WellPoint Affiliated Online Stores Prove Popular With Baby Boomers

 INDIANAPOLIS, Feb. 28, 2011 /PRNewswire via COMTEX/ — The online stores featuring the Medicare plans of WellPoint affiliated companies proved very popular with seniors during the recently concluded Annual Enrollment Period (AEP), demonstrating Baby Boomers’ confidence with learning about, pricing and buying health care services online.

The stores, which vary by brand, launched in September and steadily picked up traffic during AEP, which ran from Nov. 15 through Dec. 31, 2010. During this period, more than 225,000 different quotes were delivered on WellPoint affiliated Medicare Advantage, Medicare Supplement and Prescription Drug Plans online.

In fact, more than one in five Medicare applications came into WellPoint affiliated plans through electronic sources during AEP. The busiest day of the year for the stores was Dec. 30 as AEP was winding down.

“The first Baby Boomers are aging into Medicare this year,” explained Krista Bowers, vice president of WellPoint’s senior division. “We knew from our research that they would be more confident with the Internet than their predecessors. That’s why we launched the online stores in time for AEP. However, the extent to which the Boomers went online exceeded even our expectations.

“During AEP, we tried to meet people where they were most comfortable,” Bowers added. “Some went online by themselves, while others were assisted by our sales agents or independent brokers. Of course, we also had our regular enrollment channels, including telephone calls and face-to-face meetings.”

Nevertheless, it’s clear that Internet channels are growing in popularity among seniors, especially with 70 million Baby Boomers aging into Medicare over the next two decades. According to a 2010 study by Pew Research Center, 76 percent of older Boomers (56-64) and 81 percent of younger Boomers (46-55) go online, making up about 33 percent of the total Internet using population. The study shows that getting health information is one of their top reasons for going online.

The online stores of WellPoint affiliated companies allow visitors to learn about products, compare plans, get a quote and even enroll in a plan when eligible.

About WellPoint, Inc.

WellPoint works to simplify the connection between Health, Care and Value. We help to improve the health of our communities, deliver better care to members, and provide greater value to our customers and shareholders. WellPoint is the nation’s largest health benefits company in terms of medical enrollment, with more than 33 million members in its affiliated health plans, and a total of more than 69 million individuals served through all subsidiaries.

MedAssurant to Improve Data-Driven Care Coordination with BlueCross and BlueShield of Florida

MedAssurant Inc., a leading provider of data-driven health care solutions, today announced that Blue Cross and Blue Shield of Florida (BCBSF) is expanding its relationship with MedAssurant through the implementation of the Prospective Advantage™ solution to aid in the improvement of care coordination for their Medicare Advantage members.

MedAssurant’s Prospective Advantage combines advanced predictive analytics with patient and provider encounter facilitation to support informed care coordination. Following the analytical identification of gaps in quality, care, encounters and documentation, Prospective Advantage determines optimal timing, method, and content of outreach to patients and providers, as well as determining the necessary venue and decision support for encounters, to close gaps in a prioritized fashion. Through this sophisticated, member-specific approach, BCBSF will facilitate quality care for members by connecting them with their physicians and providing the physicians with a powerful, yet simple to use decision support platform.

“Through the expansion of our relationship with BCBSF, together we are using data and analytics to intelligently improve the quality, cost, and care initiatives that impact of Medicare Advantage members and the practitioners that support them,” said Phillip Traylor, Senior Vice President of Care and Quality Management at MedAssurant. “The MedAssurant and BCBSF relationship dates back to 2005 when MedAssurant began coordinating Health Effectiveness Data and Information Set (HEDIS) analysis, documentation and reporting. Since that time, MedAssurant has also provided BSBSF with solutions for clinical data accuracy, risk adjustment, medical record review and claims analytics.”

About MedAssurant Inc.

MedAssurant Inc. is a leading technology-enabled healthcare solutions provider focused on the importance of healthcare data and its ability to drive dramatic, objective improvement in clinical and quality outcomes, care management and financial performance throughout the healthcare community. Proprietary healthcare datasets, aggregation and analysis capabilities, combined with a national infrastructure of leading-edge technology, clinical prowess and deep human resources, empowers MedAssurant’s advanced generation of healthcare assessment and improvement through highly informed solutions. Driven by a mission to improve today’s healthcare landscape, the employees of MedAssurant proudly apply care, ingenuity and dedication to delivering a new approach to healthcare touching more than 100 million Americans – one driven by data and insight – one resulting in meaningful action. Please visit www.medassurant.com for more information.

