Health Insurance News Online

Kaiser Permanente: Hospitals Called to Improve Treatment for Heart Attacks

FHI BlogMaster — Mon, 27 Nov 2006 20:22:00 +0000

Denver, Colorado
November 13, 2006

Hospitals Called to Improve Treatment After Heart Attack

Kaiser Permanente Emergency Room Physician Among Researchers Pushing for Set of Strategies That Saves Lives

Prompt treatment saves lives when patients arrive at hospitals having heart attacks. A new study has identified simple steps that hospitals can take to speed life-saving treatment. The research, which was led by Elizabeth Bradley and a team of researchers that included David Magid, MD, MPH, Kaiser Permanente emergency medicine physician and researcher, was announced today by the New England Journal of Medicine at the American Heart Association’s annual conference.

It outlines simple hospital strategies that work when patients arrive at the emergency department needing percutaneous coronary intervention or balloon therapy. The team is challenging hospitals to improve what has been dubbed “door-to-balloon” times.

Those strategies include:

Having emergency medicine physicians activate the catheterization lab (cath lab), the hospital room where the balloon treatment is performed.

Activating the cath lab with one-call central page operators who can mobilize the entire medical team at once.

Activating based on pre-hospital electrocardiograms while the patient is still en route to the hospital as opposed to waiting until the patient arrives.

Having interventional cardiologists on location within 20 – 30 minutes.

Using real-time data feedback with emergency department and cath lab staff.

The study of 365 hospitals found that only a handful of hospitals use some of the strategies and none uses all. Researchers say implementing this simple set of effective and feasible strategies holds promise for substantially improving patient care.

Balloon therapy has become the preferred approach to treating certain kinds of heart attacks. While, hospitals have been seeking ways to improve their door-to balloon times, overall performance at most hospitals lags behind the national standard of 90 minutes or less. Dr. Magid practices at Exempla Saint Joseph Hospital and as part of this study partnered with the hospital to adopt the life-saving strategies.

Saint Joseph Hospital is one of the first hospitals in the country to make these important improvements. “The great point about these strategies is that most involve little or no cost to implement,” said Magid.

“The study offers a terrific guide for hospitals to follow as they push to improve door-to-balloon times and the quality of care for patients.”

This study is part of the Health Care Quality Improvement Project initiated by the Centers for Medicare and Medicaid Services, which has encouraged identification of quality improvement projects to improve patient safety.

It also is one of more than 100 research projects conducted every year by the Kaiser Permanente Colorado researchers.

Kaiser Permanente is the largest private health care provider in Colorado. More than 475,000 members in the Denver/Boulder and Colorado Springs areas have access to Kaiser Permanente through an expanded suite of health care products.

Kaiser Permanente physicians and care teams focus on prevention as well as curing disease, all in an effort to help patients live well and thrive.

Medicare Private Drug Plans Fail to Offer Accurate Information to Consumers, New Report

FHI BlogMaster — Fri, 17 Nov 2006 17:10:00 +0000

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Sacramento, California
October 16, 2006

Report Finds Medicare Private Drug Plans Fail to Offer Accurate Information to Consumers - Consumer Groups call for dramatic reform before 2007 Part D enrollment opens on November 15

With the next enrollment period for the Medicare Part D prescription drug benefit looming, California Health Advocates and the Medicare Rights Center are demanding that the Centers for Medicare & Medicaid Services (CMS) require Medicare private drug plans to provide timely and accurate information to people with Medicare who turn to the plans’ call centers for assistance. According to a new report issued today by the two consumer organizations, call center representatives for companies offering Part D coverage remain unable to answer basic consumer questions regarding how the benefit works.

The report found that the call centers frequently could not provide the information people with Medicare needed to make appropriate enrollment decisions. In “Getting the Runaround: Problems with Obtaining Accurate Information from Part D Plans,” the two advocacy groups state that plan call centers are expected to serve as a crucial link to information about Part D coverage, but “independent surveys and anecdotal reports from counselors show serious lapses in the ability of Part D plans to provide accurate and timely information and to successfully guide people with Medicare seeking to access the benefit.”

“Good advice is the only antidote to the convoluted prescription drug benefit that older and disabled Americans are forced to navigate,” said Robert M. Hayes, President of the Medicare Rights Center. “Too often a call to one of the private drug plans does more to mislead, than to help.”
According to the report, CMS has failed to set adequate standards for the accuracy of information given by call centers.

In preparation for the next enrollment period, the report recommends that CMS provide detailed requirements for the information customer service representatives (CSRs) must be able to provide, and take action to ensure those requirements are being met. “The level of frustration expressed by people contacting our office is acute,” remarked Clare Smith, President/CEO of California Health Advocates, “The plans must be required to put resources into the provision of responsive and reliable service to those seeking access to prescription drug benefits.”

The report recommends that CMS ensure that the training and scripts provided to call center operators enables them to provide information about the following:

Enrollment process

How the specific plan works, including explanations of the coverage gap and important information for people eligible for the low-income subsidy

Plan formulary, including which drugs are covered and specifics on any coverage restrictions and limitations

The report also recommends strengthening Medicare private drug plans’ capacity to communicate with non- and limited-English speakers and designating staff as experts in specific subject matter, such as enrollment, premium/cost-sharing, and coverage appeals.

