Here’s another company study to substantiate the use of consumer directed health plans to help reduce medical trend and to change employee behavior.    Jeff

INSERTING and REPLACING Cigna Study Shows Consumer-Driven Health Plans Can Save $9,700 Per Employee Over Five Years

·         CDHP customers lowered their costs, improved their health profile

·         Were more informed and engaged in health care choices

·         Anticipated in health improvement programs, chose generic medications, avoided unnecessary trips to the ER

Press Release: Cigna Corporation – Fri, Feb 17, 2012 12:46 PM EST

BLOOMFIELD, Conn.–(BUSINESS WIRE)–

In release dated February 15, 2012, insert three new graphs following six-point bullet list with quote from HanesBrands.

The corrected release reads:

CIGNA STUDY SHOWS CONSUMER-DRIVEN HEALTH PLANS CAN SAVE $9,700 PER EMPLOYEE OVER FIVE YEARS

• CDHP customers lowered their costs, improved their health profile
• Were more informed and engaged in health care choices
• Anticipated in health improvement programs, chose generic medications, avoided unnecessary trips to the ER

When American workers engage in health-smart habits offered in consumer-driven health plans (CDHP), they reduced their health risks and lower their total medical costs an average of $9,700 per employee over a five-year period, according to a recent study of health care claims representing 1.1 million Cigna customers in consumer-driven health plans, PPOs and HMOs.

The Sixth Annual Cigna Choice Fund Experience Study, released today, shows individuals enrolled in Cigna Choice Fund^®, Cigna’s consumer-driven health plan, lowered their costs without compromising care by becoming more engaged, informed and active health care consumers. Cigna’s CDHP pairs a qualified medical plan with a Health Savings Account (HSA) or Health Reimbursement Account (HRA). According to the study, when compared to customers in traditional PPO and HMO plans, those in a CDHP:

• Lowered their health risks: Cigna CDHP customers lowered their risk of developing or worsening a chronic condition. According to the study, when employers fully transitioned to offering only a CDHP option, individuals improved their health risk profile by 10 percent in the first year compared to customers in a traditional plan option.
• Reduced total medical costs: Cigna CDHP medical cost trend was 16 percent lower than traditional plans during the first year. Over five years, cumulative cost savings averaged $9,700 per employee enrolled in a Cigna CDHP compared to employees who remained in a traditional health plan. Cost reductions were achieved without employers shifting out-of-pocket health expenses to their employees.
• Received higher levels of care: Cigna CDHP customers had consistent or higher use of over 400 evidenced-based medical best practices (than their counterparts in traditional plans. Cigna CDHP customers also sought preventive care, such as annual office visits and mammograms, more frequently than customers enrolled in a traditional plan.
• Were more engaged in health improvement: Through proper plan design plan and the use of incentives, Cigna CDHP customers were more likely to have completed a health risk assessment and participated in the Cigna Health Advisor^® health coaching program than those enrolled in a traditional plan.
• Were more savvy consumers of health care: Cigna CDHP customers enrolled in Cigna Pharmacy Management^® were more likely to choose generic medications and had 14 percent lower pharmacy costs compared to those in a traditional plan. In addition, CDHP customers used the emergency room at a 13 percent lower rate than individuals enrolled in HMO and PPO plans.
• More likely to compare cost and quality: Cigna CDHP customers were twice as likely to use myCigna.com online cost and quality information to help them select a doctor or to review potential medical costs than customers enrolled in traditional plans.

“Each year the evidence increasingly shows that properly designed consumer-driven health plans can lower health risks, reduce medical costs and drive engagement,” said Cigna Chief Medical Officer, Dr. Alan Muney. “The data once again shows that the combination of incentives, easy-to-engage health programs, and consumer decision support tools can improve health while reducing costs.”

One company that is realizing the benefits of Cigna Choice Fund consumer-driven health plans is leading manufacturer and marketer of everyday basic apparel, HanesBrands Inc.

According to HanesBrands Vice President HR, Global Compensation, Benefits & HRIM, Annamarie S. D’Souza: "HanesBrands was an early adopter of consumer-driven health plans. We continually evolve and enhance our plans to help our employees and their families become savvy consumers of their health care.”

“As a result, we’ve seen impressive numbers of our employees choose generic medications, more fully use their preventive benefits, and reduce their total medical cost trend to a fraction of the national average,” D’Souza said. “By providing our employees with useful cost and quality information, the right health improvement programs, the right incentives, and easy-to-understand correspondence, they are making rational, wise, and successful health care decisions."

Cigna continues to improve its CDHP offering, including enhancing its online and mobile information. For example, Choice Fund customers can use their web-enabled mobile phone to look-up what expenses may be paid via their HRA and Flexible Spending Account (FSA) funds, compare drug costs and find a doctor or facility. In addition, Cigna’s new online bill pay feature, MyClaimPay, gives customers a convenient way to pay health care professionals directly from HRA and FSA funds on mycigna.com.

About Cigna

Cigna Corporation (NYSE: CI – News) is a global health service company dedicated to helping people improve their health, well-being and sense of security. All products and services are provided exclusively through operating subsidiaries of Cigna Corporation, including Connecticut General Life Insurance Company, Cigna Health and Life Insurance Company, Life Insurance Company of North America and Cigna Life Insurance Company of New York. Such products and services include an integrated suite of health services, such as medical, dental, behavioral health, pharmacy and vision care benefits, and other related products including group life, accident and disability insurance. Cigna maintains sales capability in 30 countries and jurisdictions, and has approximately 70 million customer relationships throughout the world. To learn more about Cigna, including links to follow us on Facebook or Twitter, visit www.cigna.com.

