Aetna Better Health of Illinois and Addus Home Care Launch Personal Care Pilot

CHICAGO–(BUSINESS WIRE)–Aetna Better Health of Illinois, an Aetna Medicaid plan, and Addus Home Care, a national provider of home and community-based services (HCBS), will conduct a pilot study on the impact of providing smart phones to home care aides who assist Illinois residents served under the state’s Integrated Care Program (ICP).

ICP provides assistance such as meal preparation, bathing, housekeeping and transportation to seniors and adults with disabilities who qualify for Medicaid. The pilot study seeks to demonstrate the benefits of smart phones to help home care aides report changing health conditions of members in real time to supervisors and to the members’ primary care physicians. Addus Home Care aides are in consumers’ homes on a frequent basis, observing changes in the physical, mental and environmental conditions of their clients.

In the ICP pilot, Aetna Better Health and Addus expect to leverage home and community-based services to provide similar results with emergency and acute care services. Aetna and Addus plan to conduct an outcome study on the program in 2014.

For more information, see


House Lawmakers Unveil Bill To Boost Telehealth Coverage

We are following a story that was reported on that said that a bipartisan group of House lawmakers last week introduced a bill (HR 3306) that aims to expand telehealth coverage through Medicare and Medicaid.

The Telehealth Enhancement Act of 2013 was introduced by Reps. Gregg Harper (R-Miss.), Devin Nunes (R-Calif.), Mike Thompson (D-Calif.) and Peter Welch (D-Vt.).

Among other things, the legislation would:

  • Adjust Medicare home health payments to account for remote patient monitoring;
  • Expand telehealth coverage to all critical access and sole community hospitals;
  • Cover home-based video services for hospice care, home dialysis and homebound Medicare beneficiaries; and
  • Allow state Medicaid programs to set up high-risk pregnancy networks.

The bill has been referred to the House committees on Energy and Commerce and Ways and Means. – To see more go to


Officials outline ‘Basic Health Program’

Federal health officials released the framework for ObamaCare’s long-awaited “Basic Health Program,” an initiative designed to provide a scaled-down, lower-cost coverage option to people who cannot afford health plans on the new insurance exchanges.

The Basic Health Plan will be available to citizens who aren’t eligible for Medicaid but might not be able to afford health coverage for the new insurance exchanges. Legally present non-citizens who qualify for the exchanges and those that would otherwise qualify for Medicaid may also enroll.

See the full story at

Engaging Public Health Insurance Consumers Through Social Media

MAXIMUS (NYSE:MMS), a leading provider of government services worldwide, announced today that the Company and the South Carolina Department of Health and Human Services will co-present a case study on engaging public health insurance program participants using social media at the upcoming Medicaid Managed Care Congress.

The South Carolina Department of Health and Human Services has been working with MAXIMUS, the Medicaid managed care enrollment counselor for the South Carolina Healthy Connections Choices program, on a demonstration project to examine the usefulness of social media technologies for outreach to low-income populations. The demonstration project, in partnership with the MAXIMUS Center for Health Literacy, has been successful in providing health and enrollment information to consumers and program stakeholders who are actively engaged in social media networks.

Jeff Stensland, Director of Communications for the South Carolina Department of Health and Human Services, and Sunaina Menawat, Manager of Business Development for MAXIMUS Health Services, will present their case study entitled “Utilize Social Media for Greater Member Engagement, Communication and a Broader Reach.” Stensland and Menawat will present the demonstration project from its inception, the methodology and the social media tools used, and preliminary results. They will also discuss social media in the broader context of engagement and communication.

“One of the things I like about the demonstration project is that it tests the notion that lower-income people are somehow disconnected from the changes occurring in mass media. The project’s use of social media allowed us to interact with our members in new ways,” Stensland commented. “Members saw that we established a presence on the social media sites they regularly frequent, offering them a new way to get information, offer instant feedback and even ask questions. We look forward to sharing the insight garnered from the project with the Medicaid Managed Care community.”

