1984

s M T

5 6

Aerobics

12 13

Aerobics

19 20

Aerobics 1st Day

of Spring

26 27

Aerobic

1984

s M T 2 3

Aerobics

9 10

Aerobics

16 17

Aerobics

23 24

Easter Aerobics

30

Aerobic

�cross �Shield PROFILE 3ox 1798

::mville, Florida 32231-0014

MARCH

w T

1

7 8

Aerobics

14 15

Aerobics

21 22

Aerobics

28 29

Aerobics

APRIL

w T 4 5

Aerobics

11 12

Aerobics

18 19

Aerobics

25 26

Aerobics Ticket Sale

Sea World Trip

1984

F s

2 3

9 10

16 17

23 24

Arts & March of Dimes

Craft Show Walk-A-Thon

30 31

Cypress Gardens

Trip

1984

F s

6 7

13 14

Ticket Sale

Sea World Trip

20

27

21

Holiday

Good Friday

28

Sea World

Trip

BULK RATE U.S. POSTAGE

PAID JACKSONVILLE, FL.

PERMIT No. 85

1'

I,

Partnership Arrangement at Blue Cross and Blue Shield

January/February, 1984

PROFILE Vol. 3 -- No. 1

January/February 1984

... BlueCross Blue Shield

,;, of Florida

P.O. Box 1798, Jacksonville, FL 32231-0014

Published For The Employees Of

Blue Cross and Blue Shield of Florida

By The Corporate Communications

Division.

EDITOR - Pam McCalman

GRAPHIC DESIGN - Vickie Robie

INSIDE THIS ISSUE

2-4 Florida Plan To Market PPOs

5 Benefits Corner

6 To Your Health

7-8 Flag Football

8 Employees Run Marathon

About PROFILE Questions or comments on PROFILE should

be directed to the EDITOR, Corporate

Communications, 4 T,

Ext. 8075.

® 11!" >'i, �- IA( ,·_,.

111 ..... -\ '·· J I ..... ,, ..•.. :·, · ..... ·W ... ··.· .. � '""" : . ' . .. ' . �- •_ --

\

Terri Lee Teresa Drury Med A Medicare B Claims Examining

Brenda Lightsey Dale Edwards Organization & Compensation Hearing Officers - Med B

Marie Luchi John Fraser Motors Retirees St. Petersburg

Mary Martin Fabian Fuentes Local/National Account Claims Product Management

Mary Matheson Freddie Hall Corporate Planning Rating & Underwriting

Sue Nelson Victoria Henderson St. Petersburg Private Business Claims

Laverne Patrick Susan Jones Administration Services Post Med B Claims Examining Claims Audit Terry King Brenda Robinson St. Petersburg Private Business Claims Melissa Lawrence Catherine Shane Med B Claims Examining Florida Marketing Ismail Peeranl WIiiie Scott Home Health Agency Med A Shirley Rowell Jerry Summerford Med B Claims Examining Med B Claims Sandra Smith Anna Tyner Inter Plan Claims Production & Change Control

Beverly Sneed Dwight WIison Finance/HRS/Underwriting Corporate Budget Department Support

* 5YEARS Sherry Ulbrich Private Business

Cathy Asher Michael Vickers

Med B Prepayment Utilization FEP Basic Claims Processing

Claudette Askew Richard Werner

Med B Claims Examining Tampa

Charles Beaufort Paula Womack

Provider Automated Services Private Business Claims

Attle Bridges * 1 YEAR Information Department

Spessard Boatright Joaquin Arias

Facilities & Office Services Florida Marketing

Wendy Campbell Marie Balley

Medical Director Ft. Myers

Dianne Barnett Peggy Crews Ft. Myers Health System Data

Stuart Baumel Damon Dotsls Coral Gables Audit Branch Ft. Lauderdale

Stephen Blajlan Marketing/HIS/Med A Support

Linda Brownett David Knopsnyder Inquiry Control Corporate Planning

Gladys Bullard Edward Korunes Corporate Budget System to System Networ

Lori Bunn Lucy Love Med B Reviews & Hearings Market Research

Diane Busey Robert Luman Administrative Services West Palm Beach

Patricia Colvin Robert McMichael Jacksonville District Office Med B Claims Examining

Mary Conner Donald Mccourt Word Processing Center Tampa Branch Audit

Judith Cooney Fabio Molina West Palm Beach General Accounting

Carol Digesare Sharon Morgan Small Group Products Hospital Charge Audit

Rachel Dixon Lillian Mullins Purchasing Actuarial

Letitia Farrall Diana Phipps Organization & Compensation Performance Analysis

Julia Fasbender Guytha Restall Corporate Research Accounts Payable

Cheryl Fletcher Constance Robertson Jacksonville Audit Branch Physician Relations

Desso Forman Barbara Rossignol Gainesville Special Claims Section

Audrey Gagne Angela Smedley Actuarial Legal Affairs - Assoc. Ho,

Sherry Gill Council

Medical Division Steven Stein

Gary Glandon Organization & Compens

Organization & Compensation Janice Stertzbach

Joyce Gray Personnel

Hospital Charge Audit-Central Anne Turner

Bobby Gunter Technical Services

Private Business Ronald Ureel

Jeanne Hackney Ft. Lauderdale

Gainesville Holly Valkenaar

Judy Haley Orlando

Provider Automated Services Cecil Williams

James Huffman St. Petersburg

Statistical Charlene Witz

Christi Jones Analysis & Forecast

St. Petersburg Joan Zeller

Mary Kernle Med A Utilization Review

BS Medical Review

\ n, on October 10 to leinik, Medicare A ,n & Quality Control.

