Healthcare Leaders take ‘American Idol’ Approach to Innovation

Taking a cue from American Idol, leading healthcare professionals pitched innovative ideas at a recent Boston University-hosted event. Eight teams had two minutes each to describe their innovation projects and their importance. They also had to select $12,500, $7,500 or $2,500 as the project’s funding cost.

The innovation teams that won the American Idol-like competition received a $12,500 prize to build an online network for healthcare professionals to exchange solutions to complex medical problems, $7,500 to introduce e-cigarettes to wean the homeless off tobacco, and $2,500 to recreate a program that addresses patients’ basic resource needs as a quality care standard

See the full story at  FierceHealthcare

UHC Launches Pilot of Automated Data Intake Program with NYU Langone Medical Center and Cleveland Clinic

CHICAGO, Sept. 3, 2013 /PRNewswire/ — UHC has partnered with Meddius to offer the new Automated Data Intake (ADI) Program, which will automatically extract data from UHC members’ information technology systems, seamlessly transfer the data to UHC, and translate data from disparate systems so that it can be compared. Developed for hospitals to easily submit and access both administrative and clinical data, the ADI Program will initially be deployed at two leading healthcare Information Technology centers – NYU Langone Medical Center in New York and Cleveland Clinic in Ohio.

The ADI Program is expected to save valuable labor time at UHC member organizations by eliminating the manual transfer of data and granting more timely access to much more accurate patient outcome benchmarks. In addition, instant access to their customized data warehouses will allow senior-level executives to analyze trends and more efficiently guide operational and clinical decisions.

See the full story at PRNewswire.com

 

 

Health Care Information On The Go For Bluecross Members

CHATTANOOGA – BlueCross BlueShield of Tennessee just launched its first member mobile application designed to meet the growing need for convenient mobile access to health care information. With the myBlue TN(SM) app, members can easily and quickly reach their health care information on the go.

BlueCross members can simply sign in to access in-network physicians, urgent care facilities and pharmacies based on location. They also can see how much they still owe on a deductible plus check a claim or access their mobile ID card. Members can also register for BlueAccess(SM), the online member portal, from within the application to gain access to its full feature set.

See the full story at BCBS.com

Coventry Health Care of Illinois and St. John’s Hospital Collaborate to Form High-Performance Network

SPRINGFIELD, Ill.–(BUSINESS WIRE)–Coventry Health Care of Illinois and St. John’s Hospital are pleased to announced a new high-performance network in Springfield, IL. A high-performance network collaboration consists of a group of health care providers who assume responsibility for the quality and cost of care for a group of patients.

The new product, Carelink from Coventry: A St. John’s Hospital Partnership, is effective September 1, 2013. The goal of this collaboration is to improve quality of care and lower overall health care costs in the Springfield community. The partnership demonstrates a commitment to deliver more value to the patient, no matter what his or her health care needs may be.

See the full story at Businesswire.com

Cigna Charts New Course With Requirement For Genetic Counseling Before Some Tests

The move by Cigna Corp. to require genetic counseling before selected tests are performed on its members will likely be adopted by other major carriers, reflecting not only the insurance industry’s attention to costs, but also to improving care in the highly complex field of genetic medicine, market consultants say. Beginning Sept. 16, Cigna will mandate that members considering tests to determine their risk of developing three conditions — breast cancer, colon cancer or the heart rhythm disorder Long QT syndrome — first undergo genetic counseling to gauge whether the tests are needed.

Read the full story at AISHealth.com

Express Scripts, Walgreens To Offer 90-Day Retail Solution

In an unexpected display of camaraderie, Express Scripts Holding Co. and Walgreen Co. have come up with a new offering presumably aimed at competing with CVS Caremark Corp.’s highly successful Maintenance Choice program. Industry observers say the launch of Smart90 Walgreens is a plus for both parties and reflects increased interest in custom retail networks.

In a joint press release issued on Aug. 1, the companies said Smart90 Walgreens is designed for Express Scripts clients that are “interested in 90-day prescription drug programs that drive lower costs and improve health outcomes for people with chronic diseases who require long-term treatment.” Not only will clients achieve savings from more aggressively discounted pricing on 90-day prescriptions, but the program has the potential to increase medication adherence by cutting down on the number of opportunities a member has to forget to fill a prescription, maintain the companies.

Read the full story at AISHealth.com

 

Coventry Health Care Expands Partnership with UnityPoint Health

DES MOINES, Iowa–(BUSINESS WIRE)–Coventry Health Care and UnityPoint Health on August 23,  announced the expansion of their partnership providing high-performance network plans in the state of Iowa.

Coventry’s “Carelink” high-performance network plans will now give more Iowans affordable access to care through the clinics, hospitals and home care services of UnityPoint Health – the nation’s fourth largest nondenominational health system.

Read the full story on BusinessWire.com.

Priority Health Launches Michigan’s First Statewide Home-Based Primary Care Program

GRAND RAPIDS, Mich.–(BUSINESS WIRE)–Priority Health is launching a ground-breaking program, Home-Based Primary Care, statewide to deliver health care services to the homes of patients living with advanced chronic illness.