“We are continuously looking for new ways to bring added value to our clients by improving outreach and education efforts to program participants,” commented Bruce Caswell, President and General Manager of MAXIMUS Health Services. “Until now, social media was often seen as an unconventional channel for communicating with participants of public health insurance programs, but this demonstration project shows that social media can be effectively used to reach program participants and help them make informed choices for improved long-term health outcomes.”

The Medicaid Managed Care Congress will take place May 17-19, 2010, at the Hyatt Regency in Baltimore, Maryland. The Congress brings together State and Federal Medicaid Officials, Medicaid Managed Care Executives and National Policy Experts in a collaborative environment to create efficiencies while improving access to high quality care.


MAXIMUS is a leading provider of government services worldwide and is devoted to providing health and human services program management and consulting services to its clients. The Company has more than 6,500 employees located in more than 220 offices in the United States, Canada, Australia, the United Kingdom, and Israel. Additionally, MAXIMUS is included in the Russell 2000 Index and the S&P SmallCap 600 Index.

Healthy Connections Choices

Simply Healthcare Plans of Florida Gets Equity Investment.

MBF Healthcare Partners, L.P. (MBF), a healthcare services focused private equity firm, announced its plans to invest up to $50 million of equity capital to support Simply Healthcare Plans of Florida, Inc. (SHP) an HMO based in Coral Gables, Florida.

The equity investment will be used to fund expansion and acquisition efforts in Medicare and Medicaid.  SHP is a licensed HMO in Florida that has been approved by the State to expand into the Medicare and Medicaid markets.  MBF is sponsoring a seasoned managed care team that is led by Peter Jimenez an exceptional executive with a long track record of value creation in managed care that has been credited with the success of two large HMOs in Florida, Physician Healthcare Plans, which was sold to Amerigroup Corporation in 2002 and Care Plus Health Plans, which was sold to Humana in 2005.  SHP is aggressively pursuing acquisition opportunities throughout the country while expanding its current operation and capabilities in Florida.

Mike Fernandez, Chairman and CEO of MBF said, “I believe that the current healthcare environment in the United States presents an opportune time to build and expand managed healthcare services. We believe that managed care can be an integral part in coordinating high quality healthcare services while controlling fraud and abuse in the healthcare system in State and Federal funded programs.  In addition, we believe that Medicaid will play an integral part in the Federal Government’s efforts to expand healthcare coverage to the uninsured population and that Medicare Advantage plans will continue to expand as the baby boomers reach the Medicare eligible age.  Well run managed care plans have proven that they can offer high quality services and benefits to its members while providing State and Federal government with predictable costs.   We are extremely fortunate that we have been able to assemble a team of senior executives who have a proven track record of success in managed care.  Peter Jimenez who is leading our executive team is an exceptional executive and we look forward to collaborating with him to capitalize on the opportunities created by the recent developments in the healthcare market. Our partnership with Peter and his executive team reflects another example of MBF’s current strategy in a changing private equity market to identifying highly attractive segments in healthcare services and partner with outstanding executives.”

About Simply Healthcare Plans, Inc.:

Simply Healthcare Plans, Inc., headquartered in Coral Gables, Florida, is a licensed HMO focused on providing Medicare Advantage and Medicaid managed care solutions and services.

One-Fourth of U.S. Adult Health Care Expenditures Associated With Disability.

Just over one-quarter of U.S. adult health care spending was associated with disability in 2006, according to a new study by researchers at RTI International and the U.S. Centers for Disease Control & Prevention.

The study, published in the January-February issue of Public Health Reports, found that disability-associated health care spending for U.S. adults totaled $397.8 billion in 2006, which was almost 27 percent of U.S. adult health care spending. New York had the highest disability-associated health care spending at $40.1 billion and Wyoming had the lowest, with $598 million.

Eighteen percent of all adults reported having a disability, defined as having any limitation resulting from a physical, mental or emotional problem, according to the study. The disability-associated health care costs included the treatment costs for conditions such as traumatic brain injuries, strokes, and vision impairment and some treatment costs for chronic conditions such as diabetes and arthritis.

