Aetna And Consult A Doctor™ Come Together As A 24/7 Telemedicine And Work Life Service

HARTFORD, Conn., June 19, 2012 — Aetna’s (NYSE: AET) work life platform Aetna Resources For Living has been combined with the Consult A Doctor™ 24/7 telemedicine service to provide employees with easier access to resources that help improve overall health, work/life balance and workplace productivity. Consult A Doctor Plus™ is a unique, on-demand solution that also allows employers to better manage health care costs by providing members with the help and support they need – where, when and how they need it.

Consult A Doctor Plus (CADR+) enables consumers to contact physicians, either by phone or email, for specific questions they may have. This product provides members with a variety of benefits, including:

  • Confidential 24/7 telephonic consultation and prescription-writing.
  • Access to Aetna Resources for Living work life resources and support.
  • Patient advocacy bill review/mediation, provided by The Karis Group.
  • Access to online wellness tools and health records.
  • Legal and financial consulting.

“We are pleased to work with Providence Financial Group to provide those in need with support and services in all areas of physical, emotional, psychological and social well-being,” said Louise Murphy, head of Aetna Behavioral Health. “Aetna Resources For Living is a suite of offerings designed to engage people in addressing lifestyle issues and workplace stresses by providing a comfortable and safe environment for our members. This platform together with Consult A Doctor creates a concrete combination of medical and work life services.”

Powered by TeleCare 3.0, Consult A Doctor provides customized versions of its telemedicine platform to meet the needs of all the major constituents in healthcare, including practices, hospitals, clinics, health plans and employers.

“With Consult A Doctor Plus, we are able to work hand-in-hand with Aetna to reach beyond traditional, primary care settings and explore new opportunities within the telemedicine spectrum of health care,” said Wolf Shlagman, founder and CEO, Consult A Doctor. “We are excited to provide employers with a faster, more convenient and affordable resource that gives members access to such services anytime and anywhere.”

About Providence Financial Group

Providence Financial Group (PFG) is a sales and marketing organization of industry-leading financial products and services, marketed primarily through contracted agents and brokers.
PFG is an authorized representative of both Aetna Behavioral Health and Consult A Doctor, and Reseller/Administrator of the Consult A Doctor Plus program. For more information please visitwww.pfgef.com or contact us at www.pfgef.com/contact.

About Consult A Doctor
Consult A Doctor is the leading innovator of cloud-based telemedicine services and technology platform solutions empowering organizations to lower healthcare costs, provide revolutionary access and improve outcomes. With years of experience delivering direct-to-employer and consumer telemedicine services that offer convenient 24/7 access to doctor consultations by phone, email and video, Consult a Doctor has saved employers millions of dollars in unnecessary healthcare costs, and added millions of dollars of productivity to the bottom line by helping keep employees at work and healthy. Its telemedicine network of U.S. board certified physicians in all 50 states has made it possible to give on-demand care, anytime, anywhere with access to care in the lowest cost setting. Consult A Doctor is further transforming the economic equation of care by partnering with payers, providers and other organizations to deploy its telemedicine platform solution that grants its members and patients unmatched access to quality care, offers a new revenue source for providers, and lowers costs for health plans, employers and groups. For more information about Consult A Doctor, please visit www.consultadr.com, emailtelecare@consultadr.com or call 888-688-DOCT (3628).

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.

 

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.

 

One year later, Capital BlueCross Accountable Care Arrangements proving successful

HARRISBURG, Pa., May 1, 2012 /PRNewswire/ — Today marks the one-year anniversary of Capital BlueCross’ launch of two Accountable Care Arrangements (ACA). Preliminary results demonstrate that this innovative care delivery model is improving care coordination, lowering the medical cost trend, and improving the member’s management of chronic conditions and overall satisfaction with care.  This initiative builds off of the experience Capital BlueCross gained after implementing the region’s first private patient-centered medical home pilot in 2010.