Healthways and BlueCross BlueShield of Tennessee Partner to Improve Health, Well-Being of Seniors

NASHVILLE, Tenn., Oct 26, 2010 (BUSINESS WIRE) — As part of a statewide campaign promoting well-being and prevention to its older adult members, BlueCross BlueShield of Tennessee will be offering the Healthways (NASDAQ: HWAY) SilverSneakers(R) Fitness Program to subscribers of their Medicare Advantage (BlueAdvantage) and Medicare Supplement Plans (BlueElite) throughout Tennessee. SilverSneakers is the nation’s leading social support and exercise program and was designed specifically to improve the health and well-being of seniors.

“We are pleased BlueCross BlueShield of Tennessee will be providing this important program, SilverSneakers, to its Medicare members,” said Ben R. Leedle, Jr., Healthways CEO. “While regular exercise is a crucial part of healthy living for people of all ages, it is particularly effective in preventing or more effectively managing chronic diseases for older adults. By offering SilverSneakers to its senior population, BlueCross BlueShield of Tennessee is showing that it values the health and well-being of its members. We commend the company for its continuing dedication to our shared home state.”

BlueAdvantage and BlueElite subscribers can join the award-winning program at no additional cost and reap the rewards of fitness, fun and friends for which the acclaimed program is best known. SilverSneakers is designed exclusively for older adults and taught by certified instructors, offering eligible members an innovative blend of physical activity, healthy lifestyle direction and social opportunities. Studies have found individuals who participate in SilverSneakers’ unique combination of exercise and social support have improved health and well-being and required fewer admissions to the hospital.

SilverSneakers’ robust network provides eligible members with access to a variety of participating fitness and wellness facilities throughout the country. Many sites offer amenities such as exercise equipment, treadmills and free weights and the signature SilverSneakers fitness classes. Additional signature classes, such as YogaStretch and SilverSplash(R), may be available at select locations. Designated SilverSneakers staff members are available to guide members along the way.

About Healthways

Healthways is the leading provider of specialized, comprehensive solutions to help millions of people maintain or improve their health and well-being and, as a result, reduce overall costs. Healthways’ solutions are designed to keep healthy people healthy, mitigate or eliminate lifestyle risk factors that can lead to disease and optimize care for those with chronic illness. Our proven, evidence-based programs provide highly specific and personalized interventions for each individual in a population, irrespective of age or health status, and are delivered to consumers by phone, mail, internet and face-to-face interactions, both domestically and internationally. Healthways also provides a national, fully accredited complementary and alternative Health Provider Network and a national Fitness Center Network, offering convenient access to individuals who seek health services outside of, and in conjunction with, the traditional healthcare system. For more information, please visit http://www.healthways.com.

SOURCE: Healthways

Humana and Walmart Announce Innovative Medicare Part D Prescription Drug Plan

Today, Humana Inc. (NYSE: HUM) announced an innovative Medicare Part D prescription drug plan, co-branded with Wal-Mart Stores, Inc. (NYSE: WMT) or (“Walmart”), that can provide significant savings on monthly plan premiums and prescription medicine copayments and cost-shares for Medicare beneficiaries, including seniors and people with disabilities.

The Humana Walmart-Preferred Rx Plan (PDP) offers one low national monthly plan premium of $14.80 – according to CMS,1 the lowest national plan premium in 2011 for a standalone Medicare Part D plan premium offered in all 50 states and Washington, D.C. This new co-branded prescription drug plan can save a typical Medicare Part D beneficiary who enrolls in the Humana Walmart-Preferred Rx Plan (PDP) an estimated average of more than $4502 in 2011 on plan premiums and prescription medication copayments and cost-shares when compared with the average total costs for a Part D prescription drug plan in 2010. With nearly 18 million Americans relying on Medicare Part D for their prescriptions,3 the Humana Walmart-Preferred Rx Plan (PDP) provides an affordable prescription solution for those who need it most.

