Humana Military Healthcare Services Announces New Disease Management Program for Depression

LOUISVILLE, Ky.–(BUSINESS WIRE)–Humana Military Healthcare Services, a wholly owned subsidiary of Humana Inc. (NYSE: HUM), announces its new Depression Disease Management Program for the TRICARE South Region beneficiaries. The Depression Disease Management Program offers guidance, via telephone, by one of our staffed clinicians in understanding, diagnosing, and managing Depression.

“Depression is a major behavioral health concern that impacts the everyday health and well-being of both our active and retired military populations,” said Dave Baker, president and CEO of Humana Military. “We are pleased to offer this Depression Disease Management Program and its services for our TRICARE beneficiaries, at a time when mental health and suicide prevention continues to be of rising national concern,” said Baker.

The Depression Disease Management Program topics include:

  • Signs of Depression
  • Causes of Depression
  • Depression Treatment

Beneficiaries and their TRICARE health care providers have access to on-line web resources, as well as a toll free number, 1-800-881-9227 to speak with one of our qualified, dedicated personnel. Humana Military also offers disease management services for heart failure, asthma, diabetes, and pulmonary disorders. For more information about other Humana Military Disease Management Programs, visit our Disease Management Program section under our Beneficiary portal at www.humana-military.com.

About Humana Military Healthcare Services

Humana Military, a wholly owned subsidiary of Humana Inc. and headquartered in Louisville, Kentucky, has been a Department of Defense contractor for the administration of the TRICARE program since July 1, 1996. In August 2003, Humana Military was awarded the contract to provide health-benefits support and services to approximately three million active duty and retired military and their eligible family members in the 10-state South Region. For more information about Humana Military, please visit www.humana-military.com.

About Humana

Humana Inc., headquartered in Louisville, Ky., is one of the nation’s largest publicly traded health and supplemental benefits companies, with approximately 10.1 million medical members and approximately 7 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.

Highmark Inc. Collaborates with the Alliance for a Healthier Generation to Address Childhood Obesity

PITTSBURGH, Nov. 29, 2010 /PRNewswire/ — Thirty-nine percent of the children living in Pennsylvania are overweight and are at greater risk of developing such chronic diseases as diabetes, high blood pressure and heart disease than the generation before them. To continue its efforts to address childhood obesity, Highmark Inc. has collaborated with the Alliance for a Healthier Generation to expand its obesity benefits for children in 2011.

“Highmark has signed on to collaborate with the Alliance for a Healthier Generation’s Health Care Initiative to support the goal to provide a holistic approach to the prevention, assessment and treatment of childhood obesity through multiple avenues, including health insurance offerings,” said Dr. Donald R. Fischer, Highmark’s chief medical officer. “More than 500,000 children will have access to this important care through Highmark. By decreasing the health risks of children, we decrease the number of children who will most likely develop into unhealthy adults. Highmark’s commitment to this endeavor is an investment in the health of the entire community.”

The Alliance for a Healthier Generation, a nonprofit organization founded by the American Heart Association and the William J. Clinton Foundation, works to positively affect the places that can make a difference to a child’s health — homes, schools, doctors’ offices and communities.

“We know that our network physicians are equally concerned about childhood obesity and represent a valuable resource of expertise and caring,” added Dr. Fischer. “Highmark’s participation in this initiative is helping to remove some barriers so that our network physicians can provide the optimal health care and guidance needed to address obesity.”

Starting Jan. 1, 2011, children ages 3 to 18 with a BMI over the 85th percentile for their age are eligible to receive the benefits and will be automatically enrolled. Through a preventive health benefit plan, eligible children will receive a minimum of four follow-up visits with their primary care provider (or other health care professional), along with four visits with a registered dietitian.

“Without proper prevention and treatment of childhood obesity, our current generation could become the first in American history to live shorter lives than their parents,” said Ginny Ehrlich, Alliance for a Healthier Generation executive director. “We applaud Highmark for making this ongoing commitment to help reverse the childhood obesity epidemic.”

Highmark has had a deep history in promoting children’s health. The collaboration with the Alliance for a Healthier Generation will serve as a complement to the existing programs, services and funding that Highmark has been providing to address this national issue. The alliance’s goal of providing comprehensive health benefits for the prevention, assessment and treatment of childhood obesity aligns with Highmark’s mission and the Highmark Healthy High 5 initiative to promote lifelong healthy behaviors in children and adolescents.

