The case of Ledina Lushko, a patient enrolled in a Blue Cross and Blue Shield of Illinois individual plan, highlights many of the issues that have plagued the United States healthcare system for some time. As an insurance plan provider, BCBS of Illinois takes pride in the health outcomes of our members and has a responsibility to contribute positively to their care. The fractured, ineffective care Mrs. Lushko received is disappointing, however, this case provides strong support for a shift in focus towards managed care and specifically, the Accountable Care Organization structure. The following details several aspects of Mrs. Lushko’s experience and how her care could have been improved by enrollment in BCBS of Illinois’ private ACO plan.
1. Issue: Repeat & Poorly Documented Testing
One concerning aspect of Mrs. Lushko’s experience was the lack of proper organization of test results and test history. Beginning very early within her first contact, a repeat abdominal CT was performed after this test was already carried out just a few weeks earlier by a health system in Albania. Although there is not an obvious connection or relationship with an overseas health system of this sort, Mrs. Lushko had no knowledge that repeat tests could have been avoided prior to the appointment if she had obtained her files ahead of time. Additionally, there were several occasions throughout her care where providers did not have readily available access to recent test results or test results could not be located entirely. Decisions regarding Mrs. Lushko’s care were often delayed because of these occurrences while doctors or staff worked to locate the results. Not only does this identify a major source of monetary waste within Mrs. Lushko’s care, this is also an inefficient use of the time and efforts of physicians and staff, while this time would be
