Cigna Acquires Alegis Care with Plans to Expand Medical Home and Chronic Care Services

BLOOMFIELD, Conn., September 03, 2013 – Cigna (NYSE: CI) announced today it has completed its acquisition of Alegis Care, a portfolio company of Triton Pacific Capital Partners. Alegis Care is a multi-specialty, medical health services organization dedicated to creating a comfortable medical home experience for homebound Medicare and Medicaid patients. Alegis Care specializes in serving the chronically ill and elderly with physician services, comprehensive care coordination and a high level of patient care in the safety and comfort of a patient’s own home or place of residence.

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San Francisco Area Health Centers Seek to form ACO

A prominent group of health centers in the North Bay (San Francisco) has applied to form what is known under the new federal health law as an “accountable care organization” serving thousands of Medicare patients that, if approved, could be one of the first of its kind in the nation.

Under the ACO program by Medicare, health care providers and payers are encouraged to better coordinate care, hoping to achieve the so-called “triple aim” of improving quality of care, improving patient experience and reducing costs, officials said.

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Legally Married Same-Sex Couples will be Recognized as such for Federal Tax Purposes, Certain Medicare Benefits

All same-sex couples who are legally married will be recognized as such for federal tax purposes, even if the state where they live does not recognize their union, the Treasury Department and the Internal Revenue Service said Thursday.

Separately, the Health and Human Services Department said Thursday that Medicare would extend certain key benefits to same-sex spouses, “clarifying that all beneficiaries in private Medicare plans have access to equal coverage when it comes to care in a nursing home where their spouse lives.”

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ACOs’ Coordinated Care Savings May Be Contagious

Accountable care organizations (ACOs) may actually be the unicorns we’ve been waiting for, spreading their cost-saving magic throughout the health system.

An early cost-sharing program in Massachusetts designed to cut costs for private Blue Cross Blue Shield patients also lowered costs for Medicare patients who were seen by the same providers, according to a study published Tuesday in the Journal of the American Medical Association.

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Competing to Win: TriZetto Suggests Healthcare Payer Strategies for Growth in Emerging Retail Market

DENVER–(BUSINESS WIRE)–According to The TriZetto Group, as payers continue to make the necessary business changes to comply with reform, increase administrative efficiency, and improve the cost and quality of care, these organizations will face an additional challenge—competing to win in an emerging retail market.

“Rep. Eric Cantor says 10,000 baby boomers a day are becoming eligible for benefits”

To compete effectively, it is imperative that payers stand out from the crowd and differentiate themselves with new products that drive value, increase transparency, and create opportunities for collaboration with providers and other healthcare stakeholders.

Markets for Expansion and Growth

A winning strategy involves optimizing enterprise platforms, including core administration, network management and care managementsystems, through integration. The integration of these systems can help strengthen key lines of business that are poised for rapid growth in the wake of health reform. TriZetto has identified four major markets where expansion opens new opportunities for payers:

  • Individual market
  • Ancillary services
  • Medicaid managed care
  • Medicare managed care

Prepare for Newly Insured Individuals

Beginning in 2014, 24 million people are expected to enroll in health plans via exchanges.i Payers that invest in scalable, flexible enterprise systems that can be configured to respond to changing needs will have the agility to participate in a wide variety of new opportunities related to the burgeoning exchange market.

With integrated systems, payers can use clinical analytic tools to harness the rich data in their applications to strategically address the individual market, segment populations and proactively help high-risk members manage their own health effectively. System integration also helps optimize the enrollment, eligibility, renewal and billing/collection processes.

Diversify by Growing Ancillary Services

Health plans can differentiate their brands by growing ancillary services and extending these offerings to individuals who enter exchanges and to those who have only medical coverage. Research published in 2009 by the U.S. Bureau of Labor Statistics indicated that 71 percent of workers in private industry had access to medical care benefits, 46 percent had access to dental care benefits and 27 percent had access to vision care benefits.ii A major goal of growing ancillary services such as vision and dental is to capitalize on high-growth margins by providing coverage for services typically excluded or only partially reimbursed by health plans today.