.lndsay, on October y Vieren, Actuarial.

lussell, on October 22 th Baker, Corporate

Jeannette, on r 10 to Vikki Egerman, up Inquiries.

:halen, on December lly Navarrette, FEP.

II, on December 17 to ,er, Provider

Joseph, on r 21 to Celia n, Medicare B Claims.

cole, on December 22 e Burnsed, 1ip and Billing.

Cooper, Exam Entry, Coleman in February.

fielding, Medicare B 1dence, to Edward 0. February 18.

1s, Accounts e, to Tyshell Hopkins 3.

�

�

er 1· '1 l ,1,,. .1 1 I

Clara Rose, will retire after 26 years of service.

WIiiiam King, will retire after 20 years of service.

Vlolet WIiford, will retire after 18 years of service.

Ruby Reynolds, will retire after 17 years of service.

Lora Whitehead, will retire after 16 years of service.

Lucille Harnage, will retire after 15 years of service.

Samuel Waldon, will retire after 15 years of service.

Eunice Turner, will retire after 15 years of service.

Doris Carter, will retire after 12 years of service.

Eula Johnson, will retire after 10 years of service.

Lucille Whalen, will retire after 10 years of service.

Servic* Anniversaries

* 30 YEARS Ruby Wells Tampa

* 25 YEARS Edith Bowden Physician Relations - Northern

* 20 YEARS

Linda Alvarez Gainesville

* 15YEARS Jacquelyn Adkins Operations Planning Task Force

Josephine Alexander Rating & Underwriting

Carol Blanton Med B Reviews & Hearings

Michael Bristow Organization & Compensation

Ruth Bryant Inter Plan Claims

Lucille Harnage Utilization Review

Sandra Jackson Private Business Claims

Anne Newland Systems Development

MIidred Nicholson Membership & Billing

Daniel Pentenburg Production & Change Control

Melodye Raulerson Benefits Administration

Carwyn Romedy Reim. Puerto Rico Audit

Ana Slaca FLASO Claims

John Smid Reim. Puerto Rico Audit

Annetta Stange Administration Services Post Claims Audit

Ella WIiiams Med A Utilization Review

Eloise WIiiiams FEP Basic Claims Processing

* 10YEARS Bernadette Bates West Palm Beach

Bonnie Blyler Development & Operations

Valerie Bouchelle Hospital Charge Audit

Barbara Bouranls Direct Basic/Comp. Inquiries

Eva Brown Med B Communications

Mary Burchard Ft. Lauderdale

Beulah Cone BS Basic Suspense Examining

Linda Cribb Med B Communications

Cleo Culp Major Med Comprehensive Suspense

Eunice Grant Bank Reconciliation

Shirley Grier Safety & Security

Victoria Hackford ASO State Group Correspondence

Patricia Haddock Motors Retirees

Shirley Jerkins Group Membership Communication

Shirley Johnson Med B Claims Examining

Trudy Joseph Inquiry Control

Josephine Jugo Miami

Mary Langmuir Membership & Billing

Marlene Lapierre Other Carrier Liability

Lois Latham Med B Claims Examining

James Hulsey, vice president of PPO

Florida Plan

To Market

PPOs As a part of Blue Cross and Blue

Shield of Florida's continuing

commitment to cost containment,

we will begin marketing a PPO

product in Dade, Broward and Palm

Beach counties within the next few

months. PPO stands for "Preferred

Provider Organization" and consists of a select group of

hospitals and physicians that have agreed, via contract, to provide

health care services, usually at

reduced rates, to a group of

employees whose health care

benefit program has been designed

to provide financial incentives to use the preferred hospitals and

doctors.

"We are trying to form

a partnership . . . to do

something to moderate the

rise in health care costs."

The product will be known as

"Preferred Patient Care Plan," and will be marketed in Jacksonville, Gainesville and Tampa - St.

Petersburg, and other areas later

this year. James Hulsey, vice president of

PPO, emphasized the primary goal behind the development of the

2

Preferred Patient Care Plan. "We are trying to form a partnership

between employers/employees,

hospitals, physicians and Blue Cross and Blue Shield to do

something to moderate the rise in health care costs. We are hoping,"

he said, "to market this product at a

10-20% lower premium cost than

our traditional product lines. "

" . . . . our PPO produ ct

has four components"

"External marketing demand will

dictate our priorities as far as what

geographic regions will be exposed

to the new product," said Jay Kapur, PPO Sales and Marketing

Services manager. "And, initially," he added, "the product will only be

offered to local groups and

expanded to other subscribers at a

later date. "

"The State Group, Florida's

largest single employer, has

requested that we, as the

administrator of their insurance, develop a preferred provider

product for their employees in select geographic areas," said

Hulsey.

"It is important to understand

that our PPO product has four

components," continued Hulsey.

"First is the benefits package itself.

