Independence Blue Cross Presents Next-gen Mobile Insurer Apps At Insurance & Tech Executive Summit

PHILADELPHIA, Nov 7, 2011 (GlobeNewswire via COMTEX) — Independence Blue Cross announced that its director of e-Business, Michael B. Yetter, will speak today about mobile app marketing strategies in health care with other industry leaders at the Insurance & Technology Annual Executive Summit held in Carefree, Arizona.

“As we look into 2012 and beyond, there are technologies and concepts that play a significant role in shaping development of next-gen apps for our health plan members, including Mobile Health, which is better known as mHealth,” said Yetter. “‘Gamification’ is a growing trend in the mobile app industry, which is applying game design concepts and principles to mobile apps to further strengthen our member engagement. People like to be entertained, to compete, and to be rewarded. The more these principles are applied to mobile apps, the deeper the engagement with the consumer. IBC is exploring cutting edge ways to ‘gamify’ mobile app strategies already in place, and we will soon be piloting a new wellness engagement and competition program that we hope to offer more broadly next year.”

Another hot topic as the health care industry shifts toward more individual coverage is mobile payment systems, and Yetter will discuss next-gen ideas for individuals to pay their health plan bills with their phones.

“IBC made a strong entry into the mobile app space during 2011 and we plan to continue to innovate for our customers and members, using the latest technologies to provide the time-saving features and convenience that their lives demand,” Yetter added.

Yetter will discuss the mobile platform race between Apple iOS, Google Android, Blackberry, and Windows in phone devices and tablets. He will share his insights that, while some platforms may lose market share, there is no single winner currently emerging, and developers will continue to face complexity in building apps for several health care industry platforms.

The Insurance & Technology Executive Summit is an invitation-only event for senior-level insurance company executives. The conference presents relevant content, authoritative speakers, and networking opportunities for sponsors. The event is comprised of conference sessions, vendor meetings, and networking-focused social activities.

About Independence Blue Cross

Independence Blue Cross is a leading health insurer in southeastern Pennsylvania. Nationwide, Independence Blue Cross and its affiliates provide coverage to nearly 3.1 million people. For 73 years, Independence Blue Cross has offered high-quality health care coverage tailored to meet the changing needs of members, employers, and health care professionals. Independence Blue Cross’s HMO and PPO health care plans have consistently received the highest ratings from the National Committee for Quality Assurance. Independence Blue Cross is an independent licensee of the Blue Cross and Blue Shield Association.


Bundled Payments initiative is being launched by the new Center for Medicare and Medicaid Innovation

The U.S. Department of Health and Human Services (HHS) today announced a new initiative to help improve care for patients while they are in the hospital and after they are discharged. Doctors, hospitals, and other health care providers can now apply to participate in a new program known as the Bundled Payments for Care Improvement initiative (Bundled Payments initiative). Made possible by the Affordable Care Act, it will align payments for services delivered across an episode of care, such as heart bypass or hip replacement, rather than paying for services separately.  Bundled payments will give doctors and hospitals new incentives to coordinate care, improve the quality of care and save money for Medicare.

“Patients don’t get care from just one person – it takes a team, and this initiative will help ensure the team is working together,” said HHS Secretary Kathleen Sebelius.  “The Bundled Payments initiative will encourage doctors, nurses and specialists to coordinate care. It is a key part of our efforts to give patients better health, better care, and lower costs.”

In Medicare currently, hospitals, physicians and other clinicians who provide care for beneficiaries bill and are paid separately for their services.  This Centers for Medicare & Medicaid Services (CMS) initiative will bundle care for a package of services patients receive to treat a specific medical condition during a single hospital stay and/or recovery from that stay – this is known as an episode of care.  By bundling payment across providers for multiple services, providers will have a greater incentive to coordinate and ensure continuity of care across settings, resulting in better care for patients.  Better coordinated care can reduce unnecessary duplication of services, reduce preventable medical errors, help patients heal without harm, and lower costs.