“One of the primary goals of health care reform is to make health coverage more affordable – and that’s what we’re doing with the introduction of this low-cost Medicare Part D plan,” said William Fleming, PharmD, vice president of Humana Pharmacy Solutions. “People are more likely to take the medications prescribed for them when they can afford those medications. And adhering to prescription-drug regimens can enable people to be healthier and prevent future illness. At Humana, we believe that this prevention helps people live healthier lives and achieve lifelong well-being.”

“We know every dollar counts, especially when you live on a fixed income. We believe no one should have to choose between buying their groceries or their medications,” said John Agwunobi, M.D., president of Walmart’s Health and Wellness division. “Financial health is a fundamental part of a person’s well-being. At Walmart, the customer is always front and center, and that is why we are committed to doing everything we can to ensure seniors have access to the medications they need at a price they can afford.”

Humana Walmart-Preferred Rx Plan (PDP): Benefits and Details

  • One low monthly rate nationwide. The monthly plan premium is less than $15 a month for everyone, regardless of where they live.
    • According to CMS, the $14.80 monthly plan premium is the lowest national plan premium in 2011 for a standalone Medicare Part D prescription drug plan offered in all 50 states and Washington, D.C.1
    • The Humana Walmart-Preferred Rx Plan (PDP) offers a monthly plan premium of $14.80, which is less than half the weighted 2010 national average for Medicare Part D prescription drug plans’ monthly plan premiums.4
  • Low copayments when plan members use preferred pharmacies like Walmart, Neighborhood Market or Sam’s Club pharmacies:
    • In-store copayments (at preferred pharmacies) on generic prescriptions start as low as $2 when plan members use preferred pharmacies.
    • Copayments as low as $0 for generic prescriptions filled via Humana’s RightSource home-delivery prescription service.
  • A broad competitive formulary comparable to other plans, with a list of prescription drugs included in the plan available at humana-medicare.com.

How to Enroll in the Plan: Call, Click or Go

Information on the plan is available starting today; annual enrollment for Medicare plans begins Monday, Nov. 15, 2010, and continues through Dec. 31, 2010. To get more information on the Humana Walmart-Preferred Rx Plan (PDP) and to learn more about these savings:

  • Call Humana to enroll at 1-800-899-0441. For TTY, call 711, 8 a.m. to 8 p.m., seven days a week.
  • Click on humana-medicare.com or medicare.gov to enroll.
  • Click on walmart.com/rxplan or samsclub.com/rxplan for additional plan details and links to enroll.
  • Visit a Walmart store to speak to a Humana representative.
    • Informational kiosks, including many staffed by Humana representatives, are available in approximately 3,000 Walmart stores across the country. Medicare beneficiaries can click on “Find a Location Near You” at walmart.com/rxplan to locate an on-site Humana representative.

Medicare Part D Background

Medicare Part D is the prescription drug program supported by the federal government. According to the Kaiser Family Foundation, nearly 18 million people are currently enrolled in a standalone Part D plan3 and Families USA reports that seniors generate one-third of all prescriptions filled in the United States.5

About Humana

Humana Inc., headquartered in Louisville, Kentucky, is one of the nation’s largest publicly traded health and supplemental benefits companies, with approximately 10.3 million medical members and approximately 7.3 million specialty-benefit members.

Humana is a full-service benefits-solutions company, offering a wide array of health and supplementary benefit plans for employer groups, government programs and individuals.

Humana Expands Reach with National Program to Support Additional 60,000 Living with Chronic Disease

Humana Cares, Humana Inc.’s (NYSE: HUM) complex care management division, will offer the potential to improve the quality of life for approximately 60,000 people in the United States who live with chronic disease and offer programs to address the medical and personal needs that materialize as a result.

Humana today announced its Humana Cares division, headquartered in St. Petersburg, is now hiring 270 additional associates in preparation for the January 2011 launch of its new program, Humana Cares Chronic Condition Management. The new associates will serve 60,000 Humana commercial health plan and Medicare Advantage members across the country suffering from chronic conditions, including congestive heart failure, obstructive pulmonary disease, coronary artery disease and complex diabetes.

