Blue Cross' HMO subscribers get access to Hopkins facilities


Johns Hopkins Hospital and School of Medicine won a financial and a symbolic victory yesterday when Blue Cross and Blue Shield of Maryland announced that its HMO subscribers can use all of Hopkins' services.

Blue Cross' 324,000 health maintenance organization subscribers previously had full access only to the Johns Hopkins Bayview Medical Center and to Bayview doctors. Subscribers could be admitted to Johns Hopkins Hospital and see certain Hopkins specialists only with the approval of Blue Cross.

Now, under the terms of a new contract, HMO subscribers can be referred by their primary-care physicians to any of the 1,000 Hopkins faculty doctors and to Hopkins Hospital.

The contract is financially significant for Hopkins because Blue Cross is the largest insurer in Maryland and an increasing number of its subscribers belong to HMOs. Blue Cross' traditional, non-HMO subscribers, who number 1 million, generally have had full access to Hopkins.

The contract is symbolically important because Hopkins has been striving to convince HMOs that its medical services are not only of good quality but also efficient.

Nancy A. Bray, vice president of managed care at Hopkins, said the contract also demonstrates that "it's important . . . from a marketing perspective" for insurers to offer employers and workers the opportunity to use Hopkins.

"I think Blue Cross and Blue Shield has been anxious for some time to see us reach an agreement with them," she said. "I think it really pretty much came down to coming to terms on a physician fee schedule."

She didn't disclose the rates that Blue Cross will pay Hopkins doctors but said they will be "competitive" with rates paid by other insurers.

Blue Cross President and Chief Executive William L. Jews said the contract "allows our company to offer more choice and high quality medical services to our subscribers."

Blue Cross' chief operating officer, David D. Wolf, said Hopkins "has become much more interested in dealing with the managed care organizations," meaning HMOs. He gave credit to Ms. Bray and her staff.

"The quality has always been there" at Hopkins, Mr. Wolf said, "but we just wanted to make sure it was there" on the cost side, too.

Although Hopkins and Blue Cross negotiated fees for doctor services, hospitals are barred from discounting state-determined rates. Hopkins' hospital rates are higher than rates at many other hospitals for a variety of services, a difference that Hopkins attributes to the cost of charity care and medical education.

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