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The changing Blue Cross-provider relationship.

T J Onusko

    Healthspan
    |July 9, 1987
    PubMed
    Summary
    This summary is machine-generated.

    Healthcare providers must understand evolving relationships with Blue Cross and Blue Shield (BCBS) plans. Market forces are altering these dynamics, leading to increased provider-payer conflict, as a case study demonstrates.

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    Area of Science:

    • Healthcare Management
    • Health Insurance Economics
    • Provider-Payer Relations

    Background:

    • Blue Cross and Blue Shield (BCBS) plans historically hold a dominant share of the private health insurance market.
    • The relationship between BCBS plans and healthcare providers is undergoing significant transformation.
    • Understanding these shifts is crucial for healthcare providers navigating the current market.

    Purpose of the Study:

    • To analyze the evolution of BCBS plans' relationships with healthcare providers.
    • To identify and examine the market forces driving changes in these relationships.
    • To illustrate the impact of these changes on provider-payer dynamics through a case study.

    Main Methods:

    • Historical analysis of Blue Cross provider relationships.

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  • Examination of current healthcare marketplace forces.
  • Case study illustrating contemporary provider-BCBS interactions and conflicts.

    • Main Results:

    • Market forces are profoundly altering the traditional BCBS-provider relationship.
    • These changes can lead to significant tension and conflict between insurers and providers.
    • A case study highlights the escalating hostility in certain provider-BCBS interactions.

    Conclusions:

    • Healthcare providers need to adapt to the changing landscape of BCBS payer relationships.
    • The current trajectory suggests a potential increase in adversarial interactions.
    • Proactive understanding and strategic planning are essential for providers facing these market shifts.