To respond quickly to these new opportunities, payers need an enterprise-wide core administration system that maximizes efficiencies through greater automation and enables seamless transactions among providers, members and payers. In addition, integrated network management systems can help payers efficiently and accurately pay claims across multiple services and providers.

Prepare for Medicaid’s Shift to Managed Care

According to the Kaiser Family Foundation, about 70 percent of new Medicaid enrollees will enter managed care organizations.iii This shift from traditional fee-for-service Medicaid coverage creates opportunities for payers to enhance services that help manage care and control costs for a vulnerable population, as well as increase the number of those served under new and existing Medicaid managed care plans.

There are two key areas where IT investments may help drive payer success in the Medicaid market. First, healthcare analytics can help payers and providers identify high-risk populations and proactively manage care for these members. Analytics also can help payers model and compare the value and costs of clinical and incentive-based programs.

Second, technology for value-based insurance design, which incents members to manage their own care more effectively, also supports payer goals in the Medicaid market. By proactively engaging members with personalized wellness, support and educational programs through web portals, e-mail and other automated communications, payers can help improve member health and control costs.

Invest in the Growing Senior Market

With more than 10,000 people a day (i.e., approximately 3.5 million annually) becoming eligible for Medicare, the senior market cannot be ignored.iv Despite less favorable reimbursement rules, the shift from traditional Medicare fee-for-service to managed care continues to create opportunities for payers and providers to work collaboratively toward improving the cost and quality of care for seniors. These opportunities include:

  • Developing innovative payment structures such as pre-approved bundling of all provider services for an agreed-upon amount
  • Creating methodologies for sharing risk in collaborative care settings
  • Aligning incentives based on provider adherence to clinical protocols
  • Profiling segments of members to find new ways to attract seniors who expect retail-type
  • services and personalized care
  • Managing seniors collectively who have both commercial and Medicare coverage

The emerging retail market presents compelling opportunities for profitable growth. Watch for healthcare payer organizations to leverage technology-enabled business solutions to compete and win in this new, evolving market.

About TriZetto

TriZetto provides world-class healthcare IT software and service solutions that drive administrative efficiency, improve the cost and quality of care, and increase payer and provider collaboration and connectivity. TriZetto solutions, many of which are patented or patent-pending, touch half the U.S. insured population and reach more than 21,000 physician practices. TriZetto’s payer offerings include enterprise and component softwaremanaged application services, managed business services and consulting services. Provider offerings, delivered through TriZetto’s Gateway EDI wholly owned subsidiary, include tools and services that monitor, catch and fix claims issues before they can impact a practice. TriZetto’s integrated payer-provider platform will enable deployment of promising new models of post-reform healthcare. For information, visit


i. Pear, Robert, “Heath Care Overhaul Depends on States’ Insurance Exchanges,” The New York Times, Oct. 23, 2010
ii. U.S. Bureau of Labor Statistics, “Spotlight on Statistics,” November 2009.
iii. Kaiser Family Foundation, “Medicaid and Managed Care: Key Data, Trends, and Issues,” The Kaiser Commission on Medicaid and the Uninsured. February 2010.
iv., “Rep. Eric Cantor says 10,000 baby boomers a day are becoming eligible for benefits,” Richmond Times Dispatch, May 4, 2011.




Cigna to Acquire HealthSpring

BLOOMFIELD, Conn. & NASHVILLE, Tenn., October 24, 2011 – Cigna Corporation (NYSE: CI) and HealthSpring, Inc. (NYSE:HS) today announced that they have signed a definitive agreement under which Cigna will acquire all the outstanding shares of HealthSpring for $55 per share in cash, a 37% premium over the closing stock price on Friday October 21, 2011, representing a total transaction value of approximately $3.8 billion. HealthSpring’s proven leadership team, headed by its Chairman and Chief Executive Officer Herb Fritch, will lead Cigna’s expansion in our rapidly growing Seniors and Medicare segments. The business combination is expected to be accretive to Cigna earnings per share in the first full year of operations. The agreement has been approved by the boards of directors of both companies and is subject to required regulatory approvals and customary closing conditions. The transaction is expected to close during the first half of 2012 and is not subject to a financing condition.

