Aetna and PinnacleHealth System recently announced a new accountable care agreement that is designed to improve the quality of care and lower overall health care costs for Aetna commercial plan members in the Harrisburg, Pa., area.
According to a release issued by Aetna, the collaboration will use PinnacleHealth’s comprehensive, integrated system of physicians, hospitals and ambulatory services to give area employers better health care options for their employees by:
- Creating a more coordinated patient experience;
- Saving employees money when they use providers aligned with PinnacleHealth; and
- Improving health care outcomes.
Aetna says it will introduce both fully insured and self-insured health plans in Central Pennsylvania that will use PinnacleHealth’s community-based systems of care and its network of highly respected physicians. The first product, for groups of more than 51 employees, will be available on April 1, 2014. A small-group product for groups of between two and 50 employees will be introduced July 1, 2014. – See aetna.com for more details.
Independence Blue Cross, (IBC) has announced that it extended its partnership with Relay , a new channel for customer communications, to enhance its successful mobile communication program, IBX Wire™.
Launched earlier this year, IBX Wire helps IBC members stay on top of vital personal health information, complete transactions, and get customized support from their smartphones. IBC is now taking this capability beyond its member base to educate and engage with consumers to help them understand the changes driven by the Affordable Care Act, and provide an easy way to get more information or enroll in a health plan.
IBC said that this mobile communication program is a key element of its consumer outreach and engagement strategy which also includes multi-lingual educational materials; online resources like ibx.com/careforme and ibx4you.com ; social media outreach; outreach through seminars and webinars by trained health care reform experts; and direct mail. In addition, IBC launched the Independence Express , a state-of-the-art, mobile education and retail health care experience that has been traveling throughout Southeastern Pennsylvania this summer and fall helping consumers understand the important changes associated with the Affordable Care Act. - See more information at IBX.com.
Blue Cross Blue Shield of Michigan says it is first health plan to give Michigan consumers the ability to determine eligibility for ACA subsidies through text messaging.
Under Blue Cross’ “Text for Subsidy” program, people can text “4Subsidy” to 222-752 to initiate a back and forth exchange, detailing their eligibility. Normal data plan charges will apply. The consumer will be asked to provide their zip code, age, income and number of dependents. Blue Cross will respond with whether or not they are eligible for a subsidy. – For more information see BCBSM.com.
Amber May has published an article on BenefitsPro.com that recalls a time in the 1990s when HMOs were the biggest thing in health care. She points out that the most obvious benefit of an HMO system is the coordination of care the organizations facilitate and how, since 1995, the National Health Insurance Law in Israel made participation in one of the four Israeli HMOs compulsory for all Israeli citizens.
May points out that once again the United States is experimenting with managed care. She notes that the Patient Protection and Affordable Care Act (PPACA) is attempting to address the lack of care coordination that’s developed in the American health care system by creating provisions for accountable care organizations (ACOS), coordinated groups of health care providers that provide care for specific populations of patients and are accountable for the quality, cost and outcomes of that care.
She notes that through PPACA, ACOs are tied to Medicare and speculates that a universal managed care system similar to Israel’s may be a long way off for the U.S. – To learn more see benefitspro.com.
A press release issued today by Towers Watson, the global professional services company, announced that it has acquired Liazon Corporation, one of the leaders in developing and delivering private benefit exchanges for active employees.
The release noted that this acquisition, which follows the purchase of Extend Health in June 2012, solidifies Towers Watson’s strength in the private exchange market through its OneExchange solution. Going forward, Towers Watson said it will continue to enhance Liazon’s private exchange solution and serve the needs of Liazon’s broker, consultant and carrier partners, some of which offer the Liazon product under their own brands.
According to the release, Liazon’s online benefit marketplaces are currently distributed through over 400 insurance brokers, including nine of the top 10 national firms, under either the Bright Choices® brand or as a third-party proprietary exchange.