“Most people think of disability as affecting only seniors, but many younger adults also have a disability,” said Wayne Anderson, Ph.D., a senior health policy analyst at RTI, and the paper’s lead author. “Disability often complicates obtaining health care, including for people with chronic conditions such as heart disease and diabetes. When looking for ways to improve health and control costs, the role of disability in care management should be addressed.”

According to the research, the costs of health care for people with disabilities are borne largely by the public sector, particularly Medicaid, where 68 percent of the program’s spending was associated with disability. Approximately 38 percent of all Medicare spending was associated with disability, as well as 12 percent of health care costs for those with either private insurance or who were uninsured.

The findings suggest that disability-associated health care spending may be reduced by encouraging preventive care service use such as smoking cessation and mammograms, by health improvement interventions such as nutritional improvement programs and, most importantly, by improving access to acute medical care for people with disabilities. Health promotion and disease management programs that help people with disabilities improve diet and physical activity and manage chronic conditions can help maintain functional independence and may help reduce health care spending by decreasing hospitalization and premature nursing home entry.

“We’re finding that people with disabilities aren’t getting the same level of preventive care every day as people without disabilities,” says Dr. Brian Armour, lead health scientist at CDC’s National Center on Birth Defects and Developmental Disabilities. “It’s important to realize that people with disabilities can be healthy if barriers to care are reduced.”

The study found that the costs per person with a disability were highest in the Northeast, several southeastern states, Alaska and Hawaii, where the costs exceeded $13,000 per person per year in most of those states. The lowest costs per person with a disability, less than $10,000 per person per year, were found in the West or Mountain regions (see map).

The study used data from the 2002-2003 Medical Expenditure Panel Survey and state-level data from the Behavioral Risk Factor Surveillance System.

The study was funded by the CDC.

Source: RTI International

Innovative Health Plan Earns Top Grades from New York Office of Health Insurance Programs.

Imagine receiving postcards from your health insurer, reminding you that your child needs immunizations, or that, because you have diabetes, youre due for an examination. And when was the last time your health insurer called to tell you its time for a mammogram or an eye doctor visit, and then stayed on the phone to help you set up an appointment?

Thats the level of service Hudson Health Plan members experience, which is part of the reason why Hudson ranked highest in the 2009 Quality Incentive Program, the annual grading of Medicaid managed care plans by the New York State Department of Health (DOH.)

Georganne Chapin, president and CEO of Hudson, said, Our model is to deliver cost-effective care in a culturally appropriate way to the communities we serve. We always knew that we were the best, but now we have the numbers to prove it.

The DOHs Office of Health Insurance Programs annually assesses all 20 Medicaid managed care plans in the State. Hudson scored 135.5 out of 150 points, for a final score of 90 percent. The plan with the next highest score had a final grade of 79 percent. The emphasis of the annual assessment is on quality of care, and this years benchmarks focused on several measures, including advising smokers to quit, annual dental visits for ages 2-18, controlling high blood pressure, breast cancer screening, and annual monitoring of patients on persistent medications. Hudson achieved a perfect score in customer satisfaction.

All of the outreach programs we have put into place over the years, including our mailings, our phone calls to members, and our education programs for health care professionals, have really impacted our scores, says Margaret Leonard, senior vice president of clinical services at Hudson. All these initiatives contribute to the overall health and well-being of our members.

Founded in the mid-1980s by a coalition of community health centers, Hudson Health Plans mission statement is “to promote and provide access to excellent health services for all people.” The Tarrytown-based not-for-profit organization provides comprehensive medical and dental coverage to more than 90,000 members in New Yorks Hudson Valley. Hudson Health Plan has been driving health care innovation by developing technology to support clinical quality initiatives and streamline the enrollment process for Medicaid Managed Care, Child Health Plus, and Family Health Plus.

Source: Hudson Health Plan

Doctors Cite Time, Low Reimbursement As Barriers To Providing Comprehensive Diabetes Care, Survey Shows.

A new survey has found that nearly one-third of doctors surveyed said they did not have enough time and did not receive sufficient reimbursement to provide comprehensive care to their patients with diabetes.