It has been initially set up as an 80/20 reimbursement on the

negotiated allowance when an

employee chooses the PPO network, and will change to a 60%

reimbursement should the

individual choose to go outside the

preferred provider network."

3

"The second component is

reimbursement for hospital se'rvices," he explained. "The DAG

(Diagnostic Related Group) system has been adopted here to maximize

hospitals' incentives to reduce cost and unnecessary utilization. "

Teams of Plan experts have been

actively negotiating contracts with hospitals in Dade, Broward and

Palm Beach counties. Holy Cross

Hospital in Ft. Lauderdale became the first Preferred Patient Care Plan

provider in Florida on February 16.

The following day, signed contracts

were received from North Miami

General Hospital and South Miami

Hospital. By the end of February,

three additional hospitals had

indicated their intentions to sign

PPO contracts.

"This component is

really the heart o f the

program ... "

The third component of the

Preferred Patient Care Plan is reimbursement for physician services. "The objective of this

component of the program is to contract with an adequate number

of skilled doctors by specialty and geographic location to provide

policyholders access to the

network," Hulsey said. And the fourth and possibly most

important component of the

program is utilization management. This will ensure that required

health care services are rendered in

the most appropriate and cost­

effective location.

"Everyone must be

responsible for this

partnership."

"This component is really the heart of the program," said Kapur.

"Utilization management, carried out effectively, will help to bring

health care cost down and will

ultimately reduce premium costs. " "Something must be done to

control the rising cost of health

care," continued Kapur. The PPO is

based on the premise that not just

one entity -- Blue Cross and Blue Shield or the hospital or the

subscriber or the physician -- can

accomplish the task alone," he said. "Everyone must be responsible in

this partnership. " "We, as a corporation, strongly

believe in the competitive approach to solving the problem of rising

health care costs," said Hulsey. "And we are one of the first

companies to iritroduce a

comprehensive PPO product in the

state of Florida. "

Others who have been involved in

the development of the Preferred

Patient Care Plan are Paul Mitalas,

formerly director of PPO

Development; Gerry McNair,

,l

Players anticipate their opponents' next move

Jim Gray's team members huddle for a

pre-game prayer

League 2ND place winners (L - R) Greg Carter, John Runion, Raul De/Valle, Jim Gray, Robert Gray, Buddy Bobbick, Steve Gray

John Runion scores a touchdown!

Employees Run Marathon On Saturday, January 7, the neVI

formed Jacksonville Marathon

Association held Jacksonville's f

marathon. There were quite a fe,

Blue Cross and Blue Shield of

Florida employees who participc in the 26.2 mile course that ran

along and over the St. John's Ril

At least five employees that WE know of completed the entire ra<

individually and nine others

participated in the corporate rel,

division. This division of the

marathon allowed runners from

same company or business to st the run. Each relayer ran 8.73 mi

of the race (which is approximat 1/3 of the course).

The race began at Bolles Schc on San Jose Boulevard at 8 a.m.

going south down to the Manda,

area, then north again to the Sar Marco area, across the Main Stn

Bridge, and ending downtown. 7

major sponsors of the event wer, St. Vincent's Medical Center anc

Lederle Laboratories of New Yor

Supporting sponsors were the

Tourist Development Council ar

WIVY radio.• INDIVIDUAL PARTICIPANT�

WHO COMPLETED THE COUF Henry Douglas

Cliff Frank Fred Gaudios

Frank Solomon Dave Schroeder

CORPORATE RELAY TEAM! Debbie Chandler Pat Hemingway

Terri Kline Carol Adams

Paul Rehfus Joan Baagoe

Tony Hubbard Fred Roberts

PORTS 1 Football ·ear's battle for the Intramural

:ootball Championship ended 1e controversy. Johnny

m's team finished the regular

n in first place with Jim

, team in second. Rhoden and Gray teams

:avored in the playoffs, but at

1d of the tournament both

i were thrown for a loss. On

2, at Mallison Field, Greg

s team arose victorious 1 first place in the tournament

3illy Jones' team placing

1d. • Tournament 1srp/ace winners (front L - R) Alfred Floyd, Curtis Wimberly, Curtis Perry, Ron Waye, (rear L - R) Billy Barnes, Bobby Ross, Keith Green, Greg Lowe

"Jarter calls his 71e out

Jim Gray's and David Ricke's teams meet head-to-head

Team spirit is evident in the stands. (L - R) Larry Shepard, Deb Henney, Bobby Ross, Johnny Rhoden, Debbie Collins, Frank Giordano, Sean Mahoney

"Going somewhere, Buddy Bobbick?"

'1

manager of Program Analysis; and

Vicky Brooks, junior analyst. The

PPO Task Force included Hank

Barnett - Customer Services; Larry Bold - Systems; Jim Doherty and

Richard Swift - Hospital

Reimbursement; Pat Hemingway -Utilization Management; Dave

Mandel - Actuarial; Bob Nay -

Physician Reimbursement; Sandra

Poff - Hospital Relations; Larry

Payne - Professional Relations; Jerry Vaughan and Bob Batie -

Private Business Operations;

Dianne Davis and Laura Jones -Product Management; and Tom Stanley - Legal Affairs.

