Patient-Centric Quality Measures Are Needed for True ACO Ratings

ACOs and payers should weave much more specific, function-oriented patient satisfaction and patient-driven decision-making measures into the quality standards that determine reimbursement for physicians and organizations, ACO executives say.

Creating these new quality measures — and scoring well on them — will require widespread changes in health information technology (HIT) systems, physician attitudes and organizations, says Palmer Evans, M.D., former senior vice president and chief medical officer at Tucson Medical Center in Arizona and senior advisor to the South Arizona Accountable Care Organization, which includes Tucson Medical Center and more than 170 physicians.

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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

State-federal Review of Health Insurance Rate Increases Starts Today

FOR IMMEDIATE RELEASE September 1, 2011 – Today, health insurers seeking to increase their rates by 10 percent or more must submit their request to state or federal reviewers to determine whether they are reasonable or not. This rate review program, created by the Affordable Care Act, will bring greater transparency, accountability, and, in many cases, lower costs for families and small business owners who struggle to afford coverage.

In a growing number of states, regulators now have the authority to deny or reduce rate hikes found to be excessive. Insurers that insist on going ahead with double-digit rate increases are required to post their justifications on their website, and state and federal regulators will post them as well.

“For far too long, families and small employers have been at the mercy of insurance rate increases that often put coverage out of their reach. Rate review will shed a bright light on the industry’s behavior and drive market competition to lower costs,” said Kathleen Sebelius, Secretary of Health and Human Services. “We are pleased to team with states to bring this important new protection to consumers and employers.”

As of today, insurers proposing double digit increases will have to provide clear information that indicates what factors are causing proposed increases. Experts will closely examine information about the underlying cost trends in health care to flag instances when insurance companies are unjustly raising costs. This means consumers will no longer have to take the word of their insurance company; they will have an independent expert reviewing their proposed rate increase.

Starting mid-September, consumers in every state can go to to view easy-to-access, consumer-friendly disclosure information explaining proposed increases that are 10 percent or higher than last year’s rates. Consumers will see a summary of the key factors driving rate increases and an explanation provided by insurance companies for why the proposed increase is needed. And, for the first time, consumers in every state will also be given the ability to comment on large proposed rate increases.

“Thanks to the Affordable Care Act consumers no longer have to navigate the health insurance market blindly and on their own,” said Steve Larsen, director of the Center for Consumer Information and Insurance Oversight. “The next time your insurance company tries to raise your premium by double digits, it will have to give you and rate review experts a good reason – or be labeled as unjustified, or in some states denied.”

States continue to have the primary responsibility for reviewing insurance rates. Because many states have lacked the resources needed to perform strong rate review, the Affordable Care Act provides $250 million in Health Insurance Premium Review Grants to states over five years. These new resources will improve how states review proposed health insurance rate increases and hold insurance companies accountable for unjustified premium increases. States and territories are already using $48 million in rate review grants, and HHS has made an additional $200 million available to states and territories to strengthen and improve their rate review processes.

“Thanks to our Affordable Care Act grant funds, our rate reviews are more in-depth, and we recently proposed to use future grant funds to incorporate public hearings into our rate reviews,” Oregon Insurance Division Administrator Teresa Miller said. “We have already received valuable feedback from consumer groups and look forward to continuing to improve our rate review process”

For more information on rate review and today’s announcement, please visit:

For more information on significant State achievements with rate review, please visit:


Lockton expert testified on Capitol Hill; most employers to continue health insurance

(Kansas City, MO) 1 Aug 2011 – Employers, according to Lockton Benefit Group president Michael Brewer, are remarkably committed to their employees. So much so, says Brewer, that even amidst the uncertainty of health reform and the opening of new insurance exchanges in 2014, most of Lockton’s clients who offer health coverage today plan to continue to offer group health insurance. However, the costs and administrative burdens of health reform could cause these same businesses to cut full-time jobs or limit their abilities to expand. That’s exactly what Brewer told lawmakers in Washington D.C. on July 28, 2011 while speaking at a hearing on the impact of last year’s healthcare reform law, for a Subcommittee of the Oversight and Governance Reform Committee of the U.S. House of Representatives.

Brewer testified that while more than 80 percent of employers responding to a recent Lockton survey about health reform indicated they would like to continue to offer group insurance, these employers still struggle with the cost and complexity of group plan administration, and that thus far the healthcare reform law has increased-not mitigated-costs and administrative burdens. Brewer told Congress, “One of our employers simply stated, ‘We operate our business on paper-thin margins and any additional government mandated costs will force us to either close the business or reduce the hours of our full-time employees.’ Now we know this is not the intent of health reform, but this is the result of health reform and this is the reality of health reform for many employers: job loss and reduction in employment opportunities,” said Brewer.

Only about 20 percent of employers, the Lockton survey indicated, will consider terminating their group health plans when the insurance exchanges open in 2014. But Brewer told the subcommittee that the other 80 percent overwhelmingly said the reason for their current commitment is a belief that they must offer health insurance to attract and retain the kind of employees they need. Brewer said that as the dominoes begin to fall-as other employers exit the group health marketplace, and this 80 percent of employers that now say they plan to continue to offer coverage begin to see that they do not have to offer health insurance to attract and retain the talent they want-there is likely to be a more substantial migration of employers out of the group insurance market. Brewer warned Congress that this could significantly skew Congressional Budget Office estimates on the number of Americans who are expected to seek federal subsidies to purchase insurance in the new insurance exchanges.

