TennCare, BlueCross BlueShield of Tennessee Agree to Electronic Health Records Contract; Hearing on TennCare Changes Begins
BlueCross BlueShield of Tennessee on Wednesday announced that the state has approved its contract with the Bureau of TennCare to put TennCare beneficiaries' medical records on a secure Web site, the Tennessean reports. BlueCross began testing the program, called Community Connection, last winter in several medical offices in East Tennessee. BlueCross spokesperson Bill Steverson said the program will be implemented in phases, beginning with the roughly 700,000 beneficiaries enrolled in BlueCross plans. All TennCare beneficiaries will be included by the end of 2005. The program eventually will be "one of the largest of its kind in the country" the Tennessean reports. The program will be provided at no cost for one year. If the TennCare bureau opts to continue the contract, it will pay a monthly fee of $1.20 for each beneficiary whose files are available online. Steverson said BlueCross estimates the program will save TennCare up to $58 million in reduced waste and fraud. Steverson said the Web site will include information on office visits, medical tests and diagnoses that providers already submit for insurance claims (Pack, Tennessean, 7/7).
Hearing on TennCare Changes Begins
In other TennCare news, a hearing on the state's plans to cut some beneficiaries from the program began last week, the AP/Knoxville News reports (Johnson, AP/Knoxville News, 6/29). Gov. Phil Bredesen (D) has proposed eliminating coverage for 323,000 people (Wadhwani, Tennessean, 7/6). Federal regulators have approved most of the governor's plan (Wadhwani, Tennessean, 7/1). Bredesen has said that reducing coverage is necessary to save the state $500 million to $600 million next year. If changes are approved to a consent decree the state signed in 1999 with legal advocates, 97,000 beneficiaries could retain coverage, the governor has said, the AP/Knoxville News reports (Johnson, AP/Knoxville News, 6/30). Under one change, the state would alter the definition of "medically necessary," revising "the way TennCare medical decisions are made," the Tennessean reports (Tennessean, 7/1). The change would require physicians to choose the "least costly" care that is "adequate" and use medical evidence to determine their decision on a course of treatment, according to the Tennessean. The state maintains that the change would save $8 million annually, but Stephen Cha, a Yale University medical expert, on Wednesday said that it is unclear if the changes would reduce TennCare spending at all (Tennessean, 7/7).
More Consent Decree Changes
The state also wants to change the consent decree to require beneficiaries to receive prior authorization for medications and to limit drug coverage to five prescriptions monthly. The state also is seeking to change the appeals process for beneficiaries; each appeal can cost the state $1,500, the AP/News reports (AP/Knoxville News, 6/30). The package of changes to the consent decree would save the state $93.5 million annually, according to the Tennessean (Tennessean, 7/1). The Tennessee Justice Center, an advocacy group representing beneficiaries in the hearing, opposes the changes (Gouras, AP/Memphis Commercial Appeal, 7/6). AARP, the Children's Defense Fund and other groups also oppose the changes.
Testimony
TennCare Director J.D. Hickey and CFO Darin Gordon on June 30 testified that the consent agreement has prevented the state from reducing TennCare spending because it requires the state to provide more generous benefits that might not be the most appropriate care. But Gordon Bonnyman, executive director of the Tennessee Justice Center, said, "This is not about savings. For them, (the legal agreement) is [a] cover" (Tennessean, 7/1). Stephen Soumerai, a Harvard University professor who testified Thursday on behalf of AARP, said that limiting prescription drug coverage could cost the state more money in the long run. Soumerai added, "The cost to Medicaid of such expensive medical services will be larger than any drug saving from the cap, rendering it ineffective as a cost-containment policy." But Michael Drescher, a TennCare spokesperson, said that AARP is fighting to preserve a generous drug benefit that is costing the state billions of dollars (Burke, Tennessean, 7/8). Bredesen spokeswoman Lydia Lenker said last week, "We look forward to making our case before [U.S. District Court Judge John Nixon], and we hope that his decision will allow us to preserve TennCare coverage" for some beneficiaries (AP/Knoxville News, 6/29). Lawyers expect the hearing to last for about three weeks (Tennessean, 7/1).