By focusing on a holistic approach to patient care and working with the patient to establish and manage a comprehensive plan of care, Capital BlueCross and its physician partners are helping to:

  • Enhance patient access to care
  • Decrease the risk of hospital readmissions and preventable complications
  • Promote the use of preventive care and wellness services
  • Facilitate improved communication and care coordination

Under the ACA model, Capital BlueCross partners with primary care physician practices to provide dedicated nursing resources and technology to deliver patient-centered, holistic care. By optimizing the use of technology enabled tools, such as a Population Management Tool, members with complex medical conditions or those at risk for a medical condition are identified for outreach, education, and referral for additional clinical, wellness, or community-based services. The Population Management Tool identifies members who have not received all preventive services appropriate for their age and medical condition.

As an example, a Capital BlueCross member diagnosed with type II diabetes will now receive an enhanced level of care coordination for all preventive care, ongoing treatment and specialty care, no matter which physician or specialist the member has accessed.

The member in this illustration would be assigned a Capital BlueCross care coordinator who would work closely with caregivers to ensure that patient has timely doctor appointments, on-site blood glucose tests, a customized nutrition and exercise program, a support group, and a comprehensive understanding of the medical bills and insurance benefits

Both the physician practices delivering the care and their Capital BlueCross patients are embracing the new ACA model.  For example, in a recent survey of the participating practices 100 percent of the respondents reported that they were satisfied or very satisfied with the care coordination program, and with the knowledge level of care coordinators regarding available community\network resources. One respondent commented that their care coordinator was “knowledgeable and very willing to help when needed.”

Additionally, patient participation rates for care coordination are very high, with 75 percent of patients participating in recommended care management and self-help programs. This participation rate is double the industry standard.

Last May, Capital BlueCross launched ACA programs with Lemoyne Pa.-based Heritage Medical Group and Physicians’ Alliance, Ltd. (PAL) in Lancaster, Pa.

“It is no surprise that Capital BlueCross’ Accountable Care Arrangement was successful in its first year,” said Dr. Michael Warren, Physicians’ Alliance Ltd. “We instituted the program in our practice and the feedback from patients has been extremely positive. Capital BlueCross members are noticing better coordination of their medical care, and we are witnessing a higher level of satisfaction among these patients. This has been a true partnership in the delivery of care — one that is working as advertised.”

“Early indications from patients are promising that the ACA concept is working,” said Dr. Christopher Rumpf, Capital BlueCross Chief Medical Officer. “It is important that through this model, the patients feel as though they are receiving a complete spectrum of care. At the same time, the physician practice should feel it is providing a more comprehensive, accountable approach to the delivery of medical services. From what we are seeing and hearing, this is all happening.”

Capital BlueCross has a long history of bringing innovative programs and resources, like ACAs, to its members and the community to help reduce cost, increase quality and improve satisfaction. The company is in discussions with other area physician groups interested in partnering with Capital BlueCross on an ACA.

Capital BlueCross is the leading health insurer in its region, providing health insurance coverage to residents in centralPennsylvania and the Lehigh Valley.

Capital BlueCross is committed to making health insurance simple for its customers and members through all the stages of life by offering nationally acclaimed customer service and a full range of innovative benefit programs for groups and individuals at competitive prices.

By establishing a culture of caring, Capital BlueCross constantly strives to do more in order to deliver more for the men, women and children who depend on the company for their health insurance needs. Capital BlueCross has been providing medical value to the people and communities of central Pennsylvania and the Lehigh Valley for more than 70 years and employs over 1,800 people in the region.

Headquartered in Harrisburg, Pa., Capital BlueCross is an independent licensee of the Blue Cross and Blue Shield Association.

More information about Capital BlueCross and its subsidiaries can be found by going to www.capbluecross.com.