Highmark values the Alliance for a Healthier Generation’s long-term goal that more than 6 million children, or 25 percent of all overweight and obese children in the United States, will have access to this benefit by 2012.

The picture above shows a timeline of Highmark’s history in addressing childhood obesity.

SOURCE: Highmark Inc.

Norton Healthcare and Humana Launch Accountable Care Organization in Louisville, Ky.

LOUISVILLE, Ky.–(BUSINESS WIRE)– Humana Inc. (NYSE:HUMNews) and Norton Healthcare, both based in Louisville, Ky., have been working together to launch the region’s first commercial Accountable Care Organization (ACO). The Norton-Humana partnership began in early 2010. An ACO model establishes incentives for health systems to increase quality and efficiency, better coordinate patient care, eliminate waste, and reduce the overuse and misuse of care.

The Engelberg Center for Health Care Reform at the Brookings Institution and The Dartmouth Institute for Health Policy and Clinical Practice selected Humana and Norton Healthcare to partner in one of only five national pilot sites, the only one in Kentucky, to implement the ACO model through the Brookings-Dartmouth ACO Pilot Project. The other pilot sites include Carilion Clinic, Roanoke, Va.; Tucson Medical Center, Tucson, Ariz.; HealthCare Partners Medical Group, Torrance, Calif.; and Monarch HealthCare, Irvine, Calif. Humana has worked with Brookings-Dartmouth since 2008 on exploring the ACO concept and other innovative payment models.

“Norton Healthcare’s work in developing an integrated health care delivery system and Humana’s commitment to continuous improvement in quality provide a strong foundation from which to pilot the payment reforms central to ACOs,” said Dr. Elliott Fisher, director of the Center for Population Health at The Dartmouth Institute for Health Policy and Clinical Practice.

“Norton Healthcare is proud to be a participant in the Brookings-Dartmouth ACO Pilot Project and we feel this is a tremendous opportunity to participate in an alternative model for health reform,” said Dr. Steve Hester, Norton Healthcare senior vice president and chief medical officer. “Considering our health care system’s industry-leading commitment to measuring and openly reporting on the quality of our care; our progress toward a system-wide integrated electronic medical record; and our large base of employed primary- and specialty-care physicians, Norton Healthcare was the logical choice in our region to be an ACO pilot participant.”

Humana is a leading health-benefits provider in its corporate hometown of Louisville, Ky., with a broad network of hospitals and health systems in Kentucky and Southern Indiana. Humana has had extensive experience in partnerships aimed at improving health care delivery and reimbursement models for many years. Norton Healthcare is the Louisville area’s leading health care system, caring for nearly one of every two patients at more than 100 locations throughout Greater Louisville and Southern Indiana.

“Humana is committed to innovative local and national models that improve clinical outcomes, reduce costs and improve efficiencies,” said Bruce Perkins, senior vice president of Humana’s healthcare delivery systems and clinical processes organization. “Humana plans to continue to develop more ACO models by partnering with providers in multiple regions. Our focus in exploring additional ACO relationships is to help drive innovation in the marketplace.”

Rewarding effective care, not quantity

The ACO model has gained national recognition as a meaningful way to create new financial incentives in our current health care system by holding health care providers accountable for the overall effectiveness, efficiency and cost of the care they provide. In contrast, the current fee-for-service payment system rewards volume and intensity rather than efficiency and effectiveness of care, often penalizing those systems that attempt to improve care. ACOs have been specifically addressed in the recent federal health care reform legislation through a new Medicare shared-savings program. And ACOs have been applauded for their intent to support patient engagement and the promotion of evidence-based medicine.

“Accountable Care Organizations are a model for delivery reform that can be part of a solution to help transform our nation’s health care system from one that promotes excessive costs to one that explicitly supports providers when they take steps to achieve high-quality care at lower costs,” said Dr. Mark McClellan, director of the Engelberg Center for Health Care Reform at the Brookings Institution. “We look forward to working with Norton Healthcare and Humana to test this promising new model.”

The Brookings-Dartmouth team, led by Drs. Fisher and McClellan, is working closely with Humana and Norton Healthcare to offer technical and strategic support in the implementation of the ACO model. Each ACO site defines the patient population it serves and establishes a spending target that reflects the predicted costs for their patients. The goals of ACOs are to improve efficiency and effectiveness of care and slow spending growth. ACO providers who can demonstrate that they meet these goals will receive in return a portion of the savings achieved.

