House Lawmakers Unveil Bill To Boost Telehealth Coverage

We are following a story that was reported on iHealthBeat.org 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  iHealthBeat.org.

 

SCAN Health Plan AZ Adds Two Plans for Chronic Conditions

PHOENIX–(BUSINESS WIRE)–SCAN Health Plan Arizona announced the introduction of two new HMO Special Needs Plans (HMO SNPs) for Medicare-eligible residents in Maricopa and Pima counties. The plans are designed to help members with diabetes or heart disease better manage their chronic conditions.

The SCAN Balance (HMO SNP) plan is for Medicare beneficiaries with Type 1 or Type 2 diabetes. In this plan there is no co-payment for insulin or diabetic supplies, such as a monitor, test strips or lancets. The Heart First (HMO SNP) plan is available to anyone with Medicare who has been diagnosed with congestive heart failure, cardiac arrhythmia, coronary artery disease, peripheral vascular disease or chronic venous thromboembolic disorder. SCAN uses social workers, case managers and other professionals to help members with chronic conditions. Continue reading

Study Looks at ACO Formation Drivers

An article in Physicians Briefing points to a study published in the October issue of Health Affairs that suggests that underlying provider integration in a given geographic region may be the key that drives the formation of Medicare accountable care organizations (ACOs),

The researchers found that a greater fraction of hospital risk sharing (capitation), larger integrated hospital systems, and primary care physicians practicing in large groups were key regional factors associated with ACO formation.

The study is available for purchase at HealthAffairs.org.

UPMC Includes Unique Benefits in its 2014 Medicare Offering

PITTSBURGH, Oct. 10, 2013 /PRNewswire/ — UPMC for Life – the Medicare Advantage product of UPMC Health Plan – is offering four unique HMO plans in 2014, each designed to meet the specific needs of Medicare-eligible consumers.

UPMC for Life members now have a new fitness benefit called Fit for Life. Under this benefit, members can join any gym or fitness facility they choose and they will be reimbursed for a portion of their membership, up to the annual reimbursement limit for the plan they select.

With all of the plans, members receive a vision allowance, discounts for dental services, discounts for hearing services, and Assist America®, which provides help when members travel more than 100 miles from home or to another country.

See the full story at: PRNewswire.com

San Francisco Area Health Centers Seek to form ACO

A prominent group of health centers in the North Bay (San Francisco) has applied to form what is known under the new federal health law as an “accountable care organization” serving thousands of Medicare patients that, if approved, could be one of the first of its kind in the nation.

Under the ACO program by Medicare, health care providers and payers are encouraged to better coordinate care, hoping to achieve the so-called “triple aim” of improving quality of care, improving patient experience and reducing costs, officials said.

Read the full story at northbaybusinessjournal.com

Legally Married Same-Sex Couples will be Recognized as such for Federal Tax Purposes, Certain Medicare Benefits

All same-sex couples who are legally married will be recognized as such for federal tax purposes, even if the state where they live does not recognize their union, the Treasury Department and the Internal Revenue Service said Thursday.

Separately, the Health and Human Services Department said Thursday that Medicare would extend certain key benefits to same-sex spouses, “clarifying that all beneficiaries in private Medicare plans have access to equal coverage when it comes to care in a nursing home where their spouse lives.”

Read the full story at http://news.nytco.com/

ACOs’ Coordinated Care Savings May Be Contagious

Accountable care organizations (ACOs) may actually be the unicorns we’ve been waiting for, spreading their cost-saving magic throughout the health system.

An early cost-sharing program in Massachusetts designed to cut costs for private Blue Cross Blue Shield patients also lowered costs for Medicare patients who were seen by the same providers, according to a study published Tuesday in the Journal of the American Medical Association.