 

SOURCE Capital BlueCross

 

TriZetto Founder Jeff Margolis Fusing Healthcare Population Management and Social Networking

DENVER, Jan. 9, 2012 /PRNewswire via COMTEX/ — Well known for founding healthcare payer software powerhouse, The TriZetto Group, and growing it to return $1.4 billion to shareholders in just 10 years, as well as authoring The Healthcare Cure, Jeff Margolis is now focusing on the opportunity to improve healthcare value through social networking technology.

Margolis recently became executive chairman of WellTok, Inc., developer of the social health hub network, CafeWell(TM), which is already being utilized by healthcare payers to actively engage thousands of members in improving their health. Health plan customers of WellTok have recently begun to offer expanded sponsorship onto the CafeWell channel to over 1 million members.

“Healthcare population managers, whether they are health plans or health providers, have struggled to get consumers meaningfully engaged with their health, and the nation’s health statistics and costs reflect that,” noted Margolis. “Despite having more than 80% of the U.S. population is some form of private or public ‘organized system of health care’, consumers’ knowledge and behaviors are not reflective of the ever-growing body of information available to help them optimize their health.

Social networking platforms, such as Facebook and Twitter, have changed the culture of information flow in communications. And research, such as the work of Dr. Nicholas Christakis at Harvard Medical School, has documented the impact of a person’s social network on their health behaviors.

“Harnessing both social power and social networking technology with security, privacy and alignment is a critical mandate for healthcare,” Margolis added. “At TriZetto, we delivered platforms to help population managers massively cut administrative costs, improve care management and accelerate connectivity among healthcare constituents. Now, social networking technology applied in a systematic way to consumers within managed populations can similarly lead to significant breakthroughs that will drive greater value for the money being spent in our healthcare system. That’s the desired outcome of Social Health Management.”

“Jeff’s vision and entrepreneurship has driven tremendous shareholder value across many companies over the past twenty years,” said Robert DiGia, global head of healthcare investment banking at UBS Investment Bank. “I expect that Jeff’s deep understanding of the healthcare ecosystem will create significant value for WellTok’ customers and investors.”

“Jeff has provided important input to Washington, D.C. stakeholders’ understanding of the impact information technology can have on healthcare,” said Ian Adler, senior managing director of healthcare at the Marwood Group. “Social network technology is a new frontier for healthcare and I look forward to Jeff’s continued leadership in developing this new technology to improve the cost and quality of care.”

Delivering Social Health Management(TM) (SHM)

It seems that everything you hear about today is ‘social’. As Facebook, Twitter, LinkedIn and others have introduced consumers to networking and sharing information online. But how can we harness and direct that power to make a meaningful and sustainable impact on individuals’ and population health?

“I’ll tell you this, it takes a lot more than friending on Facebook, tweeting on Twitter, or blogging on a single-topic healthcare site,” added Margolis. “In CafeWell, we’ve pioneered the infrastructure of Social Health Management, which learns from both the strengths and limitations of existing social networks, while knitting together multiple social point solutions. CafeWell is a fusion engine for creating social health engagement among members.”

Social Health Management gives population managers – whether they be health plans, employers, or physician and care delivery organizations — a new channel through which they can quickly provide programs and information to consumers, in a fun, engaging, independent and safely anonymous network.

To create true SHM, social health hub networks, such as CafeWell, must create the self-sustaining social engagement among members to get people motivated to participate repeatedly. CafeWell does that through proven engagement drivers such as challenge competitions, sponsorship and aggressive merchandising, use of engaging game mechanics, meaningful rewards, mobile capabilities, and fun and useful content providers, such as veteran professional athletes.

And, what makes Social Health Management a full solution, is that it provides the activity itinerary and analytics feedback loop that allows population managers to understand engagement, activity patterns and to gauge the relative effectiveness of social health management and wellness programs they sponsor.

WellTok can even help integrate consumer activities with value-based benefit plans to drive higher levels of engagement that truly impact the cost and quality of healthcare.

About CafeWell and WellTok, Inc.

