PHARMACY

Local Blue Cross Blue Shield offers ER alternatives to members

BY Antoinette Alexander

RICHMOND, Va. Looking to help inform consumers on how to best access emergency room alternatives and receive the same medical care with less out-of-pocket cost, Anthem Blue Cross and Blue Shield in Virginia has announced the creation of a Google Map that identifies all of the ER alternatives available to members throughout the state.

"Traditionally, emergency room visits are some of the most expensive episodes in the healthcare industry," stated C. Burke King, president of Anthem Blue Cross and Blue Shield in Virginia. "By utilizing technology to provide general education in innovative ways, we can help our members make better educated healthcare decisions and be better stewards of their healthcare dollar."

A study of Anthem claims data for its fully insured business found that more than 60% of ER visits for its members were in the area of avoidable visits or diagnoses that potentially could have been treated in alternative facilities. For example, bronchitis costs on average $646 to treat in the ER, compared with $97 for an urgent care visit and $54 for a retail health clinic. Average costs for visits for all conditions studied ranged from $441 for the ER to $98 for urgent care and $52 for retail care.

In response, Anthem created a Google Map that identifies all of the ER alternatives, including retail health clinics, urgent care centers and walk-in doctor offices, available throughout the state. This information can be accessed at Anthem.com/eralt or by typing "Anthem urgent care" into Google or Bing. A link to the information also is available on the "member" home page at Anthem.com.

In addition to using the information on the company’s website, members with the 24/7 NurseLine benefit also can contact an Anthem registered nurse to learn the best place to seek care for the medical ailment they are dealing with.

The company also is leveraging such proactive communications as interactive voice recognition calls and e-mail messaging to inform members of options. An iPhone application is expected to launch later this year.

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Pfizer suspends more tanezumab trials

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PCMA responds to government funding anti-fraud programs

BY Allison Cerra

WASHINGTON The leader of a group representing the nation’s pharmacy benefit managers responded to a House subcommittee’s decision to allot $561 million for programs designed to combat fraud, waste and abuse.

Pharmaceutical Care Management Association president and CEO Mark Merritt said the decision shows “it’s more important than ever to enhance America’s overall program integrity capabilities.” The money was provided to the Department of Health and Human Services, the Centers for Medicare and Medicaid Services and the Justice Department.

“The administration has noted that these kinds of efforts can save almost $10 billion,” Merritt said. “The other side of the anti-fraud coin is that policymakers must reject policies that inadvertently weaken the ability of public and private payers to detect and prevent waste, fraud and abuse. It’s far easier to prevent fraud than to engage in ‘pay and chase’ activities after the fact.”

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