“The ACO model really gets at bending the cost curve, which is so vital to achieving a sustainable system,” said Dr. Fisher. “Only health systems that can slow their spending growth, compared to previous years, will have the opportunity to receive shared savings.”

Although the Norton-Humana ACO is still in its early stages of implementation, the pilot has identified several initial areas of emphasis, such as improvements in the use of preventive screenings and tests (such as mammograms) and vaccinations, better coordination in the management of chronic illnesses (such as heart failure), more effective treatment of common problems (such as back pain), appropriate utilization of generic drugs to lower costs, and improved access to the appropriate level of care (such as primary care rather than emergency department treatment).

Going Forward

As the Louisville area’s largest hospital and health care system, Norton Healthcare is committed to providing quality health care. Norton has a sophisticated infrastructure for measurement of quality and data management in place. Looking ahead, Norton plans to move from process metrics to outcomes metrics, further develop innovative delivery models of care, and assume broader responsibility for health care delivery.

“Humana recognizes the need for change in health care delivery across the country. We are excited to participate in the development of new processes that encourage continuous improvement in quality while finding greater efficiencies in the delivery of care,” said Dr. Tom James, Humana corporate medical director.

In addition to providing technical support in the implementation of ACOs, the Brookings-Dartmouth team will evaluate the pilots to see how ACOs can impact the future of payment reform. The goal is to develop a model that can be replicated across the nation, building on health reform legislation which will likely make ACOs a voluntary option with Medicare participation in 2012.

“We are excited about the launch in Louisville and look forward to expanding the ACO model to other patient populations, including other commercially insured, Medicare and Medicaid beneficiaries,” said Dr. Fisher. “We are hoping that the hard work of Norton Healthcare and Humana will lead the way for other health systems and will be the start of a successful national roll-out.”

About Norton Healthcare

For more than a century, Norton Healthcare’s faith heritage has guided its mission to provide quality health care to all those it serves. Today, Norton Healthcare is the Louisville area’s leading hospital and health care system (44 percent market share) and third largest private employer, providing care at more than 100 locations throughout Greater Louisville and Southern Indiana.

The not-for-profit system includes five Louisville hospitals; 12 Norton Immediate Care Centers; 10,900 employees; more than 400 employed medical providers; and nearly 2,300 total physicians on its medical staff. For five consecutive years, Norton Healthcare has been recognized as one of the Best Places to Work in Kentucky.

The health care system serves patients in the Greater Louisville area, including Southern Indiana, and throughout Kentucky. For more information, visit www.NortonHealthcare.com.

About Humana

Humana Inc., headquartered in Louisville, Kentucky, is one of the nation’s largest publicly traded health and supplemental benefits companies, with approximately 10.1 million medical members and 7.0 million specialty members. Humana is a full-service benefits solutions company, offering a wide array of health, pharmacy and supplemental benefit plans for employer groups, government programs and individuals.

Aetna Launches Diabetes Pilot With Medical Clinic Of North Texas To Improve Health Outcomes Of Hispanic And African American Patients

DALLAS, November 22, 2010 —  Aetna (NYSE: AET) today announced a pilot with the Medical Clinic of North Texas (MCNT) aimed at improving the care of diabetic patients of Hispanic and African American descent. The new program is a year-long initiative that includes adding a bilingual diabetic educator, as well as introducing culturally appropriate materials to educate and engage patients in their health care. The pilot strengthens Aetna’s ongoing efforts to reduce disparities in health care, as well as develop and deliver culturally appropriate care for its members.

The success of the pilot will be determined by the health outcomes of the patients, which will be based on 17 distinct measures. These measures include improving levels of diabetic control, such as medication compliance, blood pressure, blood sugar and cholesterol rates, eye and foot screening rates, as well as other measures of quality health care, such as reducing avoidable inpatient and emergency room stays.

“We are pleased to work with the Medical Clinic of North Texas on this pilot,” said Wayne Rawlins, M.D., M.B.A., national medical director, racial and ethnic equality initiative at Aetna.  “Our goal is to improve the health of minority patients, and MCNT is a cutting edge medical group with an expertise in diabetes management.  They have already gathered racial and ethnic data, and their knowledge base will help us gauge the success of this pilot and determine if our targeted interventions can improve the lives of Hispanic and African American patients struggling with diabetes.”