CafeWell is a social health network that makes getting better connected to your health and fitness more fun and more rewarding. CafeWell provides one stop for consumers’ health, wellness and fitness — including social networking; advice from experts, peers and veteran professional athletes; fun health challenges with family members and co-workers; and reliable health and fitness information. Through CafeWell, sponsors can offer rewards and incentives to promote activity and health improvement. Users control the degree to which their identity is shared, with complete anonymity as the default. To learn more about CafeWell, visit www.cafewell.com.

WellTok is pioneering Social Health Management(TM) (SMH), the complete social networking solution for healthcare population managers. WellTok’s SHM suite provides a complete solution for population managers, including the industry’s most engaging social health network, CaféWell, broad member and group analytics, and integration with healthcare payers and providers’ corporate systems and MLR requirements. WellTok, Inc. is headquartered in Denver, Colo.

SOURCE WellTok, Inc.

 

Cigna and Partners In Care Launch First Accountable Care Program in New Jersey Involving an Independent Physicians Organization and a Health Plan

BLOOMFIELD, Conn. & NEW BRUNSWICK, N.J., December 20, 2011 – Cigna (NYSE:CI) and Partners In Care (“PIC”), an independent physicians organization based in Central New Jersey, have launched a collaborative accountable care initiative to expand patient access to health care, improve care coordination, and achieve the “triple aim” of improved health outcomes (quality), lower total medical costs and increased patient satisfaction. Collaborative accountable care is Cigna’s approach to accountable care organizations, or ACOs.

An ACO is a variation on the patient-centered medical home model of health care that rewards primary care doctors for improved outcomes and lower medical costs. Cigna’s program with PIC is the first patient-centered accountable care program in Central and Northern New Jersey involving an independent physicians organization and a health plan.

The program is focused on approximately 14,000 individuals covered by a Cigna health plan who receive care from among 360 doctors at more than 160 participating physician practices. Individuals who are enrolled in a Cigna health plan and later choose to seek care from one of the participating practices will also have access to the benefits of the program.

“Patients with chronic conditions, such as diabetes or hypertension, see many different specialists and health care professionals with little to no coordination among them. It is unnecessary, disorganized and dangerous,” said Steven Goldberg, M.D., chairman, PIC. “Monitoring these patients and ensuring their care givers are talking to one another – with one patient-selected personal physician in the leadership role – will undoubtedly lead to safer, more consistent, and more effective medical care.”

“Cigna and Partners In Care have shared values, and the commitment to patient-centered care is evident in every aspect of this program,” said Kevin O’Brien, president & CEO, PIC. “As we work together to help patients remain healthy, the overall costs are less – it’s a win for everyone.”

The participating physician practices will monitor and coordinate all aspects of an individual’s medical care. Patients will continue to go to their current physician and will not need to do anything to receive the benefits of the program. There also are no changes in any plan requirements regarding referrals to specialists. Patients most likely to see the immediate benefits of the program are those who need help managing chronic conditions, such as diabetes or heart disease.

Critical to the program’s benefits are clinicians and registered nurses, employed by Partners In Care, who serve as clinical care coordinators and help patients with chronic conditions or other health challenges navigate the health care system. The care coordinators will enhance care by using patient-specific data that Cigna provides to identify patients being discharged from the hospital who might be at-risk for readmission, as well as patients who may be overdue for important health screenings or who may have skipped a prescription refill. The care coordinators will work with the patient’s physician to help patients get the follow-up care or screenings they need, identify any issues related to medications and help prevent chronic conditions from worsening.

The care coordinators will also help an individual’s medical home provide health education and refer individuals to Cigna’s clinical programs, such as disease management programs for diabetes, heart disease and other conditions; and lifestyle management programs, such as programs for tobacco cessation, weight management and stress management.

“The current health care system is focused on treating illness and rewards physicians for volume rather than value; it’s not designed to drive long-term health improvement and lower costs,” said Dr. Ron Menzin, Cigna’s medical director for New Jersey. “If our goal is a healthier population and lower medical costs, we need to create a patient-centered health care system that emphasizes prevention and primary care and that rewards physicians for quality of care and improved health outcomes.”

