HealthAmerica and Preferred Primary Care Physicians Launch Pilot to Deliver Accessible, Patient-centered and Coordinated Primary Care

PITTSBURGH–(BUSINESS WIRE)–HealthAmerica and Preferred Primary Care Physicians (Preferred) in Pittsburgh, Pennsylvania, have launched a new pilot program with the goal of providing more coordinated and patient-centered primary care and improved communications among patients, their physicians and their care team.

“HealthAmerica will play an important role because of the data we track on quality measures, which is critical for coordinating care and reporting on the results. Our data are also key to promoting the practice of evidence-based medicine and using decision-support tools to guide clinical decision making.”

Preferred consists of 32 board-certified physicians and five physician extenders specializing in internal medicine and family practice. Preferred has 14 practice locations in the South Hills and three locations in Uniontown in Fayette County. In addition, Preferred offers state-of-the-art outpatient centers for cardiac testing, sleep disorders, and physical therapy.

This unique pilot program, which was effective September 1, 2011, leverages the advanced medical home model established by the American College of Physicians. The medical home is a team-based model of care led by a personal physician who provides continuous and coordinated care throughout a patient’s lifetime to maximize health outcomes. Care is facilitated by the patient’s personal physician across all elements of the complex health care system, including subspecialty care, hospitals, home health agencies and nursing homes.

“This arrangement is unique in that patients and families will participate in quality improvement activities at the practice level,” said Dr. Robert S. Mirsky, chief medical officer for HealthAmerica. “HealthAmerica will play an important role because of the data we track on quality measures, which is critical for coordinating care and reporting on the results. Our data are also key to promoting the practice of evidence-based medicine and using decision-support tools to guide clinical decision making.”

“Under this pilot program, we will continue to leverage our advanced technologies and care management capabilities to support the goal of optimal patient outcomes. These are driven by a care-planning process and effective communication among HealthAmerica, the patient, the patient’s family and his or her physician,” said Gregory Erhard, executive director for Preferred Primary Care Physicians. “We will place a focus on prevention and seamless, coordinated care. Our electronic health record (EHR) and our robust data mining capabilities will be crucial in supporting optimal patient care, performance measurement, patient education, and communication.”

HealthAmerica members who use participating practices in the program will benefit from the highly coordinated care. Customers benefit from the cost savings generated by improved outcomes and avoiding unnecessary tests and procedures. Provider incentives for achieving quality goals help keep costs down and keep medical care focused on prevention strategies and managing patients with chronic diseases.

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 among the highest rated health plans in the nation for HMO and POS plans by the National Committee for Quality Assurance.* Its Medicare plan, HealthAmerica Advantra, ranks 24 out of 341 Medicare plans evaluated nationwide, ranking second in the state and among the top 25 health plans in the nation.* 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 National Committee for Quality Assurance 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

*NCQA’s “Health Insurance Plan Rankings 2011-12 – Private; NCQA’s “Health Insurance Plan Rankings 2011-12 – Medicare.

About Preferred Primary Care Physicians

Preferred Primary Care Physicians (Preferred) was founded in 1995 by ten primary care physicians in the South Hills of Pittsburgh. These physicians shared a common commitment to provide the highest quality care to the patients that they served. To that end, the group initiated quality improvement programs, participated in research studies to advance primary care practice, and implemented electronic medical records (EHR) in 2003, well before most other practices. Today, Preferred Primary Care Physicians consists of 32 board-certified physicians specializing in internal medicine and family practice. PPCP has 14 practice locations in the South Hills and three locations in Uniontown in Fayette County. In addition, PPCP offers state-of-the-art outpatient centers for cardiac testing, sleep disorders, and physical therapy. Preferred Healthcare Informatics, LLC, a subsidiary of Preferred Primary Care Physicians delivers EHR and information technology consulting services to physician practices and hospitals, including readiness assessment, implementation, support, content development, and meaningful use achievement.


The Blue Cross and Blue Shield Association Unveils Action Plan To Improve Healthcare Quality And Rein In Rising Healthcare Costs

WASHINGTON – The Blue Cross and Blue Shield Association (BCBSA)  released a comprehensive, interconnected action plan that fundamentally transforms the healthcare system, moving it away from a fee-for-service model to a patient-centered model.  The action plan, Building Tomorrow’s Healthcare System:  The Pathway to High-Quality, Affordable Care in America, provides specific recommendations to improve healthcare quality and tackle rising costs and is based on the experience of BCBSA’s 39 Plans in all 50 states and federal territories, in every market and every zip code.  An independent economic analysis of the recommendations shows that, if adopted, this action plan will achieve more than $300 billion in federal savings over the next 10 years.

