Four Health Plans Win Pinnacle Awards from the Ohio Association of Health Plans

The Ohio Association of Health Plans (OAHP) has announced the 2010 winners of its Pinnacle Awards for best practices in the Business/Operational Performance, Health Care Programs, and Community Outreach and Partnerships categories.

Anthem Blue Cross and Blue Shield is a co-winner with Humana in the Business and Operational Programs category for the Availity Initiative. The Availity Initiative is a partnership between Ohio health insurance plans and health care providers which optimizes the information exchange between multiple health care stakeholders through a single, secure network. The online network helps providers conduct administrative functions, including claims inquiries, billing, pre-authorizations and eligibility inquiries for Ohio health plans. Ohio is one of two states in the nation participating in this pilot effort.

Anthem received the Pinnacle Award in the Community Outreach and Partnerships category for its Radio Disney “Move It!” Program, promoting healthy lifestyles to kids to help combat the obesity epidemic. Anthem sponsored Radio Disney’s “Move It!” program, and it is estimated for the fall School Challenge, kids “moved” for 21,150,000 minutes.

Paramount Health Care was the winner in the Health Care Programs category for its renal management program “Aggressive Steps 2 Reduce the Burden of Chronic Kidney Disease.” The program identifies and intervenes early, resulting in significant decreases in acute care utilization rates at an annual cost savings of over $4,000,000 a year. The most important results achieved were no disease progression in 84% and disease regression in 7% of members.

AultCare was a Meritorious Award winner in the Health Care Programs category for its Education Kit Referral Program The program decreased emergency room visits 10%, inpatient claims 37% and inpatient days 33%.

“Ohio’s health plans have long played a vital role in improving quality of care and health outcomes for Ohioans,” said Kelly McGivern, president and CEO of OAHP. “Ohio’s health plans have created and implemented innovative initiatives that have improved quality in internal practices and administration, clinical disease management, delivery of programs and services and community outreach.”

OAHP member plans are invited to participate in the annual Pinnacle Awards, which provides health plans an opportunity to demonstrate what they are doing to provide exemplary care and service for their members and community. A panel of health professionals judged the submissions and selected the winners.

SOURCE Ohio Association of Health Plans

Humana Named Top Payer For Second Consecutive Year

For the second year in a row and third time in five years, Humana Inc. (NYSE: HUM) ranks #1 in overall performance – making it the easiest payer for health care providers to do business with – in a review of 2009 claims-payment data conducted by athenahealth Inc., a provider of Internet-based business services to doctors, and Physician’s Practice magazine.

athenahealth and Physician’s Practice®, a leading practice-management journal for physicians, conduct the rankings annually to grade insurance companies on their transactions with physician offices. The complete 2010 PayerView Rankings, evaluating nearly 140 national, regional and government payers across the U.S. can be found at

“We are honored to be named the nation’s top payer for the second consecutive year by athenahealth,” said Bruce Perkins, senior vice president of healthcare delivery systems and clinical processes at Humana. “We remain committed to investments in technology that drive efficiencies, reduce administrative costs and improve customer service. Humana and athenahealth share common goals to drive innovation that creates cost-saving business transactions for health care providers, while also reducing fraud and waste in the system.”

For example, in tandem with athenahealth, Humana offers solutions such as real-time adjudication, which enables health-plan members to have a claim processed instantly before leaving the doctor’s office – which is good for all parties involved.

“The good news from athenahealth today is that Humana is continually paying physicians more quickly and accurately than our competitors, while also improving on our own company performance year over year, which results in an increasingly improved experience for our members,” Perkins said. “We take a lot of pride in that and we devote a lot of time, resources and effort into making it happen.”

Data for the 2010 rankings was derived from athenahealth’s web-based practice-management platform, athenaCollectorSM, and ranks health insurers in areas of:

  • Financial performance
  • Administrative performance, and
  • Medical-policy simplicity

The data athenahealth analyzed came from more than 23,000 health care providers in the U.S., roughly 39 million transactions and $7 billion in charges in services billed in 45 states for the full year 2009.

Humana improved across all metrics in the ratings, including dropping its “days in accounts receivable” by nearly 16 percent to an industry-leading 22.4 days. Since the ratings began five years ago, Humana has improved its performance on this metric by more than 25 percent. It is one of the most heavily weighted measures in the athenahealth rankings.

“Clearly, with its top finish three years out of five now in the athenahealth PayerView Rankings, Humana is committed to being the easiest payer for physicians to do business with,” said Jonathan Bush, chief executive officer of athenahealth. “Humana knows that this performance translates into better relationships with the medical community and more satisfied health-plan members.”

The rankings were published today on the Physician’s Practice website, in the publication’s June issue, and on athenahealth’s website.