In addition to touching the quality of life for so many, the additional 270 Humana Cares associates, to include telephonic managers, onsite field care managers and community health educators, will have a major economic impact on St. Petersburg and the surrounding Tampa Bay area. Humana Cares, which opened its doors in February 2009 with approximately 250 associates, expects to employ 780 associates by year-end.

“Humana Cares is fast becoming one of the premier health care employers in the Tampa Bay area,” said St. Petersburg Area Chamber of Commerce Chairman Sid Morgan, “and today’s announcement that Humana Cares will hire another 270 professionals this fall provides a much-needed boost to St. Petersburg’s business community and to the overall health of our bay area economy. The St. Petersburg Chamber applauds Humana Cares’ strong and growing commitment to St. Petersburg.”

“We’re very pleased that Humana has chosen to significantly expand its national chronic care management division here in St. Petersburg and bring hundreds of new jobs to our community,” said St. Petersburg Mayor Bill Foster. “It’s a great credit to the depth and skills of our labor pool that Humana Cares is once more growing its workforce and its business in our city.”

Humana Cares incorporates a holistic approach to helping those who live with chronic medical conditions, focusing not on a single disease but on the whole person.

“Today, in the United States, 38 percent of Medicare beneficiaries live with three or more chronic health conditions,” said Humana Cares President Jean Bisio. “Our goal is always to keep members independent and safe in their homes. At Humana Cares, we don’t manage a disease; we work side by side to help our members manage their health and improve their quality of life.”

And for the more than 50,000 Humana members under its current active complex care management program, this holistic approach is working. Humana Cares members have experienced a 36 percent decline in hospital admissions and a 22 percent drop in emergency room visits.

Humana Cares teams work together to:

  • Help members remain independent and safe in their homes
  • Create one-step care for both medical and quality-of-life needs, such as making sure members have safety items installed in their homes and ensuring their transportation and prescription needs are met
  • Provide education on self-care management, including preventive measures like teaching a diabetic to monitor and record daily blood sugar levels
  • Place a variety of remote bio-metric monitoring devices in the member’s home to provide education and peace of mind, and identify and treat events, such as escalating blood pressure, before they lead to emergency or inpatient admissions
  • Assist members in navigating through a complicated health care system
  • Put members in touch with community resources.

For more information about the new positions at Humana Cares or to apply online, please visit www.humana.com/resources/about/careers/.

About Humana

Humana Inc., headquartered in Louisville, Ky., is one of the nation’s largest publicly traded health and supplemental benefits companies, with approximately 10.3 million medical members and approximately 7.3 million specialty-benefit members. Humana is a full-service benefits solutions company, offering a wide array of health and supplemental benefit plans for employer groups, government programs and individuals.

Over its 49-year history, Humana has consistently seized opportunities to meet changing customer needs. Today, the company is a leader in consumer engagement, providing guidance that leads to lower costs and a better health-plan experience throughout its diversified customer portfolio.

eHealth Technology Now Powering Online Medicare Supplement Sales for Premera Companies in Washington, Oregon and Alaska

eHealth, Inc. (NASDAQ: EHTH) announced today that its eCommerce on Demand technology has been licensed by Premera companies in Washington, Oregon and Alaska to power online sales of Medicare Supplement products.

Seniors shopping online with Premera Blue Cross, Premera Blue Cross Blue Shield of Alaska, and LifeWise Health Plan of Oregon are now using eHealth’s ecommerce platform to compare and apply for a range of Medicare Supplement products through www.premera.com in Washington and Alaska and www.lifewiseor.com in Oregon.

“We’re pleased to expand our technology licensing relationship with Premera to include Medicare Supplement products,” said eHealth Executive Vice President Bruce Telkamp. “The same technology we’ve used to transform the way individual and family health insurance products are purchased will now serve seniors in Alaska and the Pacific Northwest to help them select and enroll in a Medicare Supplement product that best meet their needs and budget.”

