Category Archives: Medicare

ConnectiCare Partners with Doctors Statewide; Sees Members’ Primary Care Visits Rise

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Community Medical Group, Inc. (formerly known as New Haven Community Medical Group, Inc.) the Latest to Begin Collaboration Arrangement

FARMINGTON, CT (December 11, 2014) – ConnectiCare, Inc. and Affiliates, Connecticut’s local health plan, has made significant progress in getting its members to their doctors regularly through active collaboration arrangements with doctors statewide.  As a result, primary care visits are up and hospital admissions, readmissions and emergency room visits are down.

ConnectiCare has practice collaboration arrangements with eight Connecticut-based medical groups throughout the State including:  Integrated Care Partners (Hartford HealthCare), St. Francis HealthCare Partners, ProHealth Physicians, Connecticut State Medical Society IPA, Grove Hill Medical Group, Charlotte Hungerford Multi-Specialty Group and Connecticut Multi-Specialty Group.  Most recently, Community Medical Group, a physician-led independent practice association, based in New Haven has entered into a collaboration arrangement with ConnectiCare. Continue reading →

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Humana Launches Points of Care to Support Medicare Advantage Members in Managing Health

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LOUISVILLE, Ky.–()–More than 2.9 million Humana Medicare Advantage members and their family and friends now have access to HumanaPointsofCare.com, a new online destination from Humana Inc. (NYSE: HUM), one of the nation’s leading health and well-being companies.

“Humana Points of Care enables Medicare members and their circle of support to maintain a sense of community on their journey to achieving optimal health”

Humana Points of Care offers a variety of comprehensive health and education tools to assist Humana Medicare Advantage members nationwide and provide support and resources for their family and friends which today account for approximately 65.7 million unpaid caregivers in the United States.  Continue reading →

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

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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 →

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Are CO-OPs Doomed to Fail?

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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.

 

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SCAN Health Plan AZ Adds Two Plans for Chronic Conditions

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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 →

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Study Looks at ACO Formation Drivers

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An article in Physicians Briefing points to a study published in the October issue of Health Affairs that suggests that underlying provider integration in a given geographic region may be the key that drives the formation of Medicare accountable care organizations (ACOs),

The researchers found that a greater fraction of hospital risk sharing (capitation), larger integrated hospital systems, and primary care physicians practicing in large groups were key regional factors associated with ACO formation.

The study is available for purchase at HealthAffairs.org.

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UPMC Includes Unique Benefits in its 2014 Medicare Offering

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PITTSBURGH, Oct. 10, 2013 /PRNewswire/ — UPMC for Life – the Medicare Advantage product of UPMC Health Plan – is offering four unique HMO plans in 2014, each designed to meet the specific needs of Medicare-eligible consumers.

UPMC for Life members now have a new fitness benefit called Fit for Life. Under this benefit, members can join any gym or fitness facility they choose and they will be reimbursed for a portion of their membership, up to the annual reimbursement limit for the plan they select.

With all of the plans, members receive a vision allowance, discounts for dental services, discounts for hearing services, and Assist America®, which provides help when members travel more than 100 miles from home or to another country.

See the full story at: PRNewswire.com

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Consumer Reports Releases Annual Health Insurance Plan Rankings – Including 114 “Best Value” Plans

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YONKERS, N.Y., Sept. 26, 2013 /PRNewswire-USNewswire/ — For the fourth year in a row, Consumer Reports published rankings of hundreds of health insurance plans across the United States to help consumers determine which ones may be best for them. This marks the first time the organization took additional steps to identify plans that both provide high-quality care and avoid costly care.

“Consumer Reports’ analysis found that expensive care doesn’t mean better care. Many people incorrectly assume that the more money that’s spent on health care, the better health care will be,” said John Santa, M.D., medical director of Consumer Reports Health. “But as these ratings show, the data found no connection between cost and quality.”

The full report is available in the November issue of Consumer Reports. The latest health plan rankings are available for free online at www.ConsumerReports.org/healthinsurance.

 

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CMS Health Care Innovation Awards Round Two

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The Centers for Medicare & Medicaid Services (CMS) has released a Funding Opportunity Announcement for round two of the Health Care Innovation Awards. Under this announcement, CMS will spend up to $1 billion for awards and evaluation of projects from across the country that test new payment and service delivery models that will deliver better care and lower costs for Medicare, Medicaid, and Children’s Health Insurance Program (CHIP) enrollees.

In this round, CMS specifically seeks new payment models to support the service delivery models funded by this initiative. All applicants must submit, as part of their application, the design of a payment model that is consistent with the new service delivery model that they propose.

See the full story at innovation.cms.gov

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Study: Market Power Drives up Hospital Prices

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Hospital costs for those who are privately insured vary widely and are much higher than Medicare payment rates, a new study by the Center for Studying Health System Change (HSC) found.

Within the communities studied, hospital prices for privately-insured patients were found to be approximately one-and-a-half times the Medicare rates for inpatient care, and twice what Medicare pays for outpatient services.

See the full story at FierceHealthFinance.com

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