Humana Introduces ‘Points of Caregiving’ Program, Providing Comprehensive Resource to Nation’s 52 Million Caregivers

Humana Inc. (NYSE: HUMNews) today introduced Points of Caregiving, a comprehensive resource for the nation’s 52 million caregivers. Designed as a complete caregiver’s destination, the program includes an easy-to-use interactive website, telephonic support and customized reminders to help caregivers make decisions with confidence and to find support from peers.

Research reveals that one in five American adults, many of whom have children or other dependents, provide care to a relative, friend or neighbor. Caregivers often take on this role suddenly or unexpectedly, and frequently must make major health and financial decisions quickly for the person under their care. These new challenges and critical decisions can leave caregivers puzzled and hesitant. Humana developed the Points of Caregiving program to meet this need and to provide expert support and resources.

“Caregivers play a critical support role in the U.S. health care system and often are considered the backbone of our long-term care system,” said Gail Miller, vice president, senior product development, strategy and business planning for Humana. “With Points of Caregiving, we strive to provide a supportive, interactive community that will help informal and unpaid caregivers make the best decisions.”

Points of Caregiving is available to any caregiver, from those who perform “light” care – such as helping with shopping, transportation and cleaning – to “heavy” care, such as administering medication or injections and performing personal hygiene services like bathing. Program members receive access to a variety of tools that help support caregivers physically, emotionally and financially:

  • Tools and resources, such as worksheets and cost calculators to budget and plan for care-management, easing caregivers’ minds as they estimate income changes and caregiving expenses
  • Telephone consultation and support, including phone reminders members can personalize for medications, doctor’s appointments, or anything else a caregiver with a busy schedule must remember
  • Library of expert articles on health, insurance, legal matters and more
  • Interactive community forums where caregivers can connect with peers to receive support and advice from people in similar situations
  • Information about national, state and local community resources, such as clinics, doctors and public-service agencies that can act as advocates, support and assist with care planning, which is especially helpful to people caring from afar
  • Discounts on products and services that help caregivers save time and money as well as care for themselves and their dependents – such as discounted diet and exercise products, books, games, pill box with an alarm clock reminder, and more

Humana developed Points of Caregiving with its LifeSynch subsidiary; the program is available for Humana members and non-members for $20 a month with a one-year agreement ($240 a year), a cost quickly offset by the time and energy saved by the caregiver. Visit www.PointsofCaregiving.com to learn more about caregiving.

About Humana

Humana Inc., headquartered in Louisville, Ky., is one of the nation’s largest publicly traded health and supplemental benefits companies, with approximately 10.4 million medical members and approximately 7.2 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.

Capital BlueCross and P4 Healthcare Launch Cancer Pathways Initiative.

Capital BlueCross and P4 Healthcare announced today the launch of an innovative initiative to create clinically proven, evidence-based oncology treatment protocols aimed at enhancing the quality of care for patients. The P4 Pathways Program will provide the tools to establish disease-specific and locally-based pathways for the treatment of patients with cancer, as well as protocols for supportive care (treatment of complications and adverse events that arise from the medical condition or administration of treatment). The pathways are a collaborative effort that will be developed with oncologists across the entire Capital BlueCross network as a way to provide cost-effective care and improve the quality of health care delivery without comprising the integrity or delivery of treatment.

We are constantly looking for ways to improve the care delivered to our members. This program is compelling because it is driven by evidence-based pathways that include the guidance of local oncologists who understand the unique needs of those facing health challenges, said Capital BlueCross President and CEO Bill Lehr.

Capital BlueCross and P4 Healthcare have assembled a panel of local physicians to develop and maintain an up-to-date framework for the P4 Pathways Program based on clinical evidence to ensure best patient outcomes. The P4 Pathways are designed to provide high-quality patient care and reward physicians for delivering appropriate care while managing costs.

The P4 Pathways Program brings together the key stakeholders in the care of a patient. The intent of this program is to ensure highest quality of cancer care for Capital BlueCross patients through the adoption of evidence-based clinical pathways, said Jeffrey Scott, M.D., Chief Executive Officer, P4 Pathways.

