Priority Health Members Equipped for Smart Health Care and Better Outcomes

GRAND RAPIDS, Mich.–(BUSINESS WIRE)–Priority Health is leading the chorus of health care organizations calling for smart health care and better outcomes. A new web-based tool allows members to evaluate care options prior to choosing surgery.

“We each have a responsibility to ask questions of our care givers to ensure the care we receive is the best option available.”

“Priority Health is changing how health care is delivered by producing better outcomes and creating better experiences for members all while eliminating avoidable medical costs,” said Kimberly K. Horn, president and CEO.

According to the Centers for Medicaid and Medicare Services and other organizations, up to 50% of the cost in the total health care system is avoidable. These costs could be eliminated without impacting the quality or the outcome of care.

One case study demonstrating this fact involves Priority Health’s award-winning back pain management program. Spine surgery rates across Michigan vary. In fact, some Michigan communities have double the incidence of back surgery as the national average. In contrast, research shows that patients are more likely to choose a less invasive approach when given all of their treatment options.

Priority Health worked with its provider network to educate members with back pain. Prior to seeing a spine surgeon, members experiencing back pain see a physiatrist, a physician specializing in musculoskeletal and neurological conditions, who may recommend alternatives to surgery. The members also review a video designed to help them make an informed decision. Following that consultation, members can proceed with recommendations of the physiatrist or choose to consult with a surgeon.

The program resulted in a 26% reduction in spine surgeries and yielded high patient satisfaction with 74% reporting they were satisfied or very satisfied. “Our members’ health is our top concern,” said Horn. “Through this program and others, we’ve been successful at delivering smart health care by focusing on treatments that garner the best results for our members.

“As the number of people enrolled in consumer-engaged health plans increases, we hope to capitalize on this opportunity to create an age of consumerism within healthcare,” said Horn. “We each have a responsibility to ask questions of our care givers to ensure the care we receive is the best option available.”

To help members become informed, Priority Health offers a surgery decision support tool via its website. Members can use this interactive video tutorial to learn if the surgery they are considering is the right option for their situation. To date, thousands of members have researched their treatment options for conditions like knee pain and back pain. Most members are eligible to receive free wellness materials or fitness equipment after completing the tutorial.

About Priority Health:

Priority Health is an award-winning health plan nationally recognized for creating innovative solutions that impact health care costs while maximizing customer experience. It offers a broad portfolio of products for employer groups, individuals and Medicare and Medicaid. As a nonprofit company, Priority Health serves more than 600,000 people and continues to be ranked among the America’s best health plans by the National Committee for Quality Assurance.

Medical Home Pilot Nets Quality Gains, Cost Savings

ALBANY, N.Y. — CDPHP today announced that its nationally-recognized patient-centered medical home pilot resulted in dramatic declines in medical cost growth at three local physician practices. The pilot, designed to help physician practices transform their processes, improve care, and increase reimbursement for primary care physicians, showed that important opportunities exist to improve primary care in the area.
The three physician practices involved in the CDPHP® medical home pilot experienced a 9% reduction in the rate of overall medical cost increases—a savings of $32 per member, per month—as compared to other area physician practices, according to a Verisk Analytics™ independent analysis released by the Albany-based health plan.
The practices—Community Care/Latham Medical Group, Community Care/Schodack, and CapitalCare Family Practice Clifton Park—also demonstrated improvements in quality measures, most notably, the proper use of antibiotics and diabetic eye exams.
Data from the first year of the pilot also revealed significant reductions in advanced imaging utilization and emergency room visits. Total hospital admissions were 24 percent lower than otherwise expected among the population served by the practices participating in the pilot.
The independent analysis indicates that the novel payment model, in conjunction with the practice transformation support, made a difference in the way care was compensated and provided.
“We are very pleased by this news. It is an important first step in improving quality and transforming the way we pay for primary health care,” said Bruce Nash, MD, MBA, chief medical officer, CDPHP, who has overseen the pilot since its launch in May 2008. “While CDPHP and the physician practices currently working towards transforming their practices recognize that there are still significant opportunities for improvement, we know we’re headed in the right direction.”
The Future of CDPHP Enhanced Primary Care
In September 2010, 21 additional practices began the transformation scheduled to conclude at the end of 2011. Between the first and second phases, the program encompasses 24 physician practices, approximately 150 local physicians, and more than 50K CDPHP members. Given the third-party results and the medical community’s continued interest in the program, CDPHP will begin recruiting for Phase III of this initiative, now called the CDPHP Enhanced Primary Care program.
New elements have been added to the subsequent phases, including the embedding of CDPHP nurse case managers within the participating practices. These nurses work collaboratively with the practice staff to better facilitate medical, behavioral, and pharmaceutical services for patients. This interaction will play an integral role in realizing additional future savings from reduced hospital, emergency room, and imaging services.
Phase III will consist of primary care practices (family practice, internal medicine, and pediatrics) chosen by CDPHP by the end of May 2011. Selected practices will display strong leadership and a stable practice culture, and serve a significant number of CDPHP patients. The practice will need to demonstrate commitment in achieving NCQA Level III Medical home and enhancing access, as well as an overall willingness by practice leadership to participate and openly collaborate with CDPHP. In addition, due to the significance of technology in the medical home model, practices utilizing EMR and ePrescribing are preferred.
“The program’s initial results have thus far exceeded anyone’s projections,” said Nash. “If the results from the second year of the pilot even partially support these initial data, the CDPHP model will not only hold tremendous value for this region, but for national reform efforts as well.”
About CDPHP®
Established in 1984 as a physician-founded and guided health plan, CDPHP and its affiliates currently serve members in 24 counties throughout New York with a full family of products.