“We believe that the healthcare system needs to fundamentally change so that people get the best, most affordable care possible.  We need to put the patient back in the center of healthcare and this is going to take a significant collaborative effort between both public and private sectors,” said Scott P. Serota, president and CEO of BCBSA.  “It’s time to stop the finger pointing and start working together to make our system the best for patients.  In Building Tomorrow’s Healthcare System, we make specific recommendations for what the government should do and show how Blue companies nationwide have been working with doctors, hospitals, consumers and policymakers to transform the healthcare system.”

The proposal lays out specific, actionable steps the government should take in four key areas:

  1. Reward Safety:  National and local leadership along with new provider incentives are needed to eliminate preventable medical errors, infections and complications that harm hundreds of thousands of people each year and cost billions of dollars.
  2. Do What Works:  The incentives in our system must be changed to advance the best possible care and reward quality outcomes, instead of paying for more services that are ineffective or redundant and add unnecessary costs to the system.
  3. Reinforce Front-Line Care:  A higher value must be placed on primary care and on ensuring there is an adequate workforce of professionals to deliver necessary, timely and coordinated care that results in better outcomes and lower costs.
  4. Inspire Healthy Living:  With 75 percent of today’s healthcare dollar spent on the treatment of chronic illnesses — many of which are preventable — consumers must be empowered and encouraged to make better choices, live healthier lives and better manage their health.

If adopted, the recommendations would save $319 billion over the next decade according to an economic analysis by Ken Thorpe, Ph.D., Robert W. Woodruff Professor and Chair Department of Health Policy & Management Rollins School of Public Health, Emory University.

“The BCBSA proposal reflects a clear understanding of the transformational approach needed to reform our prevention and healthcare delivery system,” said Thorpe.  “Building evidence-based approaches to coordinate care for Medicare and Medicaid patients that will improve the quality and reduce healthcare spending is a discussion we need to have.  Rather than simply shifting federal costs to seniors, the states, or elsewhere, these proposals have the potential to reduce total healthcare spending.”

The proposal contains several examples of Blue Cross and Blue Shield initiatives underway across the country that can work as models for improving care and reducing costs.  One example is the Michigan Health and Hospital Association’s Keystone:  ICU Program, which has dramatically reduced central line-associated bloodstream infection rates and ventilator-assisted pneumonia rates in ICU patients.  More than 70 Michigan hospitals participate in this program and over a six-year period the initiative has saved 1,830 lives, eliminated an estimated 140,700 avoidable hospital days for patients, and saved more than $300 million.

“This action plan recommends changes that will bring about real improvement for our fragmented healthcare system,” said Daniel Loepp, president and CEO, Blue Cross Blue Shield of Michigan.  “In Michigan, and in local communities across the country, the Blues are seeing first hand the difference that these types of programs can make for patients.  That is why we’re encouraging the government to work with the private sector to expand on efforts that improve the quality and affordability of care.”

To read Building Tomorrow’s Healthcare System:  The Pathway to High-Quality, Affordable Care in America, please visit

The Blue Cross and Blue Shield Association is a national federation of 39 independent, community-based and locally-operated Blue Cross and Blue Shield companies that collectively provide healthcare coverage for more than 99 million members – one-in-three Americans.  For more information on the Blue Cross and Blue Shield Association and its member companies, please visit


HHS Launches New Affordable Care Act Initiative to Strengthen Primary Care

September 28, 2011 – The U.S. Department of Health and Human Services (HHS) today launched a new initiative made possible by the Affordable Care Act to help primary care practices deliver higher quality, more coordinated and patient-centered care. Under the new initiative, Medicare will work with commercial and state health insurance plans to offer additional support to primary care doctors who better coordinate care for their patients. This collaboration, known as the Comprehensive Primary Care initiative, is modeled after innovative practices developed by large employers and leading private health insurers in the private sector.

“Thanks to the Affordable Care Act, we are helping primary care doctors better coordinate care with patients so they get better care and we use our health care dollars more wisely,” said HHS Secretary Kathleen Sebelius.

The voluntary initiative will begin as a demonstration project available in five to seven health care markets across the country. Public and private health care payers interested in applying to participate in the Comprehensive Primary Care Initiative must submit a Letter of Intent by November 15, 2011. In the selected markets, Medicare and its partners will enroll interested primary care providers into the initiative.