California Health Insurance

National Committee for Quality Assurance Reports on Gaps in Health Care Quality

FHI BlogMaster — Thu, 16 Nov 2006 12:42:00 +0000

September 27, 2006
Washington

New report calls for expanding accountability for 100 million who do not benefit

More than 70 million Americans enrolled in private health plans saw the quality of their health care improve in 2005, according to a new report by the National Committee for Quality Assurance (NCQA). One in four Americans are enrolled in health plans that collect and report data on the quality of care.

Among private commercial plans, 2005 marked significant improvements in childhood and adolescent immunizations.

People enrolled in Medicare health plans saw important gains in smoking cessation while those in Medicaid plans benefited from a sharp increase in childhood immunizations. “All of us have a stake—collectively and individually—in safeguarding our nation’s health,” said NCQA President Margaret E. O’Kane. “The past decade has demonstrated the benefits of measurement, reporting and accountability, but three out of four people don’t enjoy those benefits today. It’s time to ask, ‘Why not?’” The report documents the tremendous gains in health care quality achieved over the past decade that NCQA has been reporting on health care quality. Among them:

Children in commercial health plans are nearly three times more likely to receive all recommended immunizations than eight years ago;

Diabetics are more than twice as likely to have their cholesterol controlled to recommended levels as in 1998; and

More than 96 percent of patients who suffered a heart attack were prescribed beta-blockers to help prevent a second, often fatal, heart attack, up from 62 percent in 1996—saving between 4,200 and 5,300 lives over the past decade.

While most aspects of care improved in 2005, the quality of care for Americans with mental health problems remains as poor today as it was a decade ago.

New approaches must be developed to bring mental health care quality to the level of clinical effectiveness that evidence shows is possible.
100 Million Americans ‘Left Behind’ - The report also highlights the fact that Americans in health maintenance organizations (HMOs) and point of service (POS) plans are significantly more likely to benefit from quality measurement than those in other plans.

More than 73 percent of such plans submitted performance data in 2005—the highest proportion in history. But enrollment in such plans has declined to 33 percent today.

Most Americans – more than 6 in 10 – are now in preferred provider organizations (PPOs) and consumer directed health plans (CDHPs). The overwhelming majority of those plans do not collect and report data on the quality of their care. In 2005 NCQA asked PPOs to voluntarily report their performance using HEDIS® measures; a total of 80 commercial PPOs did so in 2005. This has helped to reverse a three-year decline in the number of Americans in accountable health plans: 12 million more Americans are now in accountable plans than last year.

This holds promise for dramatic improvements in care and quality of life for millions. But more than 100 million insured Americans still do not enjoy the improved care that results from quality reporting. “Working families deserve accurate and relevant information about the quality of their health plans, doctors and hospitals. The PPOs that have stepped up to the plate deserve applause, but there is much more work to be done,” said Ann Kempski, Director of Health Systems Policy at Service Employees International Union.

“Health care is concern number one for families, and they deserve a high quality health plan that makes such information available. Quality improvement will accelerate if workers use tools such as those developed by NCQA to choose an affordable, high-quality plan that meets their families’ needs.”

Quality Gaps Remain - Despite the reported gains, enormous differences persist between the performance of the health care system as a whole and the top accountable health plans. NCQA estimates that if the entire health care system performed at the level of the top plans, between 37,600 and 81,000 lives would be saved each year.

These quality gaps also lead to over $10 billion in lost productivity and almost 65 million avoidable sick days. “The health of our workforce is a precious asset,” said Mary Bradley, Director of Healthcare Planning at Pitney Bowes. “Measuring and improving quality healthcare for our employees is a core corporate value at Pitney Bowes.”

New strategies needed to maintain improvements - After seven consecutive years of quality improvements there are signs that the pace of improvement may be slowing: fewer measures showed statistically significant year-over-year gains than in 2004.

This may indicate that in some cases, there is less room for improvement. NCQA is pursuing new strategies to achieve continued gains. One key to further improvement is increasing the number of accountable health plans that report quality data.

NCQA is working with consumers, employers and health plans to expand the number of accountable PPOs and CDHPs. That effort will receive a significant boost in 2007: The Centers for Medicare & Medicaid Services (CMS) has required PPOs participating in the Medicare Advantage program to report HEDIS measures for public reporting in 2007.

In addition, the Office of Personnel Management (OPM) has required PPOs and other fee-for-service plans serving 9 million federal employees to report five HEDIS measures in 2007 for public release in 2008. In August, President Bush recently signed an Executive Order directing federal agencies sponsoring or administering health plans to provide information on cost and quality to beneficiaries.

“President Bush has urged greater accountability and transparency in health care in the public and private sectors,” said Thomas Barker, Counselor to the Secretary of the United States Department of Health and Human Services.

“People have a right to know the price and quality of their health care. By providing information about cost and quality, we can meet the needs of all Americans.” The State of Health Care Quality 2006 may be downloaded at no cost from NCQA’s Web site, http://www.ncqa.org.

For each measure of clinical quality, the report includes complete year-over-year performance data and highlights the top-performing state. Print versions can be purchased by calling (888) 275-7585. NCQA is a private, non-profit organization dedicated to improving health care quality. NCQA accredits and certifies a wide range of health care organizations, recognizes physicians and physician groups in key clinical areas and manages the evolution of HEDIS, the tool the nation’s health plans use to measure and report on their performance.

NCQA is committed to providing health care quality information through the Web, media and data licensing agreements in order to help consumers, employers and others make more informed health care choices.

