CAPG Recommendations Included in DMHC Undertakings for Blue Shield-CareFirst Merger

Sacramento, CA—The California Department of Managed Health Care (DMHC) has included recommendations from CAPG in the fulfillment of conditions precedent (“undertakings”) for the recent Blue Shield–CareFirst merger, the first completed among several pending in the state.

The proposals request that the undertakings include three conditions to help California build a common statewide health information infrastructure for all stakeholders. A universal, automated platform would break down existing information between “silos,” allow freer exchange of data, and increase system efficiency. The Blue Shield–CareFirst undertakings require the Plan to devise a proposal, to be approved by DMHC, for building the CAPG-proposed infrastructure.

CAPG proposed the recommendations in letters dated September 9 and December 9 at meetings of the Financial Solvency Standards Board in Sacramento. The organization is calling for the undertakings requirements in three other pending mergers: Anthem-CIGNA, Aetna-Humana, and Centene-HealthNet.

The proposed requirements are:

1) A common, standardized reporting system for encounter data—the clinical information resulting from a doctor visit or procedure. Currently, incompatible systems and standards make transferring data between health plans and providers a cumbersome and inaccurate manual process. A standardized system will eliminate those hurdles, enabling faster resolution of transactions.
2) An automated, online patient deductible “accumulator” or tracking system. Consumers would have a fast, accurate way to determine how much they have spent toward their plan copays and deductibles. Providers could also use the system to determine whether to charge a specific copay, coinsurance, or deductible amount.
3) A common online portal where providers can update contact information, staff, and new patient information in one stop. In compliance with the directory reporting requirements of SB 137, this project will make provider data available to all health plan networks that include the provider, helping reduce the problems caused by inaccurate and out-of-date directories.

“We’re pleased that the DMHC seized the moment to include these undertakings requirements in the Blue Shield–CareFirst merger,” said CAPG President and CEOand CEO Donald Crane. “We urge the Department to also include them in the other pending mergers.”

“This confluence of mergers is a once-in-a-lifetime opportunity to create the healthcare information freeway that California needs,” Crane continued. “The undertakings requirements will create a funding pool for the technology upgrades to make it possible. We look forward to working with the Department to make this freeway a reality.”