The Bundled Payments initiative is being launched by the new Center for Medicare and Medicaid Innovation (Innovation Center), which was created by the Affordable Care Act to carry out the critical task of finding new and better ways to provide and pay for health care to a growing population of Medicare and Medicaid beneficiaries.

Released today, the Innovation Center’s Request for Applications (RFA) outlines four broad approaches to bundled payments.  Providers will have flexibility to determine which episodes of care and which services will be bundled together.  By giving providers the flexibility to determine which model of bundled payments works best for them, it will be easier for providers of different sizes and readiness to participate in this initiative.

“This Bundled Payment initiative responds to the overwhelming calls from the hospital and physician communities for a flexible approach to patient care improvement,” said CMS Administrator Donald Berwick, M.D. “All around the country, many of the leading health care institutions have already implemented these kinds of projects and seen positive results.”

The Bundled Payments initiative is based on research and previous demonstration projects that suggest this approach has tremendous potential. For example, a Medicare heart bypass surgery bundled payment demonstration saved the program $42.3 million, or roughly 10 percent of expected costs, and saved patients $7.9 million in coinsurance while improving care and lowering hospital mortality.

“From a patient perspective, bundled payments make sense.  You want your doctors to collaborate more closely with your physical therapist, your pharmacist and your family caregivers.  But that sort of common sense practice is hard to achieve without a payment system that supports coordination over fragmentation and fosters the kinds of relationships we expect our health care providers to have,” said Dr. Berwick.

Organizations interested in applying to the Bundled Payments for Care Improvement initiative must submit a Letter of Intent (LOI) no later than September 22, 2011 for Model 1 and November 4, 2011 for Models 2, 3, and 4.

Humana’s New Provider Quality Rewards Program Awarding Nearly $10 Million to Primary Care Physicians

LOUISVILLE, Ky.–(BUSINESS WIRE)–Humana Inc. (NYSE: HUM) has begun distributing nearly $10 million to physicians across the U.S. who participate in Humana’s Provider Quality Rewards Program. Approximately 2,800 physician practices will receive payments of as much as $175,000 in recognition of performance improvements their practices made during 2010 related to improved outcomes for Humana’s Medicare members.

“This program begins a shift to a more holistic view of the patient and changes the physician-payer relationship to focus on patients’ quality of life, improving outcomes, and lowering health care costs.”

“Humana’s Provider Quality Rewards Program seeks to support practices with the goal of improving outcomes and efficiencies in the entire health care delivery system,” said Tim O’Rourke, vice president of provider engagement at Humana. “This program begins a shift to a more holistic view of the patient and changes the physician-payer relationship to focus on patients’ quality of life, improving outcomes, and lowering health care costs.”

Humana’s payments to physician practices are based on the practices’ ability to improve quality in nine National Committee for Quality Assurance (NCQA) preventive and chronic-condition management areas, including:

  • Breast cancer screening
  • Glaucoma screening
  • Colorectal cancer screening
  • Cholesterol screening
  • Diabetes management
  • Osteoporosis medication management
  • Spirometry testing for COPD patients
  • Monitoring patients on persistent medication
  • Anti-rheumatic drugs for patients with rheumatoid arthritis

Physician practices that achieved quality improvements – regarding treatment of Humana Medicare members – in the majority of the nine measures during 2010 are receiving the largest reward payments from Humana.

“The feedback we’ve received from doctors about this program has been very good. We’re excited about the future of Humana’s provider-engagement model, and that this program is continuing in 2011, because of what it represents – a way to recognize and reward the great strides these physician practices are making toward helping their patients achieve lifelong well-being,” O’Rourke said.

About Humana

Humana Inc., headquartered in Louisville, Kentucky, is a leading consumer-focused 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. By leveraging the strengths of its core businesses, Humana believes it can better explore opportunities for existing and emerging adjacencies in health care that can further enhance wellness opportunities for the millions of people across the nation with whom the company has relationships.


