Blue Cross and Blue Shield of Florida and Mayo Clinic Strengthen Relationship by Expanding Network Options

JACKSONVILLE, Fla., April 1, 2011 /PRNewswire/ — Blue Cross and Blue Shield of Florida (BCBSF) and Mayo Clinic in Florida have expanded their agreement, making Mayo Clinic an in-network option for BCBSF BlueOptions (PPO) members, effective April 1, 2011. This multi-year contract marks the broadest relationship to date between BCBSF and Mayo Clinic in Florida as it builds off the existing Traditional Program and BlueChoice PPO networks.

“We are very pleased to have reached this agreement with Mayo Clinic that will benefit BCBSF members and the community,” says Andy Marino, vice president of network development at BCBSF. “This agreement will add great value for our BlueOption members to take advantage of Mayo Clinic’s group practice and specialty care, as well as those who are in our Traditional and BlueChoice PPO networks.”

“Mayo Clinic is committed to providing personalized, coordinated care for patients. This expanded agreement means more Blue Cross and Blue Shield members throughout Florida and the Southeast now have the ability to take advantage of our care,” says Dr. William C. Rupp, chief executive officer, Mayo Clinic in Jacksonville. “We’re delighted to be working more closely with Blue Cross and Blue Shield in the delivery of health care services to their members.”

With the expanded relationship, the following networks and products are now included in the amended agreement:

  • The BCBSF Network Blue, which includes the BCBS BlueOptions product
  • The BCBSF Preferred Patient Care (PPC) network, which includes the BlueChoice PPO product.
  • The BCBSF Traditional network, which includes the Preferred Physician Services (PPS) and Preferred Hospital Services (PHS) networks. BlueCross’ Indemnity product falls under these networks.


About Blue Cross and Blue Shield of Florida

BCBSF is a leader in Florida’s health industry. Since 1944, the company has been dedicated to meeting the diverse needs of all those it serves by offering an array of choices. BCBSF is a not-for-profit, policyholder-owned, tax-paying mutual company. Headquartered in Jacksonville, Fla., BCBSF is an independent licensee of the Blue Cross and Blue Shield Association, an association of independent Blue Cross and Blue Shield companies. For more information concerning BCBSF, please see its website at

About Mayo Clinic

Mayo Clinic is a nonprofit worldwide leader in medical care, research and education for people from all walks of life. The Jacksonville, Fla., campus, which opened in 1986, has more than 340 physicians, surgeons and scientists who specialize in more than 40 areas. For more information, visit or

SOURCE Blue Cross and Blue Shield of Florida

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.

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.

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.

Horizon Blue Cross Blue Shield of New Jersey Makes Major Investment In Next Generation Health Care For New Jersey

Most health care experts agree that, despite federal health care reform, a great deal of work remains to be done to improve the nation’s health care system.  Horizon Blue Cross Blue Shield of New Jersey (Horizon BCBSNJ) announced recently it plans to spearhead that work in New Jersey by creating a new company with a mission to energize the transformation of health care delivery to a better system marked by higher quality and more effective care, greater collaboration and efficiency, and increased affordability.

As one of the first Blue Cross plans in the nation, Horizon BCBSNJ was a pioneer in the creation of health insurance.  Horizon BCBSNJ’s new company will tap that same pioneering spirit to develop innovative collaborative models for the delivery and financing of high quality care in New Jersey.

“As the state’s oldest and largest health insurer, Horizon BCBSNJ is in the best position to initiate collaborative partnerships between the many stakeholders who are working to improve the quality of health care and bring cost increases down to a sustainable level,” said William J. Marino, Chairman and CEO of Horizon BCBSNJ.  “We believe that creating a new company is the best way to bring energy, focus, and commitment to improving the delivery and financing of health care, a goal we share with many of our colleagues throughout the health care system.”

The new company is expected to be operational in September, but Horizon Healthcare Innovations (HHI) has already begun work as a division of Horizon BCBSNJ.  HHI is already working on creating partnerships with providers, employers, and health care leaders to develop new models of care that will provide patients with better quality care, increase efficiencies, and contain costs.