Click to review Brewer’s written testimony, provided in advance to the House Subcommittee, or click to view avideo of the Committee hearing (Brewer’s testimony begins at 34 minutes into the hearing.)

Click to view more informationabout Lockton’s employer survey results.

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About Lockton

More than 4,100 professionals at Lockton provide more than 15,000 clients around the world with insurance,benefits, and risk managementservices, offering an uncommon level of client service. From its founding in 1966 in Kansas City, Missouri, USA, Lockton has grown to become the largest privately held insurance broker in the world and 9th largest overall. Independent researcher Greenwich Associates awarded Lockton its 2011 Service Excellence Award for risk management for large companies.  Business Insurancehas twice recognized Lockton as a “Best Place to Work in Insurance.” You can learn more at


hCentive Powers Sales Automation Platform for Coventry Health Care Individual Business

Sterling, VA – June 10, 2011 – hCentive, Inc ( today announced that Coventry Health Care, Inc. ( selected the hCentive WebInsure Consumer platform to power the online sales of its health plan products for individuals and families.

Online consumers shopping for health insurance and brokers who quote and sell CoventryOne Individual products are now using the hCentive WebInsure Consumer platform.

“Coventry’s goal is to offer a simple and straight-forward experience for our customers. We looked for an easy-to-use solution for both consumers and brokers. The tool that we built with hCentive accomplishes that goal and positions us for success in the growing Individual market, ” said Tom Stoiber, Vice President, Individual Products at Coventry Health Care. “We evaluated many different vendors, and hCentive offered the best platform and value for our investment.”

“We are extremely pleased with Coventry’s selection of hCentive Solution,’ said Sanjay Singh, CEO of hCentive, Inc. “Coventry’s choice reflects the value payers see in our solution. We have created a platform that helps insurance companies meet the requirements of health care reform and simplify distribution and administration. ”

About Coventry Health Care, Inc.
Coventry Health Care ( is a diversified national managed health care company based in Bethesda, Maryland, operating health plans, insurance companies, network rental and workers’ compensation services companies. Coventry provides a full range of risk and fee-based managed care products and services to a broad cross section of individuals, employer and government-funded groups, government agencies, and other insurance carriers and administrators.

About hCentive
hCentive is in the business of simplifying the complex world of health insurance. hCentive provides technology solutions for health insurers, state health insurance agencies and health care software companies. These solutions help them reduce cost and administrative complexity, while enhancing relationships with their customers.

The hCentive WebInsure Consumer and WebInsure Group platform help health insurers cost effectively acquire individual and small business customers. The hCentive WebInsure State platform helps states comply with health insurance exchange requirements of the Patient Protection and Affordable Care Act of 2010.

Blue Cross and Blue Shield of Georgia Helps Businesses Navigate Health Care Changes with New Online Tools

In an effort to help minimize confusion regarding implementation of health care reform provisions among business owners, Blue Cross and Blue Shield of Georgia (BCBSGa) has created two new tools to help business navigate the changes in health care, a grandfathering tool and a tax calculator tool.

Both tools are available at  The small business tax calculator tool and tax content were developed by The Tax Institute at H&R Block and also may be viewed by visiting

The interactive grandfathering tool is designed to help businesses better understand what grandfathering means, if they qualify for it, and what options are available to them with regard to their health plan. BCBSGa has also joined forces with H&R Block to provide a convenient, comprehensive tool to help small business owners understand the financial impact, as well as the opportunities that accompany the changes in the health care system.

“The grandfathering tool is another part of our commitment to help make health care reform work,” said Morgan Kendrick, President, BCBSGa. “This tool will allow business owners to understand what grandfathering means to them, what the qualification parameters are, and if it is potentially in their best interests to grandfather their current health plan.  This tool can help businesses quickly and easily determine a course of action based on their current plan in an easy-to-use and easy-to-understand tool.”

Kendrick added, “We are also extremely pleased to be partnering with H&R Block to make the small business tax calculator available, which can help small business owners understand the tax credits they are qualified for and allow them to better control and anticipate their health care costs.  It’s BCBSGa’s hope that this resource will enable owners to focus on running a successful business and add some clarity as they navigate the health care system.”

The small business tax calculator can help users understand the following reform provisions:

“These tools will provide us with an easy way to navigate and communicate the financial impact that health care reform may have on our small business customers,” said Jeff Fishback, President and CEO, Purchasing Alliance Solutions. “They will also help us to better communicate about grandfathering and if it might be in their best interest. For example, whether they should take advantage of the available credits and other provisions designed to improve the affordability of health care. I anticipate that interactive tools such as these will help small businesses save time and money. This is just one more example of why BCBSGa is the leader in the industry.”

About Blue Cross and Blue Shield of Georgia:

Blue Cross and Blue Shield of Georgia, Inc. and Blue Cross and Blue Shield Healthcare Plan of Georgia, Inc. are independent licensees of the Blue Cross and Blue Shield Association® . The Blue Cross and Blue Shield names and symbols are registered marks of the Blue Cross and Blue Shield Association.  Additional information about Blue Cross and Blue Shield of Georgia is available at

SOURCE Blue Cross and Blue Shield of Georgia