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.

Med-Vantage Launches Integrated Member Out-of-Pocket Cost Estimator

Med-Vantage® Inc — a healthcare software solutions company, offering innovative and distinctive solutions for consumer transparency, provider performance management, and personal health management — today announced the release of their Member Out-of-Pocket-Cost Estimator. BlueCross BlueShield of South Carolina is the first customer to launch the solution, delivering it as a standalone tool as well as integrating the members’ costs into their Doctor and Hospital Finder, built on the Med-Vantage HealthSmart Enhanced Provider Directory™, a web-based provider search tool.

The Out-of-Pocket Estimator is a web-based Med-Vantage cost analytic module that helps members understand “what is this going to cost me?” The Out-of-Pocket Estimator calculates an estimate of a member’s out-of-pocket expenses for a given procedure by applying the applicable real-time benefits of the member’s specific plan to the calculated cost range.

BlueCross is one of the first of the Blue Cross Blue Shield companies to run the Out of Pocket Estimator, based on the Blue Cross and Blue Shield Association’s National Cost Comparison Tool (NCCT) data, covering Association-defined treatment categories. This vital transparency information is fully integrated into BlueCross’ Doctor and Hospital Finder, which already provides their members with sophisticated hospital and doctor search capabilities as well as hospital quality data. “With consumers paying a larger share of healthcare costs than ever before, we felt that providing personalized cost information specific to a member’s plan and chosen provider was a critical next step,” said Laura Long, M.D., MPH and V.P. of Clinical Quality and Health Management for BlueCross.

Med-Vantage adds the Member Out-of-Pocket Estimator to its current list of clinical cost and quality analytics for a wide variety of transparency, member profiling, and provider performance measurement needs. Because most out-of-pocket calculators in existence today are designed for hospitals or providers at the point of service, they display cost information at the billing code level for a given provider – which members don’t understand. The Med-Vantage offering displays estimated costs for specific conditions, surgeries or procedures and is calculated based on a typical ‘service profile’ for the condition, surgery or procedure.  The service profile is a unique part of the Med-Vantage analytics engine that breaks a given procedure down into its components services and their associated costs, and then applies those costs against the member’s benefit structure. For example, the cost for a colonoscopy would include costs for the procedure itself, the anesthesiologist, and the actual facility providing the procedure room.

“With the growth in consumer-directed healthcare and the passage of healthcare reform, we’re seeing more and more payers seeking ways to aid members in their healthcare decision-making and planning,” said Peter Goldbach, MD, President and CEO of Med-Vantage.  “By adding the Out-of-Pocket Estimator to their provider directory, BlueCross BlueShield of South Carolina further extends their ability to engage consumers in actively managing their care and making choices that can significantly reduce their out-of-pocket costs.”

The Out-of-Pocket Estimator can be integrated into the HealthSmart Enhanced Provider Directory or be implemented as a stand-alone tool. In addition to applying costs to the Blue Cross and Blue Shield Association NCCT treatment categories, the solution also calculates estimates for 450 Med-Vantage-defined conditions, surgeries and procedures.

BlueCross BlueShield of South Carolina is an independent licensee of the Blue Cross and Blue Shield Association.

About Med-VantageMed-Vantage is software solutions company focused on driving improved healthcare by providing easy to use consumer transparency and provider performance management solutions that effectively engage users and support smart value-based choices. Founded in 2001, Med-Vantage is a California-based privately held company that is majority owned by a consortium of Blue Cross and Blue Shield licensees called BP Informatics, LLC. Plans participating in the alliance include Arkansas Blue Cross and Blue Shield, Blue Cross and Blue Shield of Florida (through its subsidiary Navigy, Inc.), Blue Cross of Massachusetts, Blue Cross and Blue Shield of North Carolina (through its subsidiary NobleHealth, Inc.), Health Care Service Corporation, and Highmark Blue Shield Inc