California Department of Insurance Warning Consumers About Faxes Offering Discount Health Insurance

FHI BlogMaster — Fri, 10 Nov 2006 17:59:00 +0000

If you are shopping for an affordable health insurance plan, make sure that you are dealing with a legitimate insurance provider or broker before purchasing coverage. Whether you are looking for health insurance in California, or another state, you can contact your department of insurance with any questions or concerns.

California Department of Insurance (CDI)
Sacramento, California
October 30, 2006

The California Department of Insurance (CDI) is Warning California consumers not to purchase health insurance offered by Prime Med Care or Prime Star Health Care.

The companies and their owners, Jesse Casares and Joe Casares of Houston, Texas, are not licensed to sell insurance in California. According to investigators, the Casares’ have sent faxes to consumers advertising their discount healthcare plans.”

The marketing solicitation advertised a “New Health Plan” and “7-day OPEN ENROLLMENT with NO HEALTH QUESTIONS” for the Medical, Dental and a “$10-$40 MAX-PAY PRESCRIPTION CARD” at “ONE LOW PRICE” which “COVERS INDIVIDUAL OR ENTIRE FAMILY.” Insurance Commissioner John Garamendi announced Monday that CDI has issued an Order to Cease and Desist, which demands that Prime Med Care, Prime Star Health Care, Jesse and Joe Casares stop transacting any and all insurance business in California. “We are warning consumers that if they have paid for insurance provided by Prime Med Care, Prime Star Healthcare, Jesse or Joe Casares, they may find they have no coverage,” said Commissioner Garamendi.

“These companies are not licensed to sell health insurance, and consumers should not purchase insurance from any of these individuals or companies.” Those who may have already purchased insurance from Prime Med Care, Prime Star Health Care, Jesse or Joe Casares are urged to contact Senior Investigator Chris Lewis at 916/492-3432.

The CDI urges all consumers and interested parties to check the Department’s website at www.insurance.ca.gov or contact the CDI Consumer Hotline at (800) 927-HELP to verify the license of a company or agent/broker before entering into an insurance transaction.

California Governor Signs Children's Health Insurance Legislation

FHI BlogMaster — Thu, 19 Oct 2006 14:11:00 +0000

California Health Insurance Legislation

Fresno, CA--Today, Governor Schwarzenegger took an important step toward ensuring that more of California's children get the health care they need by signing Senate Bill 437.

Authored by Senator Escutia and sponsored by the 100% Campaign (a collaboration of Children Now, Children's Defense Fund-CA, and The Children's Partnership) and the PICO California Project, this bill increases enrollment of children in California's Medi-Cal and Healthy Families Programs--by approximately 94,000--by making important and substantive improvements to the programs. "We applaud the Governor for his commitment to the health of California's children, our most vulnerable population," said Wendy Lazarus, founder and co-president, The Children's Partnership.

"Our collective next step to ensuring that all children have access to health coverage is the passage of Proposition 86 in November. Proposition 86 will provide on-going funding and the policy framework to allow all of California's uninsured children to have access to health coverage this year and in the future."

SB 437 makes improvements to Medi-Cal and Healthy Families, helping to increase enrollment for more uninsured children who already qualify for these health insurance programs, by simplifying the application and enrollment processes. SB 437 also helps children already enrolled in Medi-Cal and Healthy Families stay insured without experiencing gaps in coverage.

"The Legislature and now the Governor have taken important first steps to insure more of California's children," said Jim Keddy, director, PICO California Project. "We believe that Californians will now express their deep support for ensuring that all 800,000 uninsured children have access to affordable, comprehensive health insurance by voting yes on Proposition 86 on November 7th." "Comprehensive health insurance for children is cost-effective, and it provides access to early, less-costly preventive care and treatment," said Ted Lempert, president, Children Now. "Children with health insurance also perform better in school."

The public support for covering all children is widespread. Approximately 83 percent of California voters support a plan to "ensure that every child in California has health insurance," according to a recent statewide poll conducted by United Way of California.

California Health Plan Report Card - Kaiser Permanente Receives the Most Stars for Sixth Time

FHI BlogMaster — Fri, 29 Sep 2006 13:11:00 +0000

The Kaiser Permanente Northern California Region serves almost 3.3 million members. It includes 6,000 physicians in The Permanente Medical Group (TPMG) and about 54,000 employees. The region has 19 major medical centers. Each year, Kaiser Permanente donates about $300 million to a variety of community programs and agencies in Northern California.

Kaiser Permanente Northern California once again earned high marks on the 2006 report card released from the California Office of the Patient Advocate – scoring more four-star excellent ratings than any other surveyed plan. The Healthcare Quality Report Card, released today by officials with the state Office of the Patient Advocate (OPA), is the latest in a series of reports and surveys that demonstrate Kaiser Permanente’s quality leadership in Northern California.

"We are very proud of these results,” said Robert Pearl, MD, executive director and CEO of The Permanente Medical Group, which cares for members in Northern California.

“Our performance reflects the outstanding quality care we provide to our patients and the communities we serve. These high marks are a tribute to the clinical excellence of our physicians, nurses and staff." For the sixth year in a row, Kaiser Permanente received the most stars in the Healthcare Quality Report Card.

In addition, Kaiser Permanente’s Southern California Region and Northern California Region were the only two health plans this year to earn six stars of a possible eight in each of the two overall ratings: providing quality care and members rate HMO. Kaiser Permanente Northern California earned excellent ratings in clinical quality measures including asthma care, heart care, and screening for sexually transmitted infections.