Humana Inc., headquartered in Louisville, Ky., is one of the nation’s largest publicly traded health and supplemental benefits companies, with approximately 10.4 million medical members and approximately 7.2 million specialty-benefit members. Humana is a full-service benefits solutions company, offering a wide array of health and supplemental benefit plans for employer groups, government programs and individuals.T

Priority Health is Releasing a Suite of Personalized Smartphone Apps for Member ID Cards

Priority Health is releasing a suite of personalized smartphone apps for member ID cards, a first for the industry. The apps, for iPhone, BlackBerry and Android, will provide members with access to a mobile ID card.

“This tool delivers our members a better patient experience,” said Kimberly K. Horn, president and CEO for Priority Health. “You no longer have to scramble through your wallet for an ID card. Now you simply use your phone to access real-time information about your copays, physician and much more.”

The apps enable members to view an image of their ID card and send it electronically to their health care provider’s office. It also enables the member to view contact information for his or her primary care physician with one-touch-calling capability. Members can also see a list of dependents and contact information for Priority Health’s Customer Service department.

“We view this as a value-add for our members,” added Horn. “Our members will continue to receive their printed card as they always have, but we are definitely moving closer to a time when our members can have a completely paperless experience with Priority Health.”

This new tool will be available for all Priority Health employer group and individual members. It will require a one-time login with a request for a PIN. After the initial setup is complete, members will only need their PIN to access their ID card.

The suite of smartphone apps will release on a rolling timeline beginning with iPhone in June and following with the BlackBerry and Android phones over the next couple of months.

Priority Health has created an online demo to display the iPhone app. Learn more.

About Priority Health:
Priority Health is an award-winning health benefits company recognized for its innovative solutions that improve health, lower costs and increase patient satisfaction. It provides more than 600,000 people with a broad portfolio of products, including commercial and government health plans. As a nonprofit, Priority Health has a mission to make health care obtainable for all and provides its customers with a seamless health care experience. The company continues to be rated as one of America’s Best Health Plans by U.S. News & World Report and the National Committee for Quality Assurance.

UnitedHealthcare’s BrandPlus Rx Enables Small Businesses to Provide Pharmacy Benefit that Includes Cost-Effective Coverage of Brand-Name Drugs

UnitedHealthcare is launching BrandsPlus Rx, a new cost-effective pharmacy benefit plan that enables small businesses to offer their employees prescription drug coverage that includes higher-cost brand-name medications.

BrandsPlus Rx helps bridge potential coverage gaps by focusing, in part, on more costly brand-name and specialty drugs for which there is no equally effective generic equivalent, and which may be out of reach financially for some employees. These include medicines to treat asthma, diabetes, and other serious conditions such as HIV, hepatitis C and multiple sclerosis.

In addition, BrandsPlus Rx helps make prescription drug coverage more affordable by encouraging health plan customers to use, where available, the growing number of low-cost, over-the-counter options and generic medicines through “$4 generic programs” offered by many retail pharmacies. For example, a person taking Lipitor, a brand-name, cholesterol-lowering drug, would pay a $65 copay for one month’s supply, but can save $61 per month – or more than $700 a year – by switching to the $4 generic Pravastatin. UnitedHealthcare found that more than 25 percent of its processed prescription claims had $4 generic alternatives available*.

BrandsPlus Rx costs employers about half as much as UnitedHealthcare’s traditional pharmacy benefit plan for small businesses, and is price-competitive with other generic-only plans available in the market. BrandsPlus Rx is available now to small businesses in Arizona, Arkansas, North Carolina, South Carolina, Tennessee and Wisconsin.

“We created BrandsPlus Rx to help small businesses get the most out of their health insurance investment, while providing the security of pharmacy benefit insurance to their employees,” said Tim Heady, CEO, UnitedHealth Pharmaceutical Solutions. “Today, many small businesses looking for savings may be compelled to provide pharmacy benefit plans that cover only generic drugs or drop drug coverage altogether. BrandsPlus Rx is our solution that allows employers to offer their employees more affordable, broader prescription-drug coverage.”

BrandsPlus Rx features a four-tier copayment structure – vs. the traditional three-tier model – to help plan participants choose prescription drugs that are more cost-effective, and provides financial incentives for people who choose medicines that offer similar results at more affordable prices.

“For a number of conditions, including cholesterol management, depression and hypertension, there is a wide range of effective low-cost generics available. The widespread pharmacy discount programs provide affordable access to many generics,” Heady said.

UnitedHealthcare offers resources that support employers and their employees in making better decisions about their prescriptions. Enrollment and education materials, online price estimators, a pharmacy locator and 24/7 phone support help employees better understand and maximize the value of their pharmacy benefits. In addition, UnitedHealthcare health plan customers have access to a national network of more than 60,000 pharmacies.