The new PPO departmental

organization reflects the expanded

activity as the Plan approaches

implementation of the PPO. Reporting to Vice President James

Hulsey are Dudley Mendheim,

director of PPO Administration and Support; and four regional

directors: Ernie Brodsky, northern

region; Paul Mitalas, central region;

Michael Pipito, western region; and Robert Sebok, southern region.

Victoria Bankhead, manager of Professional/Provider

Reimbursement and Relations; Jay Kapur, manager of Sales and

Marketing Services; and Gerry McNair, manager of Program Analysis report to Mendheim. •

Taking a look at the PPO product (L - R) Jay Kapur, Gerry McNair, Vicky Brooks and Paul Mita/as

4

This is the first in a series of articles in which we will attempt to answer as many questions as possible regarding employee benefits. Welcome to "Benefits Corner."

In response to recent questions posed by employees regarding their retirement benefits, this article will serve to explain as much about the existing program as possible. We are a participant in the National Retirement Program which is administered by the Blue Cross and Blue Shield Association in Chicago.

The program is designed to replace 60% of an employee's salary, upon retiring at age 62 and with 30 years of service. Payment options under the program are:

Lump Sum - provides you with a single payment which is actuarially equivalent to a monthly lifetime pension.

Lifetime Only (Normal form for single employees) - provides you with a monthly pension which is payable for your lifetime. No benefits are payable to any beneficiary upon your death.

Joint and Survivor (Spouse only; normal form for married employees) - provides the participant with a monthly pension for life, and upon the participant's death, the pension would become payable to the surviving spouse.

Certain and Life (Reduced lifetime monthly pension to you with payments guaranteed, as elected) - provides a reduced lifetime monthly pension to you with payments guaranteed for a specified number of years, either 10 or 20, as elected. If you die within 1 O or 20 years after pension

5

payments commence, the pension is paid to your named beneficiary for the remainder of that period.

Level Income - if your pension is to commence prior to age 62, the Level Income Payment Option can provide a proportionately larger program pension for the years you would not be eligible for Social Security (age 62 is the earliest date that Social Security benefits are payable). At age 62, the program pension would be reduced by the amount of the estimated Social Security benefit that could be payable at age 62.

As an employee, you will become a participant in the program on the first "entry date" (January 1 or July 1) after you have completed the eligibility service and age requirements which are one year of "participation service" and the attainment of age 25.

However, if you were first hired by a Blue Cross or Blue Shield organization on or after your 60th birthday, you are not eligible to participate in the program.

The normal retirement age under the program is age 65. However, there are provisions for early and late retirement.

If you terminate your employment prior to the earliest retirement age (age 55), you may be entitled to a benefit if you meet the program service requirement for being "vested." Vested means you become entitled to pension benefits after 1 O or more years of service.

Since the employer pays the full

cost of the retirement program and the employee pays none, there are no "refunds" or other cash payable to you if you leave employment prior to retirement age. However, if you complete the vesting requirement, a pension will be payable to you when you reach that age.

If you should die when you are a participant in the program, your spouse will be entitled to the Pre­Retirement Death Benefit if the following conditions also have been met: (1) You were 55 or over at the date of death; (2) You were employed by a Blue Cross or Blue Shield organization for the twelve month period immediately preceding your death; (3) Your pension payments under the program had not commenced; and (4) You had not elected to defer the commencement of your pension under the program.

This benefit provides a lifetime monthly pension to your surviving spouse. You do not have to make a special eiection to have this coverage -- it is automatically in effect for the period prior to your retirement.

If you are interested in learning more about this particular benefit, please contact the Employee Benefits Department at Ext. 6098 or 6408. They encourage any employee who has reached the age of 54 to come in for counseling, especially if you anticipate an early retirement.

·l

il

TO YOUR HEAL TH How much is too much to drink if you are driving?

Recently, tough new laws concerning driving while intoxicated have become effective. They include bigger fines, license confiscation and stiffer penalties for repeat offenders. Those reasons, along with a concern for health and safety, should be enough to make drivers more conscious of the amount of alcohol they consume.

In many states, the legal definition of intoxication is a Blood

Weight

100

120

140

160

180

200

220

240

Alcohol Concentration (BAC) level of .10 percent and above. But long before you reach that level, your judgment and motor skills are impaired. Age, metabolism and weight are important factors that determine your BAC.

It's not true that beer or wine is less likely to make you tipsy than so-called "hard" liquor. A 6-ounce glass of wine, a 12-ounce can of beer or 1 ½ ounces of 86-proof whiskey have about the same amount of alcohol. Any of these will

DRINKS

have about the same affect on Having a full stomach will pos· the effects of alcohol, but it wi keep you from becoming intoxicated.