Kaiser Permanente Northern California also received top scores on several measures of patient satisfaction including how members rate their HMO, getting appointments and care easily and getting information from a doctor about ways to quit smoking.

On a patient satisfaction measure about member complaints, 92 percent of enrollees reported they did not have a complaint that would lead them to call or write their HMO.

In the area of clinical quality, Kaiser Permanente Northern California rated or tied for first, in ten of 28 clinical measures including meeting national standards for asthma care for adults, teenagers and children; child immunizations; treating children with throat infections and upper respiratory infections; testing and controlling cholesterol for diabetes patients; visits during pregnancy and seeing that patients continue to receive beta blocker drugs following a heart attack. This year’s Healthcare Quality Report Card rates 9 health plans in California on the quality of care enrollees receive, based on their record of health services provided to members, and in some cases, reviews of members’ medical charts.

Ratings are also based on what members say about their experiences with their health plans and medical groups.

Kaiser Permanente, founded in 1945, is a non-profit integrated health care organization, with physicians, nurses and staff working in collaboration to provide high quality care to patients and address the health care needs of communities served by the organization.

LifeWise Health Plan of Oregon Repeats as Underwriters’ Association “Carrier of the Year”

FHI BlogMaster — Sun, 17 Sep 2006 19:02:00 +0000

LifeWise Health Plan of Oregon is a member of a family of companies with operations in Portland and Bend, Oregon; Mountlake Terrace and Spokane, Washington; Anchorage, Alaska; and Scottsdale, Arizona.

LifeWise and its affiliates employ about 3,000 people and provide health insurance coverage and related services to 1.5 million subscribers and their families.

Portland, Oregon:

The Oregon Association of Health Underwriters (OAHU) has named LifeWise Health Plan of Oregon its Carrier of the Year Award for the second consecutive year.

The statewide organization announced this honorable designation earlier this month at its annual state convention in Seaside, Oregon. "Our sales teams actively participate with OAHU to broaden awareness and seek solutions to health care issues," said Majd El-Azma, LifeWise President/CEO.

“We are proud to again receive OAHU’s recognition, particularly since collaboration is key to encouraging better health and slowing health care costs.” The award recognizes association support, leadership, and participation in OAHU’s local chapters and Board of Directors. It also considers community service, volunteering and sub-committee involvement.

The Association considers all health insurance carriers operating in Oregon for the prestigious title, with the winning recipient determined through nomination and a Board member poll. “We are pleased to recognize carriers that willingly support our association and realize that we are partners in this business we call health insurance,” said Ruppert Reinstadler, OAHU President and award presenter.

“Without their help, most of our member services would not be possible. LifeWise has consistently supported our efforts – not only financially but also with the time and talents of their staff.”

Assurant to Sell Equity Interest in PHCS, Inc

FHI BlogMaster — Tue, 12 Sep 2006 23:47:00 +0000

Compare Assurant Health prices and plans to find affordable health insurance.

Assurant Health is a part of Assurant and has been in business since 1892. It is the brand name for products underwritten and issued by Time Insurance Company, John Alden Life Insurance Company and Union Security Insurance Company. Together, these three underwriting companies provide health insurance coverage for more than one million people nationwide. Each underwriting company is financially responsible for its own insurance products.

Primary products include individual medical, small group, short-term and student health insurance products, consumer-choice products such as Health Savings Accounts and Health Reimbursement Arrangements, as well as non-insurance products. With almost 3,000 employees, Assurant Health is headquartered in Milwaukee, Wis., and has operations offices in Minnesota, Idaho and Florida, as well as sales offices across the country.

New York – August 31, 2006 – Assurant, a premier provider of specialized insurance and insurance-related products and services, announced today its decision to sell its equity interest in Private Health Care Systems, Inc. (PHCS) to New York-based MultiPlan, Inc. MultiPlan, a healthcare financial risk manager, will acquire PHCS from Assurant and the two other majority shareholders in PHCS, Trustmark Mutual Holding Company and The Guardian Life Insurance Company of America. The transaction is expected to close by the end of the year pending regulatory approvals. As part of the agreement, Assurant’s health care customers will have long-term access to the PHCS and MultiPlan networks for defined access fees and with performance standards from PHCS and MultiPlan.

With nearly 450,000 providers and over 4,000 facilities, PHCS serves more than 16 million lives. MultiPlan’s network of over 4,000 hospitals, 90,000 ancillary care facilities and 700,000 practitioner locations is accessed by an estimated 27 million lives. “The network strength of PHCS and MultiPlan will bring continued strong network availability and discounts to our customers, further improving our competitive position,” said Rob Pollock, Assurant’s president and chief executive officer. “As a leading specialty insurer we continue to be focused on increasing shareholder value and long-term profitable growth.” “This arrangement aligns us with a leading network services company which allows us to focus on our core individual medical business,” said Don Hamm, Assurant Health’s president and chief executive officer.

“Assurant Health is committed to offering its customers unparalleled access to a large network of quality providers throughout the country. We believe the combined strength and experience of PHCS and MultiPlan will result in benefits for all involved – broader provider access for our customers leading to more efficient health care spending.”

