Carefirst

It came with shocking swiftness. On a Thursday night, Feb. 21, regulators took over CareFirst.It didn't seem quite possible. CareFirst was the only major health maintenance organization in Baltimore consistently reporting earnings each year. The HMO's financial statements showed a strong net worth. And revenues had been growing, year in, year out.Suddenly, though, the state's Insurance Division said CareFirst was more than $7 million in the hole. David D. Wolf, the company's chief executive for six years, had been fired.

Harford Community College has received a $25,000 grant from CareFirst BlueCross BlueShield to support development of an electronic health records system that will bolster training of the institution's nearly 2,200 Nursing and Allied Health students. The grant for Harford's Emerging Technologies Project -- Electronic Health Records will enable HCC to acquire the high-tech equipment necessary to launch the project across the Allied Health and Nursing curricula and provide state-of-the-art education in a crucial workforce skill for the health care industry.

The Federal Trade Commission today gave a green light regarding antitrust concerns to the bid by Blue Cross and Blue Shield of Maryland to buy CareFirst Inc.CareFirst, a health maintenance organization that has 118,000 members, was taken over by the state Insurance Division on Feb. 21 after the agency found the HMO had a negative net worth of $8.9 million. Blue Cross made its bid a week later.A hearing is set tomorrow in Baltimore Circuit Court to review the takeover and the proposed merger.

The Obamacare critics were no doubt gleeful this week when CareFirst BlueCross BlueShield proposed average rate increases of 25 percent for its individual HMO customers next year, when it will be required to follow the requirements of the Patient Protection and Affordable Care Act. But before we give in to conservatives' "I-told-you-so" moment, it's worth unpacking the details of what's going on in Maryland's newly created insurance exchange. Like the sticker price on a car, CareFirst's proposal is likely not going to be the final word on what Marylanders pay for health insurance.

CareFirst BlueCross BlueShield has ended a six-year affiliation with its Delaware subsidiary, the company announced yesterday. The separation comes about a month after Delaware's insurance commissioner rejected the latest plan to modify the affiliation. CareFirst said yesterday that both it and its subsidiary, Blue Cross Blue Shield of Delaware, wanted to continue their relationship, but that it would be too expensive and disruptive to continue appealing the matter. Based in Owings Mills, CareFirst has about 300,000 members in Delaware and nearly 3 million in Maryland, Washington and Northern Virginia.

Johns Hopkins University has filed a lawsuit charging CareFirst and the Health Corporation of America, with failing to pay nearly $500,000 in doctors' fees.The suit was filed Monday in Baltimore Circuit Court. It came 10 days after the Insurance Division of the state Department of Licensing and Regulation froze the assets of Carefirst to protect the 118,000 members of the financially troubled health-maintenance organization.The assets of CareFirst were frozen after regulators discovered that they had fallen below state net-worth requirements.

CareFirst BlueCross BlueShield will be sending refund checks to policyholders whose premiums were raised at the beginning of the month when they reached certain ages rather than on their birthday. P. Todd Cioni, Maryland associate insurance commissioner for compliance and enforcement, said yesterday that CareFirst had yet to calculate how many people were involved or how large the refunds would be or how far back they would extend. The insurer agreed to the refunds after a consumer complained about the practice.

THE CONTROVERSY over CareFirst BlueCross BlueShield's planned sale to WellPoint Health Networks and conversion from nonprofit status has obscured a pivotal long-term issue: If the company's proposal is rejected by the state insurance commissioner, what next? The issue recently was highlighted by a consultant's conclusion that multimillion-dollar bonuses and severance payments for CareFirst executives are illegal. We have a historic opportunity to re-invent CareFirst along the lines originally intended when the 1937 General Assembly issued a charter to CareFirst's predecessor company, Blue Cross of Maryland.

Beverly B. Byron, a former congresswoman from Western Maryland, will replace Daniel J. Altobello as chairwoman of the CareFirst BlueCross BlueShield board of directors Jan. 1, CareFirst said yesterday. The directors elect the board's leader. Altobello, who chaired the board through its effort to convert the state's largest health insurer to for-profit operation and sell the company, will leave the board along with three other members. All four had reached term limits on board service or the mandatory retirement age of 70, said CareFirst spokesman Jeffery W. Valentine.