About UnitedHealthcare
UnitedHealthcare provides a full spectrum of consumer-oriented health benefit plans and services to individuals, public sector employers and businesses of all sizes, including more than half of the Fortune 100 companies. The company organizes access to quality, affordable health care services on behalf of approximately 25 million individual consumers, contracting directly with more than 600,000 physicians and care professionals and 5,000 hospitals to offer them broad, convenient access to services nationwide. UnitedHealthcare is one of the businesses of UnitedHealth Group (NYSE: UNH), a diversified Fortune 50 health and well-being company.T

America’s 50 Largest Metro Areas Get Their Annual Physical

For the third straight year, the Washington, D.C., metro area claimed the highest ranking in the American College of Sports Medicine’s (ACSM) American Fitness Index(TM) (AFI). The AFI data report, “Health and Community Fitness Status of the 50 Largest Metropolitan Areas,” evaluates the most populous city areas to determine the healthiest and fittest metro areas in the United States.

The AFI data report reflects a composite of preventive health behaviors, levels of chronic disease conditions, health care access, and community resources and policies that support physical activity.

“The ACSM American Fitness Index not only measures the state of health and fitness in our nation’s largest communities, but evaluates the infrastructure, community assets, policies and opportunities which encourage residents to live a healthy and fit lifestyle,” said AFI Advisory Board Chair Walt Thompson, Ph.D., FACSM. “I liken the data report and rankings to the metro areas ‘getting a physical’ at the doctor’s office. The information learned from the physical will help each metro area identify areas of strength and weakness.”

ACSM received a grant from the WellPoint Foundation, based in Indianapolis, to present the 2010 data report.

“The WellPoint Foundation is pleased to be a continuing sponsor of the American College of Sports Medicine American Fitness Index(TM) (AFI) program,” said Wesley Wong, M.D., M.M.M. Regional Vice President and National Medical Director for WellPoint’s affiliated health plans and member of the AFI Advisory Board. “This initiative enhances our health improvement efforts across the country and allows us to be a stronger community partner in the states we serve.”

Digging into the Data

The Metropolitan Statistical Areas (MSA) of Washington-Arlington-Alexandria scored 73.5 (out of 100 possible points) in the AFI data report to achieve the top ranking, just as it did in 2008 and 2009.

Characteristics of the D.C. area that helped it achieve the top ranking are a relatively low smoking rate, a higher-than-average percentage of folks eating the recommended daily serving of fruits and vegetables, and lower-than-average rates of chronic health concerns such as obesity, asthma, cardiovascular disease and diabetes. D.C.-area residents also use public transportation regularly, meaning they are likely to walk to and from their places of work or transit stations. Also, the area of parkland as a percentage of the city’s land area is significant, providing residents with lots of space to run, bike, play sports or take a leisurely walk.

Metro areas completing the top five were Boston, Minneapolis-St. Paul, Seattle and Portland, Ore. The Baltimore, Md., area (ACSM’s host city for its 2010 Annual Meeting), ranked 20th.

The western United States dominated the top 10, with only three cities lying along the eastern seaboard. The nation’s three largest cities finished in the middle of the pack with New York at 21st, Chicago at 33rd and Los Angeles at 38th.

Education proved to be a valuable predictor of health and fitness; areas with a high percentage of residents with high school degrees or higher are more likely to be physically active and be in excellent or very good health. This group is also more likely to have health insurance.

Considering the challenging economic climate in recent years, the data suggests being unemployed may be a health concern. Metro areas with a higher unemployment rate are more likely to have a higher percentage of death related to cardiovascular disease.

Poverty levels, disability rates and the rate of violent crime correlated with other health concerns, suggesting that health officials and programs may need to put more emphasis on populations that may be underserved. For example, areas with a higher percentage of households below the poverty level are more likely to smoke, be obese, have diabetes, and have both cardiovascular disease and diabetes related deaths. They are less likely to be physically active, in excellent or very good health, or have health insurance.

The metropolitan rankings included in the report are:

Rank Metropolitan Area 2010 Score 2009 Rank 2009 Score
1. Washington, D.C. 73.5 1 74.4
2. Boston, Mass. 72.6 4 71.4
3. Paul, Minn. 71.7 2 72.1
4. Seattle, Wash. 70.5 6 69.7
5. Portland, Ore. 70.4 7 68.1
6. Denver, Colo. 69.9 3 71.6
7. Sacramento, Calif. 65.8 12 62.2
San Francisco,
8. Calif. 64.7 5 71.3
9. Hartford, Conn. 64.4 11 62.5
10. Austin, Texas 63.9 9 65.1
11. Richmond, Va. 62.7 NR N/A
12. Cincinnati, Ohio 62.5 14 60.8
13. San Diego, Calif. 62.0 8 66.8
14. San Jose, Calif. 61.0 13 61.3
15. Salt Lake City, Utah 60.6 NR N/A
16. Atlanta, Ga. 57.7 15 59.3
17. Virginia Beach, Va. 57.2* 10 63.1
18. Providence, R.I. 57.2* NR N/A
19. Orlando, Fla. 55.5 NR N/A
20. Baltimore, Md. 53.5 19 52.5
21. New York, N.Y. 52.9 22 48.9
22. Raleigh, N.C. 52.4 20 52.3
23. Pittsburgh, Pa. 52.0 16 54.3
24. Jacksonville, Fla. 51.2 28 45.2
25. Cleveland, Ohio 51.0 24 47.9
26. Philadelphia, Pa. 50.4 27 45.9
27. Milwaukee, Wisc. 49.2 17 53.0*
28. Buffalo, N.Y. 49.2 18 53.0*
29. Kansas City, Mo. 47.9 21 50.3
30. Tampa, Fla. 47.8 23 48.5
31. Nashville, Tenn. 47.8 26 46.8
32. Phoenix, Ariz. 47.4 32 42.5*
33. Chicago, Ill. 47.0 25 47.6
34. Charlotte, N.C. 44.0 34 40.3
35. Columbus, Ohio 42.8 29 43.9
36. Riverside, Calif. 42.8 40 35.1
37. St. Louis, Mo. 40.5 33 42.5*
38. Los Angeles, Calif. 40.5 30 43.6
39. Miami, Fla. 39.9 31 42.7
40. Dallas, Texas 39.5 35 39.6
41. New Orleans, La.(2) 37.7 NR N/A
42. Houston, Texas 37.6 41 34.7
43. San Antonio, Texas 36.9 39 35.5
44. Indianapolis, Ind. 35.9 36 39.3
45. Las Vegas, Nev. 35.3 42 34.6
46. Louisville, Ky. 32.5 38 37.7
47. Detroit, Mich. 31.9 44 30.5
48. Memphis, Tenn. 31.6 37 38.5
49. Birmingham, Ala. 31.2 43 32.2
50. Oklahoma City, Okla. 24.3 45 23.2

*Scores have been rounded to the nearest tenth of a point resulting in some apparent ties; however, the rankings are based on the full, calculated scores that were not equal in those cases.

**Editor’s note: NR = not ranked; N/A = not available – Most of the community/environmental data were not reported in these cities.

(2)New Orleans, La. replaced Rochester, N.Y. as the 50th largest metropolitan area in 2010.

Putting the ACSM American Fitness Index(TM) Report to Work

In addition to measuring the health and fitness of the 50 largest metro areas, the AFI data report aims to help communities develop and implement efforts to raise awareness of the issues and policies affecting health and fitness in their local area.

There are additional tools available on the AFI Web site ( to help kick-start action in the community, spread the message via local media and social networks, and guide local efforts that support health and fitness.

With AFI’s network of health promotion partners, community programs, allied associations and other organizations, each community will be able to tap into best practices and existing resources to address its unique makeup of opportunities and challenges. The ultimate result will be an improvement in community fitness and a reduction in the rates of obesity and other chronic diseases.

About the ACSM American Fitness Index(TM) Program and Report

To assist with measurement and to provide a baseline measure of health and fitness status, ACSM worked with the Indiana University School of Family Medicine and a panel of 26 health and physical activity experts on the methodology of the AFI data report. Researchers analyzed the data gleaned from U.S. Census data, the Centers for Disease Control and Prevention’s Behavioral Risk Factor Surveillance System (BRFSS), The Trust for the Public Land City Park Facts, and other existing research data in order to give a scientific, accurate snapshot of the health and fitness status at a metropolitan level.

The data examined fall into two categories: 1) Personal Health Indicators; and 2) Community and Environmental Indicators. Visit the online newsroom at for a complete list of the data components.

About the American College of Sports Medicine

The American College of Sports Medicine is the largest sports medicine and exercise science organization in the world. More than 35,000 international, national, and regional members are dedicated to advancing and integrating scientific research to provide educational and practical applications of exercise science and sports medicine.

About the WellPoint Foundation

The WellPoint Foundation, Inc. is a private, non-profit organization wholly funded by WellPoint, Inc. Through charitable contributions and programs, the Foundation promotes WellPoint’s inherent commitment to enhance the health and well-being of individuals and families in communities that WellPoint’s affiliate health plans serve. The Foundation focuses its funding on strategic initiatives that address and provide innovative solutions to health care challenges, as well as promoting the Healthy Generations Program, a multi-generational initiative that targets specific disease states and medical conditions. These disease states and medical conditions include: prenatal care in the first trimester, low birth weight babies, cardiac morbidity rates, long term activities that decrease obesity and increase physical activity, diabetes prevalence in adult populations, adult pneumococcal and influenza vaccinations and smoking cessation. The Foundation also coordinates the company’s annual associate giving campaign and provides a 50 percent match of associates’ campaign pledges. To learn more about the WellPoint Foundation please visit

Source: American College of Sports Medicine

Home Health Monitoring May Significantly Improve Blood Pressure Control, Kaiser Permanente Study Finds

The use of at-home blood pressure monitors and web-based reporting tools that connect clinicians and patients via the Internet appears to significantly improve patients’ ability to manage their high blood pressure to healthy levels, according to research from Kaiser Permanente.