Healthy Living Goes Social With OptumizeMe™; Free New App Available Now For iPhone® and Android Devices

Golden Valley, Minn. (March 21, 2011) — OptumHealth, one of the nation’s largest health and wellness companies, today announced the release of its OptumizeMe mobile application for iPhone® and AndroidTM devices. Initially launched for Windows® Phone 7 devices, OptumizeMe is now also available for free on these two widely used mobile operating systems.

With the OptumizeMe application, 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 helps people connect with their friends to attain their health and fitness goals using social media in a fun, interactive way,” said Rob Webb, CEO of OptumHealth’s Care Solutions business. “As our society shifts toward socially connected healthy living, OptumizeMe can serve as the perfect app to help people get the results they want.”

To extend its reach to other popular social networks, OptumizeMe is integrated with FacebookSM, which has 200 million mobile users1. With OptumizeMe, users can invite friends from their social networks and share healthy doses of motivation or create friendly competitions to achieve their health and fitness goals. This user-friendly app gives people the tools they need to create, join and track their own health and fitness progress through health-inspired challenges.

Future versions of the app will enable users to connect with virtual personal health coaches, making the application even more powerful in helping people achieve their health and fitness goals.

According to a recent New England Journal of Medicine report2, healthy behavior actually spreads through social connections. Whether an individual wants to run a race, cut down on salt intake or exercise for five minutes a day, OptumizeMe can help rally the support and motivation needed to succeed. To keep users going strong, OptumizeMe also awards virtual badges for actions such as achieving goals and creating challenges.

The OptumizeMe mission of better health through social interaction will be featured at the 2011 international CTIA Wireless Conference in Orlando, Fla., March 22-24. At CTIA, OptumHealth will conduct an onsite Walking Challenge open to all CTIA attendees. Conference attendees can sign up for the challenge, motivate their peers and track their steps through OptumizeMe. Those who stride the farthest will be rewarded with an iPhone or Android mobile device, an iPad® or an Amazon KindleTM.

About OptumHealth
OptumHealth helps nearly 60 million Americans 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 care solutions, behavioral solutions, collaborative care, and financial services. For more information about OptumHealth, visit

1 Source:
2 Source: Christakis, N. The New England Journal of Medicine, July 26, 2007; vol. 357: pp 370-379

Health Plan Innovation Congress Features Unique S.C. BlueCross Member Toolkit

Columbia, S.C. – BlueCross BlueShield of South Carolina’s Vicki Whichard presented a case study on its unique online toolkit for members at the World Congress’ Third Annual Health Plan Innovation Congress in Orlando, Fla., this week.

My Health Toolkit®, accessible through a secure website, helps BlueCross members better manage their benefits, make informed treatment and financial decisions, and improve their health.

Part of My Health Toolkit, an enhanced Doctor and Hospital Finder tool that integrates search capabilities, hospital quality data and an innovative cost calculator, was released in the first quarter of 2011. This tool allows members to research costs based on their personal benefits, alongside quality information. It more closely aligns shopping for health care treatment with shopping for any consumer product or service.

“We created My Health Toolkit to give more power to our members to manage their own benefits and health decisions,” said Whichard, who is director of consumer-driven health plans. “We are the first to show a comparison of surgery costs based on recent claims payments and match that to a calculation of the individual member’s out-of-pocket costs in this amazing tool.”

Other tools allow members to check their claims, eligibility and benefits; message customer service; verify authorizations; see how close they are to meeting their deductibles and out-of-pocket maximums; request ID cards; compare benefit plans; compare drug costs; track flexible spending account (FSA) or health reimbursement account (HRA) balances; maintain personal health records; take personal health assessments; and research in a health library.