How much is too much? Thi chart helps you decide. Find y weight in the left column then to the number of drinks you in to have over a two-hour perioc This chart shows average responses. For some people, c drink may be too many.•

(Two-Hour Period)

1 ½ ozs. 86° Liquor or 12 ozs. Beer

1 2

1 2

1 2

1 2

1 2

1 2

1 2

1 2

BE CAREFUL DRIVING DRIVING IMPAIRED DO NOT DRIVE .10% & UP

Source: NHTSA

BAC TO .05% BAC to .05-.09%

the first in a series of articles h we will attempt to answer y questions as possible ng employee benefits. ne to "Benefits Corner." ;ponse to recent questions Jy employees regarding ti rement benefits, th is article ve to explain as much about ;ting program as possible. a participant in the National ,ent Program which is ;tered by the Blue Cross and 1 ield Association in Chicago. )rogram is designed to : 60% of an employee's upon retiring at age 62 and years of service. Payment

; under the program are: > Sum - provides you with a >ayment which is actuarially ent to a monthly lifetime , me Only (Normal form for tmployees) - provides you nonthly pension which is � for your lifetime. No :; are payable to any iary upon your death. and Survivor (Spouse only; form for married ees) - provides the ,ant with a monthly pension and upon the participant's he pension would become � to the surviving spouse. 1ln and Life (Reduced monthly pension to you

yments guaranteed, as ) - provides a reduced monthly pension to you

yments guaranteed for a id number of years, either 10 s elected. If you die within l years after pension

payments commence, the pension is paid to your named beneficiary for the remainder of that period.

Level Income - if your pension is to commence prior to age 62, the Level Income Payment Option can provide a proportionately larger program pension for the years you would not be eligible for Social Security (age 62 is the earliest date that Social Security benefits are payable). At age 62, the program pension would be reduced by the amount of the estimated Social Security benefit that could be payable at age 62.

As an employee, you wil l become a participant in the program on the first "entry date" (January 1 or July 1) after you have completed the eligibility service and age requirements which are one year of "participation service" and the attainment of age 25.

However, if you were first hired by a Blue Cross or Blue Shield organization on or after your 60th birthday, you are not eligible to participate in the program.

The normal retirement age under the program is age 65. However, there are provisions for early and late retirement.

If you terminate your employment prior to the earliest retirement age (age 55), you may be entitl ed to a benefit if you meet the program service requirement for being "vested." Vested means you become entitled to pension benefits after 1 O or more years of service.

Since the employer pays the full

cost of the retirement program and the employee pays none, there are no "refunds" or other cash payable to you if you leave employment prior to retirement age. However, if you complete the vesting requirement, a pension will be payable to you when you reach that age.

If you should die when you are a participant in the program, your spouse will be entitled to the Pre­Retirement Death Benefit if the following conditions also have been met: (1) You were 55 or over at the date of death; (2) You were employed by a Blue Cross or Blue Shield organization for the twelve month period immediately preceding your death; (3) Your pension payments under the program had not commenced; and (4) You had not elected to defer the commencement of your pension under the program.

This benefit provides a lifetime monthly pension to your surviving spouse. You do not have to make a special election to have this coverage -- it is automatically in effect for the period prior to your retirement.

If you are interested in learning more about this particular benefit, please contact the Employee Benefits Department at Ext. 6098 or 6408. They encourage any employee who has reached the age of 54 to come in for counseling, especially if you anticipate an early retirement.

TO YOUR HEAL TH How much is too much to drink if you are driving?

Recently, tough new laws concerning driving while intoxicated have become effective. They include bigger fines, license confiscation and stiffer penalties for repeat offenders. Those reasons, along with a concern for health and safety, should be enough to make drivers more conscious of the amount of alcohol they consume.

In many states, the legal definition of intoxication is a Blood

Weight

1 00

1 20

1 40

1 60

1 80

200

220

I 240

Alcohol Concentration (BAC) level of .10 percent and above. But long before you reach that level, your judgment and motor skills are impaired. Age, metabolism and weight are important factors that determine your BAC.

It's not true that beer or wine is less likely to make you tipsy than so-called "hard" liquor. A 6-ounce gl ass of wine, a 12-ounce can of beer or 1 ½ ounces of 86-proof whiskey have about the same amount of alcohol . Any of these will

DRINKS

have about the same affect on you. Having a full stomach will postpone the effects of alcohol, but it will not keep you from becoming intoxicated.

How much is too much? This chart helps you decide. Find your weight in the left column then refer to the number of drinks you intend to have over a two-hour period. This chart shows average responses. For some people, one drink may be too many.•

(Two-Hour Period)

1 ½ ozs. 86° Liq uor or 1 2 ozs. Beer

1 2

1 2

1 2

1 2

1 2

1 2

1 2

1 2

BE CAREFUL DRIVING DRIVING IMPAIRED DO NOT DRIVE . 10% & UP

Source: NHTSA

BAC TO .05% BAC to .05-.09%

6

SPORTS Flag Football This year's battle for the Intramural

Flag Football Championship ended

in some controversy. Johnny Rhoden's team finished the regular

season in first place with Jim

Gray's team in second.

The Rhoden and Gray teams were favored in the playoffs, but at the end of the tournament both

teams were thrown for a loss. On Feb. 12, at Mallison Field, Greg

Lowe's team arose victorious

taking first place in the tournament

with Billy Jones' team placing

second. • Tournament 1STp/ace winners (front L - R) Alfred Floyd, Curtis Wimberly, Curtis Perry, Ron Waye, (rear L - R) Billy Barnes, Bobby Ross, Keith Green, Greg Lowe

Greg Carter calls his own time out

Jim Gray's and David Ricke's teams meet head-to-head

Team spirit is evident in the stands. (L - R) Larry Shepard, Deb Henney, Bobby Ross, Johnny Rhoden, Debbie Collins, Frank Giordano, Sean Mahoney

7

"Going somewhere, Buddy Bobbick?"

manager of Program Analysis; and Vicky Brooks, junior analyst. The

PPO Task Force included Hank Barnett - Customer Services; Larry

Bold - Systems; Jim Doherty and Richard Swift - Hospital

Reimbursement; Pat Hemingway -

Utilization Management; Dave Mandel - Actuarial; Bob Nay -

Physician Reimbursement; Sandra Poff - Hospital Relations; Larry

Payne - Professional Relations; Jerry Vaughan and Bob Batie -

Private Business Operations;

Dianne Davis and Laura Jones -Product Management; and Tom

Stanley - Legal Affairs.