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Many of you and your plan sponsors often ask about what constitutes preventive services under the new PPACA mandates.  Here is a good article  to help you with that.  As you know, we firmly advocate for having employers incentivize the use of annual preventive services as a prophylactic against catastrophic claims in a group plan.  Further, we’ve found that the use of these services gets employees into the system with a primary care physician to ensure continuity of care.  This purposeful activity allows the PCP to get baseline information on a member and to recognize changes from year to year which can signify an emerging disease process or co-morbidities.  Tactically, savvy agents and brokers are doing whatever they can to associate members with a PCP NOW since there will be a likely scarcity of PCPs once PPACA is fully enacted.  Use this information to your advantage as you teach your plan sponsors how to efficiently finance their health plans.    Jeff

Stay Healthy, Save Money with Preventive Services Covered at 100% Under Health Care Reform

Preventive health care–including annual physical exams, screenings, and immunizations–is essential to good health. Yet many Americans don’t receive the regular preventive care they need, despite the fact that chronic diseases, which are responsible for 7 of 10 deaths among Americans each year and account for 75% of the country’s health care spending–are often preventable.

Why do so few Americans get the preventive care they need? Often, the reason is cost.

The Affordable Care Act (health care reform) attempts to address this problem by requiring all new group and individual health insurance plans as of September 23, 2010 to pay 100% of the costs for preventive care services ranked A and B by the U.S. Preventive Services Task Force (USPSTF).

If your health plan qualifies, you can take advantage of a wide range of preventive care services to help you avoid illness and improve your health–at no cost to you, so long as you receive these services from a health care provider within your health plan’s network of doctors and hospitals.

You won’t have to pay a copayment at the office visit, and not a penny toward coinsurance or your deductible. Doctors and health care facilities continue to charge for these services. But now it’s the health insurance companies that pay the costs. Essentially, preventive care becomes ‘free’ for the policyholder, greatly increasing the incentive to take advantage of these services.

The following lists outline the preventive care services covered by these rules for adults, women, and children.

Adults
Covered preventive services for adults include:

• Abdominal aortic aneurysm: A one–time screening for men of specified ages who have ever smoked
• Alcohol misuse screening and counseling
• Aspirin use for men and women of certain ages
• Blood pressure screening for all adults
• Cholesterol screening for adults of certain ages or at higher risk
• Colorectal cancer screening for adults over 50
• Depression screening for adults
• Type 2 diabetes screening for adults with high blood pressure
• Diet counseling for adults at higher risk for chronic disease
• HIV screening for all adults at higher risk
• Immunization vaccines for adults (recommendations vary):

• Hepatitis A
• Hepatitis B
• Herpes zoster
• Human papillomavirus
• Influenza (flu shot)
• Measles, mumps, rubella
• Meningococcal
• Pneumococcal
• Tetanus, diphtheria, pertussis
• Varicella

Women
Covered preventive care services for women, including pregnant women, include:

• Anemia screening on a routine basis for pregnant women
• Bacteriuria urinary tract or other infection screening for pregnant women
• BRCA (breast cancer gene) counseling about genetic testing for women at higher risk
• Breast cancer mammography screenings every one to two years for women over 40
• Breast cancer chemoprevention counseling for women at higher risk
• Breastfeeding comprehensive support and counseling from trained providers, as well as access to breastfeeding supplies, for pregnant and nursing women*
• Cervical cancer screening for sexually active women
• Chlamydia infection screening for younger women and other women at higher risk
• Contraception: Food and Drug Administration–approved contraceptive methods, sterilization procedures, and patient education and counseling, not including abortifacient drugs*
• Domestic and interpersonal violence screening and counseling for all women*
• Folic acid supplements for women who may become pregnant
• Gestational diabetes screening for women 24 to 28 weeks pregnant and those at high risk of developing gestational diabetes*
• Gonorrhea screening for all women at higher risk
• Hepatitis B screening for pregnant women at their first prenatal visit
• Human immunodeficiency virus (HIV) screening and counseling for sexually active women*
• Human papillomavirus (HPV) DNA test: High–risk HPV DNA testing every three years for women age 30 or older* with normal cytology results
• Osteoporosis screening for women over 60, depending on risk factors
• Rh blood incompatibility screening for all pregnant women and follow–up testing for women at higher risk
• Tobacco use screening and interventions for all women, and expanded counseling for pregnant tobacco users
• Sexually transmitted infections (STI) counseling for sexually active women*
• Syphilis screening for all pregnant women or other women at increased risk
• Well–woman visits to obtain recommended preventive services for women under 65*

Note: Services marked with an asterisk (*) must be covered with no cost–sharing in plan years starting on or after August 1, 2012.

Children
Covered preventive care services for children include:

• Alcohol and drug use assessments for adolescents
• Autism screening for children at 18 and 24 months
• Behavioral assessments for children of all ages
• Blood pressure screening for children
• Cervical dysplasia screening for sexually active females
• Congenital hypothyroidism screening for newborns
• Depression screening for adolescents
• Developmental screening for children under age 3, and surveillance throughout childhood
• Dyslipidemia screening for children at higher risk of lipid disorders
• Fluoride chemoprevention supplements for children without fluoride in their water source
• Gonorrhea preventive medication for the eyes of all newborns
• Hearing screening for all newborns
• Height, weight, and body mass index measurements for children
• Hematocrit or hemoglobin screening for children
• Hemoglobinopathies or sickle cell screening for newborns
• HIV screening for adolescents at higher risk
• Immunization vaccines for children from birth to age 18 (recommendations vary):

• Diphtheria, tetanus, pertussis
• Haemophilus influenzae type B
• Hepatitis A
• Hepatitis B
• Human papillomavirus
• Inactivated poliovirus
• Influenza (flu shot)
• Measles, mumps, rubella
• Meningococcal
• Pneumococcal
• Rotavirus
• Varicella

It’s important to keep in mind that while the health plan cannot charge you a copayment, deductible, or coinsurance when the primary purpose of the office visit is the recommended preventive care service and the service is NOT billed separately from the office visit, you may be required to share some of the costs if the preventive service is not the primary purpose of the office visit. And remember, preventive services are covered at 100% only when received from health care providers within the health plan’s network.