Primary care practices that choose to participate in this initiative will be given support to better coordinate primary care for their Medicare patients.
This support will help doctors:

  • Help patients with serious or chronic diseases follow personalized care plans;
  • Give patients 24-hour access to care and health information;
  • Deliver preventive care;
  • Engage patients and their families in their own care;
  • Work together with other doctors, including specialists, to provide better coordinated care.

CMS will pay primary care practices a monthly fee for these activities in addition to the usual Medicare fees that these practices would receive for delivering Medicare covered services. This collaborative approach has the potential to strengthen the primary care system for all Americans and reduce health care costs by using resources more wisely and preventing disease before it happens.

Across the country, systems which are based on comprehensive, higher-functioning primary care, similar to the strategy that CMS seeks to test in this initiative, show that patients are healthier and avoid having to seek care in more complex and expensive settings when primary care practices have the resources to better coordinate care, engage patients in their care plan, and provide timely preventive care. Large businesses have been able to make independent investments to promote more comprehensive primary care – improving the health of their employees and lowering their health care costs, thus making it easier for them to hire more workers and invest in their workforce.

“We know that when doctors have time to spend time with their patients and can better coordinate care with specialists, people are healthier and we have lower costs in the health care system,” said CMS Administrator Donald Berwick, M.D.

The Comprehensive Primary Care initiative is just one part of a wide-ranging effort by the Obama Administration to promote coordinated care and lower costs for all Americans, using important new tools provided by the Affordable Care Act. Accountable Care Organizations (ACOs) are another way that doctors, hospitals and other health care providers can work together to better coordinate care for patients, which can help improve health, improve the quality of care, and lower costs.  Under the Bundled Payment initiative, payments for multiple services patients receive during an episode of care will be linked to help improve and coordinate care for patients while they are in the hospital and after they are discharged.  The Partnership for Patients is bringing together hospitals, doctors, nurses, pharmacists, employers, unions, and state and federal government to keep patients from getting injured or sicker in the health care system and to improve transitions between care settings.

For more information, please see the Comprehensive Primary Care initiative web site at:

For an overview fact sheet about the Comprehensive Primary Care initiative, visit:

Source: HHS

Health Care Service Corporation, WellPoint and Blue Cross Blue Shield of Michigan Collaborate in National Private Exchange and Defined Contribution Solution For Employers

MINNEAPOLIS, Sept. 20, 2011 /PRNewswire via COMTEX/ — Health Care Service Corporation (HCSC), WellPoint, Inc. (NYSE: WLP), and Blue Cross Blue Shield of Michigan (BCBSM) announced today a joint effort to offer a nationwide private exchange and defined contribution solution for employers to use in managing their health benefit offerings.

The three independent health insurers have invested equal stakes in Minneapolis-based Bloom Health, giving them majority ownership of the company. This is the first investment in Bloom by HCSC and WellPoint, while BCBSM is increasing its existing stake in the company. Each insurer will serve on Bloom Health’s Board of Directors, with Bloom remaining a separate company.

Bloom Health, established in 2009, provides employers and employees greater flexibility, access and choice of health care services by simplifying how they select and pay for health insurance. Through its platform, Bloom Health helps employers define and better manage their health benefits spending through a defined contribution model. The employer contributes a defined amount per employee toward the cost of employee health care benefits. Employees and individuals are presented with a wide selection of benefit plans through an online “marketplace” to best fit their individual needs.

“Currently, rising health care costs are top of mind for organizations of all sizes,” said Abir Sen, chief executive officer, Bloom Health. “Bloom Health is an important option that assists companies in responsibly managing the rising costs of health care, while at the same time making it simple, engaging and valuable to its employees.”

“HCSC is committed to making health care more accessible and affordable to all consumers. Adding a private exchange to our strong portfolio of health benefit options is essential to providing a broad array of solutions to meet consumer needs in this evolving marketplace,” said Marty Foster, executive vice president and president of plan operations, HCSC.

“We believe private exchanges will be an important solution as the rising costs of health care leave employers searching for more predictability in their health care spend,” said Ken Goulet, executive vice president, and president and CEO of WellPoint’s Commercial Business Unit. “The combined leadership, technological capabilities, brand reputation and market presence make this a natural strategic fit to providing our customer base with the best value and their employees with convenience and choice.”

