A Health Plan Showing Up in New Ways Amid COVID-19

The idea that a crisis is an opportunity for improvement couldn’t be more true now that coronavirus disease 2019 (COVID-19) has made it easier to see the problems in the American health care system while also reminding us of some of its best parts. Most critically, it is further revealing inequities for all to see as some populations, particularly communities of color, are disproportionately burdened by systemic factors such as poverty, racism, lack of access to quality health care, and more.1 There is a dire need to demonstrate leadership in newer ways to transform and reenergize the structures and systems we depend on, from hospitals to health plans to governments that shape our health care system. Amid the current devastation wrought by the global pandemic, as a nonprofit health plan in California, we feel obligated to fight through the systemic deficiencies by engaging in innovative cross-sector partnerships, leveraging new technology to target key needs exposed by COVID-19, and addressing health inequities through technology-enabled community health workers (CHWs). Read More: AJMC

Humana Adds Two New Value-Based Payment Programs for Select Medicare Advantage Plans

Humana announced today the expansion of its value-based program portfolio by adding two new programs for members of select Humana Medicare Advantage plans.

The first is the coronary artery bypass grafting episode-based model for certain members undergoing heart bypass surgery. The model provides cardiothoracic clinicians with data and analytics as well as financial incentives for enhancing patient care, delivering a more coordinated care experience, and reducing unnecessary services readmissions and complications.

The other new program is Humana’s third orthopedic payment program and is for certain members undergoing total shoulder arthroplasty. This program also provides clinicians with data and analytics, and offers payments when better health outcomes are achieved and when lower-costing surgery sites, such as at ambulatory surgical centers, are selected. Read More: HealthCareFinance

How Highmark Health Embraces Disruption and Builds for the Future

The only constant is change, and today’s companies are grappling with change on a massive scale. Even during less eventful times, companies invest significant resources to manage their change initiatives with no guarantee of success.

When change processes do stick, they can succeed beyond leaders’ expectations, going deep enough to transform the organization’s very DNA. Some companies see that as a grim surprise. Some see it as a cultural triumph.

Highmark Health is among the latter. One of the largest integrated delivery and financing systems in the U.S., Highmark Health serves 40 million customers across Pennsylvania, Delaware, and West Virginia from its Pittsburgh home office, and is affiliated with the Allegheny Health Network’s (AHN) nine hospitals and more than 200 primary- and specialty-care practices. Read More: Gallup

The Value of Connected Behavioral, Medical and Pharmacy Benefits

For the fourth year in a row, Cigna’s Value of Integration study demonstrates that connecting medical, pharmacy and behavioral benefits increases customer engagement, supports the whole person and reduces total medical costs. The results leveraged methodology developed with KPMG in 2018, in a match-case control study that examined approximately 2.2 million customers over a 2-year period.  The study compared those who have Cigna integrated medical, pharmacy, and comprehensive behavioral vs. those who have Cigna medical and basic behavioral coverage.

The study also revealed that when benefits are triple-integrated with Cigna, the focus on body and mind results in a 32% lower mental health readmissions*, 18% fewer out-of-network behavioral claims*, 5% higher utilization of high-performing, in-network providers* and a 4% reduction in out-of-network claims. * This translates to savings for both the individual and their employer.  Read More: Cigna

Reference-Based Pricing is Getting Renewed Attention

Reference-based pricing is a market disruptor. It is a viable alternative to carrier-sponsored health plans where providers are paid on a Medicare Plus basis. For the first time, transparency allows consumers to price medical services prior to care being rendered. It also introduces provider accountability. Patients can access quality metrics and performance outcomes before scheduling appointments. This is in sharp contrast to traditional health plans where patients are billed after care is rendered and required to pay as presented. Employers are motivated to consider RBP plan alternatives since carrier plan assurances, over several decades have not contained cost nor managed care.

Using a cost-up pricing approach, RBP optimizes provider payments for medical services based on publicly available cost, pricing and quality data. It establishes fair pricing for medical services by geography to ensure equitable provider payments by market. In stark contrast to PPO health plans. RBP controls cost while managing medical inflation because it is tied to Medicare’s medical trend not arbitrary pricing. Critically important for RBP plans is enhanced patient/member satisfaction and improved outcomes as medical care is based on value and provider performance. Read More: BenefotsPRO

How Payers Can Calm Member Fears, Push Virtual Care Adoption

As the healthcare landscape is becoming more digitized, payers can take steps to prevent members from falling back into old, non-digital forms of care, a recent Accenture report highlighted.

The report followed up on Accenture’s previous 2020 Digital Health Consumer Survey, which had discovered that patient engagement technology adoption dipped for the first time.

That survey revealed that mobile phone and tablet app usage dropped from 48 percent of consumers using them in 2018 down to 35 percent using these devices and wearable technology dropped around 15 percentage points.

The new report examined whether this downward trend had changed in light of the coronavirus pandemic. Read More: HealthPayerIntellegence

New Aetna Health Plan Leverages CVS’s Retail Reach

The new plan, Aetna Connected, will offer no-copay appointments at CVS MinuteClinics and HealthHUBS, as well as 1- or 2-day prescription delivery, discounts on health-related items and greater access to CVS’s managed pharmacy network. It will be available to employers with 101 or more employees beginning this January.

As part of the health plan, CVS HealthHUBs will also offer concierge services to help facilitate communication between the patient’s primary care provider, pharmacy and Aetna’s Care Manager program. Read More: BenefitsPRO

Security Health Plan Introduces New Plan Option for Employers

Security Health Plan is offering Wisconsin employers a new health plan option for 2021 that has a predictable monthly cost, opportunity for refunds, protection against catastrophic expenses and transparency on how dollars are spent. Level-funded plans are a hybrid of traditional fully-insured health plans and self-insured health plans.

With level-funded health plans, employers with 10-100 enrolled employees contribute a set, or level, monthly cost. If employers claim costs are less than their contribution for the year, they may be eligible for a refund. This makes level-funding a great option for employers who have a healthy workforce and anticipate low claim costs. Read More: Security Health

Alphabet’s Verily is Getting into Stop-Loss Insurance

The company will sell stop-loss insurance, a type that helps cover unexpectedly large claims against employers who self-fund their health-benefit policies. Generally, these employers set a threshold for how much they choose to pay out based on projected costs, and stop-loss insurance covers the claims when the threshold is surpassed.

Verily hopes that by adding its data-crunching and technological prowess to the equation, it can help employers more accurately assess what sort of risks they face and, eventually, intervene to better predict and control health-care spending on individual employees. With about 79% of private employers with 500 or more employees self-funding their health-care benefits, Verily is betting it can grab a piece of a very large pie. Read More: BenefitsPRO

Oscar, Holy Cross Health, Memorial Healthcare System Collaborate to Offer a Co-Branded Medicare 2021 Advantage Plan in South Florida

Oscar, the first tech-driven health insurance company, Holy Cross Health, a top-rated health, teaching and research institution, and Memorial Healthcare System, leading provider in high-quality healthcare services, today announced that together they will launch a co-branded Medicare Advantage plan. Broward County residents can enroll in the new plan starting on October 15, pending regulatory approvals.

The Oscar + Holy Cross + Memorial Health Medicare Advantage plan(1) is the only plan in the market to bring together Holy Cross Health and Memorial Healthcare System’s extensive physician network with Oscar’s highly personalized and patient-focused member experience. Oscar’s high-touch Care Teams are familiar with the Holy Cross Health and Memorial Healthcare System ecosystems and can connect members to the right care for them, providing a better, more convenient experience. Read More: Oscar