For the most up–to–date list of covered preventive care services, please visit http://www.uspreventiveservicestaskforce.org.

Source: Healthcare.gov

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We saw a lot this week in the press about Anthem and Aetna’s initiatives in this region around ACOs.  I’m posting some detailed information below about ACOs, what they mean and how they are likely to change the way that healthcare is financed.  It is important that brokers and consultants know and understand these changes.  The first post is from this month’s New England Journal of Medicine.  Both posts describe the incredible challenges facing this approach and conclude that rapid change and cost reduction isn’t likely.    Jeff

Keeping Score under a Global Payment System

Bruce E. Landon, M.D., M.B.A.

N Engl J Med 2012; 366:393-395February 2, 2012

Comments open through February 8, 2012

Article

References

Comments (2)

It is widely acknowledged that continued growth in health care spending is threatening the viability of the U.S. health care system. Although there are no clear comprehensive solutions to this problem, most observers see payment reform as the next best hope for reining in out-of-control costs. Our current fee-for-service payment system provides incentives to physicians to increase the delivery of services, which results in excessive utilization. Moreover, neither individual physicians nor the patients receiving the services bear the brunt of these utilization decisions. Rather, they’re reflected in ever-rising health insurance premiums or tax-financed government expenditures shared by all. Many observers are therefore calling for fundamental redesign of the ways in which physicians and hospitals are compensated for the care they provide. Most options call for bundling payments to physicians; specific approaches range from prospective payments for discrete episodes of care (e.g., coronary-artery bypass surgery) to global payment or risk-based models of care.

Global prospective payments became prevalent during the heyday of managed care in the 1990s. Such so-called capitation payments were common in many markets, whereas in others physician organizations were actively preparing themselves for a coming tide of capitation that never materialized. In a fast-growing economy, both patients and physicians bridled at the restrictions of choice and access associated with such payment arrangements, and capitation quickly fell out of favor. In addition, the information systems and infrastructure necessary to successfully manage risk under global payments were underdeveloped during that period. After a lull of more than a decade, however, global payment is again seen as the potential savior of the health care system.

Among the most important anticipated experiments in global payments are accountable care organizations (ACOs), which were included as part of the Affordable Care Act and are also being developed under the auspices of the Center for Medicare and Medicaid Innovation. ACOs represent a hybrid of our fee-for-service system and true capitation. The ACO regulations, proposed by the Obama administration last March and finalized in October, call for two models of shared savings. In the first model, health care organizations would be eligible to share in savings but would bear no risk for losses for the first 2 years. Under this program, ACOs would be eligible for approximately 50% of the savings accrued by the Medicare program after they surpassed a fixed savings threshold. In the second model, there is both upside and downside risk sharing for participating health care organizations from the start. Because these organizations are taking on risk for losses, they would also be eligible for a larger percentage of shared savings. This latter version of ACOs most closely approximates true capitation. These proposed ACOs are similar to arrangements already present in the commercial sector, such as the Alternative Quality Contract rolled out by Blue Cross Blue Shield of Massachusetts in 2009.1,2

Conceptually, global payment represents an important opportunity for changing the perverse incentives inherent in our current fee-for-service system. To be successful, however, ACOs must pass these incentives along to their member physicians, who continue to be responsible for most utilization decisions. Although organizations can implement various managerial strategies to influence physicians’ decision making (e.g., radiology decision support and prior authorization), ACOs are unlikely to reduce the rate of increase in health care spending without some essential changes in the behavior of member physicians — and therein lies the rub. The fundamental questions become how ACOs will choose to divide their global budgets and how their physicians and other service providers will be reimbursed. Thus, this system for determining who has earned what portion of payments — keeping score — is likely to be crucially important to the success of these new models of care.

Under ACOs and many commercial global payment products, providers will continue to receive traditional fee-for-service payments, and hospitals will receive their usual contracted payments, through either the diagnosis-related-group (DRG) system or per diem payments. All spending for each patient that is attributed to the ACO will then be tracked and compared with the calculated budget retrospectively at the end of the performance year in order to calculate savings or losses. Thus, standard fee-for-service payments remain the de facto method for keeping score, which works against the very design of the program. The inequities of the fee-for-service system, which reward proceduralists and specialists at the expense of cognitive specialties and primary care, remain embedded in the payment system. Although organizations can receive surplus payments, additional revenue from any surpluses will not flow into organizations until at least 18 months after the program begins.

As global payment systems are currently designed, primary care physicians stand to be among the big winners. However, to earn rewards, they will also have to shoulder the largest burden of the work needed to succeed under risk-sharing arrangements.3 In a well-functioning health care system, primary care physicians are the point of access, are responsible for care coordination and management, have perspective on the whole patient, and have the ability to manage the care of a patient population. Moreover, most quality incentives being incorporated into the payment systems for ACOs and other new global payment contracts also fall under the purview of primary care. To accomplish the care-management and quality goals, however, primary care physicians will need substantially more resources — for hiring care managers and other personnel to pursue population health management, for coordinating and managing care, and for implementing processes to ensure adherence with quality measures.

Although many ACOs will direct future surpluses to primary care, infrastructure payments to facilitate the development of the care-management functions noted above have not been built into the design of the ACO program or many new versions of capitation. Since most of these organizations will continue to rely on fee-for-service payments for the purpose of keeping score, making funds available to invest in this infrastructure would require a transfer of funds from specialists or hospitals to primary care, and it may be difficult for organizations to unilaterally alter the flow of funds to accomplish these aims. Moreover, although organizations may face strong incentives to control costs, specialist physicians who continue to be paid through the fee-for-service system and hospitals, which continue to receive DRG-based payments, face no such inherent incentives — and in fact will continue to benefit from practicing in much the same way as they do now.