“Everyone in New Jersey’s health care system understands that we cannot continue to experience spiraling costs and below average rankings across quality of care measures,” said Dr. Richard Popiel, who served as Vice President and Chief Medical Officer of Horizon BCBSNJ and will lead the new company as President and Chief Operating Officer.  “We’re committed to leading a major collaborative effort among physicians, hospitals, policy makers, employers, patients, and insurers to rethink how we deliver quality care and control costs.”

Horizon BCBSNJ decided this was an opportune time to establish a new company to address the quality and cost issues left out of the recently passed federal health care reform law.  A number of provisions of the new law will increase health care costs and result in higher insurance premiums.  The new law will add to the financial burden of many individuals and employers, who are already struggling with rising health care costs.

Horizon BCBSNJ also believes there is a significant opportunity to improve heath care quality across the state.  A 2009 Commonwealth Fund study ranked New Jersey 30th in the nation for quality of care based on measures such as prevention, treatment and avoidable hospital use and costs.

“Our goal is to energize collaborative partnerships and ignite the flames of transformation that will benefit the entire health care system – individuals, families, businesses, and providers,” added Dr. Popiel.  “The time is right for innovation and rethinking how care is delivered and financed because people are focused on our health care challenges and they know we need to act.  Horizon is making a major investment and we’re ready to act.”

Source: Horizon BCBSNJ

Humana Introduces ‘Points of Caregiving’ Program, Providing Comprehensive Resource to Nation’s 52 Million Caregivers

Humana Inc. (NYSE: HUMNews) today introduced Points of Caregiving, a comprehensive resource for the nation’s 52 million caregivers. Designed as a complete caregiver’s destination, the program includes an easy-to-use interactive website, telephonic support and customized reminders to help caregivers make decisions with confidence and to find support from peers.

Research reveals that one in five American adults, many of whom have children or other dependents, provide care to a relative, friend or neighbor. Caregivers often take on this role suddenly or unexpectedly, and frequently must make major health and financial decisions quickly for the person under their care. These new challenges and critical decisions can leave caregivers puzzled and hesitant. Humana developed the Points of Caregiving program to meet this need and to provide expert support and resources.

“Caregivers play a critical support role in the U.S. health care system and often are considered the backbone of our long-term care system,” said Gail Miller, vice president, senior product development, strategy and business planning for Humana. “With Points of Caregiving, we strive to provide a supportive, interactive community that will help informal and unpaid caregivers make the best decisions.”

Points of Caregiving is available to any caregiver, from those who perform “light” care – such as helping with shopping, transportation and cleaning – to “heavy” care, such as administering medication or injections and performing personal hygiene services like bathing. Program members receive access to a variety of tools that help support caregivers physically, emotionally and financially:

  • Tools and resources, such as worksheets and cost calculators to budget and plan for care-management, easing caregivers’ minds as they estimate income changes and caregiving expenses
  • Telephone consultation and support, including phone reminders members can personalize for medications, doctor’s appointments, or anything else a caregiver with a busy schedule must remember
  • Library of expert articles on health, insurance, legal matters and more
  • Interactive community forums where caregivers can connect with peers to receive support and advice from people in similar situations
  • Information about national, state and local community resources, such as clinics, doctors and public-service agencies that can act as advocates, support and assist with care planning, which is especially helpful to people caring from afar
  • Discounts on products and services that help caregivers save time and money as well as care for themselves and their dependents – such as discounted diet and exercise products, books, games, pill box with an alarm clock reminder, and more

Humana developed Points of Caregiving with its LifeSynch subsidiary; the program is available for Humana members and non-members for $20 a month with a one-year agreement ($240 a year), a cost quickly offset by the time and energy saved by the caregiver. Visit to learn more about caregiving.

About Humana

Humana Inc., headquartered in Louisville, Ky., is one of the nation’s largest publicly traded health and supplemental benefits companies, with approximately 10.4 million medical members and approximately 7.2 million specialty-benefit members. Humana is a full-service benefits solutions company, offering a wide array of health and supplemental benefit plans for employer groups, government programs and individuals.

Blue Cross Blue Shield of Michigan Designates More than 1,800 Physicians in Nation’s Largest Patient-Centered Medical Home Program

Blue Cross Blue Shield of Michigan has designated more than 1,800 physicians in roughly 500 practices across the state as patient-centered medical homes (PCMH), securing the initiative’s position as the largest PCMH effort in the nation.  The number of designated physicians grew by roughly 50% over the 1,200 designated PCMH physicians in 2009.