“By leveraging Bloom Health’s consumer expertise and leading-edge technology, we can offer employers a way to better manage risk all while preserving choice for their employees,” said Ken Dallafior, senior vice president of Group Business and Corporate Marketing, BCBSM. The company was the first to work with Bloom Health earlier this year to pilot a defined contribution health benefit solution to some Michigan employers during 2011, with an expanded rollout in 2012.

The Bloom solution will begin offering limited enrollment for groups renewing in 2012 and will be fully operational for all markets by 2013. For more information, visit

About Bloom Health

Bloom Health is a leader in the defined contribution health benefits marketplace, committed to assisting employers of all sizes move toward an employer-sponsored system that has effective cost predictability for employers and increased choice and personalization for employees. Bloom Health was founded in 2009 and is headquartered in Minneapolis. For more information, visit

About Health Care Service Corporation

Health Care Service Corporation is the country’s largest customer-owned health insurer and fourth largest health insurer overall, with more than 13 million members in its Blue Cross and Blue Shield plans in Illinois, New Mexico, Oklahomaand Texas. A Mutual Legal Reserve Company, HCSC is an independent licensee of the Blue Cross and Blue Shield Association. HCSC has a rating of AA- (Very Strong) from Standard and Poor’s, A1 (Good) from Moody’s and A+ (Superior) from A.M. Best Company. For more information, please visit or follow us at

About Blue Cross Blue Shield of Michigan

Blue Cross Blue Shield of Michigan, a nonprofit organization, provides and administers health benefits to more than 4.3 million members residing in Michigan, in addition to members of Michigan-headquartered groups who reside outside the state. Blue Cross Blue Shield of Michigan and Blue Care Network are nonprofit corporations and independent licensees of the Blue Cross and Blue Shield Association. For more company information, visit

About WellPoint, Inc.

WellPoint works to simplify the connection between Health, Care and Value. We help to improve the health of our members and our communities, and provide greater value to our customers and shareholders. WellPoint is the nation’s largest health benefits company in terms of medical membership, with 34 million members in its affiliated health plans, and a total of more than 69 million individuals served through its subsidiaries. As an independent licensee of the Blue Cross and Blue Shield Association, WellPoint serves members as the Blue Cross licensee for California; the Blue Cross and Blue Shield licensee for Colorado, Connecticut, Georgia, Indiana, Kentucky, Maine, Missouri (excluding 30 counties in the Kansas City area), Nevada, New Hampshire, New York (as the Blue Cross Blue Shield licensee in 10 New York City metropolitan and surrounding counties and as the Blue Cross or Blue Cross Blue Shield licensee in selected upstate counties only), Ohio, Virginia (excluding the Northern Virginia suburbs of Washington, D.C.), and Wisconsin. In a majority of these service areas, WellPoint’s plans do business as Anthem Blue Cross, Anthem Blue Cross and Blue Shield, Blue Cross and Blue Shield of Georgia, Empire Blue Cross Blue Shield, or Empire Blue Cross (in the New Yorkservice areas). WellPoint also serves customers throughout the country as UniCare. Additional information about WellPoint is available at


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.

Value-Based Benefit Designs Improve Community Health Value in Colorado Springs

COLORADO SPRINGS, CO and ST. LOUIS August 18, 2011 To reinforce the importance of engaging a community to lower health care costs and improve health and economic sustainability, the Center for Health Value Innovation (CHVI) has chronicled the efforts of three Colorado Springs employers that worked together to change how they were contracting for health. An organization devoted to health improvement through action, innovation and cost containment, CHVI has released a case study report to support other communities in implementing value-based benefit design, quality improvement and Outcomes-Based Contracting™ (aligning employee incentives to improve outcomes from health systems, drive higher value and offer better choices of providers).

“For the first time, we detail the thinking and benefit design changes that moved a community from waste reduction (use of inappropriate services, lack of medication adherence) through risk management (identifying gaps in care or under-managed conditions) and building individual and corporate accountability in purchasing health care services,” said Cyndy Nayer, CHVI President and CEO. “We detail the focus of the three employers, demonstrating the designs that drove success, so that other communities can follow the pathway to improved health and cost containment by focusing on engagement and health outcomes.”