The study, led by Kaiser Permanente Colorado in collaboration with the American Heart Association and Microsoft Corp., involved 348 patients with uncontrolled hypertension, ages 18-85 years. The initial study data was presented today by Kaiser Permanente Colorado researchers at the American Heart Association’s 11th Scientific Forum on Quality of Care and Outcomes Research in Cardiovascular Disease and Stroke.

“Kaiser Permanente Colorado’s Institute for Health Research is committed to studying innovative ways to make care more patient-centered in order to improve quality,” said lead author David Magid, MD, Kaiser Permanente senior scientist. “While more research is necessary, our study suggests that using technology to engage individuals in their care at home may be a better way to help patients achieve a healthy blood pressure.”

As many as 73 million Americans have high blood pressure (hypertension), a leading predictor of heart disease. According to the American Heart Association, approximately 69 percent of people who have a first attack and 77 percent who have a first stroke suffer from elevated blood pressure levels.

The participants were randomized to a usual care group or a home monitoring group. All patients had their blood pressure measured in the medical office at the start of the six-month study. The usual care group was managed in a typical model that involved checking blood pressure during office visits.

The home monitoring group used an at-home blood pressure device that uploaded data to the patient’s account in Microsoft HealthVault, a security-enhanced, Web-based data storage platform. At the time of entering the study, the participants opted into a Kaiser Permanente application that automatically transferred the home blood pressure readings to Kaiser Permanente’s electronic disease registry. Kaiser Permanente’s clinical pharmacists used the computerized registry to monitor readings and consulted with patients to adjust their antihypertensive medications based on proven protocols. Connected to HealthVault, patients were able to manage their data using Heart360, a free online tool provided by the American Heart Association.

At the start of the study, the average systolic blood pressure was 149 mm Hg in the home monitoring group and 145 mm Hg in the usual care group. At six months, patients in the home monitoring group were 50 percent more likely to have their blood pressure controlled to healthy levels compared to the usual care group. Similarly, a significantly greater decrease in systolic blood pressure at six months occurred in the home monitoring group (-21 mm Hg) versus the usual care group (-9 mm Hg).

Health experts have long known that the current approach to managing hypertension has its shortcomings. Patients often don’t comply with in-person visits and when they do, the measurements can be inconsistent or inaccurate. In light of these shortcomings, the American Heart Association recently began recommending home monitoring. However, prior research conducted by Dr. Magid found that when patients used home monitoring, but were required to write down and call-in results, blood pressure goals only slightly improved. This latest study provides an additional layer of automation and convenience by directly feeding the readings from the home blood pressure cuff to the patient’s care team via sophisticated health-IT tools.

“While the in-person doctor-patient relationship will always be a cornerstone of care, one day the use of coordinated, secure health information technologies based at home or work could complement visits in a medical office,” noted co-author Kari Olson, PharmD, a clinical pharmacy specialist at Kaiser Permanente Colorado.

“Engaging patients with tools that make health management more accessible is a critical step in addressing the alarming growth of chronic diseases and associated increase in costs,” said Peter Neupert, corporate vice president of the Health Solutions Group at Microsoft. “The preliminary results of this clinical trial are significant and demonstrate how cost-effective and flexible technology solutions can encourage patients to be active partners in their health and help decrease their risk for life-threatening, acute care incidents.”

This Kaiser Permanente Colorado research is part of a larger effort at Kaiser Permanente to study remote monitoring and connected telehealth to deliver health care at a distance outside of the traditional health care facilities.

About Microsoft HealthVault

Microsoft HealthVault is a personal health application platform designed to put consumers in control of their health information. HealthVault provides a privacy- and security-enhanced foundation on which a broad ecosystem of providers can build innovative health and wellness solutions such as personal health records, disease management, fitness, weight loss and other Web applications. HealthVault can be used to collect and store health information that would otherwise reside in disparate systems and transfer the information between a variety of providers’ health services and systems. It enables the reuse and free flow of interoperable and transportable personal health information. More information is available at

