Oscar: The New Kid That May Change Health Insurance

Three friends, and technology entrepreneurs, teamed up to do something that has been inconceivable to date—create a start-up health insurance company to take on conventional health insurers on the NY exchange.

Oscar co-founders, Josh Kushner, Kevin Nazemi and Mario Schlosser, plan to change the health insurance industry through technological interfaces, telemedicine and real transparency. Their goal is to redesign insurance to be geared toward the user experience, to make patients seek out their insurer before their doctor.

Read the full story at Forbes.com

EveryMove 100 Health Insurance Index Launches

SEATTLE, WA — August 27, 2013 — EveryMove, Inc., an innovator in health rewards-based marketing and incentives, today introduced the EveryMove 100 Health Insurance IndexTM, the first ranking of the top 100 health insurance companies in the U.S. based on how they engage with and empower consumers to manage their own health. The EveryMove 100 can be found online https://everymove.org/everymove-100 including detail information about each company.

With a huge impending influx of consumers to the federal and state health insurance exchanges stemming from the implementation of the Affordable Care Act, the need for comparative information about health insurance companies is greater than ever. The EveryMove 100 evaluates plans using more than 50 metrics to arrive at an aggregate score that indicates how well they meet consumer needs for accessibility, motivation, community activism and overall satisfaction.

For more information go to EveryMove.org


New Health Insurance Cooperative Goes Live With Help from Care Management Firm

Tampa, FL – August 27, 2013 – Health Integrated, Inc., a recognized innovator in care management strategies for vulnerable, fragile and at-risk individuals, has partnered with Meritus (dba Meritus Mutual Health Partners (PPO) and Meritus Health Partners (HMO)), Arizona’s first and only consumer-operated and oriented (Co-Op) insurance plan, to deliver its full care management platform for the plan and its members. Meritus will begin enrolling new members in October 2013 for coverage beginning January 1, 2014.

For Meritus, Health Integrated is providing a full suite of care management services on a state-of-the-art care management platform, including:

  • Health Risk Assessments
  • Chronic Condition Management
  • Case Management (Medical and Behavioral)
  • Utilization Management (Medical and Behavioral)
  • 24/7 Behavioral Health Crisis Line

Read the full story at HealthIntegrated.com


California Public Exchange to Delay Quality Rating System

Covered California has decided not to include a quality rating system for health plans when the new insurance marketplace kicks off enrollment in October.

The issue has been controversial because some plans have complained there is not enough time to prepare their reporting systems to track the requested data.

Read the full story at bizjournals.com


Bare Bones Health Plans Expected To Survive Health Law

Proposed and final rules issued this spring surprised many by failing to bar large employers from offering insurance policies that could exclude benefits such as hospitalization.

Offering bare-bones policies may result in some fines, but that expense could be less than the cost of offering traditional medical coverage.

The bare-bones plans cannot be offered to small businesses with fewer than 50 workers, or to individuals buying coverage through new online marketplaces that open for enrollment Oct. 1. But benefit experts expect some larger firms that buy outside the marketplaces or that self-insure to consider them.

Read the full story at KaiserHealthNews.org


ACA Sparks Renewed Interest in CDHPs; FedEx Shifts to Account-Based Plans

The trend toward consumer-directed health plans (CDHPs) got a major convert this month when package delivery giant FedEx Inc. said it would not only offer such plans, but actually switch its entire 400,000-some workforce to account-based insurance starting in 2014. Cigna Corp. and WellPoint, Inc.’s Anthem Blue Cross and Blue Shield will administer the new benefit.

Consultants and industry stakeholders didn’t blink at the news, considering that CDHPs have been around for more than a decade, but did stress that the reform law appears to be accelerating the speed at which large groups are moving away from more traditional coverage.

Read the full story at AISHealth.com


Towers Watson: Health Care Reform Heightens Employers’ Strategic Plans for Health Care Benefits

Over the short term, employers plan to retain active medical plans amid projected cost increase and excise tax concerns; greater change expected to retiree medical plans.

The breadth of health care reform is prompting changes and ushering in emerging opportunities for employers, according to a survey of 420 midsize and large companies by global professional services company Towers Watson (NYSE, NASDAQ: TW). While employers remain concerned about a predicted 5.2% increase in 2014 health care costs and the risk of triggering the excise tax* in 2018, most (82%) continue to view subsidized health care benefits as an important part of their employee value proposition in 2014.