World Congress events convene CEOs and senior executives from across the health care industry. More information can be obtained on the Health Plan Innovation Congress at
 Headquartered in Columbia, S.C., BlueCross BlueShield of South Carolina is an independent licensee of the Blue Cross and Blue Shield Association. The only South Carolina-owned and operated health insurance carrier, BlueCross BlueShield of South Carolina comprises more than 40 companies involved in health insurance services, U.S. DoD health program and Medicare contracts, other insurance and employee benefits services, and a philanthropic foundation that funds programs to improve health care and access to health care for South Carolinians.

Capital BlueCross, Pennsylvania Academy of Family Physicians Partner to Improve Delivery of Primary Care

HARRISBURG, Pa., March 8, 2011 /PRNewswire/ — Capital BlueCross and the Pennsylvania Academy of Family Physicians (PAFP) have formed a partnership unique to this region that allows the two organizations to focus on improving health care for patients and their families.

Through this professional commitment, Capital BlueCross expects to enhance its relationship with the physicians in the region through a focused approach to better understand the needs of the physician community when it comes to the delivery of health care. The two organizations expect the collaboration to result in improved coordination of health care and patient health outcomes. The initial efforts between Capital BlueCross and the PAFP will focus on the importance of early detection treatment, and prevention of chronic diseases.

“Insurers and physicians have the common goal of improving care and services to members,” said Dr. Jennifer Chambers, Capital BlueCross Medical Director. “By collaborating on such initiatives, our respective organizations can provide even more effective outcomes for health care consumers. Who better to partner with than the PAFP, the state’s only organization dedicated to family physicians?”

“We are very excited about this collaboration with Capital BlueCross,” said Janine Owen, PAFP Vice President of Education and Academia.  “There is no doubt that our physician members, their patients and families will benefit from this partnership.”  

As an early initiative resulting from this partnership, Capital BlueCross is sponsoring educational programs as part of the PAFP State College Breakaway Conference, scheduled for March 11-13, 2011 in State College. The selected educational sessions focus on two common chronic health conditions: Osteoporosis Management and Chronic Obstructive Pulmonary Disease (COPD). Information on the PAFP State College Breakaway Conference can be found by going to

Capital BlueCross is the leading health insurer in its region, providing health insurance coverage to residents in central Pennsylvania and the Lehigh Valley.

Capital BlueCross is committed to making health insurance simple for its customers and members through all the stages of life by offering nationally acclaimed customer service and a full range of innovative benefit programs for groups and individuals at competitive prices.

By establishing a culture of caring, Capital BlueCross constantly strives to do more in order to deliver more for the men, women and children who depend on the company for their health insurance needs. Capital BlueCross has been providing health security to the people and communities of central Pennsylvania and the Lehigh Valley for more than 70 years and employs about 2,000 people in the region.

Headquartered in Harrisburg, Pa., Capital BlueCross is an independent licensee of the Blue Cross and Blue Shield Association.

More information about Capital BlueCross and its subsidiaries can be found by going to

SOURCE Capital BlueCross

Humana and iCan Benefit Group Team Up To Offer Affordable Benefit Plans For Individuals

LOUISVILLE, Ky.–(BUSINESS WIRE)– Humana Inc. (NYSE:HUMNews) has teamed with the iCan Benefit Group to offer a new line of discounted products for individual consumers. Effective immediately, people can access a variety of discounted packages that include dental, vision and pharmacy products. The agreement establishes the iCan Benefit Group as the primary marketer of these products and will connect Humana with iCan’s national distribution network. iCan will offer the new products through online and TV campaigns, as well as through distribution to large organizations.  

Studies show that focusing on dental and vision care through regular dental cleanings and periodic eye exams can help detect other health problems and risks, such as heart disease, diabetes and stroke. This new initiative also provides access to favorable prescription discount pricing through the Humana Prescription Drug Savings Program now available to the public at no cost. Furthermore, combined with prescription-advocacy services, these products will deliver affordable medications to people who have no health care benefits and groups whose benefits do not include prescription, dental and vision coverage.  

“We know that many people either don’t have access to prescription discounts or they take medications that aren’t covered by their health plan. This product offered by Humana and iCan can provide value to these people,” said William Fleming, vice president of Humana Pharmacy Solutions.  

This unique relationship will provide iCan customers with access to Humana’s full suite of insured products as well as discount plans. The competitively priced benefits can be included in various product bundles. A variety of packages is now available, some of which include additional insured health benefits. Also, purchasers of these products can leverage savings programs for entertainment, travel, legal and financial services, as well as personal and family benefits, such as counseling. 

“As the focus of the industry evolves, Humana and iCan recognize in each other the commitment to providing not only quality coverage but quality service, with the goal of improving overall population health,” said Steve Tucker, chief executive officer of the iCan Benefit Group. “These new offerings of dental, vision and pharmacy benefits enable us to better provide the families we serve with affordable health solutions.”  