The report highlights the efforts of three Colorado Business Group on Health (CBGH) members, the City of Colorado Springs, Colorado Springs School District 11 and Colorado Springs Utilities, over a five year period to improve population health and contain health cost inflation. The Colorado Springs employers measured the risk to their employees and their corporations, and then prioritized their individual efforts to change how they were contracting for health care with their plans and providers. The result was the collective influence of improved health care management in their city. Important to their success, they not only secured reduction in costs for prevention, wellness, and chronic care management, they also installed incentives for minimally invasive procedures and improvement in health care quality.

The success of these employer programs reinforces a key CHVI principle – lasting value in health improvement is driven at the community level with multi-stakeholder engagement. By highlighting the efforts and results of these employers who came together to implement value-based benefit design, other companies can learn how to build healthier businesses, healthier communities and healthier people.

CHVI has followed the efforts in Colorado Springs, documenting the maturation of the four-step process of value-based benefit design chronicled by CHVI: data, design, delivery and dividends. Levers – which include insurance plan incentives (i.e. providing a premium discount for completing a health risk assessment), stand-alone incentives and disincentives (such as a reduction in co-pays for appropriate surgical procedures, or an out-of-pocket increase to reduce use of emergency departments instead of primary care clinicians or urgent care centers) – are used for better performance and are fundamental to Outcomes-Based Contracting and building engagement across stakeholders, including consumers.

“We knew we needed to address wellness in particular, since national studies indicate that 70% of health care cost is attributable to life style, said Tamara Kirk, HR Supervisor-Benefits, Colorado Spring Utilities, and CBGH Board Chair. “As we do these types of programs collaboratively, we engage other stakeholders and create reform in our local health care system, while at the same time leveraging employers’ purchasing power.”

About the Center for Health Value Innovation (CHVI)

CHVI (501c3) is focused on the pursuit of innovation in benefit designs that improve engagement, accelerate accountability and create a predictable health cost trend. CHVI members represent over 60 million lives from all market segments in the health value supply chain, sharing the evidence of improved health and economic outcomes through value-based designs, including the Outcomes-Based Contracting™ platform for accelerating meaningful change. The Center for Health Value Innovation’s goal is to improve the health of people, organizations and communities throughout the U.S.


CDHP Enrollees More Educated, Healthier, and Higher-Income Than Those in Traditional Health Plans

WASHINGTON—In the 10 years that consumer-driven health plans (CDHPs) have existed they have tended to attract participants who are better educated, healthier, and have higher incomes than people in traditional health plans, according to a new report by the nonpartisan Employee Benefit Research Institute (EBRI). But in recent years, the income differences have begun to narrow.

For instance, EBRI found that in 2005 CDHP enrollees were more likely than traditional plan enrollees to have household income of $150,000 or more, but by 2010 this was no longer the case. In 2010, CDHP enrollees were more likely to have household income of $50,000‒$100,000, but were not more likely to have household income of $100,000 or more.

Paul Fronstin, director of EBRI’s Health Research and Education Program and author of the report, said other than for these factors, there are no clear demographic differences between enrollees in consumer-driven health plans and traditional health plans.

The findings are published in the May 2011 EBRI Notes, “Characteristics of the CDHP Population, 2005−2010,” and are available on line at  The data come from the 2005‒2007 EBRI/Commonwealth Fund Consumerism in Health Care Survey and the 2008‒2010 EBRI/MGA Consumer Engagement in Health Care Survey.

Employment-based health benefits are the most common form of health insurance in the United States, but skyrocketing health expenses have forced employers to seek ways to control their costs. Starting in 2001, employers started offering account-based health plans—a combination of health plans with deductibles of at least $1,000 for employee-only coverage and tax-preferred savings or spending accounts that workers and their families can use to pay their out-of-pocket health care expenses. These health savings accounts (HSAs) and health reimbursement arrangements (HRAs) are collectively known as “consumer-driven” health plans, and are designed to give workers more control over how they pay for their health coverage.

Other findings in the EBRI report:

  • Educational Level: CDHP and high-deductible health plan (HDHP) enrollees have consistently reported higher education levels than traditional plan enrollees.
  • Age: In most years of the survey, both the CDHP and HDHP populations were less likely to be young (ages 21‒34) than the population with traditional coverage. However, in 2010, both the CDHP and HDHP populations were more likely to be ages 35‒44. There were no differences in the portion ages 45‒54 and no recent differences in the portion ages 55‒64.
  • Health Status: CDHP enrollees have consistently reported better health status than traditional plan enrollees. They have also exhibited better health behavior than traditional plan enrollees with respect to smoking, exercise, and, recently, obesity rates. HDHP enrollees have also been consistently less likely than those with traditional coverage to report that they smoke, but no recent differences were found in exercise rates and differences have never been found in obesity rates. It cannot be determined from the survey whether plan design had an impact on health status, smoking, exercise, or obesity rates.

