The Blue Cross Blue Shield Association has named Erin Barney as vice president of network solutions, effective immediately.

Ms. Barney will lead collaboration across the 34 Blue Cross and Blue Shield companies to develop, deliver and maintain network programs that fit members’ healthcare and will oversee initiatives that deliver high-value products and solutions, measure the quality and cost of programs, and promote value-based care, according to an April 8 press release.

Prior to BCBS, Ms. Barney served as vice president of market and network delivery at Health Care Service Corp.

“The high-quality health care networks the Blues have across the country are designed to suit members and their individual health care needs and ensure care is as affordable as possible,” Kari Hedges, senior vice president of market solutions at BCBSA, said. “With Erin’s leadership, we’ll be able to deliver greater, more equitable and personalized care to BCBS members, enabling them to better manage their health.”

Source: Beckers Payer

Maine Medical Center’s plan to leave Anthem’s insurance network in January could cause a significant disruption to the state’s health insurance markets and has spurred an investigation into the payer’s payment practices, according to the Portland Press Herald.

The hospital, Portland-based MaineHealth’s flagship, cited more than $70 million in unpaid claims from Anthem over the past three years as justification for the split.

Maine Hospital Association President Steven Michaud told the Herald the split involves the state’s biggest tertiary care hospital and largest payer. Indianapolis-based Anthem provides health coverage to 54 percent of the state’s residents.

“You almost can’t comprehend how disruptive it would be,” Mr. Michaud said.

About 150,000 people with an Anthem plan made a claim at Maine Medical Center in the past three years, the Herald reported.

Maine Gov. Janet Mills said in an April 6 statement that she is deeply concerned about the potential contract termination and that it should be avoided at all costs. She said the split would significantly harm the cost and access of care for the state’s Anthem customers, particularly those in southern Maine.

Despite Maine Medical Center’s announcement, Mr. Michaud said there is a lot of motivation for the sides to resolve the issues and said he is confident the departure won’t happen.

The contract dispute has led the Maine Bureau of Insurance to investigate Anthem through a market conduct examination, a move welcomed by healthcare organizations in the state, according to the Herald.

“The bureau is conducting a market conduct examination of Anthem, which will include a review of provider payment issues. The exam is expected to continue for several months. At this time, Anthem has worked through most of its backlog of claims,” a bureau spokesperson told the Herald.

The alleged provider payment issues from Anthem aren’t limited to just the MaineHealth network, according to the Herald.

Jeffrey Barkin, MD, is president of the Maine Medical Association and said individual providers in the state have faced underpaid claims, a high proportion of denied claims and nonrecognition of national identification numbers from Anthem, leaving some providers to stop accepting the payer.

“The Maine Medical Association would like to see a harmonious relationship between providers and payers, but this sort of behavior directed toward hospitals, toward doctors, has absolutely no place in the healthcare ecosystem,” Dr. Barkin told the Herald.

In a statement to the Herald, Anthem said it strives to pay claims as efficiently and quickly as possible in accordance with contracts it has with providers. Over the last year, the payer said it processed 92 percent of claims within 14 days and 98 percent of claims within 30 days.

Anthem also set up a dedicated Maine provider assistance team to deal with the issues.

“We’re proud of our progress, but these are complex issues that take time to address properly and we are committed to resolving them. We have communicated our progress to providers across Maine, and we will continue that direct dialogue as we continue to resolve these challenges,” a spokesperson said.

Source: Beckers Payer

UnitedHealthcare announced that it will expand a program to advance maternal health equity in minority communities in North Carolina.

“Access to quality maternal health care will help close the gap on health inequity in our state,” said Anita Bachmann, chief executive officer of UnitedHealthcare Community Plan of North Carolina. “We are honored to partner with Mountain Area Health Education Center and SistasCaring4Sistas of North Carolina to address disparities and outcomes with the expanded doula program.”

The payer partnered with the community-based organization SistasCaring4Sistas to expand access to the organization’s program, Doulas for Social Justice.

“Partnering with UnitedHealthcare to support families most likely to face pregnancy-related complications, even death, is such an amazing opportunity,” said Cindy McMillan, director of SistasCaring4Sistas. “United together, we value equitable, safe, and positive birth outcomes and are utilizing needed community-based support to address community health care needs within maternal health systems in North Carolina.”

The goal of Doulas for Social Justice is to improve access to care for low-income and Black mothers. The organization’s capabilities include offering prenatal services, pregnancy, childbirth, and postpartum support. Doulas help inform mothers and their families about their options for delivery and at other times throughout the pregnancy.

“Poor maternal health outcomes remain high among women in North Carolina, and together we are addressing maternal and prenatal health inequity in communities in need,” said Amanda Murphy, certified nurse midwife and medical director at Mothering Asheville. “We applaud UnitedHealthcare for recognizing the importance of maternal and child health in improving care for all pregnancies across the state.”

According to the UnitedHealthcare press release, Black women in the Tar Heel State experience severe maternal morbidity at double that of White women.

Previously in North Carolina, UnitedHealthcare channeled funding toward a healthcare practice that serves women to improve access to care for pregnant people.

The press release also noted the payer’s other efforts to reduce healthcare disparities in maternal healthcare. These include putting $14 million in grant funds toward maternal healthcare initiatives. UnitedHealthcare has also supported the nonprofit organization March of Dimes, which aims to improve health outcomes for mothers and infants.

Nationwide, maternal healthcare is characterized by significant disparities in coverage and stark differences in patient outcomes. In North Carolina specifically, Black mothers are more likely than their White counterparts to die while giving birth due to preventable causes, and they often have less access to educational materials and support throughout their pregnancies.

CMS has also highlighted the care disparities in maternal healthcare and has offered states the option to extend Medicaid coverage to better support low-income mothers.

Blue Cross Blue Shield Association tracks its progress in advancing health equity in maternal healthcare by leaning on CDC quality measures.

Blue Cross Blue Shield of Illinois (BCBSIL) focused on increasing financial support for community-based organizations in targeted regions that demonstrated high healthcare disparities—namely, specific neighborhoods in Chicago.

Like UnitedHealthcare, BCBSIL worked with CenteringPregnancy to bring educational resources and social support through federally qualified health centers to mothers across the state. Additionally, the payer funded virtual baby showers and virtual pregnancy programs to help bolster community support and expand access to care.

Payers have also recognized income-related disparities in care and have made an effort to expand access to care in low-income areas. In particular, mothers who depend on rural healthcare may have trouble accessing a care site.

Payers like Blue Cross and Blue Shield of Minnesota have provided funding to help hospitals pay for training and technology to expand their ability to serve pregnant people.

Source: HealthPayer Intelligence