Humana Once Again Named Top Payer in athenahealth® PayerView® Rankings

LOUISVILLE, Ky.–(BUSINESS WIRE)–For the second year in a row, Humana Inc. (NYSE: HUM) was ranked as the number one company for its ease of doing business with providers. Humana ranked number one in overall performance among 148 U.S. health insurers based on a review of 2013 claims-payment data conducted by athenahealth, Inc. (NASDAQ: ATHN). Continue reading

CMS to Providers Looking to Support ACA Premiums: Not so Fast!

On November 4, 2013, the Department of Health & Human Services, Centers for Medicare & Medicaid Services issued a Q&A warning hospitals, other healthcare providers, and other commercial entities that it had “significant concerns” about those entities  supporting premium payments and cost-sharing obligations with respect to qualified health plans purchased by patients in the Marketplaces.

The guidance stated that HHS has significant concerns with this practice because it could skew the insurance risk pool and create an unlevel field in the Marketplaces. HHS said it discourages this practice and encourages issuers to reject such third party payments. The agency said it intends to monitor this practice and to take appropriate action, if necessary. – See the Q&A at

New Look for Health Plan Innovation News

The Health Plan Innovation News has a new, fresher look. It will also give our readers the same great experience when using mobile devices and tablets as it does when using a computer.

Let us know what you think.


U.S. Department of Veteran Affairs Awards $28.8 Million TeleHealth Contract to AMC Health

AMC Health, a leading provider of telehealth solutions, announced September 4, that the U.S. Department of Veteran Affairs (VA) has awarded the company a five-year contract worth up to $28.8 million to provide telehealth solutions and services.

AMC Health’s integrated approach to remote monitoring will further enhance the VA’s existing telehealth initiatives to reduce hospital admissions; allow veterans with chronic diseases to live independently in their own homes; expand access to care; improve veterans’ clinical outcomes and quality of life; boost patient satisfaction; and enhance the quality, continuity, efficiency and cost-effectiveness of care for veterans nationwide. This agreement marks a major expansion of AMC Health’s Government Services divisio

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Health Plan Innovation News Makes List of Top Ten Health Technology Blogs

The Health Plan Innovation Blog is proud to have been named to a list of Top Ten Health Technology Blogs as compiled by The web publication had the following to say about the blog:

Health practitioners aren’t the only entities impacted by the technology wave. Health Plan Innovation focuses on ways to use innovation to “solve health care access, quality and funding issues.” We don’t think there’s anyone out there who would disagree that this is exactly the kind of thought leadership we need to solve the nation’s healthcare crisis.

See the entire list here:


CIGNA Individual and Family Plan Customers Use “DailyFeatsTM” to Improve Health and Well-being

BLOOMFIELD, Conn. – July 19, 2011 – CIGNA (CI:NYSE) announced today that its Individual and Family Plan customers in Colorado and Texas can now earn points and save money on real-life expenses by accomplishing “feats” that reflect good health, emotional well-being and community involvement. CIGNA is working with DailyFeats, an online site where people can “check in” the good things they do. Customers exhange points earned for rewards, including discounts at local businesses and savings on national brands. 

The free program encourages CIGNA customers to maintain good health through simple and easy behaviors, such as taking a family walk after dinner, adding fruits and vegetables to meals and helping local charitable groups better serve the community. CIGNA customers who sign up can be eligible for 2,000 bonus points instantly redeemable for a $10 gift certificate from a national retailer or saved for larger rewards. Major, well-known retailers, as well as local stores in a community, participate in DailyFeats

“Our collaboration with DailyFeats gives our customers an innovative way to get rewarded for healthy and positive choices they make each and every day,” states Chris Hocevar, president of CIGNA’s Individual and Family Plan segment. “We believe that connecting our customers with others who are also interested in sharing how they stay healthy will be another way to encourage healthy lifestyles.

CIGNA customers have access to a dedicated site that helps build online, local community discussions. “We are excited that CIGNA has joined with us to help its individual and family plan customers in Colorado and Texas live well,” states Morley Ivers, chief operation officer of Daily Feats. “We are confident that CIGNA customers will find DailyFeats to be a unique way to support them as they strive to live a healthy life.”
For more information about DailyFeats, please go to CIGNA customers in Colorado and Texas who are interested in joining this pilot program can go
CIGNA (NYSE: CI) is a global health service and financial company dedicated to helping people improve their health, well-being and sense of security. CIGNA Corporation’s operating subsidiaries in the United States provide an integrated suite of health services, such as medical, dental, behavioral health, pharmacy and vision care benefits, as well as group life, accident and disability insurance. CIGNA offers products and services in 29 countries and jurisdictions and has more than 66 million customer relationships throughout the world. All products and services are provided exclusively by such operating subsidiaries and not by CIGNA Corporation.