“As the Baby Boomers begin to retire, an increasing number of seniors are comfortable with shopping online,” said Jeff Roe, Vice President at Premera Blue Cross. “We’ve given seniors access to a powerful, easy way to quote, compare products and enroll in the products of their choice, by licensing eHealth’s ecommerce platform for Medicare Supplement sales. We’re very pleased to make this service available to our Medicare Supplement customers.”

eHealth’s eCommerce on Demand technology provides health insurance companies with cost-effective, hosted and fully customizable software solutions to power online sales channels. It streamlines the quoting and application processes and seamlessly interacts with insurance companies’ back office systems. eCommerce on Demand technology powers some of the nation’s largest and most successful insurance websites.

About eHealth

eHealth, Inc. (NASDAQ: EHTH) is the parent company of eHealthInsurance, the nation’s leading online source of health insurance for individuals, families and small businesses. Through the company’s website, http://www.eHealthInsurance.com, consumers can get quotes from leading health insurance carriers, compare plans side by side, and apply for and purchase health insurance. eHealthInsurance offers thousands of health plans underwritten by more than 180 of the nation’s leading health insurance companies. eHealthInsurance is licensed to sell health insurance in all 50 states and the District of Columbia, making it a functioning national health insurance exchange. Through its eCommerce On-Demand solution (eOD), www.ehealth.com/eOD, eHealth is also a leading provider of on-demand e-commerce software services. eHealth’s eOD platform provides a suite of hosted solutions that enable health plan providers and resellers to market and distribute products online. eHealth’s eCommerce On-Demand solution is currently available to health plan providers in all 50 states and the District of Columbia. eHealthInsurance and eHealth are registered trademarks of eHealthInsurance Services, Inc.

About Premera Blue Cross

Our mission is to provide peace of mind to our members about their healthcare coverage. We provide health coverage and related services to more than 1.4 million people. Premera Blue Cross has operated in Washington since 1933, and Alaska since 1952. Premera Blue Cross is a not-for-profit, independent licensee of the Blue Cross Blue Shield Association.

Premera Blue Cross is a member of a family of companies based in Mountlake Terrace, Washington, that provide health, life, vision, dental, stop-loss, disability, and other related products and services. Please visit www.premera.com for more information.

About LifeWise Health Plan of Oregon

LifeWise Health Plan of Oregon has been serving the health insurance needs of Oregon families and employers for more than 20 years. LifeWise is a member of a family of companies with operations in Portland and Bend, Oregon; Mountlake Terrace and Spokane, Washington; Anchorage, Alaska. LifeWise and its affiliates employ about 3,000 people and provide healthcare coverage and related services to 1.6 million members and their families

Participants Announced In Michigan Initiative To Reduce Hospital Readmissions

Blue Cross Blue Shield of Michigan, the University of Michigan and the Society of Hospital Medicine (SHM), have selected 15 physician organizations working with 14 hospitals to participate in a statewide Michigan initiative to reduce preventable readmissions to the hospital and emergency room visits.

The initiative, called “Michigan Transitions of Care Collaborative,” is based on the Society of Hospital Medicine’s Project BOOST (Better Outcomes for Older Adults through Safer Transitions) model. It involves training and mentoring to help physician organizations and hospitals develop, implement and measure programs that reduce the incidence of patients being readmitted to the hospital within 30 days of their discharge.

In a press release announcing the collaboration, it was noted that unplanned readmissions to the hospital are costly and preventable, draining the resources, time, and energy of the patient, primary care physician, and hospital.  Research in the April 2009 New England Journal of Medicine indicates that one in five hospitalized patients is readmitted to the hospital within a month of their discharge.

Nationally, unplanned readmissions cost Medicare $17.4 billion each year, making estimates about the total cost even higher.

“We are very excited about the high level of energy that has been generated for this program, and we expect this initiative to have a positive impact on improving the way providers and hospitals transition patients to outpatient settings,” says Christopher Kim, M.D., M.B.A., S.F.H.M., hospitalist at the University of Michigan and director of the state-wide collaborative program on transitions of care.  “Participating physician groups and hospitals will share best practices and key learnings, leading to improvements in quality and safety for Michigan patients.”

About SHM
SHM is the premier medical society representing hospitalists.  Over the past decade, studies have shown that hospitalists decrease patient lengths of stay, reduce hospital costs and readmission rates, all while increasing patient satisfaction.  Hospital medicine is the fastest-growing specialty in modern healthcare, with over 31,000 hospitalists currently practicing and an upward growth trajectory in full force.  For more information about SHM, visit www.hospitalmedicine.org.