In the patient-centered medical home, primary care physicians (pediatricians, internists and family practice doctors) lead care teams that bring intensive focus to their patients’ individual health goals and needs.  The care teams work with patients to keep them healthy and monitor their care on an ongoing basis.  PCMH teams coordinate patients’ health care using registries to track patients’ conditions and assure they receive the care they need.  They offer extended access to the care team, coordinate complementary care – such as nutrition counseling – and help patients learn to self manage conditions such as asthma and diabetes.  They make sure that a patient doesn’t get lost in the system.

“Blue Cross is working in partnership with some of Michigan’s leading health care professionals to improve access for patients, improve quality and lower costs,” said Thomas L. Simmer, M.D., senior vice president and chief medical officer for BCBSM.  “People want closer relationships with their doctors, not only when they are sick, but when they need advice and guidance to keep them healthy.  This program builds the type of primary care system the people of Michigan want for their families.”

Preliminary data shows that PCMH-designated doctors are succeeding in managing their patients’ care to keep them healthy and prevent complications that require expensive medical services to treat.   For example, a review of data shows that PCMH practices have a 2 percent lower rate of adult radiology usage than non-PCMH practices, and PCMH practices have a 2.6 percent lower rate of adult inpatient admissions than non-PCMH practices.

About 5,000 primary care doctors in Michigan are working toward designation as PCMH practices by transforming how their practices deliver health care services to patients.

“Physicians recognize the value that patient-centered medical home provides to their patients, and thousands are working hard to gain designation by Blue Cross,” Simmer said.  “Our designations have grown from 1,200 to 1,800 in just one year, and I’m anticipating they will continue to increase as more physician practices bring new capabilities online in the coming months and years.”

Simmer notes that while 1,800 of the 5,000 doctors attempting designation actually achieved it for 2010, the efforts of those other 3,200 physicians should be commended for their work in supporting the PCMH model of care.

“All of these physicians are partnering with Blue Cross through this initiative to improve the primary care environment throughout the state,” Simmer said.

The benefits of PCMH reach to all the practices’ patients, because not all patients walking through the doors of a PCMH practice are insured by Blue Cross.  The Blue Cross patient-centered medical home initiative is reaching close to two million Michigan residents through designated physician offices today.

The Blue Cross Blue Shield of Michigan patient-centered medical home program uses a model that considers both process of care and performance to designate physicians.  One-half of the designation score was based on the amount of PCMH capabilities the physician practices have in place – such as 24-hour telephone access, use of disease registries, and active care management.  The other one-half of the designation score was based on quality and utilization measurements, such as emergency room visits, radiology and evidence-based care measures among their patients.

Blue Cross has posted a list of PCMH designated physicians on its Web site at People interested in locating a PCMH physician in their community can go to and click on “Find Doctor” at the top of the page.

The PCMH initiative is part of Value Partnerships, a collection of collaborative initiatives among physicians, hospitals and the Michigan Blues, all aimed at improving quality in medical care. To learn more about this comprehensive effort, go to

Blue Cross Blue Shield of Michigan is a nonprofit corporation and independent licensee of the Blue Cross and Blue Shield Association. For more company information, visit

SOURCE Blue Cross Blue Shield of Michigan

CIGNA Teams With CareCentrix to Reduce Hospital Readmissions

According to a recent study, one in five hospital discharges is complicated by an adverse event within 30 days, often leading to emergency care or re-hospitalization.1 To combat this problem, CIGNA (NYSE:CI) and CareCentrix, Inc., have teamed up to offer the Care Transitions Program to people enrolled in a CIGNA health plan after they’ve been discharged from the hospital. CareCentrix will provide specialized home nursing services that will help these individuals transition from hospital care to home recovery.

The Care Transitions Program will be offered initially in Texas over the next 12 months to people enrolled in a CIGNA health plan who are identified as at-risk for hospital readmissions. The program will be extended to more people in additional locations in 2011.

“Nobody wants to return to the hospital after they’ve been discharged, but without access to proper care and support at home, many people develop complications that can send them back within just a few weeks,” said Dr. Scott Josephs, national medical officer for CIGNA. “Through the Care Transitions Program we’re offering with CareCentrix we hope to decrease hospital readmissions and help people have a safe recovery at home.”