Home-Based Primary Care provides each patient with a primary care team that features a physician, nurse practitioner, registered nurse case manager and social worker. Through the program, patients receive important routine and preventive care and direct access to care.

Priority Health is rapidly scaling the model to work with hospitals and local health care providers throughout Michigan. In fact, the company has already begun expanding the program’s capabilities in major metropolitan areas across Michigan and is currently enrolling members.

Read the full story at BusinessWire.com

 

Competing to Win: TriZetto Suggests Healthcare Payer Strategies for Growth in Emerging Retail Market

DENVER–(BUSINESS WIRE)–According to The TriZetto Group, as payers continue to make the necessary business changes to comply with reform, increase administrative efficiency, and improve the cost and quality of care, these organizations will face an additional challenge—competing to win in an emerging retail market.

“Rep. Eric Cantor says 10,000 baby boomers a day are becoming eligible for benefits”

To compete effectively, it is imperative that payers stand out from the crowd and differentiate themselves with new products that drive value, increase transparency, and create opportunities for collaboration with providers and other healthcare stakeholders.

Markets for Expansion and Growth

A winning strategy involves optimizing enterprise platforms, including core administration, network management and care managementsystems, through integration. The integration of these systems can help strengthen key lines of business that are poised for rapid growth in the wake of health reform. TriZetto has identified four major markets where expansion opens new opportunities for payers:

  • Individual market
  • Ancillary services
  • Medicaid managed care
  • Medicare managed care

Prepare for Newly Insured Individuals

Beginning in 2014, 24 million people are expected to enroll in health plans via exchanges.i Payers that invest in scalable, flexible enterprise systems that can be configured to respond to changing needs will have the agility to participate in a wide variety of new opportunities related to the burgeoning exchange market.

With integrated systems, payers can use clinical analytic tools to harness the rich data in their applications to strategically address the individual market, segment populations and proactively help high-risk members manage their own health effectively. System integration also helps optimize the enrollment, eligibility, renewal and billing/collection processes.

Diversify by Growing Ancillary Services

Health plans can differentiate their brands by growing ancillary services and extending these offerings to individuals who enter exchanges and to those who have only medical coverage. Research published in 2009 by the U.S. Bureau of Labor Statistics indicated that 71 percent of workers in private industry had access to medical care benefits, 46 percent had access to dental care benefits and 27 percent had access to vision care benefits.ii A major goal of growing ancillary services such as vision and dental is to capitalize on high-growth margins by providing coverage for services typically excluded or only partially reimbursed by health plans today.

To respond quickly to these new opportunities, payers need an enterprise-wide core administration system that maximizes efficiencies through greater automation and enables seamless transactions among providers, members and payers. In addition, integrated network management systems can help payers efficiently and accurately pay claims across multiple services and providers.

Prepare for Medicaid’s Shift to Managed Care

According to the Kaiser Family Foundation, about 70 percent of new Medicaid enrollees will enter managed care organizations.iii This shift from traditional fee-for-service Medicaid coverage creates opportunities for payers to enhance services that help manage care and control costs for a vulnerable population, as well as increase the number of those served under new and existing Medicaid managed care plans.

There are two key areas where IT investments may help drive payer success in the Medicaid market. First, healthcare analytics can help payers and providers identify high-risk populations and proactively manage care for these members. Analytics also can help payers model and compare the value and costs of clinical and incentive-based programs.

Second, technology for value-based insurance design, which incents members to manage their own care more effectively, also supports payer goals in the Medicaid market. By proactively engaging members with personalized wellness, support and educational programs through web portals, e-mail and other automated communications, payers can help improve member health and control costs.

Invest in the Growing Senior Market

With more than 10,000 people a day (i.e., approximately 3.5 million annually) becoming eligible for Medicare, the senior market cannot be ignored.iv Despite less favorable reimbursement rules, the shift from traditional Medicare fee-for-service to managed care continues to create opportunities for payers and providers to work collaboratively toward improving the cost and quality of care for seniors. These opportunities include:

  • Developing innovative payment structures such as pre-approved bundling of all provider services for an agreed-upon amount
  • Creating methodologies for sharing risk in collaborative care settings
  • Aligning incentives based on provider adherence to clinical protocols
  • Profiling segments of members to find new ways to attract seniors who expect retail-type
  • services and personalized care
  • Managing seniors collectively who have both commercial and Medicare coverage

The emerging retail market presents compelling opportunities for profitable growth. Watch for healthcare payer organizations to leverage technology-enabled business solutions to compete and win in this new, evolving market.

About TriZetto

TriZetto provides world-class healthcare IT software and service solutions that drive administrative efficiency, improve the cost and quality of care, and increase payer and provider collaboration and connectivity. TriZetto solutions, many of which are patented or patent-pending, touch half the U.S. insured population and reach more than 21,000 physician practices. TriZetto’s payer offerings include enterprise and component softwaremanaged application services, managed business services and consulting services. Provider offerings, delivered through TriZetto’s Gateway EDI wholly owned subsidiary, include tools and services that monitor, catch and fix claims issues before they can impact a practice. TriZetto’s integrated payer-provider platform will enable deployment of promising new models of post-reform healthcare. For information, visit www.trizetto.com.