Over time, if global payments become the norm, there is likely to be a resurgence of subcapitation and budgets for particular specialties, and systems will be designed to provide similar incentives to specialists while also enhancing funding for primary care. In addition, ACOs and their aligned hospitals must share incentives to control hospital costs. This transition, however, is likely to be painful and prolonged under the current design of the programs. Certainly, adjustments to the fee schedule that limit specialist pay and divert funds to primary care will be helpful, but even more helpful would be up-front payments that organizations can use to invest in their care-management and primary care infrastructure to facilitate this transition without taking funds from specialists or hospitals, at least until they achieve surpluses that ensure the continuation of this funding stream. Tightly managed multispecialty or primary care groups without strong alignment with a hospital may be well positioned to manage this transition.

The health care system is placing tremendous hope in changing incentives to control the ever-increasing costs of care. Hybrid approaches such as ACOs that incorporate global incentives but continue to keep score using fee-for-service payments will face serious challenges as they attempt to place increasing burdens on the already-stressed primary care system without providing additional resources for achieving the aims of global payments — slowed growth in costs and higher-quality care.

Disclosure forms provided by the author are available with the full text of this article at NEJM.org.

Source Information

And this is from a blog called “On Running a Hospital” by Paul Levy:

Thursday, February 02, 2012

Landon lands on the major issues about capitation

Bruce Landon offers an excellent summary in today’s New England Journal of Medicine about the necessary conditions for a capitated, or global, payment regime to be successful.  He notes:

The fundamental questions become how ACOs will choose to divide their global budgets and how their physicians and other service providers will be reimbursed. Thus, this system for determining who has earned what portion of payments — keeping score — is likely to be crucially important to the success of these new models of care.

Under ACOs and many commercial global payment products, providers will continue to receive traditional fee-for-service payments, and hospitals will receive their usual contracted payments, through either the diagnosis-related-group (DRG) system or per diem payments. All spending for each patient that is attributed to the ACO will then be tracked and compared with the calculated budget retrospectively at the end of the performance year in order to calculate savings or losses. Thus, standard fee-for-service payments remain the de facto method for keeping score, which works against the very design of the program. The inequities of the fee-for-service system, which reward proceduralists and specialists at the expense of cognitive specialties and primary care, remain embedded in the payment system. Although organizations can receive surplus payments, additional revenue from any surpluses will not flow into organizations until at least 18 months after the program begins.

My regular readers may recall that I raised a similar point last year, when I noted:

Now, though, let me let you in on a little secret with regard to capitated care. Underneath the global budget, there is still a fee-for-service arrangement establishing the transfer prices among the providers in a network. That GI specialist will still get paid for each colonoscopy. The big thing to work out in this system is the allocation of any surplus or deficit in the annual budget among the various specialists.

Unless that allocation is skewed heavily towards primary care doctors, decisions about the level of care given will not change. But, if the allocation is skewed too heavily towards the PCPs, there is no real income signal for the specialists, leading to a danger that they will not feel invested in the end result. Unless the system is accompanied by intensive, real-time reporting, along with clear penalties for excessive care, it will not work.  

Bruce appears to concur, further explaining some necessary conditions for success:

As global payment systems are currently designed, primary care physicians stand to be among the big winners. However, to earn rewards, they will also have to shoulder the largest burden of the work needed to succeed under risk-sharing arrangements. . . . To accomplish the care-management and quality goals, however, primary care physicians will need substantially more resources — for hiring care managers and other personnel to pursue population health management, for coordinating and managing care, and for implementing processes to ensure adherence with quality measures. 

He concludes: 

The health care system is placing tremendous hope in changing incentives to control the ever-increasing costs of care. Hybrid approaches such as ACOs that incorporate global incentives but continue to keep score using fee-for-service payments will face serious challenges as they attempt to place increasing burdens on the already-stressed primary care system without providing additional resources for achieving the aims of global payments — slowed growth in costs and higher-quality care.

Posted by Paul Levy at 2/02/2012 08:47:00 AM

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This piece has some interesting data.  Use the map selector for premium information and baseline data by simply clicking on the link.  The second attachment shows the data graphically.  Jeff

State Trends in Premiums and Deductibles, 2003–2010: The Need for Action to Address Rising Costs

November 17, 2011 | Volume 26

Authors: Cathy Schoen, M.S., Ashley-Kay Fryer, Sara R. Collins, Ph.D., and David C. Radley, Ph.D., M.P.H.
Contact: Cathy Schoen, Senior Vice President for Policy, Research, and Evaluation, The Commonwealth Fund, cs@cmwf.org
Editor: Deborah Lorber



Interactive Feature

Interactive map of premium costs

Downloads

• Issue Brief (4441K PDF)
• Chartpack (573K PDF)
• Chartpack (816K PPT)
• Cathy Schoen Teleconference Clip (771K MP3)

Overview

Rapidly rising health insurance costs continue to strain the budgets of U.S. families and employers. This issue brief analyzes changes in private employer-based health premiums and deductibles for all states from 2003 to 2010, and finds total premiums for family coverage increased 50 percent across states and employee annual share of premiums increased by 63 percent over these seven years. At the same time, per-person deductibles doubled in large, as well as small, firms. If premium trends continue at the rate prior to enactment of the Affordable Care Act, the average premium for family coverage will rise 72 percent by 2020, to nearly $24,000. Health reform offers the potential to reduce insurance cost growth while improving financial protections. If efforts succeed in slowing annual premium growth by 1 percentage point, by 2020 employers and families together would save $2,161 annually for family coverage, compared with projected premiums at historical rates of increase. 

Citation

C. Schoen, A.-K. Fryer, S. R. Collins, and D. C. Radley, State Trends in Premiums and Deductibles, 2003–2010: The Need for Action to Address Rising Costs, The Commonwealth Fund, November 2011.