Cigna will pay physicians as usual for the medical services they provide. Partners In Care will also pay the physicians for the care coordination services they provide on the patient’s behalf. Additionally, physicians may be rewarded through a “pay for performance” structure if they meet targets for improving quality and lowering medical costs.

“Employers bear a large portion of the nation’s health care costs, so it’s important to them to find a model of health care that can lower these costs through improved employee health,” said Laurel Pickering, president & CEO of the Northeast Business Group on Health (NEBGH). “This patient-centered collaboration between Cigna and Partners In Care is an excellent example of how health plans and physicians can work together to achieve a healthy, productive work force and create a health care system that works for everyone.”

The principles of the patient-centered medical home are the foundation of Cigna’s collaborative accountable care initiatives. Cigna then builds on that foundation with a strong focus on collaboration and communication with the physician practice. With the addition of Partners In Care, Cigna is now engaged in 17 patient-centered initiatives in 15 states, encompassing more than 170,000 Cigna customers and more than 1,800 primary care physicians, including multi-payer pilots and Cigna-only collaborative accountable care initiatives. The company plans to continue increasing the number of initiatives significantly in 2012. Cigna has been a member of the Patient-Centered Primary Care Collaborative since October 2007.

About Cigna

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.

About Partners In Care

Partners In Care, Corp. (PIC) is a privately held, physician owned, for-profit provider of healthcare and management services. With a broad network of independent community physicians throughout New Jersey.

IncentOne Launches Outcomes-Based Biometrics Incentive Solution

Lyndhurst, NJ (PRWEB) December 08, 2011, IncentOne, a provider of incentive solutions to the healthcare industry, has launched what it says is the first outcomes-based biometric incentive program through its Health Power™ platform. With this solution, IncentOne will enable payers, health service companies, employers, governments and administrators to align incentives to outcomes and improvements in 20 different biometric measures.

Key features of the solution include the ability to:

  • Combine outcomes and participation-based programs
  • Set desired biometric outcomes for 20 measures including Body Mass Index, Blood Pressure, Waist Circumference, Waist to Hip Ratio, Total Cholesterol, HDL Cholesterol, HDLc Ratio, Triglycerides, Glucose, A1C, Cotinine, and LDL Cholesterol
  • Set absolute, percentage or minimum improvements for each measure
  • Incentivize for single or multiple biometric measures attained
  • Set different target levels for men and women for each measure
  • Implement pass/fail criteria for each measure
  • Integrate data from past testing periods
  • Utilize multiple testing periods
  • Utilize physician attestation forms for alternative facilities
  • Allow for reasonable alternative health activities based on physician recommendations
  • Manage the process for contested measures

“Biometrics are a central component of any outcomes-based engagement strategy.” says Michael Dermer, President and CEO of IncentOne. “Our customers can now execute a wide variety of outcomes-based designs tied to biometric data that have demonstrated cost savings. We believe that Incentive Driven Healthcare™ is the next wave in healthcare and this is one step to help our customers see that movement in action.”

About IncentOne
IncentOne delivers cost savings and health improvement by engaging healthcare consumers and providers through the use of incentives. IncentOne serves customers representing more than 75 million lives, has processed 20 million health transactions and driven 15 million health milestones through 125 data partners. IncentOne’s Universal Remote™ technology enables customers to drive “any action for any value for any reward via any medium” and to align incentives not only to long-term savings but also to immediate and intermediate savings via its Trifecta™ methodology. IncentOne’s solutions are married with leading-edge strategies such as value-based benefit design, medical homes, accountable care organizations, telehealth, pay-for-performance and provider payment reform to deliver true engagement. IncentOne programs target consumers to improve utilization, increase prevention, avoid hospitalizations, reduce readmissions, choose lower cost providers, reduce health risks, increase medication adherence and steer benefit selection and providers to adopt e-prescribing and EMR technology, adhere to treatment protocols, and improve patient safety. For more information go tohttp://www.incentone.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/

 

Contacts

 

HealthRally Raises $400K to Motivate Wellness

SAN FRANCISCO–(BUSINESS WIRE)–HealthRally, a social health company developing a new crowdfunding platform for personal health motivation, announced that it raised more than $400,000 in seed funding and assembled an expert board of strategic advisors.