“We at MCNT are excited to partner with Aetna on this pilot,” said Karen Kennedy, CEO, Medical Clinic of North Texas.  “What is particularly appealing is that the pilot focuses on greater access for our diabetic Spanish speaking and African American patients.  We’ll be measuring what the pilot’s components will actually do for our patients, and have developed concrete measures to quantify the program’s success.”  Approximately 5,000 patients are expected to participate in this pilot.

A primary component of the pilot is the hiring of a part-time bilingual diabetic educator, who will serve as a care coordinator to assist in diabetic education and patient coaching.  Additionally, patients and MCNT staff will be provided with bilingual, culturally competent educational materials that are easy to understand.  These include brochures produced by the American College of Physicians Foundation as well as materials from the Joslin Diabetes Center, considered the world’s preeminent diabetes research and clinical care organization.

“The collection of this data gives Aetna a better understanding of its member population, enabling us to deliver on our longstanding commitment to improve racial and ethnic equality in health care,” Rawlins said.  “Our goal is to identify information that helps us to create and deliver effective health management programs and services to members who can benefit from them.”

About Aetna
Aetna is one of the nation’s leading diversified health care benefits companies, serving approximately 35.4 million people with information and resources to help them make better informed decisions about their health care. Aetna offers a broad range of traditional and consumer-directed health insurance products and related services, including medical, pharmacy, dental, behavioral health, group life and disability plans, and medical management capabilities and health care management services for Medicaid plans. Our customers include employer groups, individuals, college students, part-time and hourly workers, health plans, governmental units, government-sponsored plans, labor groups and expatriates. For more information, see www.aetna.com. To learn more about Aetna’s innovative online tools, visit www.aetnatools.com.

MedAssurant to Improve Data-Driven Care Coordination with BlueCross and BlueShield of Florida

MedAssurant Inc., a leading provider of data-driven health care solutions, today announced that Blue Cross and Blue Shield of Florida (BCBSF) is expanding its relationship with MedAssurant through the implementation of the Prospective Advantage™ solution to aid in the improvement of care coordination for their Medicare Advantage members.

MedAssurant’s Prospective Advantage combines advanced predictive analytics with patient and provider encounter facilitation to support informed care coordination. Following the analytical identification of gaps in quality, care, encounters and documentation, Prospective Advantage determines optimal timing, method, and content of outreach to patients and providers, as well as determining the necessary venue and decision support for encounters, to close gaps in a prioritized fashion. Through this sophisticated, member-specific approach, BCBSF will facilitate quality care for members by connecting them with their physicians and providing the physicians with a powerful, yet simple to use decision support platform.

“Through the expansion of our relationship with BCBSF, together we are using data and analytics to intelligently improve the quality, cost, and care initiatives that impact of Medicare Advantage members and the practitioners that support them,” said Phillip Traylor, Senior Vice President of Care and Quality Management at MedAssurant. “The MedAssurant and BCBSF relationship dates back to 2005 when MedAssurant began coordinating Health Effectiveness Data and Information Set (HEDIS) analysis, documentation and reporting. Since that time, MedAssurant has also provided BSBSF with solutions for clinical data accuracy, risk adjustment, medical record review and claims analytics.”

About MedAssurant Inc.

MedAssurant Inc. is a leading technology-enabled healthcare solutions provider focused on the importance of healthcare data and its ability to drive dramatic, objective improvement in clinical and quality outcomes, care management and financial performance throughout the healthcare community. Proprietary healthcare datasets, aggregation and analysis capabilities, combined with a national infrastructure of leading-edge technology, clinical prowess and deep human resources, empowers MedAssurant’s advanced generation of healthcare assessment and improvement through highly informed solutions. Driven by a mission to improve today’s healthcare landscape, the employees of MedAssurant proudly apply care, ingenuity and dedication to delivering a new approach to healthcare touching more than 100 million Americans – one driven by data and insight – one resulting in meaningful action. Please visit www.medassurant.com for more information.