WHO DECIDED it was a terrific idea to give merger-linked pay worth tens of millions of dollars to a few managers at the nonprofit CareFirst BlueCross BlueShield? Not me, said the CEO. "I don't remember making this specific proposal," CareFirst chief executive William L. Jews said under oath. Not me, said the chairman. "The board ... relied on the assistance of a number of outside expert consultants," according to board head Daniel J. Altobello. Not me, said the lawyer. "I didn't see it as my place to decide what the amount was, but rather that the process [CareFirst's board]

Blaming the cost to implement health care reform, the state's largest health insurer has proposed eye-popping rate increases to state regulators for individuals and small businesses. CareFirst BlueCross BlueShield wants to raise rates an average of 25 percent on those who buy coverage individually. Chet Burrell, the insurer's CEO, said the increase was needed to cover the cost of more sick people who will be joining the insurance rolls under health care reform. People with pre-existing conditions were denied coverage prior to health care reform, keeping insurance costs down.

The Supreme Court's recent ruling on federal health care reform may have settled legal concerns, but the heads of Maryland's top insurer and two largest medical institutions said there are still unanswered questions and worries about the law. "There are many unknowns, given the complexities of the act," said Chester "Chet" Burrell, president and CEO of CareFirst BlueCross BlueShield. "There could be surprises and unintended effects because of the complexity. All of the regulations are still not out yet and so it's hard to know how it will work out in the final analysis.

About 60 percent of the doctor practices that are participating in a special patient-oriented program from CareFirst BlueCross BlueShield have save on health care costs and improved care, the insurer said Thursday. Those were the goals of the patient-centered medical hom e iniitative, according to CareFirst, which launched the program in January 2011 as the state was forming its own similar program. The practices earned increased reimbursements from CareFirst based on the savings they achieved against the projected care costs for 2011 for the insurer's members.

Charles Orestus Smith, a retired CareFirst Medicare contractor who was an avid fan of the opera and symphony, died Jan. 3 of a heart attack at his home in the Northway Apartments in Guilford. He was 74. Born in Baltimore and raised in Guilford, Mr. Smith was a 1954 graduate of Polytechnic Institute. After graduating from high school, he enlisted in the Army and was sent to the Army Language School in Monterey, Calif., where he learned Russian. While serving in Japan, he met and married the former Yasuko Takagi in 1958.

A well-connected group of doctors wants Annapolis to let orthopedists and other specialists refer patients to their own MRI machines and other expensive equipment. This kind of arrangement drives up health costs by giving doctors the incentive to profit from unnecessary scans, numerous studies show. Fortunately, powerful Maryland groups harmed by the ruinous spiral of medical inflation have every reason to fight back. There's CareFirst BlueCross BlueShield, the state's biggest health insurer.

CareFirst BlueCross BlueShield is offering primary care doctors a 12 percent increase in reimbursement for preventive care ("CareFirst's promising idea for primary care," Sept. 23). Primary care doctors are expected to draw up care plans, have in depth encounters with their patients and follow their patients more frequently to be eligible, and if they show good outcomes with less hospitalizations and surgeries for the same patients, they will be rewarded up to 80 percent of the savings in cost that CareFirst anticipates it will reap from this program.

A computer glitch at the state's largest health insurer recently blew Sharon Nobles' life into disarray, leaving her family with overdue medical bills and, at times, vital prescriptions denied at the pharmacy. And she might not be the only one affected. CareFirst BlueCross BlueShield officials confirm that even as information technology specialists are working to resolve internal system problems, thousands of its members who participate in consumer-directed health plans (CDHP) could be affected, too. "I've spent months trying to fix this problem, but I've gotten nowhere," said Nobles, the mother of twin 11-year-old boys who were diagnosed three years ago with Asperger's syndrome, a neurobiological disorder that can produce autistic-like behavior.

CAPITALISM is a great system, but sometimes its worst enemies are the capitalists. We can probably blame at least half of all commercial regulation on a few executives or firms whose misbehavior brought the arm of government down on everybody. Two kids shoot rubber bands and the whole class misses recess. CareFirst BlueCross Blue- Shield boss William L. Jews and his lieutenants are trying to sell the health insurer to WellPoint Health Networks Inc. of California. The deal makes sense.

It's a triumph of hope over experience, perhaps, but as much as Maryland physicians complain about insurance company cost-cutting, there seems to be genuine optimism among doctors over CareFirst BlueCross BlueShield's latest effort to reduce the cost of health care in this state. That alone bodes well for what amounts to a voluntary program that will rely on support from primary care doctors for it to have any chance to work. Approved this week by the Maryland Health Care Commission, CareFirst's Primary Care Medical Home or PCMH is designed to move away from the nearly universal fee-for-service model that offers financial incentives to the medical community for treatment of illnesses but not for any improvement in the health of patients.

State health officials have approved a plan by CareFirst BlueCross BlueShield to reward primary physicians for improving health outcomes for patients. The insurance company is the first in the state to be approved by the Maryland Health Care Commission for the "single payer" medical home initiative. The program is designed to encourage doctors who participate to focus on treating the sickest patients. The insurance company hopes that if people visit primary care physicians, illness would be caught and treated early.