Towers Watson said it plans to continue these relationships based upon their current terms and use the Liazon name in the market with its broker partners. Towers Watson indicated that it will also continue to offer its OneExchange solution, which primarily serves larger employers. The OneExchange and Liazon solutions together will help organizations of all sizes deliver self- and fully insured benefits to both employees as well as pre- and post-65 retirees in new and cost-effective ways, Towers Watson said.
We have been tracking some of the health plan innovations that are being funding as part of the Affordable Care Act. (ACA). Stateline, the daily news service of the Pew Charitable Trusts, has published an article that looks into the progress states are making in their efforts to grapple with the relatively high cost and low quality of U.S. health care.
Stateline notes that out of the $1.8 trillion the ACA is projected to cost over the next decade, $10 billion is dedicated to innovation programs. Susan Dentzer of the Robert Wood Johnson Foundation, a nonprofit group that promotes improvements in the U.S. health care system told Stateline, “The idea is to take governors up on their claim that states are the laboratories of democracy where meaningful innovations can occur.”
So far, Stateline reports, Arkansas, Maine, Massachusetts, Minnesota, Oregon and Vermont have applied for funds under the under an ACA program called the State Innovation Models Initiative, and this year, they began testing new health care financing models. Another 19 states are in various stages of developing similar experiments. Continue reading
GoLocalWorchester.com is reporting today that Tufts Health Plan is the first insurance carrier in Rhode Island and Massachusetts to offer a defined contribution model to large employers – those with 51 or more employees. Called RightChoice, Tufts’ defined contribution model allows an employer to fix a certain dollar amount as its contribution, and employees pay or save the difference, depending on the plan they select.
According to the report,Tufts presents pre-bundled plan sets for employers with 51 to 99 employees – six in Rhode Island and eight in Massachusetts in its online marketplace. For groups with 100 or more employees, Tufts will customize bundles, giving even more plan flexibility. See the full story at GoLocalWorchester.com.
As Accountable Care Organizations (ACOs) begin to change the patient care model nationwide, coordination of care between acute and post-acute care providers is an important component for ACO success.
ACOs will need to partner with Long Term Care (LTC) pharmacies, Home Infusion and Specialty pharmacies, HME and Respiratory providers, and Long Term Care facilities including Skilled Nursing, Assisted Living and Rehabilitation facilities.
To address this issue, Managed Health Care Associates, Inc. (MHA), a health care services and technology company focused on alternate site health care providers, has announced the formation of the MHA ACO Network. MHA says that by working with both Commercial and Medicare Accountable Care Organizations (ACOs), the MHA ACO Network will provide access to the largest national network of alternate site post-acute care providers in the country. - For more information, visit www.mhainc.com.
Nov. 12, 2013 - TRAVERSE CITY, Mich. — Munson Healthcare and Blue Cross Blue Shield of Michigan say they are launching a new value-based hospital reimbursement agreement in northern Michigan designed to improve patient care and medical outcomes while also enhancing efficiency and holding down the cost of care.
According to a press release posted on BCSCM.com, their agreement provides a fair base-rate increase in reimbursement from BCBSM to the hospital. In addition Blue Cross will reward the hospitals with a share of the savings achieved when hospitals and physicians coordinate the delivery of efficient and effective care, eliminate reuse and overuse of care, and prevent re-hospitalizations. Continue reading
Newark, NJ – November 7, 2013) – Horizon Blue Cross Blue Shield of New Jersey (BCBSNJ), which has been leading an effort with physicians, hospitals and health care leaders throughout the state to transform how health care is delivered, has developed a new product for employers to encourage employees to use physicians focused on improving the value of care patients receive, rather than the volume of care. The goal of the new product is to increase the number of Horizon BCBSNJ members who will seek care in patient-centered practices to improve patient outcomes and reduce overall health care costs.
The new product – the Horizon Patient-Centered Advantage EPO Plan – is now being offered to fully-insured employer groups for coverage that becomes effective on January 1, 2014.