The Employee Benefit Research Institute (EBRI) is a private, nonprofit research institute based in Washington, DC, that focuses on health, savings, retirement, and economic security issues. EBRI does not lobby and does not take policy positions.

Source: EBRI

Employers Stress Healthier Habits and Behavior Change in an Effort to Lower Health Care Costs

LINCOLNSHIRE, Ill., June 2, 2011 /PRNewswire/ — Employers are beginning to rely more on employees to stem the tide of rising health care costs, but the inability to motivate and change habits has prompted concern, according to Aon Hewitt, the global human resource consulting and outsourcing business of Aon Corporation (NYSE: AON).

Aon Hewitt surveyed 1,028 employers nationwide in its 2011 Health Care Survey and found that the top health care outcomes organizations would like to achieve this year are improving employee health habits (56 percent), lowering the health care cost trend (49 percent), decreasing worker health risk (44 percent), increasing participant awareness of health issues (37 percent) and enhancing participation in health improvement/disease management programs (37 percent).  This survey suggests that success may be difficult, as 56 percent of respondents say motivating participants to change unhealthy behaviors is the most significant challenge to accomplishing 2011 health care program goals.  This was followed by issues involving reluctance to change (26 percent), unpredictability of costs (23 percent), government regulations/compliance (22 percent) and managing the health of an aging workforce (21 percent).

In addition, this survey revealed that many companies offer disease management (70 percent), health and wellness improvement (64 percent) and behavioral health (60 percent) as key components to health care strategies.  In an acknowledgement that more needs to happen to achieve success, many organizations are looking to expand efforts during the next three to five years and implement strategies that focus on total well being to improve physical and mental health (60 percent), absence management (53 percent), and integrated safety and health improvement efforts (50 percent).

“Despite reform, organizations still face rising costs and worsening population health,” said John Zern, Americas Health & Benefits Practice leader with Aon Hewitt.  “It’s clear that traditional annual trend mitigation tactics alone won’t work.  As a result, leading employers are implementing a ‘house money, house rules’ environment, using a mix of incentives, penalties and targeted messaging to reward healthy behaviors.”

While some companies are budgeting for a medical trend increase during the next four years, many do not have a long-term increase built into their budgets as of yet.  Nearly one-third of respondents (30 percent) have budgeted an annual medical trend increase between 4 percent and 7 percent from 2011 – 2015, and 22 percent have budgeted an increase of more than 8 percent during that time.  Meanwhile, 42 percent have not built an annual long-term increase into their budget at this point.

“Employers are spending millions of dollars annually on health care, and yet many report they do not have a specific plan for how best to manage that investment,” notes Jim Winkler, Large Employer Segment leader in the Health & Benefits Practice with Aon Hewitt.  “Given the risks and opportunities presented by health care reform, it is imperative that employers develop a written strategy for controlling cost and improving health.”

Rewarding & Penalizing Participants

The Aon Hewitt survey also showed that 22 percent of employers will have programs in place by the end of 2011 to reward participants for achieving specific health outcomes, and 10 percent will have similar programs to penalize participants for exhibiting unhealthy behavior.  However, by 2016, 64 percent of organizations said they will add programs that reward for good health, while 46 percent said they will add programs that penalize for unhealthy outcomes.

Respondents currently offer incentives to employees for participation in key initiatives, such as biometric screenings (33 percent), health risk assessments (33 percent), wellness programs (31 percent) and tobacco cessation programs (27 percent).  Conversely, some employers are imposing a penalty for non-participation in biometric screenings (5 percent), health risk assessments (5 percent), wellness programs (2 percent) and tobacco cessation programs (6 percent).

Money serves as the primary incentive and penalty these employers use to promote employee participation in key programs, including health risk assessments (66 percent have a monetary incentive; 9 percent have a monetary penalty); biometric screenings (65 percent have a monetary incentive; 8 percent have a monetary penalty); disease/condition management (54 percent have a monetary incentive; 9 percent have a monetary penalty); and wellness programs (59 percent have a monetary incentive; 6 percent have a monetary penalty).

“In a challenging economy, organizations are using financial incentives, as a mix of rewards and penalties, to motivate behavior change,” said Jennifer Boehm, principal in the Aon Hewitt Health & Benefits Practice, and a project leader for the survey.  “However, leading employers also recognize that success requires more than just dollars; those organizations also focus on marketing health improvement services, eliminating barriers to needed care and measuring the impact of specific interventions.”