The new PPO departmental

organization reflects the expanded

activity as the Plan approaches

implementation of the PPO.

Reporting to Vice President James Hulsey are Dudley Mendheim,

director of PPO Administration and Support; and four regional

directors: Ernie Brodsky, northern

region; Paul Mitalas, central region; Michael Pipito, western region; and

Robert Sebok, southern region. Victoria Bankhead, manager of Professional/Provider

Reimbursement and Relations; Jay

Kapur, manager of Sales and Marketing Services; and Gerry

McNair, manager of Program

Analysis report to Mendheim. •

Taking a look at the PPO product (L - R) Jay Kapur, Gerry McNair, Vicky Broo and Paul Mita/as

3d Patient Care Plan. "We

n g to form a partnership

n employers/employees,

Is, physicians and Blue

ind Blue Shield to d o

ing t o mod erate the rise in

:;are costs. We are hoping,"

, "to market this prod uct at a

lower premium cost than

1 itional prod uct lines."

. . . our PPO produ ct

four com ponents "

m al marketing d emand will

our priorities as far as what

phic regions will be exposed

, ew prod uct," said Jay PPO Sales and Marketing

s manager. "And , initially,"

�d , "the prod uct will only be

to local groups and

ed to other subscribers at a

.te. "

State Group, Florid a's

single employer, has

:ed that we, as the

;trator of their insurance,

> a preferred provid er

t for their employees in

1 eographic areas," said

important to und erstand

r PPO prod uct has four 1 ents," continued Hulsey.

; the benefits package itself.

een initially set up as an � imbursement on the

.ted allowance when an

ee chooses the PPO < , and will change to a 60%

rsement should the J al choose to go outsid e the

�d provid er network."

"The second component is

reimbursement for hospital

se'rvices," he explained . "The DRG

(Diagnostic Related Group) system has been ad opted here to maximize

hospitals' incentives to red uce cost and unnecessary utilization."

Teams of Plan experts have been

actively negotiating contracts with

hospitals in Dad e, Broward and

Palm Beach counties. Holy Cross

Hospital in Ft. Laud erdale became

the first Preferred Patient Care Plan

provid er in Florid a on February 16.

The following d ay, signed contracts were received from North Miami

General Hospital and South Miami

Hospital. By the end of February, three additional hospitals had

ind icated their intentions to sign

PPO contracts.

"This com ponent is

really the hearl o f the

program ... "

The third component of the

Preferred Patient Care Plan is

reimbursement for physician services. "The objective of th is

component of the program is to contract with an adequate number

of skilled d octors by specialty and geographic location to provid e

policyhold ers access to the network," Hulsey said .

And the fourth and possibly most important component of the

program is utilization management. This will ensure that required

health care services are rendered in

the most appropriate and cost­

effective location.

"Every one must be

res pons ible for this

pa rlnership. "

"This component is really the heart of the program," said Kapur.

"Utilization management, carried

out effectively, will help to bring

health care cost d own and will

ultimately reduce premium costs." "Something must be d one to

control the rising cost of health care," continued Kapur. The PPO is

based on the premise that not j ust

one entity -- Blue Cross and Blue Shield or the hospital or the

subscriber or the physician -- can

accomplish the task alone," he said . "Everyone must be responsible in

this partnership."

"We, as a corporation, strongly believe in the competitive approach to solving the problem of rising

health care costs," said Hulsey. "And we are one of the first

companies to introd uce a

comprehensive PPO prod uct in the state of Florida."

Others who have been involved in the d evelopment of the Preferred

Patient Care Plan are Paul Mitalas,

formerly d irector of PPO

Development; Gerry McNair,

,t

Players anticipate their opponents ' next move

Jim Gray's team members huddle for a

pre-game prayer

League 2ND place winners (L - R) Greg Carter, John Runion, Raul De/Valle, Jim Gray, Robert Gray, Buddy Bobbick, Steve Gray

John Runion scores a touchdown!

Employees Run Marathon On Saturd ay, January 7, the newly­

formed Jacksonville Marathon

Association held Jacksonville's first

marathon. There were quite a few

Blue Cross and Blue Shield of

Florid a employees who part icipated

in the 26. 2 mile course that ran along and over the St . John's River.

At least five employees that we

know of completed the entire race

ind ivid ually and nine others

part icipated in the corporate relay

d ivision. This d ivision of the

marathon allowed runners from the

same company or business to share

the run. Each relayer ran 8.73 miles of the race (which is approximately

1/3 of the course).

The race began at Bolles School on San Jose Boulevard at 8 a.m. ,

going south down to the Mandarin

area, then north again to the San Marco area, across the Main Street Brid ge, and end ing downtown. The

major sponsors of the event were

St . Vincent's Medical Center and Led erle Laboratories of New York.

