Medica to Improve Access to Recommended Health Care Services Through Partnership with Target

MINNETONKA, Minn.–(BUSINESS WIRE)–Medica is introducing programs designed to provide its members with improved access to affordable, convenient and recommended health care services through a partnership with Target. The programs are built around increasing flu vaccinations; ensuring babies get a healthy start; and accessing care for common everyday ailments.

“We believe these programs will help motivate our members to get care that follows recommended guidelines and best practices,” said Mark Werner, M.D., Medica chief clinical and innovation officer. “Medica is committed to ensuring convenient, quality care at affordable prices. We are delighted to introduce these programs that benefit our members.” Continue reading

Connecticut Health Care Redesign Plan Focuses on Primary Care, Doctor Payments and Reducing Waste

The ct Mirror is reporting that a team of state officials and health care industry representatives are trying to redesign the way health care is paid for and delivered to the vast majority of Connecticut residents.

According to a draft of their plan, their vision includes bolstering primary care practices to take on a larger role in patient care and offer treatment during expanded hours. It calls for better linking of medical practices with social services and other supports that could help people in high-risk communities. And it includes changing the way health care providers are paid by giving them an incentive to rein in what their patients’ care costs — a model that’s been embraced by Medicare and insurance companies but has drawn fire from patient advocates. Continue reading

Are CO-OPs Doomed to Fail?

Over on FierceHealthPayer is asking the question: Are Co-Ops doomed to fail? She notes that of the 24 Co-Ops now open for business, one has closed, another is struggling and at least nine other startup insurance companies are projected to have financial problems.

Where they not designed with enough financial support, or are there other problems at work? – See more at FierceHealthPayer.com.

 

Narrow-Network Plans Spark Lawsuits and Renewed Debate

Carriers are increasingly turning to narrow-network plans help lower premiums to attract cost-conscious consumers to thier products offered through insurance exchanges .

This trend is getting pushback from some hospitals in the form of lawsuits and has renewed the debate over what is “reasonable access.”

AISHealth examines this issue in their featured Health Business Daily story found here.

SCAN Health Plan AZ Adds Two Plans for Chronic Conditions

PHOENIX–(BUSINESS WIRE)–SCAN Health Plan Arizona announced the introduction of two new HMO Special Needs Plans (HMO SNPs) for Medicare-eligible residents in Maricopa and Pima counties. The plans are designed to help members with diabetes or heart disease better manage their chronic conditions.

The SCAN Balance (HMO SNP) plan is for Medicare beneficiaries with Type 1 or Type 2 diabetes. In this plan there is no co-payment for insulin or diabetic supplies, such as a monitor, test strips or lancets. The Heart First (HMO SNP) plan is available to anyone with Medicare who has been diagnosed with congestive heart failure, cardiac arrhythmia, coronary artery disease, peripheral vascular disease or chronic venous thromboembolic disorder. SCAN uses social workers, case managers and other professionals to help members with chronic conditions. Continue reading

Hub and Spoke ACOs May be Hard Sell In U.S.

A post today on AISHealth.com describes a new alliance in western Pennsylvania between Highmark Health Services and six Allegheny Health Network (AHN) hospitals as being “like an ACO without walls.”

The article, which was reprinted from THE AIS REPORT ON BLUE CROSS AND BLUE SHIELD PLANS, reported that this alliance is part of Highmark’s effort to accelerate the shift from volume-based, fee-for-service (FFS) payment to a system that pays for value.

Highmark describes the alliance, in this article, as a way to foster more integrated care, moving beyond primary care physicians (PCPs) in its Patient-Centered Medical Home (PCMH) program to add specialists and hospitals to the mix. Continue reading

Priority Health Opens One-Stop Insurance Shops in Michigan

Last week we reported here that Blue Cross Blue Shield of Michigan (BCBSM) had announced that it is re-focusing its 10 welcome centers located across the state of Michigan to help consumers understand and navigate ACA marketplace changes. Today, another Michigan health insurer, Priority Health has has opened three new information centers to provide resources for the uninsured and others needing to purchase insurance coverage.

“Priority Health is committed to improving the health and lives of those we serve,” said Joan Budden, chief marketing officer for Priority Health. “That’s why, as the health care landscape continues to change, we are making sure that we are positioned to answer questions and provide information to help consumers make informed decisions when choosing a health plan.”

Are Private Exchanges Good or Bad for Health Insurer Profits?

An article that appeared in today’s AISHealth is saying that health insurers could see their profit margins more than double if their large employer clients transition from a self-insured model to full risk via private insurance exchanges.

The article, which was reprinted from INSIDE HEALTH INSURANCE EXCHANGES, says that the Sept. 17, announcement that Walgreen Co. would move its 160,000 self-insured employees to Aon Hewitt’s multicarrier insurance exchange has gotten the buzz started. Continue reading

CDHPs Continue to Grow: Aon Study

New research from Aon Hewitt shows Consumer-Driven Health Plans (CDHPs) have become the second most prevalent plan offered by employers after preferred provider organizations (PPOs), and could potentially surpass PPOs as the most common plan type offered in the next three to five years.

According to Aon Hewitt’s 2013 Health Care Survey of nearly 800 large and mid-size U.S. employers covering more than 7 million employees, 56 percent of employers currently offer CDHPs as a plan choice, and another 30 percent are considering offering one in the next three to five years.

While 10 percent of employers offer CDHPs as the only plan option, another 44 percent are considering doing so in the next three to five years. In 2012, employers reported at least a 2 percentage point lower cost trend for CDHP plans (4 percent) versus other plans, including PPOs (6 percent), HMOs (7 percent) and Exclusive Provider Networks (6 percent).

See the full story at PRNewswire.com

PA Blues Plan Offers Consumers Choice Of ‘Health-Care Tiers’

An article in today’s Kaiser Health News produced in association with the Philadelphia Inquirer describe how two new HMO plans introduced last week on the federal insurance exchange by Independence Blue Cross (IBC) are offering Philadelphia-area consumers a road map to cut out-of-pocket health-care costs.

The article notes that consumers who sign up for Blue Cross’ HMO Proactive plans will need to choose hospitals, primary-care physicians, and specialists in the least expensive of IBC’s three price tiers of health-care providers.

IBC officials emphasized that tier one, the cheapest, is not a limited or narrow network because customers have access to the entire network; they just have to pay more if they choose a provider – a doctor or a hospital – in tiers two or three.

The article notes that it is far too soon to say how IBC’s tiered network will affect the Philadelphia market because it is uncertain how many people will choose such plans.

What do you think? Join the discussion below.

See the full story at KaiserHealthNews.com.