CDPHP and MVP Health Care: Ellis Medicine Warrantees Cardiac Surgery

SCHENECTADY, NY – Through an unprecedented collaboration with CDPHP and MVP Health Care, Ellis Medicine is essentially guaranteeing the quality of its care. Under this unique program, if a patient undergoes coronary artery bypass (CABG) at Ellis and is readmitted to the hospital for related complications within 90 days of discharge, Ellis will share with CDPHP and MVP Health Care, in the responsibility for the hospital costs.
The overall goal of the warranty program is to enhance quality, standardize care and prevent patients from winding up back in the hospital.
“As a top 50 cardiovascular hospital we’ve demonstrated our expertise and we’re confident that our new quality initiatives will help us provide even better care,” said James W. Connolly, president and CEO, Ellis Medicine. “By putting our money where our awards are, we’re allowing our MVP Health Care and CDPHP patients to obtain both financial and clinical benefits from our good work. Our warranty says, ‘Our care is outstanding and we stand behind it’. It’s as simple as that.”
At the center of Ellis’ unique Cardiac Surgery Warranty is a series of new steps designed to enhance the quality of care for all patients – before, during and after cardiac surgery. They range from clinical checklists, pathways and patient compacts to a collaborative effort with organizations such as Visiting Nurse Service of Schenectady and Saratoga Counties to ensure a smooth transition of care.
“As evidenced by the successful restructuring of hospital care and the creation of the Medical Home in Schenectady — re-inventing health care, one patient at a time, begins right here at home,“ said Connolly. “We’re grateful to our health insurance partners, CDPHP and MVP Health Care, for working with us to develop creative ways to enhance quality, reduce health care costs and bring shared financial accountability to the process,” he added. “This is our joint commitment to health care reform.”
“CDPHP believes that higher quality actually drives costs down,” said John D. Bennett, MD, president and CEO, CDPHP. “An initiative such as this will boldly lay the groundwork to demonstrate a joint commitment to high-quality health care and a partnership for better health value to our members and the community-at-large. We laud Ellis Medicine for taking the lead on guaranteeing care, and are pleased to collaborate with them and MVP Health Care on fulfilling their vision.”
“What we’re announcing today is a way for doctors and hospitals to be paid appropriately for delivering the best care possible,” said David W. Oliker, MVP president and CEO. “I’ve said for many years that high quality care doesn’t necessarily mean high-cost care. In fact, high quality care is quite often less costly. This program to reduce readmissions is an excellent example of what I mean,” Oliker said.
Cardiology Associates of Schenectady is an integral part of the new warranty program. “As cardiologists, we’re committed to delivering the highest quality of care to our patients. As one of the nation’s top 50 cardiovascular hospitals, we’re proud of our entire cardiac team and we’re excited about this opportunity to support Ellis Medicine’s steadfast dedication to cardiac excellence,” said John Nolan MD, Chair, Cardiac Sciences, Ellis Medicine.
“As cardiac surgeons, we’re confident in the ability of our team to provide the safest, most skilled surgical care, said Herb Reich, M.D., Ellis’ Chief of Cardiothoracic Surgery. “Ellis is backing up the quality of its heart surgery with a warranty – that makes us even more proud of the work we do for our patients,” he added.
This unique program aligns quality initiatives with reimbursement. It places Ellis well ahead of the curve with regard to impending federal healthcare mandates that will penalize hospitals for costly readmissions. As part of the new federal standards, Ellis and other hospitals will get paid based on the quality of care that is delivered.
Ellis Medicine was recently recognized as one of the nation’s Top 50 Cardiovascular hospitals by Thomson Reuters, a global health research organization.

HealthPartners Announces Performance Bonuses for Providers

BLOOMINGTON, Minn.–(BUSINESS WIRE)–HealthPartners today announced that primary and specialty care groups earned more than $700,000 for meeting quality measures on care and patient satisfaction. The bonuses are part of the pay-for-performance program which will pay out a total of $28.4 million for goals met in 2009. That’s a significant increase from last year, when the program paid out more than $25.3 million for goals met in 2008.