P4 Healthcare, creators of the P4 Pathways Program, will provide proprietary technology, tools, expertise, educational programs, and hands-on training for developing, implementing, and continually monitoring and reporting on anything relating to the P4 Pathways Program. Practices implementing P4 Pathway programs have historically shown less variability in regimens, reduced misuse of chemotherapy, better managed toxicity, optimized use of biologics and better defined treatment milestones.

About Capital BlueCross:

Capital BlueCross is the leading health insurer in its region, providing health insurance coverage to nearly one million people in central Pennsylvania 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 at competitive prices. The company has been providing health security to the people and communities of central Pennsylvania and the Lehigh Valley for more than 70 years and employs about 2,100 people in the region. Capital BlueCross is an independent licensee of the Blue Cross and Blue Shield Association.

About P4 Pathways, a P4 Healthcare company:

P4 Pathways partners with payors across the country to establish clinically proven, evidence-based oncology treatment protocols designed to promote the delivery of high quality, cost efficient patient care. These protocols seek optimal patient outcomes by ensuring selections of the most cost effective medications, minimizing side effects, reducing errors, and minimizing toxicities. Patients, Payors and Physicians all benefit alike. Significant cost savings and enhanced care are realized by eliminating unnecessary medical costs, reducing hospitalization and selecting the most cost effective medications. P4 Pathways, LLC is a P4 Healthcare company. For more information, visit www.p4pathways.com.

BCBSNC Rewarding Physicians for Better Care, Not More Care, Through Blue Quality Physician Program.

Blue Cross and Blue Shield of North Carolina (BCBSNC) is leading an effort to reward health care quality in North Carolina by introducing a new reimbursement model for participating primary care physicians.

BCBSNC, the states largest health insurer, is offering substantially higher payments to physicians who take steps to further improve the quality of patient care they provide. Under its Blue Quality Physician Program, about 4,000 primary care physicians across the state have been invited to apply for the higher reimbursement structure. The program is designed to reward quality over quantity in the delivery of medical services.

For too long our health care system has been built on paying for the volume of procedures rather than the quality of outcomes, said Don Bradley, M.D., BCBSNC senior vice president and chief medical officer. Blue Quality Physician Program is our way of getting incentives where they belong with quality outcomes, not volume.

The program is open to North Carolina primary care physicians family and general practitioners, internists, pediatricians, obstetricians and gynecologists who agree to BCBSNCs standard contract for in-network physicians.

Participating physicians who meet a set of criteria that includes nationally recognized, evidence-based standards for quality of care are eligible for reimbursement that offers double-digit increases over BCBSNCs standard fee schedule for some of their most commonly billed codes. BCBSNC will reimburse at a higher level once the physician is approved for the program.

Physicians understand the need to measure quality and improve efficiency, but often dont have the resources to upgrade their office infrastructure and evaluate results, said Joseph Ponzi, M.D., with Goldsboro Pediatrics, a practice with multiple offices in Eastern North Carolina. Programs like these are a great incentive to investing in improving patient care, developing the medical home concept and meeting higher quality standards, while becoming eligible for higher reimbursement.

BCBSNC introduces Blue Quality Physician Program on the heels of its successful Bridges to Excellence quality improvement program. That three-year pilot program, which concluded in April 2009, brought the nationally recognized Bridges to Excellence program to North Carolina, offering incentive payments to physicians meeting national standards.

Following the Bridges to Excellence pilot, BCBSNC determined that providing incentives for meeting quality standards had a payoff in terms of higher quality measures and lower health care spending per patient. For example, patients of physicians who met Bridges to Excellence quality standards for efficiencies in practice management received fewer high-cost imaging tests such as CT scans and didnt visit the emergency department as often.

Health care is embracing quality and efficiency standards, which also offer promise for improving the affordability of health care, said Milo Brunick, BCBSNC vice president of Network Management. Blue Cross and Blue Shield of North Carolina looks forward to collaborating even more with physicians, hospitals and other health care providers to improve cost and quality for patients.