UnitedHealthcare’s “UnitedHealth Personal Rewards” Program Gives Consumers Customized Road Maps to Healthier Lifestyles

MINNETONKA, Minn.–(BUSINESS WIRE)–UnitedHealthcare has launched “UnitedHealth Personal Rewards,” an innovative program that uses health scorecards to encourage healthy behaviors and target specific health actions using customized information, financial incentives and ongoing support for consumers.

UnitedHealth Personal Rewards uses personalized, secure online scorecards that serve as unique health care road maps for each consumer based on health status, lifestyle and personal health needs. The program offers customized health action plans and encourages regular care for people living with chronic illnesses. Incentives to participate include savings on an employee’s monthly premium, extra money for a health care account or one-time cash payments.

The scorecards help people track their progress and keep tabs on the health actions they can take in order to earn incentives. As individuals complete the actions, their point scores increase, making them eligible for greater rewards and potentially improved health, which may result in medical expense savings. Some actions, such as preventive doctor visits, are available to all participants, while others are customized to an individual’s life stage or health status, such as getting a mammogram or enrolling with a health coach.

UnitedHealth Personal Rewards is currently available to self-insured National Accounts and Public Sector employers with more than 3,000 UnitedHealthcare medical plan participants. Large companies including Jones Lang LaSalle (NYSE: JLL) and The Hertz Corporation (NYSE: HTZ) have already implemented the program.

“UnitedHealth Personal Rewards is a personally tailored wellness program that encourages people to make positive health and behavior changes rather than waiting to treat illness,” said Sam Ho, M.D., chief medical officer, UnitedHealthcare Employer & Individual. “The program offers plan participants personalized health care road maps based on each individual’s unique health status and the needs of an employer’s population. By connecting specific actions with meaningful incentives, we’re confident we’ll be able to motivate healthier behaviors over the long term.”

According to the Centers for Disease Control and Prevention (CDC), 50 percent of a person’s health status is a result of behavior – choices made each day with respect to physical and emotional well-being. CDC studies also show that nearly half of the health care decisions people make are “sub-optimal,” meaning an alternative choice may have led to a better clinical and/or financial outcome.

Jones Lang LaSalle, a Chicago-based commercial real estate services firm, was among the first companies to offer its employees UnitedHealth Personal Rewards in January. Park Ridge, N.J.-based Hertz rolled out its program, called A Credit to Your Health, to more than 15,000 of its plan participants in September, and UnitedHealth Group has been offering the program since January to its own employees and family members enrolled in the company’s health benefit plans.

“UnitedHealth Personal Rewards is attractive to us because it fits in with our business priorities and philosophy of empowering our employees to make personally relevant choices that can improve their health while helping to control their health care costs,” said Howard Futterman, vice president of benefits, Jones Lang LaSalle. “We’re able to provide a health management program that rewards all of our employees – regardless of their health status – with incentives that are tied to action and results.”

UnitedHealthcare estimates that a positive return on investment (ROI) can be seen as early as year two of the program. Jones Lang LaSalle is projecting a strong 2011 ROI for its Health Empowerment Program, of which UnitedHealth Personal Rewards is a key component. The company also expects a 10-percent improvement in its employees’ baseline biometric scores in 2011 compared with 2010.

“We wanted to incent and energize our employees to become more aware of and accountable for their own health,” said LeighAnne Baker, senior vice president and chief human resources officer for The Hertz Corporation. “Personal Rewards is about employees ‘owning’ their health decisions and taking the essential steps to get healthy, stay healthy and enjoy a better life.”

Recent UnitedHealthcare research confirms incentives drive better health behaviors. When offered incentives, individuals report that they are “extremely likely” or “very likely” to complete recommended preventive health care actions such as annual exams and cancer screenings, and enrolling in weight-management, disease-management or smoking-cessation programs.1

In January, UnitedHealth Group began offering UnitedHealth Personal Rewards as a pilot program to its more than 90,000 employees and family members. So far:

  • 71 percent of plan participants have earned points in the program
  • 45 percent of plan participants have earned at least half of their incentive
  • 51 percent of eligible employees have completed worksite biometric screenings
  • Year-over-year results from January to September 2010 compared to the same period in 2009 show that wellness coaching enrollment has increased more than 400 percent.

About UnitedHealthcare
UnitedHealthcare (www.unitedhealthcare.com) 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 more than 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.