The bonuses recognize excellent and superior care for primary care (large and small groups) and pediatric care, as well as several specialty areas, including cardiology, OB/GYN, physical therapy, behavioral health and ENT. Pharmacies were also rated.

“We’re always happy to pay these bonuses because it means patients are getting better care,” said Babette Apland, HealthPartners senior vice president for health and care management.

HealthPartners Partners in Quality program was introduced in 1997. It rewards providers in practices throughout Minnesota and bordering states. The measures are based on guidelines developed by the Institute for Clinical Systems Improvement which represents more than 7,500 physicians in Minnesota.

About HealthPartners
Founded in 1957, the HealthPartners ( family of health care companies serves more than one million medical and dental health plan members nationwide. It is the largest consumer-governed, nonprofit health care organization in the nation providing care, coverage, research and education to improve the health of members, patients and the community. HealthPartners is the top-ranked commercial health plan in Minnesota and is also ranked 19th in the nation according to NCQA’s Health Insurance Plan Rankings 2010-11 – private.

BlueCross Patient-Centered Medical Home Initiative Grows to Largest in Tennessee

CHATTANOOGA, Tenn. — BlueCross BlueShield of Tennessee has partnered with 15 physician practice groups to build the state’s largest Patient-Centered Medical Home (PCMH) initiative with 31 sites. Ten additional practices are slated to open in 2011. More than 25,000 BlueCross members from Memphis to Bristol as well as individuals covered by competing health plans will benefit from this personalized model of care—a model that has been proven to have a positive return on investment through better health outcomes, lower costs and higher satisfaction levels.

“The U.S. health care system is undergoing a massive transformation and every aspect of the industry is under the microscope,” said Dr. Thomas Lundquist, vice president of performance and improvement for BlueCross. “The PCMH model promotes a change in the way care is delivered and financed by fostering unique patient-physician relationships that focus on prevention and primary care, as well as better coordination of chronic disease management.”

A medical home is a health care setting, usually a doctor’s office, where the primary care physician leads a professional health care team to take responsibility of the ongoing care of patients through all stages of life. Members of the team also work to encourage patients to self-manage their conditions through shared goals, education and health coaches. The goal is to help improve quality of care and efficiency by creating partnerships between patients and primary care physicians.

BlueCross is championing the PCMH program for their members by providing additional funding for health information technology, as well as an on-site care coordinator who engages in proactive outreach to patients and the community. Several million dollars will be reallocated and invested across the state to enable practices to provide personalized care. These resources redistribute funding to primary care practices and assist them in managing in a much more coordinated fashion those patients with chronic conditions such as heart disease, chronic lung disease and diabetes. Additionally, BlueCross will reward the practices based on quality and effectiveness.

The PCMH program allows chronic condition members to receive greater medical access and personalized attention through their primary care physician. This access can be same day appointments, telephonic consultations, extended hours or other options for the patients. A confidential, secure patient online service is also available at some practices to give patients quick and convenient access to both their medical information and their personal doctor. Personal health coaching is also provided. This enhanced access allows the patient to better manage their health care conditions and concerns, yielding positive outcomes such as decreasing per-person health care costs, reducing emergency room visits and declining hospital admission trends.

“We are encouraged by the strong efforts and early results demonstrated by our medical home program,” says Kevin Raynor, manager of provider performance management for BlueCross. “This partnership is the first step towards a stronger, more integrated care system that delivers better quality, better costs and overall value for everyone. We look forward to future expansions.”

The current PCMH programs focus on managing chronic conditions, which the Centers for Disease Control and Prevention estimate account for 75 percent of the nation’s total health care costs. The conditions currently being focused on by the PCMH program include diabetes, asthma, congestive heart failure, hypertension, coronary heart disease and chronic obstructive pulmonary disease.