About Kaiser Permanente

Kaiser Permanente is committed to helping shape the future of health care. We are recognized as one of America’s leading health care providers and not-for-profit health plans. Founded in 1945, our mission is to provide high-quality, affordable health care services and to improve the health of our members and the communities we serve. We currently serve 8.6 million members in nine states and the District of Columbia. Care for members and patients is focused on their total health and guided by their personal physicians, specialists and team of caregivers. Our expert and caring medical teams are empowered and supported by industry-leading technology advances and tools for health promotion, disease prevention, state-of-the art care delivery and world-class chronic disease management. Kaiser Permanente is dedicated to care innovations, clinical research, health education and the support of community health. For more information, go to:

About Microsoft

Founded in 1975, Microsoft (Nasdaq “MSFT”) is the worldwide leader in software, services and solutions that help people and businesses realize their full potential. Note to editors: For more information, news and perspectives from Microsoft, please visit the Microsoft News Center at Web links, telephone numbers and titles were correct at time of publication, but may have changed. For additional assistance, journalists and analysts may contact Microsoft’s Rapid Response Team or other appropriate contacts listed at

Combining CIGNA Pharmacy and Medical Plans Proven to Yield Healthy Savings

Individuals who have a health plan that offers both medical and pharmacy benefits that are designed to work together are far more likely to obtain necessary care, according to data presented today at the International Society for Pharmacoeconomics and Outcomes Research (ISPOR) 15th Annual International Meeting. ”Gaps in care”, including not taking medications appropriately or getting necessary lab tests associated with chronic conditions such as diabetes or high cholesterol, are more likely to occur when health and pharmacy benefits are provided by different companies.

The results of the CIGNA analysis showed that individuals in health plans that combine medical and pharmacy benefits from the same company were 2.8% more likely to close gaps in their health care than those in plans where the pharmacy benefit is not integrated with the medical benefit or where pharmacy claims data is imported from another pharmacy benefit management company. By closing gaps in health care, individuals are more likely to be able to prevent complications or the progression of their conditions. The improvements in obtaining necessary care by condition were:

  • 14% higher for individuals with asthma
  • 11.7% higher for individuals with chronic renal failure (CRF)
  • 7.6% higher for individuals with hypertension (high blood pressure)
  • 7.4% higher for individuals with coronary artery disease (CAD)
  • 7.0% higher for individuals with hyperlipidemia (high cholesterol)
  • 6.5% higher for individuals with diabetes

The analysis, “Pharmacy Benefit Integration and Adherence to Evidence-Based Medicine in a Commercially-Insured Population,” was authored by Thomas J. Bunz, Pharm.D., Clinical Program Manager and co-authored by Ha V. Nguyen, senior informatics specialist, CIGNA Pharmacy Management. The abstract for this analysis was published in the May 2010 issue of Value in Health.

Integrated benefits provide the best possible connection between data, systems, people, and programs. However, to date, there has been little data to back up the assertion that these connections result in improved clinical outcomes for individuals. “The data in this analysis supports the assertion that the connection between pharmacy and medical benefits really does make a difference,” concluded Dr. Bunz. “By improving people’s health and reducing costs, we are helping to improve the quality of their lives.”

About the analysis

A retrospective cohort analysis was conducted on 262,000 individuals with medical coverage in 2008 from 25 integrated and 15 carve-out clients. Criteria included 12 months of continuous enrollment with the same employer with either an integrated or carve-out pharmacy benefit, clean demographic data, and enrollment in the CIGNA Gaps in Care program. A gap in care was defined as any month where an individual was found to be not in compliance with an applicable evidence-based rule. A closed gap was any gap in care where the individual was non-compliant in one or more months, and then compliant with the rule for the remaining months of the study year. A two part regression model (logistic regression analysis and generalized linear model) and recycled predictions were required to control for potential confounders.


CIGNA (NYSE:CI), a global health service company, is dedicated to helping people improve their health, well being and sense of security. CIGNA Corporation’s operating subsidiaries provide an integrated suite of medical, dental, behavioral health, pharmacy and vision care benefits, as well as group life, accident and disability insurance, to approximately 46 million people throughout the United States and around the world. To learn more about CIGNA, visit

eHealth Technology Now Powering Online Medicare Supplement Sales for Premera Companies in Washington, Oregon and Alaska

eHealth, Inc. (NASDAQ: EHTH) announced today that its eCommerce on Demand technology has been licensed by Premera companies in Washington, Oregon and Alaska to power online sales of Medicare Supplement products.

Seniors shopping online with Premera Blue Cross, Premera Blue Cross Blue Shield of Alaska, and LifeWise Health Plan of Oregon are now using eHealth’s ecommerce platform to compare and apply for a range of Medicare Supplement products through in Washington and Alaska and in Oregon.

“We’re pleased to expand our technology licensing relationship with Premera to include Medicare Supplement products,” said eHealth Executive Vice President Bruce Telkamp. “The same technology we’ve used to transform the way individual and family health insurance products are purchased will now serve seniors in Alaska and the Pacific Northwest to help them select and enroll in a Medicare Supplement product that best meet their needs and budget.”

