Blue Cross and Blue Shield Announces Pricing Reforms with Local Hospitals

Strategic Insights -

Blue Cross and Blue Shield of Western Pennsylvania, Pennsylvania Blue Shield, and Keystone Health Plan West have approved new pricing proposals from six local hospitals, marking the beginning of significant changes in the region's managed care landscape. The reform aims to reduce costs for Blue Cross managed care patients, with over 500,000 Western Pennsylvanians currently enrolled in such programs. The hospitals involved in the agreement are The University of Pittsburgh Medical Center, Shadyside Hospital, Magee-Womens Hospital, Passavant Hospital, St. Margaret Memorial Hospital, and South Hills Health System.

Key Takeaways:

  • Six local hospitals, including The University of Pittsburgh Medical Center, Shadyside Hospital, Magee-Womens Hospital, Passavant Hospital, St. Margaret Memorial Hospital, and South Hills Health System, have submitted separate pricing proposals to Blue Cross and Blue Shield.
  • The approved proposals offer further price reductions as the hospitals treat more Blue Cross managed care patients.
  • These agreements will significantly influence preferred referral patterns within the network and provide opportunities for cost savings.
  • William M. Lowry, president and CEO of Blue Cross of Western Pennsylvania, highlighted the potential for long-term relationships between Blue Cross and healthcare providers.
  • The reforms aim to reduce costs for Blue Cross managed care patients and promote quality care at an affordable cost.
  • Blue Cross and Blue Shield officials anticipate that hundreds of thousands of Western Pennsylvanians will join managed care programs by the beginning of next year.

Statistics:

  • Over 500,000 Western Pennsylvanians belong to a Blue Cross and Blue Shield managed care program.
  • More than 200,000 additional Western Pennsylvanians are expected to join managed care programs by the beginning of next year.

Sources:

  • "Six local hospitals have submitted separate proposals to lower their prices for persons enrolled in... Blue Cross managed care programs..." - PRNewswire, May 25
  • "This gives Blue Cross and Blue Shield an incentive to inform our participating physicians that referrals of certain patients to these hospitals may offer unique opportunities for cost savings..." - William M. Lowry, president and CEO of Blue Cross of Western Pennsylvania