About BlueCross

BlueCross BlueShield of Tennessee is the state’s oldest and largest not-for-profit health plan, serving nearly 3 million Tennesseans. Founded in 1945, the Chattanooga-based company is focused on financing affordable health care coverage and providing peace of mind for all Tennesseans. BlueCross serves its members by delivering quality health care products, services and information. BlueCross BlueShield of Tennessee Inc. is an independent licensee of BlueCross BlueShield Association. For more information, visit the company’s Web site at

Norton Healthcare and Humana Launch Accountable Care Organization in Louisville, Ky.

LOUISVILLE, Ky.–(BUSINESS WIRE)– Humana Inc. (NYSE:HUMNews) and Norton Healthcare, both based in Louisville, Ky., have been working together to launch the region’s first commercial Accountable Care Organization (ACO). The Norton-Humana partnership began in early 2010. An ACO model establishes incentives for health systems to increase quality and efficiency, better coordinate patient care, eliminate waste, and reduce the overuse and misuse of care.

The Engelberg Center for Health Care Reform at the Brookings Institution and The Dartmouth Institute for Health Policy and Clinical Practice selected Humana and Norton Healthcare to partner in one of only five national pilot sites, the only one in Kentucky, to implement the ACO model through the Brookings-Dartmouth ACO Pilot Project. The other pilot sites include Carilion Clinic, Roanoke, Va.; Tucson Medical Center, Tucson, Ariz.; HealthCare Partners Medical Group, Torrance, Calif.; and Monarch HealthCare, Irvine, Calif. Humana has worked with Brookings-Dartmouth since 2008 on exploring the ACO concept and other innovative payment models.

“Norton Healthcare’s work in developing an integrated health care delivery system and Humana’s commitment to continuous improvement in quality provide a strong foundation from which to pilot the payment reforms central to ACOs,” said Dr. Elliott Fisher, director of the Center for Population Health at The Dartmouth Institute for Health Policy and Clinical Practice.

“Norton Healthcare is proud to be a participant in the Brookings-Dartmouth ACO Pilot Project and we feel this is a tremendous opportunity to participate in an alternative model for health reform,” said Dr. Steve Hester, Norton Healthcare senior vice president and chief medical officer. “Considering our health care system’s industry-leading commitment to measuring and openly reporting on the quality of our care; our progress toward a system-wide integrated electronic medical record; and our large base of employed primary- and specialty-care physicians, Norton Healthcare was the logical choice in our region to be an ACO pilot participant.”

Humana is a leading health-benefits provider in its corporate hometown of Louisville, Ky., with a broad network of hospitals and health systems in Kentucky and Southern Indiana. Humana has had extensive experience in partnerships aimed at improving health care delivery and reimbursement models for many years. Norton Healthcare is the Louisville area’s leading health care system, caring for nearly one of every two patients at more than 100 locations throughout Greater Louisville and Southern Indiana.

“Humana is committed to innovative local and national models that improve clinical outcomes, reduce costs and improve efficiencies,” said Bruce Perkins, senior vice president of Humana’s healthcare delivery systems and clinical processes organization. “Humana plans to continue to develop more ACO models by partnering with providers in multiple regions. Our focus in exploring additional ACO relationships is to help drive innovation in the marketplace.”

Rewarding effective care, not quantity

The ACO model has gained national recognition as a meaningful way to create new financial incentives in our current health care system by holding health care providers accountable for the overall effectiveness, efficiency and cost of the care they provide. In contrast, the current fee-for-service payment system rewards volume and intensity rather than efficiency and effectiveness of care, often penalizing those systems that attempt to improve care. ACOs have been specifically addressed in the recent federal health care reform legislation through a new Medicare shared-savings program. And ACOs have been applauded for their intent to support patient engagement and the promotion of evidence-based medicine.