OptumHealth Debuts OptumizeMe Fitness App to Help Microsoft® Windows Phone 7 Users Connect and Compete for Better Health

GOLDEN VALLEY, Minn.–(BUSINESS WIRE)– OptumHealth, one of the nation’s largest health and wellness companies, today announced the release of the OptumizeMe mobile application. Designed exclusively for the many new Windows® Phone 7 devices, OptumizeMe helps people pursue their health goals through their own online social networks, where they can track their progress and issue fun fitness challenges to their friends, family and coworkers.

OptumizeMe, selected by Microsoft as a Premier Launch App, is designed to maximize the features of the Windows Phone 7 platform. It is available now, free of charge, at the Windows® Phone Marketplace. The app is part of the Microsoft Windows Phone 7 showcase.

With OptumizeMe, people can create and challenge each other to fitness competitions, and trade both encouragement and “digs” along the way. Users can network with friends using the app, or link to their existing social networks to create new fitness challenges. The application tracks their progress on challenges, and rewards them with virtual badges as they achieve their goals. OptumizeMe also uses the Windows Phone 7’s location capabilities to help fitness enthusiasts locate and join open challenges happening near them.

“If you’re the kind of person who lives life on the go, wants to increase your fitness and can’t resist a good challenge, OptumizeMe is the app for you,” said Rob Webb, CEO of OptumHealth Care Solutions. “It makes living a healthy lifestyle easier and more fun for people with Windows Phone 7 mobile devices by creating connections with friends who share similar fitness goals. Most of us already use our social networks to stay in touch with each other, so why not use them to share the experience of getting healthier together?”

According to a recent New England Journal of Medicine report, healthy behavior actually spreads through social connections. OptumizeMe links with online social networks like Facebook to make healthy activity a social activity. For example, OptumizeMe can post updates to a user’s Facebook wall to allow friends to monitor the person’s progress and post messages of support.

“Windows Phone 7 is backed by a rich developer ecosystem that is creating a variety of quality apps and games designed to help people get the most out of their phone,” said Todd Brix, senior director, Windows Phone Marketplace, Microsoft Corp. “OptumizeMe is a great example of the innovative apps available on Windows Phone Marketplace that take advantage of Windows Phone 7’s unique features and design.”

Sixty mobile operators in 30 countries will offer Windows Phone 7 mobile devices, available in the United States Nov. 8.

About OptumHealth

OptumHealth helps individuals navigate the health care system, finance their health care needs and achieve their health and well-being goals. The company’s personalized health advocacy and engagement programs tap a unique combination of capabilities that encompass public sector solutions, care solutions, behavioral solutions, specialty benefits and financial services. Serving nearly 60 million people, OptumHealth is one of the nation’s largest health and wellness businesses, and is a UnitedHealth Group (NYSE:UNHNews) company. More information about OptumHealth can be found at www.optumhealth.com.

Oregon Small Businesses Now Have More Health Benefit Options with UnitedHealthcare’s ‘Multi-Choice’ Plan

PORTLAND, Ore.–(BUSINESS WIRE)– UnitedHealthcare is now offering a new health plan package in Oregon called Multi-Choice that gives small businesses across the state more benefit plan options they can offer their employees while keeping cost-effective coverage in place.

Multi-Choice, available to businesses with up to 50 employees, allows employers to offer their employees as many as 15 different health plan options, each with different coverage levels, deductibles and premiums. Employers assemble a package of benefit designs for their employees and set a defined contribution level; each employee then has the opportunity to select a plan that best meets his or her needs. This flexibility makes offering health insurance more cost-effective and financially predictable, helping small-business owners continue their ability to offer coverage for their workers.

Employees enrolled in Multi-Choice have several health plan designs to choose from, including:

  • traditional benefit designs with various premium, deductible and coinsurance levels;
  • consumer-driven designs paired with a health savings account (HSA) or health reimbursement account (HRA); and
  • health plans that add specialty benefits, including dental, life, disability and vision.

“Small businesses in Oregon are looking for health care options that are both cost-effective and flexible, and that is why small businesses are showing so much interest right now in Multi-Choice,” said Stephanie Murphy, principal producer of The Ladd Group, a benefit consultant firm in Portland. “This innovative package of health benefit plans is providing employers and their work forces with a new level of choice and financial predictability, which is helping companies to continue to offer coverage.”