Read the full story at KaiserHealthNews.org

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

 

Cigna to Acquire HealthSpring

BLOOMFIELD, Conn. & NASHVILLE, Tenn., October 24, 2011 – Cigna Corporation (NYSE: CI) and HealthSpring, Inc. (NYSE:HS) today announced that they have signed a definitive agreement under which Cigna will acquire all the outstanding shares of HealthSpring for $55 per share in cash, a 37% premium over the closing stock price on Friday October 21, 2011, representing a total transaction value of approximately $3.8 billion. HealthSpring’s proven leadership team, headed by its Chairman and Chief Executive Officer Herb Fritch, will lead Cigna’s expansion in our rapidly growing Seniors and Medicare segments. The business combination is expected to be accretive to Cigna earnings per share in the first full year of operations. The agreement has been approved by the boards of directors of both companies and is subject to required regulatory approvals and customary closing conditions. The transaction is expected to close during the first half of 2012 and is not subject to a financing condition.

“HealthSpring is a great fit with Cigna’s growth plans to expand into the Seniors and Medicare segment through a premier business and trusted brand name,” said David M. Cordani, President and Chief Executive Officer. “Our two companies share a common strategic vision and philosophy that we create customer value by partnering with health care professionals, and use information and incentives to deliver high-quality, differentiated programs.”

“We are thrilled to announce this transaction with Cigna,” said Herb Fritch. “Following a review undertaken by our Board of Directors of the company’s strategic options, we concluded that the combination is in the best interests of our shareholders. The combination will also expand our ability to serve our physician partners and customers. Cigna recognizes the value in HealthSpring’s differentiated model of physician engagement, and shares our commitment to providing high quality, cost effective care to the members and communities we serve. We truly look forward to continuing and expanding upon this mission.”

 

Humana and Reader’s Digest Association To Promote Co-Branded Medicare Products

LOUISVILLE, Ky. & NEW YORK–(BUSINESS WIRE)–Humana Inc. (NYSE: HUM), a national leader in health care coverage, and The Reader’s Digest Association, Inc. (RDA), parent company of Reader’s Digest – one of America’s best known and trusted brands – today announced a new alliance focused on enhancing seniors’ health and well-being. As part of this alliance, the companies will develop and promote a new suite of co-branded Medicare products from Humana, with the first of these products expected to be available to Medicare beneficiaries later in 2011.

“We see opportunities from combining Humana’s expertise with Reader’s Digest brand trust, scale and skill at making complex issues like health care and other subjects simple and understandable, as a powerful combination with unlimited growth potential.”

The co-branded Humana and Reader’s Digest plans will begin with a Medicare Supplement product offered in a select number of states, with plans to eventually make the product available in all 50 states, Washington D.C. and Puerto Rico. Benefits of the plans offered will include dental and vision coverage. Other unique features apart from the contracted benefits will include discounts or services such as discounts on Reader’s Digest products and publications, and customized, easy-to-understand health and well-being content.

As part of their alliance, Humana and RDA will promote the new co-branded products across the range of Reader’s Digest print and digital channels, and Reader’s Digest will introduce a new guide to Medicare decision-making and senior health debuting on newsstands and online in September 2011.

“Our alliance with Reader’s Digest provides both the audience reach and a wealth of easy-to-understand health-related information that enable Humana to expand on its mission to make meaningful connections with our members,” said Tom Liston, senior vice president and leader of Humana’s Medicare organization. “We’re continually searching for engaging ways to interact with our members, to help them live healthier lives and achieve lifelong well-being. We’re confident that working with RDA and the Reader’s Digest brand will enable Humana to build on our decades of experience effectively serving Medicare beneficiaries.”

“Humana’s deep understanding of the Medicare consumer and customer-focused approach make them the ideal partner for Reader’s Digest,” said Tom Williams, president and CEO of the Reader’s Digest Association. “We see opportunities from combining Humana’s expertise with Reader’s Digest brand trust, scale and skill at making complex issues like health care and other subjects simple and understandable, as a powerful combination with unlimited growth potential.”

About The Reader’s Digest Association, Inc.

RDA is a global media and direct marketing company that educates, entertains and connects more than 130 million consumers around the world with products and services from trusted brands. With offices in 44 countries, the company reaches customers in 78 countries, publishes 90 magazines, including 50 editions of Reader’s Digest, the world’s largest-circulation magazine, operates 83 branded websites and sells nearly 40 million books, music and video products across the world each year. Further information about the company can be found at www.rda.com.

About Humana

Humana Inc., headquartered in Louisville, Kentucky, is a leading health care company that offers a wide range of insurance products and health and wellness services that incorporate an integrated approach to lifelong well-being.