Supporting sponsors were the

Tourist Development Council and

WIVY radio. • INDIVIDUAL PARTICIPANTS

WHO COMPLETED THE COURSE Henry Douglas

Cliff Frank Fred Gaud ies

Frank Solomon Dave Schroed er

CORPORATE RELAY TEAMS Debbie Chand ler Pat Hemingway

Terri Kline Carol Adams

Paul Rehfus Joan Baagoe

Tony Hubbard Fred Roberts

8

-!� Bi�ff Kevin Alan, on October 1 0 to Bonnie Kleinik, Medicare A Production & Quality Control.

Jennifer Lindsay, on October 15 to Judy Vieren, Actuarial.

Charles Russell, on October 22 to Deborah Baker, Corporate Budget.

Michelle Jeannette, on November 1 0 to Vikki Egerman, State Group Inqui r ies.

Bradlee Chalen, on December 1 6 to Shelly Navarrette, FEP.

Dana Aprll, on December 1 7 to Bob Gruber, Provider Relations.

Nathaniel Joseph, on December 21 to Celia Tomlinson, Medicare B Claims.

Natalie Nlcole, on December 22 to Tammie Burnsed, Membership and Bi ll ing .

Marriages Jeanne L. Cooper, Exam Entry, to J immy Coleman in February.

Elzabeth Yleldlng, Medicare B Correspondence, to Edward 0. Maury on February 1 8.

Kubl Keyes, Accounts Receivable, to Tyshel l Hopkins on March 3.

9

�

�

e r 1 ' • l , . . . . ,I , I

Retirees Clara Rose, will retire after 26 years of service.

WIiiiam King, will retire after 20 years of service.

Violet WIiford, wi 11 retire after 18 years of service.

Ruby Reynolds, will retire after 1 7 years of service.

Lora Whitehead, wi ll retire after 1 6 years of service.

Lucille Harnage, will reti re after 1 5 years of service.

Samuel Waldon, will retire after 15 years of service.

Eunice Turner, will retire after 1 5 years of service.

Doris Carter, will retire after 12 years of service.

Eula Johnson, will retire after 1 0 years of service.

Lucille Whalen, wil l retire after 1 0 years of service.

Servic* Anniversaries

* 30YEARS Ruby Wells Tampa

* 25YEARS Edith Bowden Physician Relations - Northern

* 20 YEARS

Linda Alvarez Gainesville

* 15YEARS Jacquelyn Adkins Operations Planning Task Force

Josephine Alexander Rating & Underwrit ing

Carol Blanton Med B Reviews & Hearings

Mlchael Bristow Organization & Compensation

Ruth Bryant Inter Plan Claims

Lucille Harnage Utilization Review

Sandra Jackson Private Business Claims

Anne Newland Systems Development

MIidred Nlcholson Membership & Bi ll ing

Daniel Pentenburg Production & Change Control

Melodye Raulerson Benefits Administration

Carwyn Romedy Reim. Puerto Rico Audit

Ana Slaca FLASO Claims

John Smid Reim. Puerto Rico Audit

Annetta Stange Administration Services Post Claims Audit

Ella WIiiams Med A Utilization Review

Eloise WIiiiams FEP Basic Claims Processing

* 1 0YEARS Bernadette Bates West Palm Beach

Bonnie Blyler Development & Operations

Valerie Bouchelle Hospital Charge Audit

Barbara Bouranis Direct Basic/Comp. Inqui ries

Eva Brown Med B Communications

Mary Burchard Ft. Lauderdale

Beulah Cone BS Basic Suspense Examining

Linda Cribb Med B Communications

Cleo Culp Major Med Comprehensive Suspense

Eunice Grant Bank Reconc i liation

Shirley Grier Safety & Security

Victoria Hackford ASO State Group Correspondence

Patricia Haddock Motors Retirees

Shirley Jerkins Group Membership Communication

Shirley Johnson Med B Claims Examining

Trudy Joseph Inqui ry Control

Josephine Jugo Miami

Mary Langmuir Membership & Billing

Marlene Lapierre Other Carrier Liab i lity

Lois Latham Med B Claims Examining

James Hulsey, vice president of PPO

Florida Pia

To Market

PPOs As a part of Blue Cross and Bl

Shield of Florida's continuing

commitment to cost containm

we will begin marketing a PPC

product in Dade, Broward anc

Beach counties within the nex

months. PPO stands for "PrefE

Provider Organization" and

consists of a select group of

hospitals and physicians that I

agreed, via contract, to provid

health care services, usually a

reduced rates, to a group of employees whose health care

benefit program has been des

to provide financial incentives

use the preferred hospitals an, doctors.

"We are trying to form

a partnership . . . to do

something to moderate i

rise In health care costs. '

The product will be known ,

"Preferred Patient Care Plan, "

will be marketed in Jacksonvil

Gainesville and Tampa - St.