“Accountable Care Organizations are a model for delivery reform that can be part of a solution to help transform our nation’s health care system from one that promotes excessive costs to one that explicitly supports providers when they take steps to achieve high-quality care at lower costs,” said Dr. Mark McClellan, director of the Engelberg Center for Health Care Reform at the Brookings Institution. “We look forward to working with Norton Healthcare and Humana to test this promising new model.”

The Brookings-Dartmouth team, led by Drs. Fisher and McClellan, is working closely with Humana and Norton Healthcare to offer technical and strategic support in the implementation of the ACO model. Each ACO site defines the patient population it serves and establishes a spending target that reflects the predicted costs for their patients. The goals of ACOs are to improve efficiency and effectiveness of care and slow spending growth. ACO providers who can demonstrate that they meet these goals will receive in return a portion of the savings achieved.

“The ACO model really gets at bending the cost curve, which is so vital to achieving a sustainable system,” said Dr. Fisher. “Only health systems that can slow their spending growth, compared to previous years, will have the opportunity to receive shared savings.”

Although the Norton-Humana ACO is still in its early stages of implementation, the pilot has identified several initial areas of emphasis, such as improvements in the use of preventive screenings and tests (such as mammograms) and vaccinations, better coordination in the management of chronic illnesses (such as heart failure), more effective treatment of common problems (such as back pain), appropriate utilization of generic drugs to lower costs, and improved access to the appropriate level of care (such as primary care rather than emergency department treatment).

Going Forward

As the Louisville area’s largest hospital and health care system, Norton Healthcare is committed to providing quality health care. Norton has a sophisticated infrastructure for measurement of quality and data management in place. Looking ahead, Norton plans to move from process metrics to outcomes metrics, further develop innovative delivery models of care, and assume broader responsibility for health care delivery.

“Humana recognizes the need for change in health care delivery across the country. We are excited to participate in the development of new processes that encourage continuous improvement in quality while finding greater efficiencies in the delivery of care,” said Dr. Tom James, Humana corporate medical director.

In addition to providing technical support in the implementation of ACOs, the Brookings-Dartmouth team will evaluate the pilots to see how ACOs can impact the future of payment reform. The goal is to develop a model that can be replicated across the nation, building on health reform legislation which will likely make ACOs a voluntary option with Medicare participation in 2012.

“We are excited about the launch in Louisville and look forward to expanding the ACO model to other patient populations, including other commercially insured, Medicare and Medicaid beneficiaries,” said Dr. Fisher. “We are hoping that the hard work of Norton Healthcare and Humana will lead the way for other health systems and will be the start of a successful national roll-out.”

About Norton Healthcare

For more than a century, Norton Healthcare’s faith heritage has guided its mission to provide quality health care to all those it serves. Today, Norton Healthcare is the Louisville area’s leading hospital and health care system (44 percent market share) and third largest private employer, providing care at more than 100 locations throughout Greater Louisville and Southern Indiana.

The not-for-profit system includes five Louisville hospitals; 12 Norton Immediate Care Centers; 10,900 employees; more than 400 employed medical providers; and nearly 2,300 total physicians on its medical staff. For five consecutive years, Norton Healthcare has been recognized as one of the Best Places to Work in Kentucky.

The health care system serves patients in the Greater Louisville area, including Southern Indiana, and throughout Kentucky. For more information, visit

About Humana

Humana Inc., headquartered in Louisville, Kentucky, is one of the nation’s largest publicly traded health and supplemental benefits companies, with approximately 10.1 million medical members and 7.0 million specialty members. Humana is a full-service benefits solutions company, offering a wide array of health, pharmacy and supplemental benefit plans for employer groups, government programs and individuals.

Docs and Patients Now Have More Ways to Get CIGNA’s Real-Time Itemized Cost Estimates

BLOOMFIELD, Conn., November 09, 2010 – CIGNA (NYSE: CI) announced today that it will expand access to its CIGNA Cost of Care Estimator® through four of the largest health information networks in the U.S.: Availity, NaviNet, Passport Health Communications Inc. and RealMed (an Availity Company). These companies service 90 percent of America’s physician practices, hospitals, and clinical facilities.