“HealthSpring is a great fit with Cigna’s growth plans to expand into the Seniors and Medicare segment through a premier business and trusted brand name,” said David M. Cordani, President and Chief Executive Officer. “Our two companies share a common strategic vision and philosophy that we create customer value by partnering with health care professionals, and use information and incentives to deliver high-quality, differentiated programs.”

“We are thrilled to announce this transaction with Cigna,” said Herb Fritch. “Following a review undertaken by our Board of Directors of the company’s strategic options, we concluded that the combination is in the best interests of our shareholders. The combination will also expand our ability to serve our physician partners and customers. Cigna recognizes the value in HealthSpring’s differentiated model of physician engagement, and shares our commitment to providing high quality, cost effective care to the members and communities we serve. We truly look forward to continuing and expanding upon this mission.”


HealthAmerica Opens Health Insurance Kiosks in Malls

HARRISBURG, Pa. & PITTSBURGH–(BUSINESS WIRE)–Got a question about Medicare or individual insurance coverage? Now you can ask a person. Face to face. One-on-one.

“Our new kiosks allow consumers to meet in person, face-to-face with a HealthAmerica representative to discuss their specific coverage needs rather than over the phone or going online”

That’s the premise behind HealthAmerica’s new kiosks that opened in 13 malls last month across Pennsylvania. The kiosks are aimed at consumers who want to understand and evaluate their Medicare and individual health plan options by personally meeting with a health insurance specialist.

“Our new kiosks allow consumers to meet in person, face-to-face with a HealthAmerica representative to discuss their specific coverage needs rather than over the phone or going online,” said Mary Lou Osborne, chief operating officer for HealthAmerica. “By locating in malls, we are placing our individual and Medicare health plan products closer to consumers.”

Osborne said the HealthAmerica insurance kiosks are a response to growing trend of more consumers buying their own insurance and seniors looking for more choices to navigate through their insurance options. “Consumers want to be more informed and better understand all of their health care options,” added Osborne. “Plus, we want to be even more recognized in the marketplace as consumers shift to play a bigger role in choosing their own individual health plan.”

The types of services provided at HealthAmerica kiosks include a benefits check-up, assistance with questions, and information on the local Medicare Advantage plan. The “benefits check-up” is provided in conjunction with the National Council on Aging. Health insurance specialists will review a senior’s benefits to help them find and enroll in all the benefits to which they are entitled including federal, state, local and private programs that help pay for prescription drugs, utility bills, meals, health care and other needs.

About HealthAmerica

With over 36 years of providing health care benefits, HealthAmerica has earned a reputation as one of the most trusted and experienced health insurers in Pennsylvania. The company ranks 14th in the nation for HMO and POS plans by the National Committee for Quality Assurance, and its Medicare plan ranks 28th nationally. It has ranked among the top health plans by NCQA for six consecutive years. HealthAmerica provides a range of traditional and consumer-directed health insurance products, including self-funded, Medicare, Medicaid, indemnity, nongroup, and pharmacy plans. It currently has “Excellent” accreditation by the NCQA for its commercial HMO, POS, and Medicare plans. HealthAmerica’s corporate offices are in Harrisburg, Philadelphia, and Pittsburgh, Pennsylvania. For more information, visit HealthAmerica’s website at


Humana and Reader’s Digest Association To Promote Co-Branded Medicare Products

LOUISVILLE, Ky. & NEW YORK–(BUSINESS WIRE)–Humana Inc. (NYSE: HUM), a national leader in health care coverage, and The Reader’s Digest Association, Inc. (RDA), parent company of Reader’s Digest – one of America’s best known and trusted brands – today announced a new alliance focused on enhancing seniors’ health and well-being. As part of this alliance, the companies will develop and promote a new suite of co-branded Medicare products from Humana, with the first of these products expected to be available to Medicare beneficiaries later in 2011.

“We see opportunities from combining Humana’s expertise with Reader’s Digest brand trust, scale and skill at making complex issues like health care and other subjects simple and understandable, as a powerful combination with unlimited growth potential.”

The co-branded Humana and Reader’s Digest plans will begin with a Medicare Supplement product offered in a select number of states, with plans to eventually make the product available in all 50 states, Washington D.C. and Puerto Rico. Benefits of the plans offered will include dental and vision coverage. Other unique features apart from the contracted benefits will include discounts or services such as discounts on Reader’s Digest products and publications, and customized, easy-to-understand health and well-being content.