Participating physicians in Blue Quality Physician Program earn higher reimbursement by achieving standards in three categories:

  • Clinical quality outcomes, which includes recognitions by the National Committee for Quality Assurance, use of electronic prescribing and other quality-related standards
  • Administrative efficiency, including electronic claims submission
  • Patient experience with care, which measures the physicians ability to provide such patient-centered needs as after-hours care and electronic visits

BCBSNC will review physicians applications and assign scores based on the number of quality criteria met. Any physicians not meeting minimum scores may re-apply.

About BCBSNC:

Blue Cross and Blue Shield of North Carolina is a leader in delivering innovative health care products, services and information to more than 3.7 million members, including approximately 900,000 served on behalf of other Blue Plans. For 76 years, the company has served its customers by offering health insurance at a competitive price and has served the people of North Carolina through support of community organizations, programs and events that promote good health. Blue Cross and Blue Shield of North Carolina is an independent licensee of the Blue Cross and Blue Shield Association. Access BCBSNC online at www.bcbsnc.com.

Physicians Health Choice Receives Senior Choice Gold Award for 2010 Medicare Plan Benefits.

Physicians Health Choice is one of only 35 Medicare plans nationally to be recognized for cost-sharing effectiveness and value in the design of their 2010 medical and Part D prescription drug benefits for Medicare beneficiaries. The Medicare Advantage company won for its Standard plans in Austin, Corpus Christi, and Rio Grande Valley, Texas; Las Cruces, NM; and Little Rock, Ark.

SCGA2008_cmykThe Physicians Health Choice plans are the only Medicare Advantage plans in those markets to win the 2010 Senior Choice Gold Award.

Physicians Health Choice is a physician-owned Medicare Advantage plan that provides health care benefits in several areas across the southern United States.

The award selections were based on the 2010 estimated cost-sharing comparisons conducted in over 120 cities during October 2009 by HealthMetrix Research Inc. The annual comparisons estimate the out-of-pocket costs for beneficiaries based on health status categories (healthy/episodic/chronic) and corresponding utilization of the most common plan benefits (physician office visits, emergency or urgent care, hospital care, prevention care, prescriptions). The comparisons identify the Medicare plans with the lowest and highest estimated annual out-of-pocket costs based on the approved 2010 member co-payments, deductibles and premiums that appear in the Medicare Options Compare database (www.medicare.gov).

About Physicians Health Choice:

Physicians Health Choice offers more than 30 Medicare Advantage health plans to more than 19,000 members across the southern United States, including Austin, Corpus Christi, El Paso and the Rio Grande Valley in Texas; Las Cruces and Alamogordo, New Mexico; Little Rock, Arkansas and Ft. Lauderdale and Palm Beach, Florida.

Medical Travel Quality Alliance to Certify Medical Tourism Agents for Safer, Quality Health Care for Traveling International Patients.

Medical Travel Quality Alliance (MTQUA, http://www.mtqua.org/), has announced what it says is the first program to train and certify international patient care managers and medical travel providers worldwide.

“All medical tourists who want treatment in another country now can plan, arrange and complete medical travel with a Certified International Patient Advisor (CIPA) and map out the best road to safer, top quality care, great doctors, and great hospitals,” says Julie Munro, MTQUA’s founder and a leading medical travel facilitator.

MTQUA says that traveling patients often try to check doctor credentials and hospital standards. “Good advice, but impossible to do alone,” according to Munro. “MTQUA trains medical tourism facilitators in how to get this information, how to screen and prepare patients, and how to judge quality of care.”

In a news release, MTQUA says that doctors also benefit from the service by knowing that a CIPA is managing their traveling patients lessens the worry of patients being left stranded during the course of treatment abroad, of getting the wrong sort of care or medications, or of having no follow up after they return home.

“As more international hospitals and insurers make medical tourism safer and better by using only certified agents when accepting international patients, medical travel will become a standard option for patients everywhere and this will truly be health care reform,” says Munro.

MTQUA’s certification program details for medical travel facilitators and travel agents, and the white paper Best Practices in the Care and Management of Traveling International Patients are on the organization’s web site.

