger part of the health care dollar, and drugs are split across the pharmacy and medical benefits, it’s extremely important that employers understand that they can better control their expenses when they keep their pharmacy benefits with the health plan’s PBM. Only then can we see total cost of care and manage the member completely and effectively. Carving out only leads to disconnected data and management that results in waste and worse outcomes. This is an easy decision that can potentially save an employer nearly $150 per employee every year.”

The Regence and Prime authors received a platinum ribbon for their research from the Academy of Managed Care Pharmacy (AMCP). The award-winning research poster is included in the AMCP’s 2020 virtual learning event April 20-24.

[1] Adjusted for baseline population differences

About the Study
The large regional study utilized unidentifiable data from patients covered by a Regence plan in 2017 and 2018. The plans included were Regence BlueShield of Idaho, Inc., Regence BlueCross BlueShield of Oregon, Regence BlueCross BlueShield of Utah and Regence BlueShield (select counties in Washington). There were 207,000 members who had insurance plans with integrated benefits (carve-in) and close to 130,000 with a pharmacy benefit separate from the medical benefit plan (carve-out). The data represents members in self-insured plans only. Medicare members, members with changes in their benefit design, and those who were not continuously enrolled in the health plan during the analyzed period were excluded from the study. These exclusions represented less than two percent of the full data set.

About Prime Therapeutics
Prime Therapeutics LLC (Prime) makes health care work better by helping people get the medicine they need to feel better and live well. Prime provides total drug management solutions for health plans, employers, and government programs including Medicare and Medicaid. The company processes claims and offers clinical services for people with complex medical conditions. Prime serves more than 30 million people. Prime is a separate and independent company that provides pharmacy benefit manager services for Regence members. For more information, visit www.primetherapeutics.com or follow @Prime_PBM on Twitter.

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Regence BlueShield of Idaho names Trish Quarles as its first Director of Account Management

Regence — Thu, 09 Apr 2020 15:00:00 GMT

BOISE, Idaho – Regence BlueShield of Idaho is pleased to welcome Trish Quarles as its new Director of Account Management, effective May 4. As director, Quarles will lead a highly respected team of account executives focused on customer retention through relentless focus on business needs, exceptional service and the timely introduction of novel health care solutions.

“Regence’s focus is now and always has been on our customers – the individuals and organizations we’re privileged to serve,” said Regence BlueShield of Idaho President Sean Robbins. “Trish understands that customer-first imperative and, more importantly, how to deliver. She brings a dynamism and passion for innovative solutions that fit perfectly with our company’s vision for the future of health care.”

"I’ve been privileged to see the Regence team in action for many years,” Quarles said. “The intensity and sincerity of their focus on their customers as well as their willingness to roll up their sleeves on important community causes has always impressed me. I look forward to doing my part to help take those already market-leading efforts to even higher levels."

Quarles is widely respected across the state for her expertise in the area of employee benefits design, implementation and service. Through her career, she’s developed broad and deep expertise in all aspects of sales, plan development, delivery, evaluation and client retention. Most recently, Quarles served in an executive capacity with PayneWest where she designed benefits packages for large group clients, developed a specialized self-funding unit at the company, and drove increased revenue by educating existing clients on additional services and products such as ancillary benefits, worksite wellness programs and benefit administration systems.

Prior to her time with PayneWest, Quarles was with Mercer. There, she grew a significant book of business by establishing and maintaining positive client relationships, advised clients on industry and demographic standards for benefits packages to maintain competitive offerings and maximize employee retention, and developed and monitored internal control systems.

“Trish is such a respected professional,” said Scott Jones, Regence BlueShield of Idaho vice president of Sales. “She brings a can-do attitude and solutions-driven personality to our team. She’s a proven winner.”

Quarles will report to Jones and will be based in Boise.

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Regence health plans to cover cost of coronavirus (COVID-19) treatment at no cost to members through June 30, 2020

Regence — Thu, 02 Apr 2020 19:41:00 GMT

The people and communities Regence serves are facing unprecedented challenges. In alignment with the company’s values and a commitment to ease access to care for members during this public health crisis, Regence announced today that it will cover treatment for coronavirus (COVID-19) without any out-of-pocket costs for fully insured members through June 30, 2020.

“Standing beside those we serve has been our north star for over 103 years. As our nation faces this public health crisis, we are working to ensure our members aren’t deterred from the care they need for COVID-19,” said Mark Ganz, CEO of Regence’s parent company. “Extraordinary times call for extraordinary measures. This decision, along with previous measures we have taken, ensures members and families have the support they need if they are diagnosed with the illness.”

By eliminating financial barriers to care for those with COVID-19, Regence fully insured members will be able to get the recognized treatment they need without copays, coinsurance, deductibles or pre-authorization. Regence previously waived member costs for testing and the related office visit.

Members with COVID-19 symptoms such as fever, cough, or difficulty breathing should call their doctor or urgent care center first before seeking care. Regence is working with self-funded partners to implement similar cost share arrangements when directed, and with federal officials to ensure coordination of benefits for Medicare members and those with health savings accounts (HSA).

Additionally, Regence is supporting its members, business partners and local communities through the following actions:

Expanded access through virtual care: Members can reach their providers through telephone, video, text and other options to help them get the care they need during the COVID-19 state of emergency while maintaining social distancing. Services may include virtual office visits through telehealth, instant messaging with doctors and nurses, and home health visits in select areas. This includes both routine preventive services and COVID-19-related concerns with primary care and behavioral health providers.

Easing access to medications: As of March 2, “refill too soon” policies for medications were loosened (excluding opioids) to ensure members have needed medications on hand. For certain medications that treat chronic conditions, members may also request a 90-day refill. Drug lists and additional policies will be adjusted in the event of a drug shortage to ensure members have uninterrupted access to the medications they need without additional costs.

Proactive outreach to high-risk members: Since late January, Regence has been proactively contacting high-risk members in its management program to ensure they have the care they need.

Helping doctors, specialists and other providers care for patients: In addition to increasing member access to virtual visits to help alleviate pressure on in-person providers, Regence is expediting provider payments of claims, supporting discharge needs to accommodate care for critical patients, expediting credentialing to help meet emerging demands, and more as detailed here.

Standing beside our employers: Regence is listening to and collaborating with our customers facing unprecedented challenges on solutions such as grace periods and leave of absence to achieve continuation of employee coverage. Regence is also working with our customers to help them understand the full array of federal and state financial resources that are available.

Supporting community partners on the front lines: Regence, together with its corporate foundation, have initiated new investments of $500,000 to care for people and families affected by COVID-19 and the health care workforce on the front lines of this public health crisis. Regence is also matching employee donations at 100% (up to $100,000) to designated nonprofits who are working to help ensure all Americans can stay healthy and fed during this crisis.

Regence’s website, regence.com/go/covid-19, is being regularly updated with the latest information, including how to prevent the spread of disease and care options for members. Regence has been highly engaged with provider partners and local, state and federal public health officials to offer help and resources in responding to community needs and ensure out-of-pocket costs are not a barrier to people seeking testing for, and treatment of, COVID-19.

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