The Care Transitions Program was developed in conjunction with physicians and researchers who specialize in hospital discharge and transition planning. It will provide people with clinical education, resources and guidance from nurses who will monitor and support their hospital discharge, transition and recovery at home. The program will provide support in five key areas including:

  • Identifying a caregiver and involving that person in the individual’s care
  • Educating individuals and their caregivers about the individual’s hospital discharge plan
  • Building awareness of the individual’s condition, signs/symptoms of the condition and what to do if the individual’s condition worsens
  • Helping individuals manage their prescriptions and other medications
  • Facilitating follow-up medical appointments

“We are excited to expand our relationship with CIGNA to bring the Care Transitions Program to the people CIGNA serves,” said Eric Reimer, chief executive officer, CareCentrix. “We are leveraging our home health care expertise and extensive home care provider network to provide people with proven and timely support to ensure they successfully transition from the hospital to recovering in the comfort of their home. In addition to reducing the number of hospital readmissions, our goal is to support people enrolled in a CIGNA health plan achieve better health outcomes over the long-term.”


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, to approximately 46 million people throughout the United States 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: @cigna and visit CIGNA’s YouTube channel at

About CareCentrix

Founded in 1996, CareCentrix manages home nursing, infusion and medical equipment services for more than 10 million people across the country through a network of 5,000 credentialed home care providers. The company provides health care plans and providers with a one-stop solution that coordinates care for patients in the home including skilled nursing services, durable medical equipment and home infusion drug therapies. CareCentrix has developed a new program that will help payers and providers reduce the rising rate of hospital readmissions. CareCentrix is headquartered in East Hartford, Connecticut, and has operations in Melville, New York; Phoenix, Arizona; Tampa, Florida; and Albuquerque, New Mexico; and a new regional care center recently opened in Overland Park, Kansas. For more information about CareCentrix visit

Consumer Engagement Improves Radiology Outcomes

More consumers than ever before are seeking additional knowledge to make more informed decisions, especially when it comes to their health care.

To help members lower their out-of-pocket costs and enhance the quality of their care through informed decision-making, HealthAmerica has partnered with National Imaging Associates (NIA) to provide an innovative consumer engagement program for diagnostic imaging services.

“By educating our members on their benefits and providing information on advanced medical imaging procedures, we enable them to take an active role in their health care,” said David P. Crosby, president of HealthAmerica.

This carries added significance in the field of diagnostic imaging, especially given concerns about radiation safety, clinically inappropriate examinations, and rising health care costs. HealthAmerica and NIA representatives pointed to multiple independent studies that found as many as one-third of all advanced imaging services are either clinically inappropriate or do not contribute to a physician’s diagnosis or the ultimate health outcomes for the patient.

“When consumers are engaged in the imaging process, they make more informed decisions about their care, and this improves outcomes, affordability, and consumer satisfaction,” said Tina Blasi, CEO of NIA, a Magellan Health Services company (Nasdaq: MGLN). “Our commitment to transparency, education, patient safety, and patient choice is at the very heart of our company’s philosophy.”

The services from HealthAmerica and NIA include a Facility Selection Support program that assists members with the selection of a quality imaging facility for their examinations, based on such convenience factors as location, proximity to public transportation, and the availability of evening and weekend appointments. NIA also can assist in identifying if there are any cost differences for the individual member and can provide patients with support in scheduling the image exams, as needed.

“Like most businesses, our employees pay an increasing share of their health care costs,” said Greg Drake, senior manager of Facilities and Purchasing for Isaac’s Deli Inc. “It’s important that we provide them with tools they can use to make sure they are using their health care benefits wisely. HealthAmerica’s imaging program provides a greater level of transparency on radiology services for my employees who are eager to get more involved in health care decisions.”

Additional NIA tools to support consumer engagement will be provided to HealthAmerica members later this year. This includes the launch of NIA’s new online consumer portal, which guides members through the imaging decision process, explain radiation safety considerations, and offer expanded information on imaging facility options. These resources, featuring age-specific content for adults and children, are designed to help members better understand their imaging procedures, engage in dialogue and shared decision-making with their physicians, and make knowledgeable decisions about their health care.