“The CIGNA Cost of Care Estimator is delivering on our promise to both our contracted physicians and our customers to make our health plans transparent,” said James Nastri, CIGNA vice president of product and service transparency. “By opening access to Estimator through the nation’s largest health information networks, we can help more individuals understand their plan coverage and address any cost issues upfront, so that both doctors and patients can focus on improving health rather than worrying about potential financial unknowns after the fact.”

Since it was launched nationwide in April 2009 on the CIGNA for Health Care Professionals website, (, the CIGNA Cost of Care Estimator® has delivered real-time, pre-care itemized estimates of specific treatment charges and payments for 21,000 health care professionals. The Estimator’s Explanation of Estimate provides a simple, clear explanation of the key elements of payment for medical procedures and treatments and is designed to correspond with the award-winning CIGNA Explanation of Benefits.

Sekine, Rasner & Brock OB/GYN Practice Administrator Judi Lento says she prints out a CIGNA explanation of estimate for every CIGNA-covered patient: “The estimate really makes the whole process simpler for both our office and our patients. It is essential for defining the treatment, coverage and any potential out-of-pocket costs up front — so there’s no guesswork, confusion or administrative issues. Our patients really appreciate getting accurate information in advance, and the CIGNA Estimator has helped our practice save hundreds of thousands of dollars.

“The Estimator approach is truly revolutionary because unlike real-time claims adjudication, it does not require purchasing technology and re-keying information into our practice management system,” said Lento. “Because we will now be able to access CIGNA’s estimates through a multiple payer system, our office flow will be even better than before.”

The CIGNA Explanation of Estimate provides the key information individuals need to know about how their CIGNA medical benefits are applied to their physician’s services:

  • Total Cost: Estimation of the total cost of services, including both the amount to be paid by CIGNA and the amount the covered individual will owe;
  • Patient Cost: The anticipated amount covered individuals will owe after their plan benefits are applied to the estimated total cost, including any deductible, coinsurance, or co-payment;
  • Potential Fund Payment: This displays the estimated amount to be paid automatically to the health care professional at the time the estimate is run from available funds in the covered individual’s Flexible Spending Account (FSA), Health Savings Account (HSA), or Health Reimbursement Arrangement (HRA) as well as any additional funds that may be owed. Ninety-two percent of individuals enrolled in CIGNA’s consumer-driven, account-based health plans have opted for automatic claims payment.

Beginning in the fall of 2010, health care professionals have the additional option of producing estimates for their patients enrolled in CIGNA health plans in targeted markets using:

  • Availity, a health information network supporting the exchange of more than one billion transactions per year on behalf of more than 200,000 physicians;
  • NaviNet Network, America’s largest health care communications network that connects 70 percent of the nation’s physicians to leading health plans and information for 121 million insured patients;
  • Passport Health Communications Inc., eCare Patient Access Suite includes revenue cycle software and services to help health care organizations verify patient demographic and insurance information, maintain payer compliance and accurately estimate and collect patient payments. Passport OneSource is used by one-third of all U.S. hospitals.
  • RealMed, an Availity Company, delivering revenue cycle management solutions to more than 30,000 health care professionals and processing more than half a billion transactions per year.


CIGNA (NYSE:CI), a global health service company, is dedicated to helping people improve their health, well being and sense of security. CIGNA Corporation’s operating subsidiaries provide an integrated suite of medical, dental, behavioral health, pharmacy and vision care benefits, as well as group life, accident and disability insurance, through 60 million customer relationships with individuals in the U.S. and around the world. To learn more about CIGNA, visit To sign up for email alerts or an RSS feed of company news, log on to Also, follow us on Twitter at @cigna, visit CIGNA’s YouTube channel at and listen to CIGNA’s podcast series with healthy tips and information at or by searching “CIGNA” in iTunes.