The company is building a social health platform focused on inspiring the nearly 100 million Americans who spend over $50 billion annually trying to achieve wellness goals such as losing weight, quitting smoking, or improving one’s overall health and fitness.

The seed round was funded by Esther Dyson, a prominent angel investor in disruptive technologies; Isy Goldwasser, a successful biotech entrepreneur; Dick Sass, a medical device entrepreneur; Ty Danco, a prolific angel investor; and Jeff Thiel, a former Microsoft executive.

“Games and badges are great, but most people would probably rather have an iPad, a vacation, or cool new pair of shoes,” says Zack Lynch, CEO and co-founder of HealthRally. “HealthRally combines the power of social networks with the latest findings in behavioral science for healthy motivation and sustained support.”

HealthRally ties together advances in behavioral economics — which shows that financial incentives triple one’s chance of reaching a health goal — with cutting edge social networking science — which proves that engaging close friends and family increases success rates. In practice, when friends and family contribute financially to one’s goals, peer support and success rates dramatically increase.

“It’s the oldest trick in the book,” says Esther Dyson. “Make a commitment to a group of friends, and you ‘have’ to deliver! HealthRally helps you assemble the friends and manage the process, and adds the psychological value of making the commitment and incentives explicit and formal.”

HealthRally’s advisory panel includes researchers and entrepreneurs with deep experience in behavioral economics and social networking, including: Paul Zak, Director, Center for Neuroeconomic Studies, Claremont Graduate University; Tom Valente, Social Networks and Health expert, Keck School of Medicine, USC; Denise Thomas, former President, Healthiest You; and Ross Mayfield, Chairman and co-founder, Socialtext; among others.

The company is currently in private beta and will be launching a public beta in time to help people conquer their New Year’s resolutions. Individuals can request an invitation to participate at www.healthrally.com.

About HealthRally

HealthRally is a social health company that has developed a crowdfunding platform that uses social motivation and positive financial incentives to inspire people to achieve their health and wellness goals. HealthRally was co-founded by Zack Lynch and Peter Kaminski. Zack is the founder of the Neurotechnology Industry Organization and author of The Neuro Revolution: How Brain Science Is Changing Our World (St. Martin’s Press.) Peter has been technical co-founder at several companies including Socialtext and Yipes Communications.

 

Contacts

HealthRally
Zack Lynch, 415-279-7462
CEO
Zack.lynch@healthrally.com
or
Ross Gillfillan, 415-599-4403
ross@torchcommunications.com

 

OpenEnrollment123.com Helps Benefits Managers Educate Employees about Consumer-Directed Health Plans

EDEN PRAIRIE, Minn., Nov 14, 2011 (BUSINESS WIRE) — Optum(TM) is offering benefits managers at companies of all sizes free online resources designed to help educate their employees about consumer-directed health plans and tax-advantaged health care accounts.

The resources, available at OpenEnrollment123.com, provide benefit managers free tools that can be incorporated into their existing open enrollment and health plan education programs to help employees determine if a consumer-directed health plan and a tax-advantaged health care account is the right option for their health care needs. These tools can be used in employee meetings, on company websites, in mailings to employees or posted in the workplace.

An increasing number of employers are offering consumer-directed health plans with a tax-advantaged health care account. The number of people covered by health savings account/high-deductible health plans (HSA/HDHPs) totaled 11.4 million in January 2011, an increase of 14 percent since 2010, according to a survey of U.S. health insurance carriers conducted by America’s Health Insurance Plans (AHIP).