Assurant is a premier provider of specialized insurance products and related services in North America and selected international markets. Its four key businesses—Assurant Employee Benefits, Assurant Health, Assurant Solutions and Assurant Specialty Property—have partnered with clients who are leaders in their industries and have built leadership positions in a number of specialty insurance market segments worldwide. Assurant, a Fortune 500 company, is traded on the New York Stock Exchange under the symbol AIZ. Assurant has more than $20 billion in assets and $7 billion in annual revenue.

Kaiser Permanente California to Offer Health Savings Accounts in 2007

FHI BlogMaster — Mon, 04 Sep 2006 23:29:00 +0000

Supporters of Health Savings Accounts have concentrated on a few key advantages. The most frequently cited advantage is that HSAs are tax-free. This is true; Health Savings Accounts are tax-free when used for qualified medical expenses. Which products and services are considered qualified medical expenses? That is the sole responsibility of the consumer to determine.

Latest CDHC Product Emphasizing Prevention & Consumer Engagement

Kaiser Permanente today announced the launch of Custom Care HealthInvestor (HSA), (Health Savings Account) in its California regions. The new offering will be effective January 1, 2007.

The California regions now join Georgia, Colorado, Mid-Atlantic States, and the Northwest regions in offering HealthInvestor (HSA) products which pair a High Deductible Health Plan (HDHP) with a health savings account option. HealthInvestor (HSA), the latest offering in the Custom Care consumer directed health care suite of products, complements the recently announced (May 2006) Custom Care HealthBuilder (HRA) and the current deductible HMO. It is available to individuals, employers, and their employees.

HealthInvestor (HSA) is a comprehensive package of services and tools that include:
HSA-qualified high deductible health plans with lower premiums; CarePay health savings account with a range of investment options; Preventive and wellness services; Online support tools. Contributions to the CarePay HSA may be made by the employer, the member, or both - similar to a 401K or IRA.

Funds can roll over year after year with no income limitations, are not taxed when they are used for qualified medical expenses, and the account is portable. A debit card is provided which allows convenient access to funds to pay for health care services. "HealthInvestor (HSA) offers convenience to the individual health care consumer, and also addresses the needs of employers who are looking for solutions that reduce their costs and help their employees stay healthy” stated Ted Wise, senior vice president, health plan strategy and product innovation.

“The ability of the individual to save for specific health care expenditures, to benefit from important tax advantages, and to have a portable account makes it easier for Kaiser Permanente members to save and pay for their health care expenses. It’s a win for everyone.” The introduction of HealthInvestor (HSA) in California is part of Kaiser Permanente’s evolving business strategy to better serve the changing needs of its customers and members by developing new products that are responsive to the marketplace.

Kaiser Permanente now offers an array of consumer directed health care products with a range of benefit design and financial account options that have the advantage of providing access to Kaiser Permanente’s unique integrated delivery system.

It is part of an overall strategy that includes a major investment in technology that advances its clinical, management and business systems; engages members in their own health care with sophisticated online health information, decision support tools, and discount programs. Preventive health and wellness services, for which the organization has long been known, are a key advantage of Kaiser Permanente’s Custom Care product suite– which includes HealthInvestor (HSA). A wide range of Healthy Living classes and programs are offered at local medical centers that include Stress Reduction, How to Live with Chronic Conditions, Smoking Cessation, Yoga, even Tai Chi. Discounts are available for massage therapy, acupuncture, and select fitness clubs.Online consumer support tools offer a broad array of assistance and services, and help to engage Kaiser Permanente members in making wise health care decisions.

Among the online tools available are: Decision support tools that help consumers better understand the cost of their health care decisions such as a sample fee list that provides pricing transparency; Financial management of individual health accounts; Health assessment tools offered through Kaiserpermanente.org that include interactive health calculators designed to help members eat better and lose weight, reduce stress, stop smoking, access to health and drug encyclopedias, and online health topics with related links.

Kaiser Permanente is America’s leading integrated health plan. Founded in 1945, it is a not-for-profit, group practice program headquartered in Oakland, Calif. Kaiser Permanente serves more than 8.5 million members in nine states and the District of Columbia.

Today it encompasses the not-for-profit Kaiser Foundation Health Plan, Inc., Kaiser Foundation Hospitals and their subsidiaries, and the for-profit Permanente Medical Groups. Nationwide, Kaiser Permanente includes approximately 154,000 technical, administrative and clerical employees and caregivers, and more than 12,000 physicians representing all specialties.

If you are considering a health savings account, it is extremely important that you thoroughly research your options in the interest of making an informed decision.

PRAM Insurance to Provide Pharmacy Benefit Management Services by Regence Rx

FHI BlogMaster — Sat, 02 Sep 2006 20:53:00 +0000

PORTLAND, OREGON

The Regence Group is supported by the Blue Cross Blue Shield name, and its years of experience and strong reputation in providing affordable health insurance.

The Regence Group announced today that its pharmacy benefit management subsidiary, RegenceRx, has been retained by PRAM Insurance Services, Inc. to provide comprehensive pharmacy benefit management services for PRAM clients. Based in California, PRAM is one of the nation’s leading Pharmacy Underwriters.

The company also provides pharmacy consulting, underwriting and employee benefit services to local, regional and national accounts. RegenceRx will provide PRAM and its clients with a full range of services including prescription drug coverage, claims processing, a Preferred Medication List, clinical support, customer support, an extensive retail pharmacy network, mail order pharmacy network, specialty pharmacy network and comprehensive consumer tools and information. “We appreciate the opportunity to extend our best-in-class pharmacy services and clinical expertise to PRAM and its clients,” said David Clark, President of RegenceRx.