Petersburg, and other areas la

this year. James Hulsey, vice presider

PPO, emphasized the primary behind the development of the

ROflLE J I . 3 -- No. 1

m uary/February 1 984

� (ii) Blue Cross r � �!,�!Shield

0. Box 1798, Jacksonvi lle , FL 32231-0014

Jbl i shed For The Em ployees Of l ue Cross and Blue Shie ld of Florida '/ The Corporate Commun ications iv i sion . )ITOR - Pam McCalman

RAPHIC DESIGN - Vickie Robie

�SIDE THIS ISSUE

-4 orida Plan To Market PPOs

rnefits Corner

> Your Health

- 8 :19 Footbal l

n p loyees Run Marathon

About PROFILE Questions or comments

on PROFILE should

be directed to the EDITOR, Corporate

Communications, 4 T,

Ext. 8075.

®

Terri Lee Med A

Brenda Lightsey Organization & Compensation

Marie Luchl Motors Retirees

Mary Martin Local/National Account Claims

Mary Matheson Corporate Planning

Sue Nelson St. Petersburg

Laverne Patrick Administration Services Post Claims Audit

Brenda Robinson Private Business Claims

Catherine Shane Florida Marketing

WIiiie Scott Med A

Jerry Summerford Med B Claims

Anna Tyner Production & Change Control

Dwight WIison Corporate Budget Department

* 5 YEARS Cathy Asher Med B Prepayment Util ization

Claudette Askew Med B Claims Examining

Charles Beaufort Provider Automated Services

Attle Bridges Information Department

Spessard Boatright Facilities & Office Services

Wendy Campbell Medical Director

Peggy Crews Health System Data

Damon Dotsis Ft . Lauderdale

Teresa Drury Med icare B Claims Examining

Dale Edwards Hearing Officers - Med B

John Fraser St. Petersburg

Fabian Fuentes Product Management

Freddie Hall Rating & Underwriting

Victoria Henderson Private Business Claims

Susan Jones Med B Claims Examining

Terry King St. Petersburg

Melissa Lawrence Med B Claims Examining

Ismail Peeranl Home Health Agency

Shirley Rowell Med B Claims Examining

Sandra Smith Inter Plan Claims

Beverly Sneed Finance/HRS/Underwriting Support

Sherry Ulbrich Private Business

Michael Vickers FEP Basic Claims Processing

Richard Werner Tampa

Paula Womack Private Business Claims

* 1 YEAR Joaquin Arias Florida Marketing

Marie Balley Ft. Myers

Dianne Barnett Ft. Myers

Stuart Baumel Coral Gables Aud it Branch

Stephen Blajlan Marketing/HIS/Med A Support

Linda Brownett David Knopsnyder Inquiry Control Corporate Planning

Gladys Bullard Edward Korunes Corporate Budget System to System Network

Lori Bunn Lucy Love Med B Reviews & Hearings Market Research

Diane Busey Robert Luman Administrative Services West Palm Beach

Patricia Colvin Robert McMichael Jacksonvi lle District Office Med B Claims Examining

Mary Conner Donald Mccourt Word Processing Center Tampa Branch Aud it

Judith Cooney Fabio Molina West Palm Beach General Accounting

Carol Digesare Sharon Morgan Small Group Products Hospital Charge Aud it

Rachel Dixon Lillian Mullins Purchasing Actuarial

Letitia Farrall Diana Phipps Organization & Compensation Performance Analysis

Julla Fasbender Guytha Restall Corporate Research Accounts Payable

Cheryl Fletcher Constance Robertson Jacksonville Aud i t Branch Physician Relations

Desso Forman Barbara Rossignol Gainesville Special Clai ms Sect ion

Audrey Gagne Angela Smedley Actuarial Legal Affai rs - Assoc. House

Sherry GIii Counci l

Medical Division Steven Stein

Gary Glandon Organization & Compensation

Organization & Compensation Janice Stertzbach

Joyce Gray Personnel

Hospital Charge Aud it-Central Anne Turner

Bobby Gunter Technical Services

Private Business Ronald Ureel

Jeanne Hackney Ft. Lauderdale

Gainesville Holly Valkenaar

Judy Haley Orlando

Provider Automated Services Cecil Williams

James Huffman St. Petersburg

Statistical Charlene Witz

Christi Jones Analysis & Forecast

St . Petersburg Joan Zeller

Mary Kernie Med A Ut il ization Review

BS Med ical Review

1 0

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4

11

18

25

s

1

8

15

22

Easter

29

Blue Cross Blue Shield of Florida

P. 0. Box 1798

1984

M T

5 6

Aerobics

12 13

Aerobics

19 20

Aerobics 1st Day

of Spring

26 27

Aerobic

1984

M T

2 3

Aerobics

9 10

Aerobics

16 17

Aerobics

23 24

Aerobics

30

Aerobic

PROFILE Jacksonville, Florida 32231-0014

MARCH

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1

7 8

Aerobics

14 15

Aerobics

21 22

Aerobics

28 29

Aerobics

APRIL

w T

4 5

Aerobics

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Aerobics

1 8 19

Aerobics

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Aerobics Ticket Sale

Sea World Trip

1984

F s

2 3

9 10

16 17

23 24

Arts & March of Dimes

Craft Show Walk-A-Thon

30 31

Cypress Gardens

Trip

1984

F s

6 7

1 3 14

Ticket Sale

Sea World Trip

20

27

21

Holiday

Good Friday

28

Sea World

Trip

BULK RATE U .S. POSTAGE

PAID JACKSONVILLE, FL.

PERMIT No. 85

Partnership Arrangement at Blue Cross and Blue Shield

January/February, 1984