However, the 2013 Health Care Changes Ahead Survey found that a majority of employers do anticipate making moderate to significant changes in their health benefit programs for all employees and retirees by the beginning of 2016. It also revealed a clear disparity in how employers view public and private exchanges. Nearly 30% of employers have confidence in public health insurance exchanges as a viable alternative to employer-sponsored coverage in 2015. In contrast, private exchanges are more appealing, with 58% having confidence in them as a viable alternative. In short, employers are intrigued by the potential of private exchanges to control cost increases, reduce administrative burdens and provide greater value.

Read the full story here: TowersWatson.com



Highmark Direct health insurance store to open in Erie, PA

PITTSBURGH (June 21, 2012) — Highmark Inc. announced today that it will open a Highmark Direct retail health insurance store in Erie, Pa. The store will be the ninth location in Pennsylvania.

“Across other parts of the state, the Highmark Direct stores have helped customers better understand health insurance and make more informed decisions about their health,” said Matt Fidler, Highmark vice president of consumerism and retail marketing. “With the addition of the Erie store, we’ll be able to reach even more Pennsylvanians who need health insurance support.”

Highmark opened its first two Highmark Direct stores in March 2009, added four stores in 2010 and two additional stores in 2011. Since inception, the stores have seen more than 144,000 visitors and provided health insurance to thousands of individuals and their families.

The Highmark Direct Erie store is scheduled to open in August and will be located at 5753 Peach Street in Kingswood Plaza. Eight additional employees will be hired as staff for the new store location.

Highmark Direct offers consumers in Highmark’s service area the opportunity to meet one-on-one with a health insurance specialist to discuss their health insurance options and their benefits as a Highmark member. The stores sell health insurance plans to individuals, seniors and small businesses, as well as ancillary products such as dental insurance, critical illness and accident insurance as well as a personalized genetic health program.

About Highmark
Highmark Inc., based in Pittsburgh, is an independent licensee of the Blue Cross and Blue Shield Association, an association of independent Blue Cross and Blue Shield plans. Highmark serves 4.9 million members in Pennsylvania, West Virginia and Delaware through the company’s health care benefits business and is one of the largest Blue plans in the nation. Highmark has 20,000 employees across the country and provides a broad range of health and wellness related services through subsidiary and affiliate companies. For more information, visit www.highmark.com.


Consumer Driven Health Care Plans Can Help Reduce Health Care Spending and Make Positive Behavior Changes: HCSC

CHICAGO, June 13, 2012 /PRNewswire via COMTEX/ — Consumers enrolled in Consumer Driven Health Plans (CDHPs) are more likely to make sustainable, positive behavior change leading to significant health plan spend reductions year over year, according to data studied by Health Care Service Corporation (HCSC), operator of the Blue Cross and Blue Shield Plans in Illinois, Texas, Oklahoma and New Mexico. Members who migrated to CDHP plans – those that have a higher deductible, prompting consumers to be more directly involved with the selection and usage of health care services – reduced their health care spending significantly.

This study is unique because of its focus on tracking individual members who migrated from traditional health plan coverage to CDHP coverage in order to analyze their health care behavior and their health care spending habits both before and after the switch. The data also showed that changes in behavior, including increases in preventive care and use of generic prescriptions, helped contribute to a reduction in health care spending for both employers and members.

The CDHP program, BlueEdge(TM), is offered through the four Blue Cross and Blue Shield Plans, and includes Health Savings Account (HSA) and Health Reimbursement Account (HRA) options. BlueEdge enrollment surpassed 1.5 million members earlier this year, after experiencing double-digit percentage increases for six straight years.

Key results from the study indicate that, following migration from a traditional non-CDHP plan to a CDHP, on average, the CDHP members studied:

  • were four percent more likely to take advantage of preventive services.
  • reduced health care utilization by an aggregate of more than 12 percent.
  • were 10 percent more likely to fill their prescriptions with generics.
  • spent 24 percent less on inpatient hospital services and eight percent less on outpatient services.
  • had a 12 percent decrease in emergency room visits.
  • reduced combined medical and pharmacy spend by an aggregate of 11 percent

In addition, data showed that employers who offered only a CDHP saw even greater spend reductions – up to an aggregate of 14.4% over the three years following migration from a traditional plan to a CDHP.

“Our BlueEdge CDHP program gives consumers the flexibility and tools to help make positive decisions to reduce their healthcare spend, coupled with broad access to care, award-winning service, comprehensive incentives, wellness and care management programs, and a personalized, engaging health care experience,” said Thomas Meier, Vice President, product development, HCSC. “Our experience finds that CDHP members tend to be more engaged and informed in making better health care decisions.”