About Medical Travel and Health Tourism Quality Alliance:

MTQUA (mtqua.org) promotes standards and practices, and provides training and workshops in all aspects of medical travelers’ continuum of care. MTQUA’s advisory panel includes Harvard and Johns Hopkins affiliated hospitals and established health care travel agencies. Founder Julie Munro is a noted medical tourism expert and CEO of InterMed Global (InterMedGlobal.com) who, in 2003, founded Cosmetic Surgery Travel (CosmeticSurgeryTravel.com).

Source: Medical Travel Quality Alliance

Web Site: http://www.mtqua.org/

HealthFitness Attains NCQA Wellness & Health Promotion Accreditation.

Health Fitness Corporation (NYSE Amex: FIT), a leading provider of integrated employee health and productivity management solutions, today announced it has received Wellness & Health Promotion Accreditation from the National Committee for Quality Assurance (NCQA), a private, non-profit organization dedicated to improving health care quality.

healthfitnesslogoNCQA Wellness & Health Promotion Accreditation is a nationally recognized evaluation that purchasers and consumers can use to assess wellness and health promotion programs. NCQA Wellness & Health Promotion Accreditation comprehensively evaluates key areas of health promotion, including how wellness programs are implemented in the workplace, how services such as health coaching are provided to help eligible individuals develop skills to make healthy choices and how sensitive health information of eligible individuals is properly safeguarded.

NCQA Wellness & Health Promotion Accreditation standards are purposely set high to encourage wellness and health promotion organizations to continually enhance their quality measures. No other comparable evaluation exists for wellness and health promotion programs.

“HealthFitness works everyday to provide the highest level of service to the people we serve,” said Gregg O. Lehman, Ph.D., president and chief executive officer, HealthFitness. “We are proud that our programs and services to support and enhance employee health and well-being have met the standards for NCQA Wellness & Health Promotion Accreditation.”

“NCQA’s Wellness & Health Promotion Accreditation requires organizations to demonstrate their compliance with well-defined standards and quality measures,” said Margaret E. O’Kane, NCQA President. “The NCQA seal will provide employers and consumers with the information they need to choose the best program in their markets.”

About HealthFitness

HealthFitness is a leading provider of integrated employee health improvement services to Fortune 500 companies, the health care industry and individual consumers. With 30-plus years of experience, HealthFitness partners with employers to effectively manage health care and productivity costs by improving individual health and well-being. HealthFitness provides a portfolio of health and fitness management solutions, including best-in-class integration, INSIGHT Health Risk Assessments, screenings, EMPOWERED(TM) Health Coaching, and fitness facility design and management. For more information on HealthFitness, visit www.hfit.com.

Source: HealthFitness

New Software Program Helps Health Plans Work With Physicians to Lower Costs and Improve Quality, Access.

Tracking medical quality indicators can be a challenge for health plans with large provider networks, but a new release of a software program promises to make the task easier and allow plans to incorporate provider effectiveness as part of future provider payment reforms.

dsthealthsollogo_prodbgDST Health Solutions has announced the general availability of CareAnalyzer Version 3.1. DSTHS CareAnalyzer helps health plans meet reporting requirements for the Healthcare Effectiveness Data and Information Set (HEDIS) and effectively identify high-risk members for care management. The latest version pf CareAnalyzer is said to also include new provider profiling capabilities that can be used to support pay for performance, identify access issues and detect patient groups receiving lower quality care.

“CareAnalyzer’s provider reporting module allows health plans to evaluate the relative efficiency of primary care providers and to hold providers accountable to quality standards,” said Amy Salls, business solutions director of decision support, DST Health Solutions.

The software’s profiling capabilities are said to be able to identify providers or provider groups that are less effective than their peers at delivering efficient, high quality care. Health plans are also able to detect providers with costly or unusual referral patterns and submit outlier providers for further investigation.

“We expect to see innovative pilot programs which incorporate provider effectiveness as part of future provider payment reform,” Salls added. “This release of CareAnalyzer will allow our customers to provide feedback to physicians, and stimulate voluntary changes in behavior either prior to or concurrent with payment reform.”

More information can be found at http://www.dsthealthsolutions.com/.