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   For the last few weeks I’ve sent out various postings that feature carrier initiatives and partnerships with mobile technology vendors.  Remote monitoring is a big thing this year.  We’ve also been posting about advances in telemedicine.  Savvy agents and brokers are paying attention to these initiatives.  Health care reform is creating a scarcity of primary care physicians.  PCP capacity will become a big problem for most plan sponsors.  Consumer initiatives and education promise to create more activist health plan membership.  Educated consumers seem to engage the system more responsibly and often advocate for themselves.  Best practice brokers are activating plan sponsors and their members with these leading edge technologies while teaching members about the importance of securing a PCP now.  Members will come to appreciate cost and quality if they have a relationship with a PCP and other tools to monitor their personal health on a daily basis.  This is a powerful combination!

   We are most interested in working with  brokers who are trying to get employers to incentivize membership usage of preventive benefits.  We’re finding that brokers who are doing this are getting positive feedback and are setting themselves up to talk about the next level of engagement with members.   Members who are activated, i.e. have a reason to suddenly be involved in the maintenance of their health, need ways to track their progress and failures.  These new devices are effective and inexpensive and often give members a reason to stay engaged.  Multiyear strategies that first incentivize and then engage members seemingly are producing long term ROI. 

   Last week I posted about Aetna’s new relationship with Best Buy stores to sell monitoring devices.  This piece speaks to United’s new program.  Agents and brokers are being given new opportunities to affect change within groups.  These are exciting times to engage.     Jeff

UnitedHealth Group Announces New Strategic Partnerships with Mobile Health Technology Firms

·         CareSpeak Communications, Lose It! and Fitbit offer mobile technologies designed to help improve and enhance consumers’ health and well-being

·         CEOs of these three companies to present at UnitedHealth Group’s exhibitor booth at the 2012 International Consumer Electronics Show in Las Vegas

Press Release: UnitedHealth Group – Mon, Jan 9, 2012 12:08 PM EST

MINNETONKA, Minn.–(BUSINESS WIRE)– UnitedHealth Group has announced strategic partnerships with three health technology companies that offer mobile products and services designed to help improve consumers’ health and well-being.

UnitedHealth Group’s new business partners – CareSpeak Communications, Lose It! and Fitbit – help simplify the consumer health care experience by making relevant, practical information easier to access by using consumer-friendly technology devices such as smartphones and other mobile devices.

“Technology is playing an increasingly important role in the way that people take control of their health. UnitedHealth Group is committed to developing innovative solutions, and we look forward to working with such creative partners as CareSpeak Communications, Lose It! and Fitbit to help people live healthier lives,” said Rick Jelinek, executive vice president and CEO of Emerging Business Group at UnitedHealth Group.

CareSpeak Communications has developed a medication and disease management application that helps patients manage their health using two-way text messaging on their mobile phones. The CareSpeak system can be used by individual patients to self-manage their therapies, by a pharmaceutical company or pharmacy to provide alerts as a value-added service to their customers, by a health benefits provider to help plan participants manage their health, and by clinicians to manage their patients’ health. The technology enables patients to report, via text message, their medication intakes and biometric data (blood glucose levels, blood pressure, weight, etc.) to their clinician and/or care providers, and receive educational and motivational messages, incentives and rewards for meeting their health goals.

“We are thrilled to work with UnitedHealth Group – one of the largest and most sophisticated health care companies in the world,” said Serge Loncar, founder and CEO, CareSpeak Communications. “Finding innovative ways to improve clinical outcomes is of great significance, and we share UnitedHealth Group’s commitment in doing just that.”

Lose It!, created by FitNow Inc., is a mobile app and website that helps consumers manage their weight and improve their health by tracking their progress, offering peer support, and providing important caloric and nutritional information on what they eat. The mobile app is available for iPhones and Android devices.

“Healthy weight and nutrition management are key to helping people be happier and healthier, but are also critical to managing health care costs,” said Charles Teague, CEO, FitNow Inc. “Millions of people have used our tools to help them lose weight – more than 7 million pounds to date. We look forward to working with UnitedHealth Group to further leverage our technology and reach even more people.”

Fitbit offers a sleek, wireless tracker that includes an accelerometer to more accurately count how many steps a user takes, and an altimeter to track stairs climbed. The device also calculates how many calories are burned. The mobile device is also a sleep monitor that tracks both how long and how well the user sleeps. The information can be uploaded wirelessly to Fitbit.com where consumers can analyze their physical activity.

Fitbit will be integrated with the OptumizeMe® mobile health app developed by UnitedHealth Group’s health services company, Optum. OptumizeMe engages and empowers consumers to achieve health goals and encourages healthy behaviors. With coaching, relevant and personalized content, and connection to social networks, OptumizeMe also lets people create health challenges – with friends, co-workers and others – to help achieve health and fitness goals.

“Physical activity is paramount in helping people improve their health and well-being. Fitbit is dedicated to developing innovative and simple ways to motivate and empower consumers to achieve the results they want for their health and fitness,” said James Park, co-founder and CEO, Fitbit.

Loncar, Teague and Park will be featured speakers this week at UnitedHealth Group’s exhibitor booth at the 2012 International Consumer Electronics Show (CES) in Las Vegas. UnitedHealth Group is participating in CES to showcase the health and well-being company’s innovative technology products and services to help consumers live healthier lives and help improve and enhance the health care system.

The 3,500-square-foot booth will feature Microsoft Xbox with Kinect fitness challenges, real-time biometric screenings, presentations by leading health experts, innovative product and service demonstrations, and more. UnitedHealth Group will also provide a cyber café with Internet-enabled workstations and a coffee lounge area for CES attendees. UnitedHealth Group’s own experts will present as part of the CES Digital Health Summit and the Silvers Summit.

For more on UnitedHealth Group’s presence at CES as well as the company’s booth, fitness challenges and speaking engagements, please visit www.ceshealth.com or follow @CESHealth on Twitter.