“Quality, cost, and convenience are becoming increasingly important to our patients,” said Paul DeLoia Jr., chief executive officer of Tristán Associates. “HealthAmerica’s radiology benefit management program supports our providing high quality imaging services with maximum safety and convenience to our patients. In addition, the program helps provide our patients with greater visibility on their out-of-pocket expenditures when visiting one of our sites.”

As Blasi said, it comes down to supporting the consumers in safeguarding the quality and cost of their health care.

“Consumers who become engaged in the health care process are active participants in ensuring that they receive the right medical scan, in the right place, at the right time,” Blasi said. “This is the right thing to do for those we serve, and it is bringing a new level of empowerment and transparency to the health care experience.”

About HealthAmerica

Listed among the country’s top 20 health plans in the U.S.News/NCQA America’s Best Health Insurance Plans 2009-10 list, HealthAmerica has been offering health benefits in Pennsylvania for over 34 years. The company provides a range of health insurance products, including consumer-directed, 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. It has corporate offices in Harrisburg, Philadelphia and Pittsburgh, Pennsylvania. For more information, visit HealthAmerica’s website at

About NIA

Headquartered in Avon, Conn., NIA (National Imaging Associates) leads the radiology benefits management industry by delivering innovative solutions to effectively manage the cost and quality of diagnostic imaging. NIA is a subsidiary of Magellan Health Services, Inc. (Nasdaq:MGLN), a leading specialty health care management organization. For more information about NIA, visit

Innovative Value-Based Health Insurance Plan Designs Can Improve Member Health at No Added Cost, Study Says.

Value-based insurance design programs — which reduce patient co-payments for highly effective treatments — can break even financially or possibly save money, according to a new study from University of Michigan, Harvard and other researchers.

In an article published today by Health Affairs, the researchers analyzed data from a large corporation that implemented a VBID program in 2005. Co-payment rates were reduced for employees using five classes of drugs used to treat several serious but common chronic conditions, including diabetes, hypertension and heart disease.

In this VBID program, patients using the specified medications were offered at least a 50% co-payment reduction. The study’s authors examined both the amounts spent on the high value services and overall spending by the employer using the VBID plan.

“From a total cost perspective, the VBID program likely broke even, and possibly saved money,” said A. Mark Fendrick, M.D., co-director of the University of Michigan’s Center for Value-Based Insurance Design [].

The financial returns from an employer perspective will be less favorable, but significant savings from reduced use of non-drug services are likely and will substantially offset the added employer spending on prescription drugs, the researchers found.

“But even if the VBID program were to slightly increase employers’ medical costs, our expectation is that as people increase the use of high-value services, their health will not only improve, but overall medical costs will decline.”

Fendrick, who also is a professor in the Department of Internal Medicine and professor of Health Management and Policy, created the VBID concept with Michael Chernew, professor in the Department of Health Care Policy at Harvard Medical School. Both are authors on the new study.

VBID intervention is a least cost neutral

“It seems reasonable to conclude that the financial effects of this VBID intervention were at least cost neutral – if not cost saving – from a total cost perspective. Value-based insurance designs could be an important component of a broader cost containment strategy,” says Chernew about the study.

Fendrick stresses that VBID programs focus on removing barriers for treatments that are proven to be effective. When costs are reduced, patients are more likely to use high value services. For those with lower co-payments, the percentage of patients not taking their medication declined by about 10 percent in 4 of the 5 drug classes.

The financial impact of behaviors resulting in improved health can be measured in terms of savings on both medical [such as fewer emergency room visits and hospitalizations] and non-medical [such as fewer disability days, less absenteeism and greater worker productivity] spending, Fendrick says.

Fendrick and Chernew currently are working with Congressional leaders on incorporating VBID concepts in health care reform. Language encouraging the use of VBID concepts is in the bill being negotiated in conference committee.

“The clinical benefits of removing barriers to high value services were clear, but before this paper, the economic ramifications of VBID programs were uncertain. We can now say, at worst, VBID programs are cost neutral from a total cost perspective,” Fendrick says.

Chernew adds. “Payers are facing tremendous pressure to reign in health care costs. Compared to the status quo, we are confident that, if carefully designed, VBID programs can produce more health at any price. We believe that VBID should remain an integral part of ongoing health care reform discussions.”

Source: University of Michigan Health System