“Using a tax-advantaged health account is new for many people. We want to help them understand how consumer-directed health plans work so they can make smart choices at enrollment time and thereafter,” said Heidi Sirota, vice president of marketing for OptumHealth Financial Services(SM). “OpenEnrollment123.com gives employers a set of easy-to-use tools to share with their employees so they can decide on the best plan for their situations.”

Key resources on OpenEnrollment123.com include:

— “Two-Minute Answers” videos that introduce the basics of HSAs;

— brief, interactive presentations employees can rewind, pause, and skip ahead to learn about tax-advantaged health accounts;

— live and prerecorded webinars with experts in health accounts;

— brochures and flyers to share in person or online with employees; and

— simple math examples that illustrate the tax savings of a flexible spending account (FSA) and HSA.

OptumHealth’s financial services business manages more than 2.3 million consumer-directed health care accounts and more than $1.3 billion in HSAs and related investment assets at its OptumHealth Bank(SM), Member FDIC. The financial services business also reduces waste and inefficiency in health care by electronically transmitting about $4 billion in payments every month from health plans to nearly 700,000 doctors, hospitals and other health care providers.

About Optum:

Optum is an information and technology-enabled health services company serving the broad health care marketplace, including care providers, plan sponsors, life sciences companies and consumers. Its business units — OptumInsight(TM), OptumHealth(R) and OptumRx(TM) — employ more than 30,000 people worldwide. Visit www.optum.com or www.optumhealth.com for more information.

SOURCE: OptumHealth

 

Independence Blue Cross Presents Next-gen Mobile Insurer Apps At Insurance & Tech Executive Summit

PHILADELPHIA, Nov 7, 2011 (GlobeNewswire via COMTEX) — Independence Blue Cross announced that its director of e-Business, Michael B. Yetter, will speak today about mobile app marketing strategies in health care with other industry leaders at the Insurance & Technology Annual Executive Summit held in Carefree, Arizona.

“As we look into 2012 and beyond, there are technologies and concepts that play a significant role in shaping development of next-gen apps for our health plan members, including Mobile Health, which is better known as mHealth,” said Yetter. “‘Gamification’ is a growing trend in the mobile app industry, which is applying game design concepts and principles to mobile apps to further strengthen our member engagement. People like to be entertained, to compete, and to be rewarded. The more these principles are applied to mobile apps, the deeper the engagement with the consumer. IBC is exploring cutting edge ways to ‘gamify’ mobile app strategies already in place, and we will soon be piloting a new wellness engagement and competition program that we hope to offer more broadly next year.”

Another hot topic as the health care industry shifts toward more individual coverage is mobile payment systems, and Yetter will discuss next-gen ideas for individuals to pay their health plan bills with their phones.

“IBC made a strong entry into the mobile app space during 2011 and we plan to continue to innovate for our customers and members, using the latest technologies to provide the time-saving features and convenience that their lives demand,” Yetter added.

Yetter will discuss the mobile platform race between Apple iOS, Google Android, Blackberry, and Windows in phone devices and tablets. He will share his insights that, while some platforms may lose market share, there is no single winner currently emerging, and developers will continue to face complexity in building apps for several health care industry platforms.

The Insurance & Technology Executive Summit is an invitation-only event for senior-level insurance company executives. The conference presents relevant content, authoritative speakers, and networking opportunities for sponsors. The event is comprised of conference sessions, vendor meetings, and networking-focused social activities.

About Independence Blue Cross

Independence Blue Cross is a leading health insurer in southeastern Pennsylvania. Nationwide, Independence Blue Cross and its affiliates provide coverage to nearly 3.1 million people. For 73 years, Independence Blue Cross has offered high-quality health care coverage tailored to meet the changing needs of members, employers, and health care professionals. Independence Blue Cross’s HMO and PPO health care plans have consistently received the highest ratings from the National Committee for Quality Assurance. Independence Blue Cross is an independent licensee of the Blue Cross and Blue Shield Association.