About CareSpeak Communications
CareSpeak Communications provides mobile communications technology solutions to health care professionals, patients, and caregivers for better medication and clinical compliance, resulting in improved outcomes. The company offers its services to clinical organizations, insurers, payers, benefit managers, and the pharmaceutical industry. CareSpeak Communications is a privately held company, headquartered in New Jersey. Visit www.carespeak.com for more information.

About Fitbit
Founded in 2007 in San Francisco, CA, Fitbit is dedicated to delivering simple, innovative health and fitness products and services that help people lead healthier, more active lives by giving them the tools to become more aware, more motivated and more fit every day. Fitbit’s Ultra Wireless Activity + Sleep Tracker is the leading wireless fitness tracker on the market, with distribution at leading national retailers such as Amazon.com, Best Buy, Brookstone, Radio Shack, REI and Target. Fitbit is funded by the Foundry Group, True Ventures and SoftTech VC. For more information please visit www.fitbit.com or connect with us on Facebook or Twitter.

About Lose It!
Lose It! is a mobile application and website that uses proven principles of weight loss tracking and peer support to help users manage their weight. Lose It! is available directly to consumers, but can also be incorporated into corporate wellness or professionally administered weight loss programs, as a tool to help manage populations. More than 10 million people have used Lose It! on their mobile device or on the web since 2008. FitNow, Inc., the creator of Lose It!, is a privately held company headquartered in Boston, Massachusetts. Learn more at www.loseit.com or download Lose It! from your mobile device’s app store.

About UnitedHealth Group
UnitedHealth Group (NYSE: UNH – News) is a diversified health and well-being company dedicated to helping people live healthier lives and making health care work better. With headquarters in Minnetonka, Minn., UnitedHealth Group offers a broad spectrum of products and services through two distinct platforms: UnitedHealthcare, which provides health care coverage and benefits services; and Optum, which provides information and technology-enabled health services. Through its businesses, UnitedHealth Group serves more than 75 million people worldwide. For more information, visit UnitedHealth Group at www.unitedhealthgroup.com.

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Wellness initiatives and other snap on programs seemingly aren’t affecting the big claimants in most plans since these populations are already disease processed.  So, while we can prevent big claims in the future…….how do we get to the big $$$$ NOW??  Here’s a great piece.  More and more carriers are talking about ACOs and tiered networks as the best way to treat the most complex medical cases.  Are you familiar with these organizations in your area?  If you’re not….you should be.  As a benefit professional in your area are you meeting with the BEST doctor’s groups to hear their value proposition so that you can bring it to your customers??  Our co morbid populations are killing our plans. This piece talks about working with benefit administrators and executives to pick networks that coordinate care and deliver the best care.  Plenty of opportunity here.  Great piece that touches on many of the health care policy issues that we’ll address this year.   Take a look.  Jeff

It’s 2012. Let’s Recap

Posted on January 4, 2012 by Brian Klepper

Tom Emerick

Posted 1/02/11 on Cracking Health Costs

Let’s hit a few highlights of 2011.  In Cracking Health Costs we described certain…um…scary trends in health care in the US:

• US spending on health care is lapping our peer countries while our life expectancy is declining comparatively.  This is a major drain on our economy and is costing us jobs.
• We have a huge amount of unnecessary surgery and testing.  It’s getting worse, not better.  (Read The Treatment Trap by Rosemary Gibson and Janardan Prasad Singh for real life examples.)
• In health plans today, a small number of members are spending most of the money.  I’ve seen very large plans in which 10% of members are spending 80% of plan dollars.   These “outliers” are usually in the middle of serious acute health crises and are way beyond wellness, preventive, value-based purchasing, HSA incentives, consumer driven health care, public/private partnerships, etc.  “Outliers” often need specialized tertiary or quaternary care.
• There is huge variation between tertiary and quaternary referral centers in terms of getting the diagnoses right, having the best outcomes, and saving lives.  The best referral centers are the most cost effective too.
• Most specialists in the US don’t coordinate care or diagnoses.  As a consequence, a large number of “outliers” are misdiagnosed and/or have bad treatment and surgical plans.  This is a huge opportunity for benefit plans.
• Alas. We know that true reform can never and will never come from Washington. Members of Congress will see to it that clinics and hospitals in their districts are protected.
• Health insurers understand this but are often not supported by corporate benefit executives when they delete poor performing doctors and hospitals from their networks.
• Most benefit executives are looking for the deepest discounts when selecting a network, not the lowest net cost, a big difference.  Lowest net cost comes from getting diagnoses right, avoiding bad surgery, and coordinating care.  Those traits trump deepest discount every time.  A small but growing number of large corporations are getting this one right.
• If the system is to be reformed it will be done by corporate benefit executives.  Congress can’t.  Insurers can’t.
• Most of the clinicians who over-test and do a poor job of getting diagnoses and treatment plans right aren’t going to improve until someone takes their patients away.  Period.

The question is, how to take their patients away.  There’s a way.

If you are a benefit executive:

• Ask your TPA, carrier, or PPO to start figuring out who the “A players” are and load your networks with them.  Ask them to identify the “C clinicians” and begin the process of deleting them from your network.  The savings potential from this is huge. Plus, you will be protecting your employees and improving the quality of their care.
• Educate your employees about this.
• For your outlier population, implement centers of excellence for their specialized needs.
• If your company has more than 5,000 covered lives or so, you should develop and implement direct contracts with the best of the best centers of excellence, ones like Mayo Clinic and Cleveland Clinic.  Great companies like Pepsi, Walmart, and Lowes have done just this, plus many others. You can do it too.

Tom Emerick is a former VP of US Benefits for Walmart. He now consults, and writes at Cracking Health Costs.