Additional Survey Data

  • One-third of organizations currently offer stress reduction programs and 35 percent offer nutrition programs to employees.
  • Slightly more than half (52 percent) of employers have initiatives targeted to employees with chronic conditions (e.g., asthma, diabetes, heart conditions).
  • Less than 20 percent of organizations have performance goals tied to wellness success or participation levels, while 49 percent plan to add this type of program in the next three to five years.
  • By 2016, 77 percent of employers plan to have targeted communications on their health care programs, based on workforce demographics.
  • By 2016, 61 percent of employers plan to use social media to reinforce smart health behaviors and actions with their plan participants.

About this Survey

Aon Hewitt surveyed more than 1,000 HR Professionals nationwide on their current and future health care plans and practices.  In the findings report, Aon Hewitt offers analysis on the trends and insights within the context of four dimensions of a successful health care strategy: optimizing plan design and funding, reducing expenses, engaging participants in managing health, and improving health and workforce productivity.  To download a copy of Aon Hewitt’s 2011 Health Care Survey Report, please visit

About Aon Hewitt

Aon Hewitt is the global leader in human resource consulting and outsourcing solutions.  The company partners with organizations to solve their most complex benefits, talent and related financial challenges, and improve business performance.  Aon Hewitt designs, implements, communicates and administers a wide range of human capital, retirement, investment management, health care, compensation and talent management strategies.  With more than 29,000 professionals in 90 countries, Aon Hewitt makes the world a better place to work for clients and their employees.  For more information on Aon Hewitt, please visit

MagnaCare Releases White Paper on Chronic Care Management

NEW YORK–(BUSINESS WIRE)–MagnaCare, a health plan services company with national reach, announces the release of a White Paper significant to the health care industry and reform efforts nationwide: “The New Face of Chronic Care Management” explores the new paradigm of chronic care management in which coordinated specialty care helps to prevent minor health problems from becoming catastrophic and costly health issues.

“Traditionally, chronic care management has involved health care providers educating patients about their chronic diseases”

“Traditionally, chronic care management has involved health care providers educating patients about their chronic diseases,” says Joseph Berardo Jr., president and CEO of MagnaCare, pointing out that chronic disease affects approximately 133 million Americans regardless of their age, race, or economic status, and, in coming decades, that number is estimated to increase by 37 percent. “Given the emphasis on cost and the failure to address the complexity of chronic conditions, this model has not worked. Today, we understand that truly coordinated care across multiple settings is the key to improving care or controlling costs.”

“The New Face of Chronic Care Management” demonstrates how this approach can lead to a 20 percent reduction in health care costs per member enrolled in a chronic care management program, with patients experiencing better health and fewer costly emergency room visits, hospitalizations, and other major medical episodes.

Effective chronic care management serves the guiding principles behind health and wellness reimbursement by:

·   Controlling costs through improved health status of members

·   Utilizing claims, lab, and pharmacy data to identify opportunities to improve member health status

·   Prospectively applying medical management processes to the population

·   Selecting individuals who will benefit from intervention

·   Incenting providers to participate in the process

The document further discusses the main objectives of chronic care management to transform member data into actionable information; create insights to target root causes of poor outcomes and high costs; design programs that empower consumers and improve outcomes; and develop provider incentive to support behavior.

“The challenges in chronic care management are ever present, the biggest being how to induce consumers to take an active role in their own health care and how to incent providers to engage patients,” Berardo concludes.

About MagnaCare
MagnaCare, a health plan management company, is proactively reducing the cost of healthcare by offering self-funding options for employers of every size – as few as 15 employees. For more than 20 years, MagnaCare has served commercial employers, health insurers, workers compensation and auto carriers, TPA’s, government entities, and labor markets. MagnaCare offers access to a high quality broad provider network, predictive modeling analysis, member outreach programs or an integrated solution that includes full plan management services. Services include claims adjudication, population management, client/customer service and a full suite of ancillary products.

Highmark Partners with Navigenics for a New Generation of Personalized Wellness Powered by Genetic Knowledge

April 14, 2011 | Foster City, Calif., and Pittsburgh, Pa. — A new generation of personalized wellness powered by genetic knowledge will be offered to Highmark members and individuals through a partnership between Highmark and Navigenics, the two companies announced today. The first partnership of its kind in the nation between Highmark, one of the country’s largest Blue Cross and Blue Shield plans, and Navigenics, a pioneer in the application of genetic knowledge to improve individual health, aims to apply an integrated approach to health and wellness that is personalized for individuals based upon their genetic risks.