About Blue Cross Blue Shield of Michigan
Blue Cross Blue Shield of Michigan, a nonprofit organization, provides and administers health benefits to 4.5 million members residing in Michigan in addition to members of Michigan-headquartered groups who reside outside the state.  The company offers a broad variety of plans including: Traditional Blue Cross Blue Shield; Blue Preferred®, Community BlueSM and Healthy Blue IncentivesSM PPOs; Blue Care Network HMO; BCN Healthy Blue LivingSM; Flexible BlueSM plans compatible with health savings accounts; Medicare Advantage; Part D Prescription Drug plans, and MyBlueSM products in the under-age-65 individual market.  BCBSM also offers dental, vision and hearing plans.  Blue Cross Blue Shield of Michigan and Blue Care Network are nonprofit corporations and independent licensees of the Blue Cross and Blue Shield Association.  For more company information, visit bcbsm.com.

CIGNA and Humana form Alliance on Retiree Solutions for Employers

CIGNA Corporation (NYSE: CI) and Humana Inc. (NYSE:HUM) have formed an alliance to better serve employers who provide health care benefits for their employees and retirees.

The new alliance will blend CIGNA’s consultative approach and single point of contact for clients with Humana’s industry-leading group Medicare Advantage products and services and strong name recognition. Clients will benefit from a simplified management structure, additional geographic offerings, and a cost-effective solution that addresses the full range of benefit needs for their employees and retirees. Employees will benefit from CIGNA’s health and wellness programs and award-winning quality and service, and retirees will benefit from the scale and breadth of Humana’s Medicare offerings. The alliance will address the needs of employees as they approach retirement by offering a coordinated solution through the employer.

“By bringing together the capabilities of two strong companies, we’re offering market-leading solutions and creating differentiated value for our clients in these uncertain times,” said Sam Srivastava, CIGNA’s president of Government Segments. “Through this alliance, we can expand CIGNA’s portfolio, while Humana is able to expand its distribution to a larger base of employer customers for its Medicare Advantage plans. It’s a winning blend for employers and their retirees who will have access to broad-based, affordable coverage from two companies widely recognized for their service excellence.”

“CIGNA and Humana are driving innovation through this unique alliance,” added Thomas Liston, Humana senior vice president of senior products. ”We are excited that CIGNA will be exclusively supplementing its retiree offerings with Humana’s Medicare Advantage plans, enabling CIGNA to offer a cost-effective, one-stop solution.”

Humana is recognized for its best-in-class Medicare products and services, comprehensive health and wellness solutions and the scale and breadth of its Medicare offerings. CIGNA brings a broad commercial product portfolio, nationally recognized health and wellness programs, and award-winning service to the alliance. The Group Medicare Advantage alliance products are expected to be available beginning July 1, 2010, subject to regulatory approvals. Under the terms of the alliance, CIGNA and Humana will coordinate services and share financial results equally.

According to Srivastava, retirees who opt for an affordable Medicare Advantage plan through the alliance can be confident that it has been carefully tailored to meet their needs and will provide access to clinical programs that can enhance their quality of life and help improve or maintain their health.

CIGNA will continue to independently offer its comprehensive suite of group and individual retiree pharmacy solutions, commercial group medical plans that supplement Medicare, and its Arizona Medicare Advantage HMO health plan, in addition to its full array of commercial medical, dental, pharmacy, disability and behavioral plans.

Humana will continue to independently offer its comprehensive array of commercial and Medicare Advantage health, pharmacy and supplementary benefit plans for employer groups, government programs and individuals.


CIGNA (NYSE:CI), a global health service company, is dedicated to helping people improve their health, well being and sense of security. CIGNA Corporation’s operating subsidiaries provide an integrated suite of medical, dental, behavioral health, pharmacy and vision care benefits, as well as group life, accident and disability insurance, to approximately 46 million people throughout the United States and around the world. To learn more about CIGNA, visit www.cigna.com. To sign up for email alerts or an RSS feed of company news, log on to http://newsroom.cigna.com/rss/. Also, follow us on Twitter: @cignatweets and visit CIGNA’s You Tube channel at http://www.youtube.com/cignatv

About Humana

Humana Inc., headquartered in Louisville, Kentucky, is one of the nation’s largest publicly traded health and supplemental benefits companies, with approximately 10.3 million medical members and 7.2 million specialty members. Humana is a full-service benefits solutions company, offering a wide array of health and supplemental benefit plans for employer groups, government programs and individuals.