“As the Baby Boomers begin to retire, an increasing number of seniors are comfortable with shopping online,” said Jeff Roe, Vice President at Premera Blue Cross. “We’ve given seniors access to a powerful, easy way to quote, compare products and enroll in the products of their choice, by licensing eHealth’s ecommerce platform for Medicare Supplement sales. We’re very pleased to make this service available to our Medicare Supplement customers.”

eHealth’s eCommerce on Demand technology provides health insurance companies with cost-effective, hosted and fully customizable software solutions to power online sales channels. It streamlines the quoting and application processes and seamlessly interacts with insurance companies’ back office systems. eCommerce on Demand technology powers some of the nation’s largest and most successful insurance websites.

About eHealth

eHealth, Inc. (NASDAQ: EHTH) is the parent company of eHealthInsurance, the nation’s leading online source of health insurance for individuals, families and small businesses. Through the company’s website,, consumers can get quotes from leading health insurance carriers, compare plans side by side, and apply for and purchase health insurance. eHealthInsurance offers thousands of health plans underwritten by more than 180 of the nation’s leading health insurance companies. eHealthInsurance is licensed to sell health insurance in all 50 states and the District of Columbia, making it a functioning national health insurance exchange. Through its eCommerce On-Demand solution (eOD),, eHealth is also a leading provider of on-demand e-commerce software services. eHealth’s eOD platform provides a suite of hosted solutions that enable health plan providers and resellers to market and distribute products online. eHealth’s eCommerce On-Demand solution is currently available to health plan providers in all 50 states and the District of Columbia. eHealthInsurance and eHealth are registered trademarks of eHealthInsurance Services, Inc.

About Premera Blue Cross

Our mission is to provide peace of mind to our members about their healthcare coverage. We provide health coverage and related services to more than 1.4 million people. Premera Blue Cross has operated in Washington since 1933, and Alaska since 1952. Premera Blue Cross is a not-for-profit, independent licensee of the Blue Cross Blue Shield Association.

Premera Blue Cross is a member of a family of companies based in Mountlake Terrace, Washington, that provide health, life, vision, dental, stop-loss, disability, and other related products and services. Please visit for more information.

About LifeWise Health Plan of Oregon

LifeWise Health Plan of Oregon has been serving the health insurance needs of Oregon families and employers for more than 20 years. LifeWise is a member of a family of companies with operations in Portland and Bend, Oregon; Mountlake Terrace and Spokane, Washington; Anchorage, Alaska. LifeWise and its affiliates employ about 3,000 people and provide healthcare coverage and related services to 1.6 million members and their families

Participants Announced In Michigan Initiative To Reduce Hospital Readmissions

Blue Cross Blue Shield of Michigan, the University of Michigan and the Society of Hospital Medicine (SHM), have selected 15 physician organizations working with 14 hospitals to participate in a statewide Michigan initiative to reduce preventable readmissions to the hospital and emergency room visits.

The initiative, called “Michigan Transitions of Care Collaborative,” is based on the Society of Hospital Medicine’s Project BOOST (Better Outcomes for Older Adults through Safer Transitions) model. It involves training and mentoring to help physician organizations and hospitals develop, implement and measure programs that reduce the incidence of patients being readmitted to the hospital within 30 days of their discharge.

In a press release announcing the collaboration, it was noted that unplanned readmissions to the hospital are costly and preventable, draining the resources, time, and energy of the patient, primary care physician, and hospital.  Research in the April 2009 New England Journal of Medicine indicates that one in five hospitalized patients is readmitted to the hospital within a month of their discharge.

Nationally, unplanned readmissions cost Medicare $17.4 billion each year, making estimates about the total cost even higher.

“We are very excited about the high level of energy that has been generated for this program, and we expect this initiative to have a positive impact on improving the way providers and hospitals transition patients to outpatient settings,” says Christopher Kim, M.D., M.B.A., S.F.H.M., hospitalist at the University of Michigan and director of the state-wide collaborative program on transitions of care.  “Participating physician groups and hospitals will share best practices and key learnings, leading to improvements in quality and safety for Michigan patients.”