New 2011 Health Care Benefits Data: High Deductible Plans Demonstrate Savings

BOSTON & ARLINGTON, Va.–(BUSINESS WIRE)–HighRoads, the industry leader in employer health care regulation compliance, and the Corporate Executive Board (NYSE: EXBD) (CEB), a leading research and advisory services company, today announced the results of their first joint study on health care benefits plan design data. The combined study from The Lab®, HighRoads’ real-time employer benefits database, shows that employees can save an average of $187 a year in premium savings alone by using a high-deductible consumer-driven health plan (CDHP). Families can save an average of $204 a year by using a CDHP. While CDHP’s provide savings in premiums, and in over-all maximum out-of-pocket exposure, the savings may be too small and the deductible too high relative to traditional Preferred Provider Organization plans (PPOs) and Health Maintenance Organization plans (HMOs) to encourage a larger percentage of employees switching to CDHPs. As such, PPOs still remain the most popular health care plan offering.

“As employee benefits professionals devise their benefit plan designs for 2012, fresh data on average plan designs will provide them with the industry-standard metrics and trends they need to make informed decisions”

The Lab, which includes Fortune 500 benefits data from HighRoads, CEB’s Corporate Leadership Council, and Thomson Reuters Healthcare, is comprised of data from over 10,500 real medical plan designs and rates, representing over 30 million lives.

“The data available through this partnership provides employers with a wealth of information on health care plan designs,” said Ania Krasniewska, senior director, Corporate Executive Board. “Leveraging this robust benchmarking tool, organizations now have the ability to compare their health plans against the national landscape of employers to ensure a best practice approach as they prepare for the Fall open enrollment period.”

Based on a recent data snapshot which shows results for 2011, The Lab reveals the following trends:

1. PPO plans are still the most widely offered employer plans, despite heavy communications around consumerism strategies with high deductible CDHPs. PPOs represent 39% of employer plans. Health Maintenance Organization plans (HMOs) represent 27%. High deductible plans represent 17%.

2. Monthly employee premiums for traditional (non high deductible plans) are consistent across the board, with an average monthly, employee only, premium of $132.11. PPOs are $149.88 per month. HMOs are $132.73 per month. Exclusive Provider Organization plans (EPOs) are $111.36 per month.

3. Monthly employee premiums for CDHPs are much lower, with an average monthly, employee only, premium of $62.14.

4. CDHP plans, for most individual employees and families, offer a lower annual total out-of-pocket cost compared to PPOs. When adding the average out-of-pocket costs for annual premiums, in network deductibles, and health savings account (HSA) contributions (specifically for CDHP plans), the average total annual individual out-of-pocket cost is $2,128 for CDHP plans compared to PPOs which have an annual out-of-pocket cost of $2,315. For families, the average total annual out-of-pocket cost is $5,656 for CDHPs and $5,860 for PPOs.

“As employee benefits professionals devise their benefit plan designs for 2012, fresh data on average plan designs will provide them with the industry-standard metrics and trends they need to make informed decisions,” said Eric Parmenter, Vice President of Consulting, HighRoads. “Data from The Lab shows that employee education around the cost savings possible with CDHP may help many employees reduce their out-of-pocket health care expenses while offering them increased flexibility and control over their health care decisions.”

The recent study also showed average co-pays and coinsurance contributions for in-network primary care physicians and specialists, non-traditional services including chiropractor and physical therapists, and urgent care facilities. Average in-network co-pays are $19 per visit for primary care providers, $31 per visit for specialists, and $103 per visit for emergency room.

To request a complete copy of the report, please contact Petra Marino at

About The Lab

The Lab is the single largest benchmarking repository of health care benefit plan data in the U.S. It provides a number of health care benchmarks including statistics on alternative care, preventative care testing and screening, surgery, maternity, mental health, family planning, prescription drugs, vision and hearing care. Employers use The Lab data to compare their plans with other organizations by industry, geography, company size, plan and employee type.