Bayer's CONTOUR USB Meter (PRNewsFoto/Bayer Diabetes Care)

Bayer's CONTOUR USB Meter (PRNewsFoto/Bayer Diabetes Care)

According to the results of a study of endocrinologists and primary care doctors published today in American Health & Drug Benefits, 32 percent of physicians felt unable to provide comprehensive diabetes care, and most cited time or reimbursement as the major barrier. Furthermore, 83 percent of physicians surveyed said Medicaid reimbursement was inadequate, while 67 percent said private insurance reimbursement was inadequate.

Physicians surveyed said they did not have adequate resources — including medical and administrative time, facilities, staff and materials — to ensure multi-disciplinary team care (32 percent), to provide lifestyle and behavior modification counseling (28 percent), or patient education on self-care and preventing complications (15 percent). Fewer than half (47 percent) of doctors surveyed said they had adequate resources to provide psychological and social status assessments.

Self-monitoring blood glucose levels

The most common service that doctors provided their patients with diabetes was instruction in, and evaluation of, self-monitoring blood glucose levels. Blood glucose monitoring is critical for patients to prevent serious complications such as hypoglycemia, the leading cause of diabetes-related hospitalizations. While 89 percent of all doctors surveyed said they or their staff provided this service, fewer than half provided other services important to managing diabetes, such as medical nutrition therapy (36 percent) and multi-disciplinary care coordination (49 percent). Nearly three-quarters of all doctors surveyed said their practices provided annual eye exams and blindness education (74.5 percent) and weight loss counseling and physical activity instruction (76 percent).

“Diabetes requires multidisciplinary care and a team-based approach for the best outcomes,” Lana Vukovljak, Chief Executive Officer of the American Association of Diabetes Educators, said. “In addition to aggressively managing their blood glucose levels and monitoring their overall health, these patients benefit when provided substantial education on nutrition and the importance of weight loss, physical activity and smoking cessation,” said Ms. Vukovljak.

Data for the study was collected via a web-based survey of primary care physicians and endocrinologists as well as during a follow-on, online discussion group of a sample of physicians representing the two specialties.

Source: National Changing Diabetes Program

Web Site:

Medical College to Provide Specialty Services to Underserved Area via Innovative Telehealth Network.

Innovation Alert!

AmeriChoice by UnitedHealthcare, a Medicaid managed care organization that provides medical and behavioral health care services to TennCare members in East, Middle, and West Tennessee has expanded access to specialty health care services using a telehealth network.

Through an arrangement with Meharry Medical College, AmeriChoice members throughout Tennessee, who are seeking adult specialty services such as a dermatologist or a neurologist, will be able to visit a local community health center and use telehealth technology to consult with specialists composed of physicians who also serve on the faculty at Meharry Medical College.

According to a release issued by AmeriChoice, recent telehealth infrastructure expansion is propelling the advancement of telemedicine technology allowing patients to access medical or behavioral health specialists at local community health centers instead of traveling to the city.

AmeriChoice, a unit of UnitedHealth Group (NYSE: UNH), serves more than 2.7 million people in Medicaid, Medicare and Children’s Health Insurance Programs in more than 20 states and the District of Columbia.

Health Savings Accounts for Poor Tested

The popularity of health savings accounts for the poor will be put to the test in Indiana under a program approved Friday by the Bush administration. This according to a story published by The Associated Press and carried on Under the plan, someone making $20,000 a year could get health coverage for about $19 a week.

According to the report, under the Indiana program, eligible residents can pay up to 5 percent of their incomes into state-subsidized “Personal Wellness and Responsibility Accounts” that cover their initial medical expenses up to $1,100. Once that deductible is reached, private insurance purchased by the state kicks in.

The story reported that eligibility is limited to adults with incomes below twice the federal poverty level. The poverty level is now $10,210 for an individual and $20,650 for a family of four.

Obviously, the Health Plan Innovation Blog and other will be watching closely the results of this program and the implications it might have for providing health insurance coverage for the poor.

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