“UnitedHealthcare Multi-Choice enables more small businesses to provide the right coverage levels to each of their employees while still controlling costs,” said David Hansen, CEO, UnitedHealthcare of Oregon. “We recognize that small businesses and their employees are faced with many challenges in today’s economic environment, so we created Multi-Choice to help them access flexible, cost-effective health care options.”

Multi-Choice plan participants have access to UnitedHealthcare’s wellness and disease management programs, 24/7 access to OptumHealth’s NurseLineSM, and a national network of more than 600,000 physicians and 5,000 hospitals, including more than 5,500 physicians and 50 hospitals in Oregon.

About UnitedHealthcare
UnitedHealthcare provides a full spectrum of consumer-oriented health benefits 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:UNHNews), a diversified Fortune 50 health and well-being company.

Docs and Patients Now Have More Ways to Get CIGNA’s Real-Time Itemized Cost Estimates

BLOOMFIELD, Conn., November 09, 2010 – CIGNA (NYSE: CI) announced today that it will expand access to its CIGNA Cost of Care Estimator® through four of the largest health information networks in the U.S.: Availity, NaviNet, Passport Health Communications Inc. and RealMed (an Availity Company). These companies service 90 percent of America’s physician practices, hospitals, and clinical facilities.

“The CIGNA Cost of Care Estimator is delivering on our promise to both our contracted physicians and our customers to make our health plans transparent,” said James Nastri, CIGNA vice president of product and service transparency. “By opening access to Estimator through the nation’s largest health information networks, we can help more individuals understand their plan coverage and address any cost issues upfront, so that both doctors and patients can focus on improving health rather than worrying about potential financial unknowns after the fact.”

Since it was launched nationwide in April 2009 on the CIGNA for Health Care Professionals website, (www.cignaforhcp.com), the CIGNA Cost of Care Estimator® has delivered real-time, pre-care itemized estimates of specific treatment charges and payments for 21,000 health care professionals. The Estimator’s Explanation of Estimate provides a simple, clear explanation of the key elements of payment for medical procedures and treatments and is designed to correspond with the award-winning CIGNA Explanation of Benefits.

Sekine, Rasner & Brock OB/GYN Practice Administrator Judi Lento says she prints out a CIGNA explanation of estimate for every CIGNA-covered patient: “The estimate really makes the whole process simpler for both our office and our patients. It is essential for defining the treatment, coverage and any potential out-of-pocket costs up front — so there’s no guesswork, confusion or administrative issues. Our patients really appreciate getting accurate information in advance, and the CIGNA Estimator has helped our practice save hundreds of thousands of dollars.

“The Estimator approach is truly revolutionary because unlike real-time claims adjudication, it does not require purchasing technology and re-keying information into our practice management system,” said Lento. “Because we will now be able to access CIGNA’s estimates through a multiple payer system, our office flow will be even better than before.”

The CIGNA Explanation of Estimate provides the key information individuals need to know about how their CIGNA medical benefits are applied to their physician’s services:

  • Total Cost: Estimation of the total cost of services, including both the amount to be paid by CIGNA and the amount the covered individual will owe;
  • Patient Cost: The anticipated amount covered individuals will owe after their plan benefits are applied to the estimated total cost, including any deductible, coinsurance, or co-payment;
  • Potential Fund Payment: This displays the estimated amount to be paid automatically to the health care professional at the time the estimate is run from available funds in the covered individual’s Flexible Spending Account (FSA), Health Savings Account (HSA), or Health Reimbursement Arrangement (HRA) as well as any additional funds that may be owed. Ninety-two percent of individuals enrolled in CIGNA’s consumer-driven, account-based health plans have opted for automatic claims payment.

Beginning in the fall of 2010, health care professionals have the additional option of producing estimates for their patients enrolled in CIGNA health plans in targeted markets using:

  • Availity, a health information network supporting the exchange of more than one billion transactions per year on behalf of more than 200,000 physicians;
  • NaviNet Network, America’s largest health care communications network that connects 70 percent of the nation’s physicians to leading health plans and information for 121 million insured patients;
  • Passport Health Communications Inc., eCare Patient Access Suite includes revenue cycle software and services to help health care organizations verify patient demographic and insurance information, maintain payer compliance and accurately estimate and collect patient payments. Passport OneSource is used by one-third of all U.S. hospitals.
  • RealMed, an Availity Company, delivering revenue cycle management solutions to more than 30,000 health care professionals and processing more than half a billion transactions per year.