About HighRoads

The world’s leading employers choose HighRoads to gain complete control over their health care costs and compliance. With HighRoads’ service, employers have online access to benefits plan information and pricing, competitive benefits benchmarks, and complete benefits supply chain management. The privately-held company is headquartered in Woburn, MA. For more information, visit

About the Corporate Executive Board

The Corporate Executive Board drives faster, more effective decision making among the world’s leading executives and business professionals. As the premier, network-based knowledge resource, The Corporate Executive Board provides customers with the authoritative and timely guidance needed to excel in their roles, take decisive action and improve company performance. Powered by an executive network that spans over 50 countries and represents approximately 85 percent of the world’s Fortune 500 companies, The Corporate Executive Board offers unique research insights along with an integrated suite of exclusive tools and resources that enable the world’s most successful organizations to deliver superior business outcomes. For more information, visit


Humana and the United States Bowling Congress Form Alliance

LOUISVILLE, Ky.–(BUSINESS WIRE)– Humana Inc. (NYSE:HUMNews), one of the nation’s largest publicly traded health and supplemental benefits companies, and the United States Bowling Congress (USBC), the national governing body for bowling as recognized by the United States Olympic Committee, announced today that they have formed an alliance enabling Humana to market its products directly to USBC’s more than two million members.

 “Humana is pleased to announce this alliance intended to support a favorite American pastime and demonstrate the importance of engaging in activities that promote well-being through physical movement and social interaction,” said Fred Wheeler, a Humana vice president. “Bowling is a sport that is appealing to both young and old and through this partnership we hope to emphasize our commitment to well-being for the entire family.”

 Under terms of the agreement, Humana and USBC will bring the message of Humana’s well-being commitment to USBC members, tournament participants and TV viewers. The alliance seeks to spotlight the relationship between bowling – engaging individuals in healthy activity at every age – and Humana, which offers benefits and services to people of all ages.

 Humana Medicare Advantage plans will be offered to USBC members who are eligible for Medicare. And all USBC members will have access to a discount prescription-drug program from Humana, beginning in March. Humana individual medical, dental, vision, life and supplemental plans will also be offered to USBC members through this alliance.

 “We are pleased to work with Humana and continue to demonstrate the positive impact bowling can have on one’s health and the positive business results USBC can deliver to partners,” USBC Executive Director Stu Upson said. “We look forward to working with Humana to share exciting offerings of new benefits to USBC members as a result of this partnership.”

 Bowling, according to the USBC, is the largest participatory sport in the United States with more than 70 million bowlers. USBC says the sport grew four percent in 2009 and has a $10 billion annual impact on the U.S. economy.

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, 7.0 million specialty members, and operates more than 300 medical centers and 240 worksite medical facilities.

Humana is a full-service benefits and well-being solutions company, offering a wide array of health, pharmacy and supplemental benefit plans for employer groups, government programs and individuals, as well as primary and workplace care through its medical centers and worksite medical facilities.

CVS Caremark Annual Employer Survey Finds Majority of Employers Rate Managing Costs as Top Priority in 2010.

CVS Caremark (NYSE:CVS) today announced the results of the Company’s annual employer client benefit survey about priorities for PBM services in the coming year. The majority of employers surveyed (94 percent) said they will seek opportunities to improve savings even more in 2010, while they look for ways to improve the overall member experience. Overall, employers listed price (86 percent), customer service (86 percent), trust and reliability (84 percent) and consumer engagement capabilities (46 percent) as key priorities for their PBM procurement strategy.

“The economic environment continues to impact companies this year, with 66 percent telling us that reducing overall health care costs is their number one success measure,” said Jack Bruner, Executive Vice President, Strategic Development, Caremark Pharmacy Services. “Employers tell us they are looking for more aggressive solutions to increase generic utilization and manage specialty pharmacy costs, while also focusing on programs to increase medication adherence and manage chronic diseases.”

This annual survey enables CVS Caremark to provide clients with a barometer that highlights shared issues and priorities among their peer group and provides insights into what strategies other companies are implementing or considering. The account teams also use this information to work directly with their clients to determine specific priorities and tailor PBM services that best help them reach their goals.

“We are well positioned to deliver on both of our employer clients’ key priorities – lowering costs while improving the member experience,” said Bruner. “We are able to provide our clients with access to a variety of plan designs that manage costs while also incorporating services that counsel members so that they better understand their options and can make informed decisions that result in savings for both the member and the benefit sponsor.”

With regard to plan designs to help employers manage costs, CVS Caremark offers a variety of options to increase generic utilization and brand to generic conversions. Survey results show that the majority of employer clients are strongly considering adopting some of the more progressive strategies to encourage the use of lower-cost generic medications. For example, almost half of employers surveyed are considering implementing plan designs that require using a generic medication first before moving to a branded drug (48 percent) and those that provide members a co-pay waiver to switch to generic medications (56 percent). In addition, compared to the 2009 survey results, there has been a significant increase in employers who are adopting or considering solutions to improve medication adherence.