Footnotes

i. Pear, Robert, “Heath Care Overhaul Depends on States’ Insurance Exchanges,” The New York Times, Oct. 23, 2010
ii. U.S. Bureau of Labor Statistics, “Spotlight on Statistics,” November 2009. http://www.bls.gov/spotlight/2009/health_care/
iii. Kaiser Family Foundation, “Medicaid and Managed Care: Key Data, Trends, and Issues,” The Kaiser Commission on Medicaid and the Uninsured. February 2010. http://www.kff.org/medicaid/upload/8046.pdf
iv. PolitiFact.com, “Rep. Eric Cantor says 10,000 baby boomers a day are becoming eligible for benefits,” Richmond Times Dispatch, May 4, 2011.http://www.politifact.com/virginia/statements/2011/may/04/eric-cantor/rep-eric-cantor-says-10000-baby-boomers-day-are-be/

 

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WellPoint Earns Industry Recognition for Health Care Consumer Empowerment and Protection

INDIANAPOLIS, Oct. 20, 2011 /PRNewswire via COMTEX/ — WellPoint, Inc., (NYSE: WLP) today announced it has been awarded Silver and Honorable Mention honors for Health Care Consumer Empowerment and Protection by URAC, a leading health care accreditation organization. The awards recognize industry achievements in advancing the role of consumers as active participants in their health care through heightened awareness and education.

“URAC’s Best Practices awards program is a unique celebration of innovative health care management programs. These organizations have implemented leading programs that have made a difference in the lives of the consumers they serve with demonstrable results that matter,” said Alan P. Spielman, president and CEO of URAC. “This year’s winners are recognized for their leadership in delivering on the promise of a quality health care system that puts consumers first.”

WellPoint received the Silver Award for the MyHealth Advantage member messaging program and honorable mentions for the Imaging Cost and Quality Program and the Emergency Room Utilization Management Initiative, which are available to members in select health plans.

“Helping people understand that they play a vital role in their health care and providing the resources they need to get quality, affordable care when they need it and in the right setting is our top priority. This recognition underscores our companywide commitment to continuous improvement and highlights our associates’ hard work and ingenuity in developing programs that empower consumers to make better decisions about their health care,” said Sam Nussbaum, M.D., chief medical officer for WellPoint.

The MyHealth Advantage program involves clinical messaging to members and physicians that leads to improved evidence-based compliance, better member health and a potential reduction in avoidable costs. For instance, members taking a prescription medication may receive messages to restart that medication if they are not adhering to the prescribed regimen or to stop taking a medication that is contraindicated. A study on the program demonstrated that messaging both members and physicians about gaps in clinical care significantly improves compliance with medical care guidelines.

The Emergency Room Utilization Management Initiative helps members find information through online search engines, interactive calls and print brochures. This educational information assists members in knowing what conditions may be treated at a retail health clinic or urgent care centers and their out-of-pocket costs associated with each. A pilot study conducted by HealthCore Inc. in Virginia demonstrated a 14 percent decrease in ER visits for those who participated in the program compared with those who did not.

The Imaging Cost and Quality Program uses technology from WellPoint subsidiary American Imaging Management (AIM) to proactively identify members whose health care providers have recommended they receive an imaging service such as an MRI or CT scan. The program calls those members to offer them an opportunity to switch to a high-quality but lower-cost facility, promoting quality care and transparency while enabling them to use their health care dollars more wisely.

Additionally, WellPoint associate, Patricia Moreno, a health promotion consultant working in its state sponsored business division, received a URAC Health Care Stars! award. This individual honor recognizes Moreno’s work in promoting the welfare of health care consumers by helping to improve lives and prevent adverse health outcomes.

Entries were judged by a distinguished 20-member panel of prestigious, independent judges including recognized experts in program evaluation, care coordination, health information technology, employer and purchaser decision making and patient safety. Entries were reviewed and scored by the judges based on objective criteria including whether the program was measurable, if it was reproducible and delivered through a collaborative approach. Honors were awarded in the categories of Consumer Decision-Making and Consumer Health Improvement.

About WellPoint, Inc.

WellPoint works to simplify the connection between Health, Care and Value. We help to improve the health of our members and our communities, and provide greater value to our customers and shareholders. WellPoint is the nation’s largest health benefits company in terms of medical membership, with 34 million members in its affiliated health plans, and a total of more than 69 million individuals served through its subsidiaries.

About URAC

URAC, an independent, nonprofit organization, is well-known as a leader in promoting health care quality through its accreditation, education and measurement programs. URAC offers a wide range of quality benchmarking programs and services that keep pace with the rapid changes in the health care system, and provide a symbol of excellence for organizations to validate their commitment to quality and accountability. Through its broad-based governance structure and an inclusive standards development process, URAC ensures that all stakeholders are represented in establishing meaningful quality measures for the entire health care industry. For more information, visit http://www.urac.org/.

SOURCE: WellPoint, Inc