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We’ve talked a lot over the course of the last year about the pending adverse effects of healthcare reform.  One of the biggest concerns and outcomes surrounds the lack of primary care physicians in this country.  This problem is also known as ‘lack of capacity’.  Agent, brokers and consultants have unique opportunities to affect the architecture and choreography of their plan sponsor’s health package.  We’ve also talked a lot about the need to efficiently finance the plan sponsor’s plan.  More importantly, we’ve talked a lot about the growth of alternative access points to providers for members including retail clinics, telemedicine, medical tourism and even in house provider clinics.  While the vision of the article below may seem far flung;  it appears that the technology exists NOW to allow patients to be remotely monitored 24/7 for all of their vital signs and for providers to do real consultations thousands of miles away.  The saving grace for our healthcare problems relative to cost, quality and capacity may very well be………technology.  Something to think about for 2012.  Happy New Year!  Jeff

Digitizing Human Beings

Posted on December 28, 2011 by Brian Klepper

Eric Topol

First posted on The Health Care Blog on 12/26/2011

Our day-to-day lives were reformatted when the consumer mobile wireless device era, beyond cell phones, was ushered in by iPods in 2001 and followed in short order by Blackberries, smartphones, e-readers, and tablets. Nurturing our peripatetic existence, we could immediately and virtually anywhere download music, books, videos, periodical, games and movies. Television is soon to follow. But these forms of digital communication and entertainment are a far cry from digitizing people.

This decade will be marked by the intersection of the digital world with the medical cocoon, which until now have been largely circulating in separate orbits. The remarkable digital infrastructure that has been built—which includes broadband Internet, cloud and supercomputing, pluripotent mobile devices and social networking― is ripe to provide the framework for a most extraordinary upgrade and rebooting of medicine.

When I was finishing my internal medicine training in 1982 the term “digital” in medicine referred exclusively to the rectal examination. Now, 3 decades later, there are 4 domains of what comprises digital medicine―genomics, wireless sensors and devices, imaging and health information systems. Each of these digital medical technologies are on exceptionally accelerated growth curves. In 2012, complete DNA sequencing of all 6 billion bases of a diploid human genome will be accomplished in 2 hours at a price well under $4000. Already DNA sequencing is having an impact in medicine for specific gene-drug interactions, targeting of cancer therapy by defining tumor driver mutations (comparing somatic versus germ-line DNA), and demystifying life-threatening idiopathic diseases. Just a few years ago wireless sensors got their start for consumers in the health and fitness space, with wearable accelerometers in running shoes, bracelets, necklaces or clips. Now a brain wave sensor can be used to continuously monitor one’s phases of sleep and wakefulness.

Sensors for real time, continuous or intermittent remote monitoring are now available for glucose, heart rhythm and ocular pressure. Virtually every relevant physiologic metric can be captured via a wireless sensor that is in development, including all vital signs such as blood pressure and blood oximetry. A third domain of miniature high resolution imaging, in the form of handheld ultrasound devices the size of a cell phone with wireless transmission capacity, and other portable imaging including X-ray and magnetic resonance in development. The fourth domain of electronic health records and health information systems is the only part of digital medicine that the United States Affordable Care Act has been given a significant priority and a $40 billion investment.

In aggregate, the 4 domains of digital medicine provide an entirely new panoramic window to each person’s biology, physiology and anatomy– “high definition man”―for the first time in the history of medicine. For example, take the 70 million Americans already diagnosed with hypertension. It has been exceptionally difficult to get multiple readings for any patient and we know that at least 50% of patients with hypertension are poorly controlled. Lack of adequate control of blood pressure is associated with a higher incidence of stroke and heart attack. With the capability of continuous, seamless, remote blood pressure monitoring we will have a new window of this metric while an individual is sleeping or emotionally upset. And such data can be archived, processed, sent to one’s physician, or to a social network to set up managed competition among a group of hypertensives for optimal blood pressure control. The same principle can be applied across the board of physiologic metrics, such as glucose.

There are several challenges that lie ahead in order for the potential of digitizing humans to be actualized. First, there is the data flooding that is already occurring from sequencing genomes and capturing biosensor data. The signal processing of such big data sets, development of algorithms, software tools for annotation, and transforming rich data to practical information is daunting and a rate limiting step. Second, there is the concern about costs with the precedent that with every new medical technology there has been an associated increased economic burden to the health system. Will these tools in digital medicine provide a new precedent? That remains to be seen, but there are some promising early indicators such as the sequencing capabilities far outstripping Moore’s Law (and correspondingly costs are plummeting), and the obvious reduction of cost afforded by the use of a heart rhythm app for a smartphone instead of a Holter monitor or a handheld ultrasound pre-empting the need for a formal study. Third, each of these technologies needs clinical validation through rigorous trials. However, the size of such trials could be conceived as very small, with the extraordinary amount of data collected for each individual the ability to enroll the most suitable individuals and to favorably impact them with an intervention may be enhanced. In fact, the whole concept of “N of 1” clinical trials has been brought to the forefront with the new opportunities of data capture and targeted intervention. Fourth, there are clearly issues of privacy and security that need to be addressed, as with any digitized package that engenders the possibility for hacking and breach of the data. Already this has been a significant issue with electronic medical records indicating that much work must be done in this area for avoidance of a “digital dystopia” in medicine. Fifth, the paradox of having so much (or too much) information for any individual but for physicians to instead treat the scan, genomic data, or physiologic metric.

Notwithstanding these challenges, there remains a distinct and exciting opportunity for medicine to undergo a radical transformation. One that is driven by consumers, as it is their DNA, their smartphone, and their data—leading to active participation and real empowerment. The likelihood that consumers can drive this revolution is health care is potentiated by powerful social networking which has already had the profound impact of rapidly mobilizing millions of people for common goals.

Ultimately the need for hospitals except for intensive care unit beds will be put to question, as most patients can have remote pan monitoring at markedly lower cost. Similarly, the need for in person office visits should be greatly reduced with the ability to rapidly transfer relevant data and leveraging video links such as Skype and Face Time.  This might be conceived as “house calls” for the 21st century.