“We share PRAM’s commitment to providing consumers with safe, cost-effective and clinically sound medication options and we look forward to partnering with PRAM to provide high-quality pharmacy care.”

RegenceRx, one of the nation’s few not-for-profit pharmacy benefit management groups, is a wholly-owned subsidiary of Regence.

Created in 1996, Regence is the largest health insurer in the Northwest/Mountain State Region, operating Blue Cross/Blue Shield plans in Oregon, Washington, Utah and Idaho. It includes Regence BlueShield of Idaho, Regence BlueCross BlueShield of Oregon, Regence BlueCross BlueShield of Utah and Regence BlueShield (in Washington).

Through these plans, Regence provides health, life, vision and dental insurance to nearly three million members. Regence plans are not-for-profit, independent licensees of the Blue Cross and Blue Shield Association. More than one in three Americans have coverage from the Blues.

The Regence Group is headquartered in Portland, Oregon, and employs approximately six-thousand individuals in Washington, Oregon, Idaho, and Utah. The Regence Group has a vast selection of providers in each of these states, with a total of approximately 38,532.

CDC Reports Increase in Health Insurance Coverage for Children in 2005

FHI BlogMaster — Thu, 17 Aug 2006 20:20:00 +0000

Health Insurance for Children Improved in 2005; Overall Coverage Varies by State

New estimates of health insurance coverage and other major indicators of health and health care were released today in two new reports by the Centers for Disease Control and Prevention (CDC).

In addition to health insurance, the reports present the latest data on health habits, such as smoking, preventive health care including immunizations, and prevalence of diabetes, asthma and psychological distress. Highlights of the reports include:

In 2005, 41.2 million persons of all ages (14.2 percent) were currently without health insurance, down from 15.4 percent in 1997.

In the same time period, children experienced the greatest increase in coverage with only 8.9 percent without insurance in 2005 compared to 13.9 percent in 1997.

Insurance coverage varied widely among the 20 states for which data are now available, from 6 percent without health insurance in Massachusetts to over 24 percent lacking health insurance in Texas.

Both diagnosed diabetes and asthma are on the rise, up to 7.4 percent and 7.8 percent of the population respectively.

The 2005 estimates of influenza vaccinations reflected the shortage that occurred during the 2004-2005 flu season, but rates for those 65 years of age or older rebounded quicker than for other age groups.

Zoloft and Zocor Patents to Expire, Generic Versions Become Available

FHI BlogMaster — Thu, 06 Jul 2006 20:48:00 +0000

The Blue Cross and Blue Shield Association consists of forty locally operated, independent member companies. For over seventy years, BCBSA has prided itself on providing affordable health insurance without compromising the quality of health care. Blue Cross and Blue Shield Plans provide coverage for over ninety-two million people in all fifty states, the District of Columbia and Puerto Rico.

Generic Versions of Zoloft and Zocor Will Save Consumers and Employers Money...

June 23, 2006

Generic versions of the blockbuster cholesterol-lowering drug Zocor (simvastatin) and Zoloft (sertraline), a popular anti-depressant, create a unique opportunity for American consumers and employers to reap billions of dollars in savings, according to the Blue Cross and Blue Shield Association (BCBSA).

Effective today, generic versions of Zocor will be available; Zoloft will go off patent within the next week. “A switch to generic versions of Zocor and Zoloft represents a watershed event that will significantly improve affordability for consumers, employers and government-run healthcare programs,” said Allan Korn, M.D., BCBSA chief medical officer.
“By the end of 2006, nearly 57 percent of the pharmaceuticals dispensed across the 38 Blue Cross and Blue Shield Plans will be generic drugs, proof that our efforts to educate consumers about generics are making a difference. Blue Cross and Blue Shield Plans are committed to providing consumers the information they need to make informed healthcare decisions in areas like generics, which are as safe and effective as brand-name drugs and more affordable,” Korn added.

Blue Cross and Blue Shield Plans are actively promoting the use of generics in their communities through educational and awareness campaigns, changes in benefit design, sampling programs, physician and member communications, academic detailing, co-pay waivers for generic switches, radio and television advertisements. As required by the Food and Drug Administration, generic versions of these drugs must have quality, strength, purity and stability equal to the brand-named drugs losing patent protection.

“It is estimated that the generic versions of Zocor (simvastatin) scheduled for release will lower the price by 80 percent over the next six-to-eight months,” said Joel Owerbach, Pharm D., chief pharmacy officer, Excellus Blue Cross and Blue Shield.

That means for consumers without prescription drug coverage, the retail cost of a 30-day supply of generic Zocor may fall to $25 or less. Blue Cross and Blue Shield HMO and PPO members nationally may expect to save, respectively, $204 to $240 annually on co-payments by switching, depending on their benefits. Employers would see significant savings as well. Blue Cross and Blue Shield Plans spend a combined 15 percent of pharmacy benefit dollars on drugs like Zocor and Zoloft. According to Rob Seidman, Pharm D., chief pharmacy officer, WellPoint, if physicians shifted their prescribing patterns to the new Zocor and Zoloft generics, pharmacy benefit costs could fall significantly. “A survey of Blue Cross and Blue Shield Plans found that switching to generic equivalents could result in overall pharmacy benefit savings of 5 percent or $2 billion a year.”