“If we can help our members understand their specific, individual genetic risk factors together with personal health factors such as family history and lifestyle, then we can help them take the right steps to stay healthy and well,” said Steven Nelson, senior vice president of health services strategy, product and marketing at Highmark. “Our hope is that individuals use this program as a preventive, proactive health planning tool to understand their risks and then change their lifestyle or take the necessary medical steps with their doctor to prevent long-term disease.”

Better health lies in delaying or preventing conditions before they develop. The Navigenics program identifies the genetic risk factors of an individual — through DNA analysis using a saliva sample — for health conditions such as cancers, cardiac diseases and Type 2 diabetes. The service also includes a panel on pharmaceutical responses, which reviews 12 medications for potential side effects or dosing considerations. Examples include Plavix, Warfarin and statin medications.

Navigenics selects only health conditions where genetic insight can guide an individual to an informed plan of action. Results are coupled with access to a board-certified genetic counselor, the ability to coordinate with personal physicians and the tools and resources to understand steps to address the identified health risks in conjunction with an individual’s overall health profile.

Highmark will offer the personalized wellness program through its group customer relationships in order for employers to provide a personalized option of health and wellness to their employees.

“The Navigenics personalized approach is particularly meaningful to employers who strive to infuse a ‘culture of health’ across their employee population,” said Vance Vanier, M.D., president and CEO of Navigenics. “Our goal is to heighten the impact of employer-sponsored wellness and prevention programs by giving individuals unprecedented access to knowledge about their unique health risks. We know that this information can be a catalyst for healthier decisions leading to higher quality, longer lives that are free of preventable disease.”

One Highmark employer group, Pittsburgh Technical Institute, has already become a participant in the new program.

“We see this as an exciting opportunity to improve health engagement,” said Nancy Sheppard, director of human resources at the educational institution. “Our organization has a long history of supporting our employees with innovative wellness programs, and we believe that through the introduction of genetic information and a session with a genetic counselor, our employees will not only have the option to gain greater insight into their health, but will be empowered to be more engaged in prevention.”

To help support testing participants who are also Highmark members, Navigenics genetic counselors may refer participants to Highmark-specific resources such as health coaching or online lifestyle improvement programs.

“Highmark offers our members a variety of programs to help them better manage their health,” said Nelson. “From health coaches to comprehensive lifestyle improvement programs to preventive screenings, Highmark understands the value of health prevention and maintenance. Having one more piece of valuable information — your personal genetic makeup — through a personalized health program powered by genomics gives individuals even more information and power to make the right lifestyle and health choices.”

Highmark will not have access to any results of any test purchased through Navigenics. Genetic testing results are also protected under federal law. The Genetic Information Nondiscrimination Act (GINA) of 2008 protects Americans from being treated unfairly because of differences in DNA that may affect health. The law prevents DNA information from being used against individuals in health insurance or the workplace.

Also starting today, the program will be offered to individuals through an educational conversation with a trained specialist at six Highmark Direct locations in Pennsylvania.

About Navigenics
Navigenics, Inc. develops and commercializes genetics-based products and services to improve individual health and wellness. Navigenics educates and empowers individuals and their physicians by providing clinically actionable, personalized genetic insights about disease risk and medication response to catalyze behavior change and inform clinical decision-making. The company was founded by leading scientists and clinicians, and continues to advance genomic knowledge and adoption of molecular medicine through studies with leading academic centers. Navigenics’ services are available through employer wellness programs and health plans, as well as through physicians and medical centers. Among Navigenics’ investors are Kleiner Perkins Caulfield and Byers, Mohr Davidow Ventures and The Procter & Gamble Company. For more information, visit

About Highmark Inc.
Highmark Inc., based in Pittsburgh, is an independent licensee of the Blue Cross and Blue Shield Association, an association of independent Blue Cross and Blue Shield plans. Highmark serves 4.8 million members in Pennsylvania and West Virginia through the company’s health care benefits business and is one of the largest Blue plans in the nation. Highmark has 19,500 employees across the country. For more than 70 years, Highmark’s commitment to the community has consistently been among the company’s highest priorities as it strives to positively impact the communities where we do business. For more information, visit