About SHM
SHM is the premier medical society representing hospitalists.  Over the past decade, studies have shown that hospitalists decrease patient lengths of stay, reduce hospital costs and readmission rates, all while increasing patient satisfaction.  Hospital medicine is the fastest-growing specialty in modern healthcare, with over 31,000 hospitalists currently practicing and an upward growth trajectory in full force.  For more information about SHM, visit

About Blue Cross Blue Shield of Michigan
Blue Cross Blue Shield of Michigan, a nonprofit organization, provides and administers health benefits to 4.5 million members residing in Michigan in addition to members of Michigan-headquartered groups who reside outside the state.  The company offers a broad variety of plans including: Traditional Blue Cross Blue Shield; Blue Preferred®, Community BlueSM and Healthy Blue IncentivesSM PPOs; Blue Care Network HMO; BCN Healthy Blue LivingSM; Flexible BlueSM plans compatible with health savings accounts; Medicare Advantage; Part D Prescription Drug plans, and MyBlueSM products in the under-age-65 individual market.  BCBSM also offers dental, vision and hearing plans.  Blue Cross Blue Shield of Michigan and Blue Care Network are nonprofit corporations and independent licensees of the Blue Cross and Blue Shield Association.  For more company information, visit

UnitedHealthcare Wellness Programs Now Available With At-Home Health Screening Kits

UnitedHealthcare, a UnitedHealth Group (NYSE: UNH) company, is now offering at-home health screening kits as part of corporate wellness programs for employers. The health screening kits enable employees to more easily test for conditions such as diabetes and heart disease. Test results will help patients work with their doctors to detect conditions early and develop appropriate treatment plans.

The kits, developed by Santa Barbara, Calif.-based BioIQ, are available nationwide to employers who self-fund their health benefit plans. Each BioIQ at-home health screening kit contains components and instructions for drawing a tiny blood sample, from a finger prick, that is mailed to a certified laboratory for analysis. The easy-to-understand lab reports, along with personalized health recommendations based in part on the test results, are available through password-protected accounts on BioIQ’s secure Web portal. In addition, the lab reports are automatically populated into the patient’s online health assessment and personal health record on

UnitedHealthcare is among the first health insurers in the nation to offer at-home health screening kits as part of a wellness program. Employers are increasingly adopting wellness programs as a way to improve employee health and productivity and to better manage their health care costs. Wellness Council of America estimates that a $1 investment in a wellness program saves $3 in health care costs.

“At-home health screening kits can make an impact in the early detection of certain illnesses, and ultimately save lives,” said Sam Ho, M.D., UnitedHealthcare executive vice president and chief medical officer. “We believe these kits can help improve employees’ health and reduce their health care expenses, which employers are looking for. Home test kits help provide consumers with the care support they need through one of our many wellness and care management programs that supplement the essential relationship individuals have with their physicians.”

The kits test for both heart disease and diabetes from one small blood sample – only a few drops of blood are required. For heart disease, they measure the amount of total cholesterol, HDL, triglycerides and LDL cholesterol value. The kits also include a choice of diabetes tests – either for A1c, which measures average blood sugar over the past 90 days, or glucose, which measures blood sugar at the time of testing.

Also, each kit contains everything needed to collect and mail one small blood sample, including clear, step-by-step instructions and a postage-paid return envelope.

“These kits can help empower people to consult with their physicians in order to detect diseases early and develop an appropriate treatment program,” said Dr. Ho. “In addition to the lab results, individuals receive a physician discussion form that can help foster dialog between patients and their physicians.”

The national launch of the at-home screening kits follows a UnitedHealthcare pilot program last year with select employers in the state of Washington. The program resulted in helping to identify about 10 percent of participating employees as having high cholesterol and 4 percent as having elevated indicators for diabetes.

Spokane, Wash.-based ACRAnet was one of more than 80 firms that participated in the pilot. “Employees were very receptive to the program, in part because the tests were easy, accurate and, most importantly, private,” said Preston Ritter, ACRAnet assistant general manager. “The program helped keep our health care costs down, enhanced employee productivity and improved the overall health of our work force.”

“These test kits are safe, easy to use and have the potential to significantly improve disease detection in this country,” said Justin Bellante, CEO of BioIQ. “Testing involves only a quick pin prick that can be done in the comfort of a person’s home. People then put the sample in a prepaid envelope and drop it in the mail.”

About BioIQ
BioIQ develops and markets medical diagnostic solutions through corporate, institutional and direct-to-consumer channels. The company’s affordable and innovative home test kits are commonly used to monitor or screen for diabetes, cancer, heart disease, kidney disease, thyroid disorder, osteoporosis and other chronic health conditions. BioIQ programs include comprehensive health reports, live customer support, optional health coach follow-up, integration with electronic health records and a complete communications plan for encouraging participation with employees and dependents.

About UnitedHealthcare
UnitedHealthcare provides a full spectrum of consumer-oriented health benefit plans and services to individuals, public sector employers and businesses of all sizes, including more than half of the Fortune 100 companies. The company organizes access to quality, affordable health care services on behalf of approximately 25 million individual consumers, contracting directly with more than 600,000 physicians and care professionals and 5,000 hospitals to offer them broad, convenient access to services nationwide. UnitedHealthcare is one of the businesses of UnitedHealth Group (NYSE: UNH), a diversified Fortune 50 health and well-being company.