“Oral and ocular health are important to an individual’s overall health and well-being and these plans will give people access to affordable dental and vision care,” said Beth Bierbower, Humana’s specialty benefits chief operating officer.  

If you would like more information about these offerings, please go to or call 1-800-530-4226.  

About iCan Benefit Group LLC  

Founded in 2004, iCan Benefit Group, LLC is a dynamic, customer-centric family of companies providing its customers with access to comprehensive, affordable insurance and lifestyle benefit solutions, including health, life, lifestyle, property and casualty. With tens of thousands of existing customers, iCan Benefit Group is the answer for many to the healthcare crisis suffered by more than 53 million people in the U.S. today. iCan focuses on increasing access and utilization of wellness-based initiatives, including telemedicine services provided through its InteractiveMD platform The company is based in Boca Raton, Florida and can be found online at:  

About Humana  

Humana Inc., headquartered in Louisville, Ky., is one of the nation’s largest publicly traded health and supplemental benefits companies, with approximately 10.2 million medical members, 7.1 million specialty members, and operates more than 300 medical centers and 240 worksite medical facilities. Humana is a full-service benefits and well-being solutions company, offering a wide array of health, pharmacy and supplemental benefit plans for employer groups, government programs and individuals, as well as primary and workplace care through its medical centers and worksite medical facilities.

Aetna HealthFund Consumer-Directed Plans Save Employers, Consumers Millions of Dollars Each Year

Hartford, Conn., February 28, 2011 — Employers that replaced their traditional health benefits plans with Aetna HealthFund® consumer-directed plans saved $21.5 million over a five-year period for every 10,000 members, based on a recent study of Aetna (NYSE: AET) health care claims and utilization. The study showed that members of consumer-directed plans accessed more preventive care and screenings than people with traditional Preferred Provider Organization (PPO) plans. In addition, Aetna HealthFund plan members were more engaged health care consumers and continued to get the care they need.

The study, which is the longest-running review of consumer-directed health plans in the industry, included more than 2 million Aetna members. The study compared people with PPOs and those with Aetna HealthFund plans, which consist of Health Savings Accounts (HSA) and Health Reimbursement Arrangements (HRA). When compared to PPO members, HSA members used online tools to look up cost information nearly three times as often and took a health assessment twice as often.

“Aetna has been on the forefront of the consumer-directed health plan movement since the beginning,” said Aetna CEO and President Mark Bertolini. “The rising cost of health care has been a concern for companies for many years now. We have shown that by working together to engage consumers in their own care and by giving them easy-to-understand tools and actionable information, we can help companies keep their employees healthy and save money.”

While companies that switched completely to Aetna HealthFund plans reaped the highest cost savings, those that offered Aetna HealthFund HRA and HSA plans as one option experienced savings of $9 million over five years for every 10,000 members enrolled in all health plan options.  Among other findings, members in the Aetna HealthFund plans:

  • Spent 12 percent more on preventive care and accessed higher levels of screenings for breast and cervical cancer compared to members in PPO plans. In particular, diabetics in the Aetna HealthFund plans accessed screenings at higher rates than diabetic members in PPO plans;
  • Visited the emergency room for non-urgent care five percent less than members in a PPO plan; and
  • Used the prescription drugs to treat chronic conditions, such as diabetes, heart failure, high blood pressure and high cholesterol, at rates similar to PPO members.

The results also showed that HSAs continue to demonstrate more dramatic savings than HRAs. HSA members had 15 percent lower primary care physician utilization for non-routine visits, which may include a cold or sore throat, 11 percent lower specialist utilization and 9 percent lower overall medical costs in 2009.

The study looked at nearly 2.3 million members, which consisted of 1.8 million members whose employer offered an Aetna HealthFund product but who chose another product, and 498,000 Aetna HealthFund members. The study period extended from January 1, 2002 to December 31, 2009.

In addition, this year the study analyzed the impact of plan design on cost savings. Employers that offered plans that required increased member responsibility exhibited the best 2009 total cost trends. Specifically, those who offered Aetna HealthFund plans with deductibles of at least $1,500 for individuals experienced approximately 4 percent lower total cost trend than plans with deductibles that were less than $1,000.

The Aetna HealthFund study also provides employers with examples of how to maximize the potential of their Aetna HealthFund plan, including:

  • Designing a plan that includes appropriate levels of member responsibility;
  • Encouraging employees to enroll in the consumer-directed plan option by lowering the employees’ contribution levels or increasing the amount of funds in the account;
  • Communicating and educating members on how to use the plans; and
  • Offering wellness programs and incentives for healthy behaviors.

For more detailed information about the study, click here.

About Aetna
Aetna is one of the nation’s leading diversified health care benefits companies, serving approximately 35.3 million people with information and resources to help them make better informed decisions about their health care. Aetna offers a broad range of traditional, voluntary 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.