In particular, many employer clients are considering programs that impact adherence through counseling and intervention with the member, including: counseling to improve adherence the first time a member fills a maintenance medication (62 percent), outreach to prescribers to resolve gaps in care (56 percent) and outreach to members and prescribers to provide counsel about therapy drop-off (65 percent).

The CVS Caremark client survey was conducted on-line from October 5, 2009 through December 31, 2009 and includes responses from current CVS Caremark clients representing 285 employers and approximately 7.3 million lives.

Cisco Launches HealthPresence Telemedicine Solution, Providing Increased Access to Medical Care Worldwide.

At the Healthcare Information and Management Systems Society (HIMSS) Conference in Atlanta today, Cisco announced the availability of the Cisco HealthPresence™ platform. Cisco HealthPresence is an advanced, care-at-a-distance technology platform that allows patients to connect with doctors and clinicians for health care consultations in ways never before possible. Traditional telemedicine or telehealth approaches have focused mostly on the problem of physical access to medical care. Cisco HealthPresence addresses four additional key health care delivery challenges:

* Capacity (the scarcity and productivity of clinical expertise)
* Collaboration (one patient with many clinicians, many providers with many providers, and many patients with many patients)
* Information exchange (the ability of participants to share and view vital health information)
* Personalization (engaging patients in ways that make them more active participants in consults)

Cisco HealthPresence extends and expands access to health services and quality care. HealthPresence creates new, streamlined clinical encounters by integrating two technology innovations: Cisco TelePresence™ and Cisco® Unified Communications. With high-definition video, clear audio and connected medical devices, Cisco HealthPresence supports collaboration and personalization rarely accomplished in traditional face-to-face consultations. Patients in HealthPresence encounters can see images and listen to sounds from a variety of diagnostic devices, such as digital stethoscopes, actively participating with what clinicians see and hear.

Beginning with HealthPresence trials in 2008, patients have described how the immersive video experience, along with the real-time transmission of physiologic information, draws them into the medical encounter. At the same time, clinicians report more effective patient management with HealthPresence. Equally important, HealthPresence allows multiple members of a patient’s care team to simultaneously participate in consultations, creating new ways to deliver and coordinate care. This is a significant innovation from typical point-to-point telemedicine solutions and even traditional in-person medical examinations. With HealthPresence, primary care physicians and specialists, care managers and rehabilitation therapists, family members, and caregivers can all participate in treatment and care planning. These new capabilities are essential for information and communications technologies to play a vital role improving access to, and the affordability and quality of, health care.


* Cisco HealthPresence is planned to be available beginning March 2010 in markets across the United States, Canada and Europe. It is classified as a Class I medical device by the U.S. Food and Drug Administration.

* To evaluate patients in an interactive and highly participatory way, Cisco HealthPresence arms clinicians with the essential tools, including:
o Cisco Vitals Software, which captures physiological data and streaming high-definition video feeds, sending them to the clinical team with a high degree of security.
o Cisco TelePresence units in clinical and patient locations.
o Integrated voice, video and data capabilities that collect patient medical information for transmission among multiple health care providers or between a single doctor and patient before, during and after telemedicine consultation. Cisco’s custom software offers highly secure encryption technology to protect the privacy and security of patient data exchanged in distance communications between patients and caregiver staff.
o Medical devices located at the patient’s end unit: a general camera for external observation, ear-nose-throat camera, digital stethoscope, and a vital signs device to capture blood pressure, temperature, pulse rate, and blood oxygen levels.
* Cisco HealthPresence can be deployed in permanent facilities or mobile units.
* Cisco HealthPresence was piloted by the Cisco Internet Business Solutions Group (IBSG)
* Cisco HealthPresence has already been successfully adopted through pilot programs in the United States and other countries, including:
o A groundbreaking HealthPresence pilot with Molina Healthcare, two community health centers in San Diego, and the state of California to provide health and wellness services to underserved communities throughout the state.
o HealthPresence pilots in Aberdeen, Scotland, with a division of the Scottish National Health Service, and in San Jose, Calif., with employees at Cisco’s corporate headquarters. Both 2009 pilots achieved equally favorable feedback: More than 90 percent of participants said they would recommend the service to others.
o Helping connect patients in need with critical medical resources in international locations including France, the United Kingdom, South Africa and China.

More information is available at;

Source: Cisco, Inc.