AmeriHealth NJ to Offer Self-Funded Administrative Services to Employers with 51-99 Employees

CRANBURY, N.J.–()–AmeriHealth New Jersey today announced it will provide employers with 51-99 employees the option of obtaining self-funded administrative services. Continue reading

Humana Teams Up with CoverMyMeds to Improve Prior Authorization Process for Members

LOUISVILLE, Ky.–()–Humana Inc. (NYSE: HUM) and CoverMyMeds, a leading health care innovation company, have recently teamed up to implement an electronic prior authorization model that allows providers to streamline prescription authorization requests, giving patients expedited access to the medications they need.

“Depending on the prescription, some medications require prior authorization before coverage which, as of now, is a time-consuming process for all parties”

Under the new agreement, physicians can submit drug prior authorizations directly to Humana via an online portal. The requests begin processing immediately and providers receive a notification of the status of the member’s prior authorization, often before the member even leaves the doctor’s office. Continue reading

PwC’s Health Research Institute Identifies the Top 10 Health Industry Issues for 2014

NEW YORK, /PRNewswire/ — Implementation of the Affordable Care Act (ACA) is only one of the factors forcing a rapid reshaping of the $2.8 trillion U.S. healthcare industry in 2014 according to PwC’s Health Research Institute (HRI). In its annual report on the Top Health Industry Issues for 2014, PwC’s HRI identifies the top 10 issues facing the U.S. health sector this year, including the need to adjust to empowered consumers, rapid innovation, and increasing competition from non-traditional players. The report includes the results of a survey of 1,000 U.S. consumers and interviews with health industry leaders that provide insights into the emerging new health economy.

The report notes that much of the health industry has accepted that reform is here to stay – and forward-looking executives are making decisions based on a post-ACA landscape that has altered the provision of insurance and the delivery of care. Continue reading

ReAdmission Solutions Launches Pilot with Independence Blue Cross to Prevent Hospital Readmissions

PHILADELPHIA and NEW YORK, Dec. 16, 2013 /PRNewswire/ — Independence Blue Cross (IBC) and ReAdmission Solutions, LLC (RAS) today announced they have signed a letter of agreement to implement a pilot program to prevent hospital readmissions. RAS will conduct the pilot for IBC Keystone 65 and Personal Choice 65 Medicare Advantage members.

According to a joint statement, the objective of the pilot is to prevent hospital readmissions for members regardless of the patient’s diagnosis or the hospital where they treated. It is expected that the first phase of the pilot will run 90-120 days and include 180 hospitalized IBC Medicare Advantage members, which is considered a statistically valid sample to determine effectiveness.

The statement noted that ReAdmission Solutions will provide a registered nurse clinical coordinator to coordinate discharge planning and post acute care with hospital staff and other healthcare professionals. – See more details at PRNewswire.com.

Aetna Combining Voluntary, Consumer Directed Health Plans

HARTFORD, Conn.–()–Aetna (NYSE: AET) announced today a new strategy to help employers and their employees reach the full value of a consumer directed health plan (CDHP). Called the CDHP Accelerator, the strategy combines CDHPs with voluntary products. The CDHP Accelerator provides greater financial protection once the member has reached certain limits on their high-deductible health plan.

In a statement, Aetna said that combining a CDHP with voluntary financial protection plans – like Hospital Indemnity, Critical Illness or Accident –provides additional financial protection if someone experiences an unexpected illness or hospital stay. They note that these plans provide cash benefits that employees can use for whatever they need, from meeting their deductible to paying everyday expenses like rent, daycare or groceries, and that by helping to boost financial confidence, voluntary benefits can increase enrollment in consumer directed health plans. – For more details see Businesswire.com.

Cigna ACO Showing Higher Quality, Lower Costs in First Year

CONCORD, N.H. & BLOOMFIELD, Conn., December 11, 2013 – Cigna today is reporting on the first-year results from its collaborative accountable care initiative with Granite Healthcare Network (GHN), a partnership among five independent charitable health care organizations in New Hampshire.

According to a Cigna release, the program is making strides toward achieving its goals of improved healthaffordability and patient experience.They also say the initiative has helped GHN deliver a higher level of care in New Hampshire while controlling total medical costs for its 30,000 patients who are covered by a Cigna health plan.

Cigna noted that when the program started last year, it evaluated how well GHN followed nationally recognized evidence based medicine guidelines (a measure of quality) and Continue reading

Aetna, PinnacleHealth System Form Accountable Care Relationship

Aetna and PinnacleHealth System recently announced a new accountable care agreement that is designed to improve the quality of care and lower overall health care costs for Aetna commercial plan members in the Harrisburg, Pa., area.

According to a release issued by Aetna, the collaboration will use PinnacleHealth’s comprehensive, integrated system of physicians, hospitals and ambulatory services to give area employers better health care options for their employees by:

  • Creating a more coordinated patient experience;
  • Saving employees money when they use providers aligned with PinnacleHealth; and
  • Improving health care outcomes.

Aetna says it will introduce both fully insured and self-insured health plans in Central Pennsylvania that will use PinnacleHealth’s community-based systems of care and its network of highly respected physicians. The first product, for groups of more than 51 employees, will be available on April 1, 2014. A small-group product for groups of between two and 50 employees will be introduced July 1, 2014. – See aetna.com for more details.

 

Tufts Health Plan to Offer a Defined Contribution Model to Large Employers

GoLocalWorchester.com is reporting today that Tufts Health Plan is the first insurance carrier in Rhode Island and Massachusetts to offer a defined contribution model to large employers – those with 51 or more employees. Called RightChoice, Tufts’ defined contribution model allows an employer to fix a certain dollar amount as its contribution, and employees pay or save the difference, depending on the plan they select.

According to the report,Tufts presents pre-bundled plan sets for employers with 51 to 99 employees – six in Rhode Island and eight in Massachusetts in its online marketplace. For groups with 100 or more employees, Tufts will customize bundles, giving even more plan flexibility. See the full story at GoLocalWorchester.com.

 

New Horizon Blue Cross Blue Shield of New Jersey Product Brings Innovative Accountable Care Model to Employers

Newark, NJ – November 7, 2013) – Horizon Blue Cross Blue Shield of New Jersey (BCBSNJ), which has been leading an effort with physicians, hospitals and health care leaders throughout the state to transform how health care is delivered, has developed a new product for employers to encourage employees to use physicians focused on improving the value of care patients receive, rather than the volume of care. The goal of the new product is to increase the number of Horizon BCBSNJ members who will seek care in patient-centered practices to improve patient outcomes and reduce overall health care costs.

The new product – the Horizon Patient-Centered Advantage EPO Plan – is now being offered to fully-insured employer groups for coverage that becomes effective on January 1, 2014.

Private Exchanges Debated; Fully Insured or Self-Funded?

Should large employers offering employee health plans through a private exchange be doing so on a self-funded or fully insured basis, or should they be bothering with this new concept at all?

According to an article in Health Insurance Exchange, that was a topic for discussion at the recent Self-Insurance Institute of America’s 33rd annual National Education Conference & Expo in Chicago.

Several industry representatives discussed the pros and cons of private exchange companies, whether benefits offered through these exchanges should be fully-insured or self funded and if the exchanges will save employers money in the long run. -See the full story at Health Insurance Exchange.