Over its 49-year history, Humana has consistently seized opportunities to meet changing customer needs. Today, the company is a leader in consumer engagement, providing guidance that leads to lower costs and a better health plan experience throughout its diversified customer portfolio.

More information regarding Humana is available to investors via the Investor Relations page of the company’s web site at www.humana.com.

Study Suggests Low-Consuming Medicare Beneficiaries With Chronic Disease Are More Costly to Program.

Findings released today and detailed in the analysis Low Consumption and Higher Medicare Cost: Consumption Clusters in a Medicare Fee-for-Service Population, examine how individuals utilize benefits and services under the Medicare program. The research suggests that beneficiaries with chronic diseases who consume the least of their Medicare benefits and services (referred to as “low consumers”) and potentially under manage their disease may experience an acute event that requires costly emergency room visits and hospitalizations.

The research, spearheaded by the National Minority Quality Forum (The Forum), analyzed Medicare data over a six-year period. The Forum found that Medicare beneficiaries may be clustered into five consumption groups (crisis consumers, heavy consumers, moderate consumers, light consumers and low consumers) based on how much Medicare reimburses for services provided to beneficiaries in any year. The two most-costly clusters are crisis consumers and heavy consumers — representing only 11 percent of Medicare beneficiaries, but 65 percent of all costs. These are dynamic clusters as consumption patterns among beneficiaries can significantly vary from one year to the next. Beneficiaries who are low consumers one year may become heavy consumers the next sparked by a critical and often costly health event. There is ample evidence that in the immediate future, significant increases in reimbursements may be anticipated for those beneficiaries with diabetes who rank among the lowest consumers of benefits. It is likely that similar patterns exist for those with other chronic diseases.

“The findings paint a new picture of the Medicare beneficiary living with a chronic disease and how that individual utilizes the program,” said Gary Puckrein, PhD., Founding Partner of the Diabetes Care Project and President and CEO of the National Minority Quality Forum. “If we can identify these patients, who are under-managing their chronic condition putting them at high-risk for disease complications, we can intervene to help these individuals manage their disease more effectively, and, ultimately, reduce overall health care costs.” One out of every four Medicare dollars is spent on beneficiaries with diabetes, with a high percentage attributed to tertiary illness caused by unmanaged or under-managed diabetes.

“We know that diabetes and other chronic conditions disproportionately affect the elderly, and with an aging population and a rapid influx of Baby Boomers entering the Medicare program, we need to better understand the barriers associated with managing their chronic diseases,” said James R. Gavin III, MD, PhD, CEO and Chief Medical Officer, Healing Our Village and Chairman Emeritus, National Diabetes Education Program. “If we can better understand our Medicare patients, we can help them achieve better health outcomes.”

The Diabetes Care Project (DCP), founded by The Forum, Roche Diagnostics and in partnership with the American Association of Diabetes Educators (AADE) and Healthways, Inc., is a new coalition of patient advocates and health partners who are committed to dramatically reducing acute events that are a consequence of diabetic complications through early interventions and improved chronic-care management (www.diabetescareproject.org). In 2010, the DCP plans to undertake a series of projects that will help better understand the low consuming diabetic, and their impact on the health care system. The purpose of these initiatives is to offer guidance as to how policies, regulations, targeted interventions, education, and personalized diabetes care management plans may help improve patient outcomes and lower costs for the entire health system.

Diabetes is a growing public health epidemic affecting over 23 million Americans. According to the Centers for Disease Control and Prevention, type 2 diabetes, fueled by rising rates of obesity, accounts for nearly 90-95 percent of all people with diabetes and disproportionately affects minority and aging populations in the U.S. (nearly 20 percent of Medicare beneficiaries have diabetes). The U.S. spends approximately $174 billion in annual total costs for diagnosed diabetes with $166 billion in direct medical costs.

Source: Diabetes Care Project

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.