Blue Cross of Northeastern Pennsylvania recognized with Prestigious Awards


Northeastern, PA – Blue Health Solutions, the wellness program available to members and customers of Blue Cross of Northeastern Pennsylvania (BCNEPA), has once again been recognized by a national certification agency for its program excellence.

The Disease Management Purchasing Consortium (DMPC), the industry’s leading outcomes certification organization, recently honored Blue Health Solutions with three awards for its ongoing success with chronic disease management.

The most prestigious of the three awards honored Blue Health Solutions for achieving a 3.8-to-1 return on investment (ROI) based on a decline in events and a decline in events relative to prevalence with chronic diseases. As a result, DMPC awarded BCNEPA its Letter of Validation for ROI using the transparent and valid event rate-based methodology described in DMPC president Al Lewis’s critically acclaimed book Why Nobody Believes the Numbers – Distinguishing Fact from Fiction in Population Health Management.

Another award singled out BCNEPA for achieving the greatest validly measured improvement in outcomes for members with chronic disease of any health plan in Pennsylvania this year.

Blue Health Solutions achieved such outstanding results by bringing focus to health status improvement and impacting the inpatient admission and emergency room visit event rates for diabetes, coronary artery disease, chronic obstructive pulmonary disease (COPD) and congestive heart failure.

A. Paul Holdren, senior vice president and chief sales and marketing officer for BCNEPA, recognizes the benefits of Blue Health Solutions for his customers and members.

“By utilizing the experienced health coaches and online tools that are provided by Blue Health Solutions, we offer our customers, their employees, and their covered family members the support they need to achieve their wellness goals, manage chronic diseases and engage in more healthy behaviors,” said Holdren.

The tools available through Blue Health Solutions include a suite of care management, lifestyle and wellness programs, including access to registered nurses and social workers who serve as health coaches and work directly with individual members.

“Our success comes from the individual approach our health coaches take with each member,” said Laura Mertz, vice president and general manager. “Creating a personalized management plan that reflects the participant’s health status and goals helps that member manage their condition and achieve better outcomes.”

In validating the outcomes of Blue Health Solutions, DMPC president Al Lewis distinguished the program from all the others in the Commonwealth, saying “No other Pennsylvania carrier’s disease management program has been validated by any vendor that accepts financial risk for the veracity of their statements and methodology.”

“The results Blue Health Solutions is achieving show that there is real value in disease management and wellness programs, both for individual members and for employers,” said Mertz. “When chronic conditions are better managed, participants can improve their health status and quality of life. And the data from employees who are engaged in a wellness or disease management program indicate lower health care costs.”

About Blue Cross of Northeastern Pennsylvania: Headquartered in Wilkes-Barre, Blue Cross of Northeastern Pennsylvania is an independent licensee of the Blue Cross and Blue Shield Association. BCNEPA offers a comprehensive portfolio of health insurance products and administrative services to nearly 545,000 individuals in 13 counties in northeastern and north central Pennsylvania. The company’s mission is to provide integrated health care services and products to improve the quality, accessibility and affordability of health care in the populations it serves.