The government’s Medicare program would also benefit from the switch to generics. A January 2006 Consumer Reports Best Buy Drugs study “found that the government’s Medicare program, Part D plans and 12 million beneficiaries who take statins could realize savings of $8.2 billion a year if they switched from brand-named statins to generics,” said Seidman.

The switch to generics will also help Medicare beneficiaries delay or avoid the program’s coverage gap or “doughnut hole” that begins after seniors have incurred $2,250 in drug costs. According to IMS, the pharmaceutical and healthcare industry market intelligence firm, an estimated $18 billion to $20 billion of branded pharmaceutical drugs will lose patent protection in 2006.

The BCBSA Plans had over one-thousand members in 1929, three million members in 1939, and over eighty-eight million members by 2003. The ‘Blue Plans’ continue to grow in enrolment by focusing on its members, and providing top quality, affordable health care coverage. Compare Blue Cross Blue Shield health insurance quotes with other top carriers in your state.

New York Tri-State Region to Receive CIGNA "Custom Benefit Builder"

FHI BlogMaster — Fri, 11 Aug 2006 15:26:00 +0000

Consumers May Now Custom Design Their Health Benefits Plan

New York
July 27, 2006

CIGNA HealthCare today announced that it is expanding the availability of its new CIGNA Custom Benefit Builder SM to mid-sized customers in the New York Tri-State region.

CIGNA Custom Benefit Builder gives consumers more choices and an easy way to build a customized health benefits plan to fit their individual health care and financial needs. Tri-State mid-sized employers with 500 or more employees now can have access to state-of-the-art technology combined with consumer information and decision support tools to give consumers a simple, step-by-step way to learn about and model their benefits.

Consumers can compare and then personalize various copayment and coinsurance levels, deductibles and out-of-pocket maximums. As these choices are made, CIGNA Custom Benefit Builder automatically calculates how much the plan will cost and consumers can then enroll for benefits, all using one integrated online application. “Our goal is to give consumers the same choice and control over their health care decision-making that they have in other aspects of their lives,” said Charles Catalano, president, CIGNA HealthCare of New York-New Jersey-Connecticut. “CIGNA Custom Benefit Builder is an industry-leading next step in achieving that goal."

Catalano indicated that in the past, an employer would have had to offer dozens of separate benefit plans to get the same level of choice that CIGNA Custom Benefit Builder will now enable through an online tool in just a few simple steps. According to a recent CIGNA HealthCare survey conducted by Ipsos Public Affairs, the option to personalize their health care insurance to their needs and budget is one that would be clearly valued by a majority (81%) of consumers.

More than three-quarters (79%) of consumers indicated that they are confident in their ability to decide how much coverage they need and how much they are willing to pay for that coverage. In addition to choice, consumers also want ease when building their customized benefit plan.

Seventy-two percent of consumers would value a health plan that would allow them to make their health insurance choices using online technology in a manner similar to online shopping for consumer products. Powered by Choicelinx technology, CIGNA Custom Benefit Builder allows consumers to:

model their expected heath care use based on age, gender and health status

conduct “what if” scenarios demonstrating how different choices affect costs

calculate how much their health care benefits will cost them each pay period based on the options they select and their employers’ contributions to their benefits

choose the pharmacy plan that best meets their needs

review available incentives offered by the employer for enrolling in wellness and disease management programs

understand all their benefit options

enroll online

The CIGNA HealthCare survey was conducted by Ipsos Public Affairs, a survey-based research company, and was fielded February 17-20, 2006.

It includes responses from a random sample of 683 individuals who have access to an employer-sponsored health insurance plan. Survey results based on 683 interviews are considered accurate to within 3.7 percentage points.

Choicelinx is a CIGNA-owned benefits technology and services company specializing in a new generation of Web-based and consumer-focused employee benefits products for the health insurance industry.

Choicelinx products improve health plan operations and achieve efficiencies through seamless automation of data collection and transmission. Choicelinx is headquartered in Manchester, New Hampshire.

CIGNA HealthCare, headquartered in Bloomfield, CT, provides medical benefits plans, dental coverage, behavioral health coverage, pharmacy benefits and products and services that integrate and analyze information to support consumerism and health advocacy.

“CIGNA” and “CIGNA HealthCare” refer to various operating subsidiaries of CIGNA Corporation. Products and services are provided by these operating subsidiaries and not by CIGNA Corporation.

CIGNA members have the advantage of a large provider network, a statewide specialty care network, reasonably priced co-pays, office visits that include x-rays and lab work, as well as discounts on services such as LASIK, dental care, and acupuncture.

CIGNA HealthCare offers health insurance plans that provide access to preventive care and health education programs. Members receive information regarding local and national wellness programs that encourage healthy living.

CareFirst Launches Campaign With American Stroke Association

FHI BlogMaster — Fri, 04 Aug 2006 13:14:00 +0000

American Stroke Association and CareFirst BlueCross BlueShield Join Forces on "Power To End Stroke" Awareness Campaign

In its 71st year of service, CareFirst, an independent licensee of the Blue Cross and Blue Shield Association, is a not-for-profit health care company which, through its affiliates and subsidiaries, offers a comprehensive portfolio of health insurance products and administrative services to nearly 3.4 million individuals and groups in Northern Virginia, the District of Columbia, Maryland and Delaware.

Through its CareFirst Commitment initiative and other public mission activities, CareFirst supports efforts to increase the accessibility, affordability, safety and quality of health care throughout its market areas.