This is the second year that HCSC has done this analysis, this year studying more than five years of data for more than 265,000 members (with pharmacy data available on 121,000 of those members). HCSC continues to invest in more consumer focused approaches, adding more robust incentives and value-based insurance design products in 2013 to complement both traditional and CDHP plans.

“Our findings are significant because they indicate both real and potential health care spend reductions. Rather than comparing the utilization of different groups of consumers, we have focused on the utilization changes of members who migrated from traditional plans to CDHP. The fact that we are comparing the same members in both plans allows us to minimize inherent risk differentials,” said Guy McGinnis, Vice President, client analytics, HCSC.

About Health Care Service CorporationHealth Care Service Corporation, a Mutual Legal Reserve Company, is the country’s largest customer-owned health insurer and fourth largest health insurer overall, with more than 13 million members in its Blue Cross and Blue Shield plans in Illinois, New Mexico, Oklahoma and Texas. HCSC is an independent licensee of the Blue Cross and Blue Shield Association. For more information, please visit www.HCSC.com , visit our Facebook page or follow us at www.twitter.com/HCSC .

SOURCE Health Care Service Corporation


New Program Helps Aetna Members Make Informed Decisions When Considering Surgery

HARTFORD, Conn., June 07, 2012 — Surgery often is the most extreme approach to care for most health conditions, and in many cases, alternative options for care are available. Aetna (NYSE: AET) recently made the Welvie Surgery Decision Support Program available to help Aetna members who are considering surgery work with their health care providers to make the best choices for their unique situations.

The online program – which includes easy-to-understand video content – guides members through six steps. The first three steps focus on helping members work with their doctors to determine an accurate diagnosis and understand all of the potential treatment options, including surgery. If surgery is the determined course of treatment, the last three steps help members prepare for the procedure and recovery.

“We are consistently looking for ways to help our members become more informed and allow them to take control of their own health care,” said Paul Marchetti, head of Aetna’s National Care Management. “The Welvie decision support program can help members work in concert with their health care provider to make the right decision when surgery is one of the options for care.”

Aetna members can access Welvie through Aetna Navigator®, a secure member website. The decision support program provides information related to nearly 60 medical procedures, including lower back surgery, C-section delivery and tonsillectomy.

“Surgery should never be taken lightly,” said Welvie Executive Chairman Chip Tooke. “We designed our program to show people that they can take an active part in the surgery process. And when they do, they can help improve the outcome.”

Positive Feedback from Employers and Members
The Welvie program is available to all Aetna members. Plan sponsors can also select a premium version that includes increased communications to members about the program, as well as reporting on usage among an employee population. Beginning in April 2011, Aetna conducted a pilot study featuring the premium Welvie program with five large national employers who collectively cover approximately 800,000 Aetna members.

“As a company that relies on a physically active group of employees, we want to offer programs that can help our employees maintain their health and well-being,” said Randy Moon, Vice President, Benefits and Human Resources Information Services at Lowe’s, which participated in the pilot program. “The Welvie program is a resource for entire families, whether we have employees looking for more information about their own health options or those of a parent, spouse or child. Our employees who used the Welvie program were very satisfied with how easy it was to use and how helpful it was as they were evaluating their health care options, including surgery.”

Member satisfaction rates among individuals who used the Welvie tool were also extremely high:

• 96 percent were satisfied with how Welvie prepared them for surgery
• 95 percent are likely to take the steps necessary to prepare for surgery as a result of the Welvie program
• 92 percent are likely to recommend the Welvie program to family and friends
• 93 percent feel that Welvie helped prepare them to speak with their health care provider about surgical options

About Welvie

Welvie is a pioneering surgery decision support company. Its shared decision-making program helps consumers make fully informed decisions about surgery, while helping employers and health plans ensure patients receive the best outcome, whether they choose surgery or not.

About Aetna
Aetna is one of the nation’s leading diversified health care benefits companies, serving approximately 36.1 million people with information and resources to help them make better informed decisions about their health care. Aetna offers a broad range of traditional, voluntary and consumer-directed health insurance products and related services, including medical, pharmacy, dental, behavioral health, group life and disability plans, and medical management capabilities, Medicaid health care management services and health information technology services. Our customers include employer groups, individuals, college students, part-time and hourly workers, health plans, health care providers, governmental units, government-sponsored plans, labor groups and expatriates. For more information, see www.aetna.com.