About CIGNA

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, through 60 million customer relationships with individuals in the U.S. and around the world. To learn more about CIGNA, visit www.cigna.com. To sign up for email alerts or an RSS feed of company news, log on to http://newsroom.cigna.com/rss/. Also, follow us on Twitter at @cigna, visit CIGNA’s YouTube channel at http://www.youtube.com/cignatv and listen to CIGNA’s podcast series with healthy tips and information at http://www.cigna.com/podcasts or by searching “CIGNA” in iTunes.

New Study Highlights the Success of Hudson Health Plan’s Distinctive Pay for Performance Program

Tarrytown, NY — November 5, 2010…Although many health insurers offer pay for performance (P4P) bonuses to reward doctors for quality care, policy experts continue to debate how to design and implement these programs. But now researchers have singled out a P4P program, designed by Hudson Health Plan, for its effectiveness. The program, which rewards pediatricians for fully immunizing children at the age of two, is the focus of an article to be published in the December, 2010 issue of the Health Services Research Journal, “Improving Timely Childhood Immunizations through Pay for Performance in Medicaid-Managed Care,” by Alyna T. Chien, MD, MS, who is a pediatrician at Children’s Hospital Boston; and Zhonghe Li, MS and Meredith B. Rosenthal, PhD., both of the Harvard School of Public Health.The study behind the article was supported by a grant from the Commonwealth Fund.

The article reports that from 2003 to 2007, Hudson’s immunization rates for two-year-olds jumped from 60% to approximately 80%. This increase for Hudson enrollees was 11% greater than that of other New York Medicaid Health Plans when comparing 2003-2007 data.

The article’s authors credit Hudson’s “distinctive ‘piece rate’ P4P program” for outperforming comparable plans. A “piece rate” program pays doctors a bonus for every Hudson member who is fully immunized. Most P4P programs pay bonuses based on the practice’s overall rate of fully immunized patients.

“Our own data showed that immunization rates for our members had improved, but we knew that rates had also improved state-wide and we wanted a rigorous independent evaluation of the program,” explains Janet Sullivan, MD, Chief Medical Officer of Hudson. “We were gratified to see that the study confirmed improvement greater than other comparable Medicaid health plans.”

Hudson’s program, Supporting Excellence in Childhood Immunization and Screening, pays practices up to $200 for every two-year-old child insured by Hudson who is fully immunized and screened for exposure to lead and tuberculosis. Study authors found the bonus represents a potential increase of 15% to 25% over the basic payment to the primary care practices caring for two-year-olds. To help physicians and nurse practitioners improve their performance, Hudson sends practices monthly lists of patients who have reached their second birthday in the prior month, as well as quarterly reports summarizing each child’s immunization and screening status.

Hudson’s sizeable bonus, along with the reports, have encouraged providers such as Hudson River HealthCare (HRHC) to search for ways to improve care delivery, according to Nancy Walter, RN, MPH, Vice President for Ambulatory Care Services at the federally qualified community health center. When HRHC reviewed patient charts, she says, “We saw we were missing opportunities to immunize the children when they came in sick.” The practice began to vaccinate children in need of immunization whenever they visited. Furthermore, the pediatricians embraced the practice for all children, not just Hudson members, raising the quality of care for all patients. “[The practice] started out with Hudson Health Plan, but eventually it went across the board,” Ms. Walter points out.

Hudson now uses similar incentives to reward providers for quality care for patients with diabetes. For more information about Hudson’s Supporting Excellence program, please visit: www.hudsonhealthplan.org/providers/supporting-excellence.

About Hudson Health Plan

Founded in the mid-1980s by a coalition of community health centers, Hudson’s mission statement is “to promote and provide access to excellent health services for all people.” The Tarrytown-based not-for-profit organization provides comprehensive medical and dental coverage to more than 100,000 members in New York’s Hudson Valley. Hudson has been driving health care innovation by developing technology to support clinical quality initiatives and to streamline the enrollment process for Medicaid Managed Care, Child Health Plus, and Family Health Plus. According to A Consumer’s Guide to Medicaid Managed Care in the Hudson Valley, it has earned the highest ratings in overall satisfaction among Medicaid Managed Care members in the Hudson Valley region every year since 2003.