As part of their alliance, Humana and RDA will promote the new co-branded products across the range of Reader’s Digest print and digital channels, and Reader’s Digest will introduce a new guide to Medicare decision-making and senior health debuting on newsstands and online in September 2011.

“Our alliance with Reader’s Digest provides both the audience reach and a wealth of easy-to-understand health-related information that enable Humana to expand on its mission to make meaningful connections with our members,” said Tom Liston, senior vice president and leader of Humana’s Medicare organization. “We’re continually searching for engaging ways to interact with our members, to help them live healthier lives and achieve lifelong well-being. We’re confident that working with RDA and the Reader’s Digest brand will enable Humana to build on our decades of experience effectively serving Medicare beneficiaries.”

“Humana’s deep understanding of the Medicare consumer and customer-focused approach make them the ideal partner for Reader’s Digest,” said Tom Williams, president and CEO of the Reader’s Digest Association. “We see opportunities from combining Humana’s expertise with Reader’s Digest brand trust, scale and skill at making complex issues like health care and other subjects simple and understandable, as a powerful combination with unlimited growth potential.”

About The Reader’s Digest Association, Inc.

RDA is a global media and direct marketing company that educates, entertains and connects more than 130 million consumers around the world with products and services from trusted brands. With offices in 44 countries, the company reaches customers in 78 countries, publishes 90 magazines, including 50 editions of Reader’s Digest, the world’s largest-circulation magazine, operates 83 branded websites and sells nearly 40 million books, music and video products across the world each year. Further information about the company can be found at

About Humana

Humana Inc., headquartered in Louisville, Kentucky, is a leading health care company that offers a wide range of insurance products and health and wellness services that incorporate an integrated approach to lifelong well-being.

WellPoint Affiliated Online Stores Prove Popular With Baby Boomers

 INDIANAPOLIS, Feb. 28, 2011 /PRNewswire via COMTEX/ — The online stores featuring the Medicare plans of WellPoint affiliated companies proved very popular with seniors during the recently concluded Annual Enrollment Period (AEP), demonstrating Baby Boomers’ confidence with learning about, pricing and buying health care services online.

The stores, which vary by brand, launched in September and steadily picked up traffic during AEP, which ran from Nov. 15 through Dec. 31, 2010. During this period, more than 225,000 different quotes were delivered on WellPoint affiliated Medicare Advantage, Medicare Supplement and Prescription Drug Plans online.

In fact, more than one in five Medicare applications came into WellPoint affiliated plans through electronic sources during AEP. The busiest day of the year for the stores was Dec. 30 as AEP was winding down.

“The first Baby Boomers are aging into Medicare this year,” explained Krista Bowers, vice president of WellPoint’s senior division. “We knew from our research that they would be more confident with the Internet than their predecessors. That’s why we launched the online stores in time for AEP. However, the extent to which the Boomers went online exceeded even our expectations.

“During AEP, we tried to meet people where they were most comfortable,” Bowers added. “Some went online by themselves, while others were assisted by our sales agents or independent brokers. Of course, we also had our regular enrollment channels, including telephone calls and face-to-face meetings.”

Nevertheless, it’s clear that Internet channels are growing in popularity among seniors, especially with 70 million Baby Boomers aging into Medicare over the next two decades. According to a 2010 study by Pew Research Center, 76 percent of older Boomers (56-64) and 81 percent of younger Boomers (46-55) go online, making up about 33 percent of the total Internet using population. The study shows that getting health information is one of their top reasons for going online.

The online stores of WellPoint affiliated companies allow visitors to learn about products, compare plans, get a quote and even enroll in a plan when eligible.

About WellPoint, Inc.

WellPoint works to simplify the connection between Health, Care and Value. We help to improve the health of our communities, deliver better care to members, and provide greater value to our customers and shareholders. WellPoint is the nation’s largest health benefits company in terms of medical enrollment, with more than 33 million members in its affiliated health plans, and a total of more than 69 million individuals served through all subsidiaries.

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 for more information.