The American Stroke Association and CareFirst BlueCross BlueShield (CareFirst) are teaming up to reduce the high incidence of stroke in the African-American community.

Both organizations see the potential for change through the multi-faceted "Power to End Stroke" awareness campaign. "The African-American community is at risk--way beyond other groups--and we are proud to spearhead a campaign that informs the public of the power they have to lower their risk of stroke," said Rhonda Chatmon, Director, State Health Alliances, American Stroke Association. Stroke is the third leading cause of death in the Mid-Atlantic region, with African-Americans having almost twice the risk of suffering first-ever strokes compared to Caucasians.

African-Americans also have a higher prevalence of stroke risk factors, such as high blood pressure, high cholesterol, poor eating habits and lack of physical fitness. "The campaign will be instrumental in creating awareness about stroke risk factors and advising people on stroke prevention," said Jon Shematek, M.D., CareFirst Vice President, Quality and Medical Policy.

"CareFirst looks forward to working with the American Stroke Association to lower the number of people having strokes in the African-American community and beyond." Support of the "Power to End Stroke" awareness campaign is a component of CareFirst Commitment, an initiative which supports efforts to increase the accessibility, affordability and quality of health care in the communities CareFirst serves.

CareFirst Commitment's community-focused efforts include a variety of programs aimed at closing gaps in access and delivery of health care. The campaign will include an effort to engage local business leaders and discuss the financial impact of stroke, distribution of physician toolkits specifically designed to help doctors better inform patients, a fitness/cooking event, and radio advertising on DC-based WKYS-FM, and WWIN-FM in Baltimore.

The goal of the American Stroke Association, a division of the American Heart Association, is to reduce disability and death from stroke through research, education and advocacy. In its 2003-04 fiscal year, the association spent $162.4 million on stroke.

RWJ Foundation to Reevaluate Potential of Personal Health Records

FHI BlogMaster — Thu, 27 Jul 2006 18:44:00 +0000

For over thirty years the Robert Wood Johnson Foundation has brought experience, commitment and a rigorous, balanced approach to the problems that affect the health and health care of those it serves, because when it comes to helping Americans lead healthier lives and get the care they need, the Foundation expects to make a difference in our lifetime.

The Robert Wood Johnson Foundation (RWJF) today issued a call for proposals for a new program to stimulate innovations in personal health information technology. The national initiative, called Project HealthDesign: Rethinking the Power and Potential of Personal Health Records, encourages technology pioneers to design the next generation of personal health record (PHR) systems in ways that empower patients to better manage their health and health care.
The $3.5 million program will support up to 10 multidisciplinary teams in a collaborative effort to design and test innovative PHR applications that can be built upon a common technology platform.

All teams will work closely with patients and consumers throughout the process to ensure that their designs align with end users’ needs and preferences. Upon completing the design phase of the program, teams will test prototype applications with patient populations. Project HealthDesign is directed by Patricia Flatley Brennan, R.N., Ph.D., professor of Nursing and Industrial Engineering at the University of Wisconsin-Madison.

The program is part of RWJF’s Pioneer Portfolio, which supports innovative projects that can lead to fundamental breakthroughs in the health and health care of all Americans. “It’s critical that people have access to their medical information, but they also need tools that help them manage and apply that information to improve their health and health care,” said Stephen Downs, S.M., RWJF senior program officer and deputy director of its Health Group.

“Project HealthDesign aims to spark new ideas by attracting the best and brightest technology pioneers to design a diverse set of applications that consumers can use to build on the information in their medical record. Ultimately, they should be able to choose and tailor these tools based on their specific needs to improve the way they manage their health and therefore enhance their quality of life.”

Experts say the advancement of computer-based personal health records has already empowered many people to become better health care consumers and more informed patients, but the potential of personal health record systems to improve patient management of specific diseases needs further exploration. “PHRs to date tend to help patients collaborate with physicians and hospitals, by obtaining prescription renewals or reviewing laboratory results, for example. Most people find PHRs to be effective and helpful─the technical challenge is in creating a suite of PHRs that work together to help people achieve all of their health goals in an integrated fashion,” said Dr. Brennan.

“Project HealthDesign will help create PHR systems that provide a range of flexible tools that can best support individuals’ needs and preferences. These tools may remind a patient to take medications or schedule appointments, or even help people with asthma incorporate weather and air quality updates into their daily health decisions.” In this two-phased initiative, design teams will first participate in a six-month structured process to create user-centered personal health applications that address specific health challenges faced by individuals and families.

In the 12-month prototype phase, these personal health applications will then be tested in target populations. “This initiative allows technology designers to push the envelope in thinking about what a PHR system could become, in terms of empowering patients and improving their health,” said Paul Tang, M.D., vice president and chief medical information officer at the Palo Alto Medical Foundation in California. “This program builds on the good work that has been done so far and challenges all of us to think about the transformative potential of PHRs in the near future.” RWJF is pleased to collaborate with the California HealthCare Foundation (CHCF), which contributed an additional $600,000 to Project HealthDesign.

“Well-designed PHRs can help patients to better manage their health by giving them the right information and tools—when they need it—to support their decisions,’’ said Veenu Aulakh, M.P.H., senior program officer with CHCF’s chronic disease program. “This project will help ensure that the needs of patients, rather than providers and institutions, are the primary focus of the PHR system.’’ Applicants may be either public entities or nonprofit organizations that are tax-exempt under Section 501(c)(3) of the Internal Revenue Code. The program is also open to for-profit entities.