The dominant outgrowth of digitizing human beings is the realization of practicing individualized medicine. Instead of the profound waste in the use of prescription drugs, which amounts to more than $300 billion per year in the United States, the use of pharmacogenomics offers promise of precisely matching up the right individual with the right drug and dose. Similarly, the ability to capture data we have never been able to see before in people, like continuous blood pressure, may be a segue for better protection from heart attacks and strokes. Beyond the single metric like blood pressure, systems to detect an impending asthma attack (via integrating multiple metrics) or congestive heart failure before they happen may fulfill the long-standing goal of prevention. Steve Jobs was right on target when he said, “I think the biggest innovations of the twenty-first century will be the intersection of biology and technology. A new era is beginning, just like the digital one was when I was my son’s age.”

Eric Topol is chief academic officer at Scripps Health, a professor of genomics at TheScripps Research Institute and the author of The Creative Destruction of Medicine.

Jeffrey Hogan|Northeast Regional Manager

Rogers Benefit Group

One Forest Park Drive| Farmington, CT  06032

P: 860.606.0370|F: 860.677.5098|C: 860.424.2600

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The healthcare market place is changing rapidly.  Agents and brokers have real opportunities with their plan sponsors to get tactical.  If members don’t have PCPs, many brokers/consultants are taking an activist approach to bring doctor’s groups into the group to educate.  If members are abusing the use of the emergency room (costing their plan big dollars) many brokers/consultants are educating groups on the value of retail clinics and other convenient ways to handle simple ailments and health annoyances.  What is telemedicine and what is telehealth?  If you aren’t investigating this phenom for your plan sponsors….you’re missing the boat.  Many members use technology and like it.  Many members are very busy and don’t have time for the nuisance of a cold or other malady.  Telemedicine promises to help these folks and will likely save a lot of money.  What do you say…..you haven’t heard about it?  Time to do some research.  If you aren’t talking to your customers about it likely someone else will.   See the post below.   Jeff

UK Finds Telehealth Reduces Mortality by 45%; Telehealth’s Tipping Point is 2012

Posted on December 14, 2011 by Brian Klepper

Jane Sarasohn-Kahn

Posted 12/13/11 on Health Populi

As we approach 2012, we health prognosticators like to forecast what we’ll likely see in 2012. One of the for-certain trends will be the uptake of telehealth programs, which will be publicly, privately, and jointly-funded. The business case is clear for telehealth, both in the U.S. and globally.

Jon Linkous, CEO of the American Telemedicine Association, told the mHealth Summit last week that, the “shift in the way healthcare is paid will put providers in driver’s seat when it comes to choosing the best way  to deliver healthcare and whether or not to use telemedicine.”

The forces are converging for telehealth to grow, based on sound business models, in 2012.

What’s held back the adoption of telehealth in the U.S. has been a lack of an evidence base. This week, the evidence based for telehealth grew with the announcement by the United Kingdom Department of Health’s Whole System Demonstrator Programme that telemedicine programs could reduce mortality by 45% in the UK. The Programme launched in 2008 and considers itself the largest randomized control trial of telehealth in the world, involving 6,191 patients and 238 general practices in 3 sites in England: Cornwall, Kent and Newham. The trial addressed three chronic conditions — COPD, diabetes and heart failure. At least 12 months’ worth of data for each patient was analyzed, concluding as of September 2010.

This landmark study found that “if correctly delivered,” telehealth could result in a 15% reduction in emergency department visits, 14% reduction in hospital admissions, and — the headline finding — a 45% reduction in mortality rates.

Several developments have also been announced in recent days that point to telehealth’s coming-of-age:

• Earlier this month, the USDA awarded over $30 million worth of grants to telehealth programs in rural areas around the U.S. The monies will support 100 programs in 30 states, according to a press release from the USDA.
• Beijing Ditan Hospital launched a telemedicine network to help stem the spread of infectious disease in China.
• PhoneDOCTOR (PDRx), one of several medical video-consult firms, hit its 30,000th telemedicine consult visit between doctors and patients this week.
• The Veterans Administration continues to expand telemedicine to patients who live far afield from VA Hospitals; this article talks about one program in California, representative of many innovative telehealth projects the VA has implemented.
• Telehealth programs are expanding beyond physical health to mental and behavioral health programs. Breakthrough in California extends psychological care at a distance to nursing home residents.
• Cisco and Walgreens are marketing telemedicine programs to corporate partners who want employees to be able to access health care through worksite clinics.
• The Grand Masonic Lodge of Pennsylvania donated $40,000 to Nemours to fund technology to enable doctors at A.I. DuPont Children’s Hospital in Wilmington, DE, to remotely evaluate young patients at Dover Air Force Base.

Note that the funding and business models for each of these projects varies – some government-funded, others supported solely by the private sector.

Health Populi’s Hot Points: As Linkous pointed out to the mHealth Summit, evolving models of health financing are laying the way and economic rationale for the adoption of telehealth programs by health care providers, from mobile health apps to remote monitoring and telehealth consultations for depression and dermatology.

Why is this the case? Current paying regimes in the U.S., with the exception of the VA/DOD and “closed” health plans like Kaiser, Group Health and Geisinger, are largely based on fee-for-service reimbursement where telemedicine’s costs can’t be absorbed into present coding mechanisms for payment. When payment is organized through accountable care, medical home, bundling and paying-for-performance, providers get reimbursed based on actual quality of care and outcomes — not on “production” or encounters. Frequency of in-person visits, in fact, is discouraged and disincented through these new kinds of payment programs. It is best to keep the patient comfortable, healthy and safe at home — or treated in lower-cost settings — than have the patient re-admitted into the emergency department, hospital bed, or rehab facility. Thus, remote monitoring, mobile health apps and helpful text reminders to take medications, become useful — I’ll emphasize crucial and strategic – complements to in-person visits with providers. Nurse and health educator callers and reminders, medication adherence tools like Vitality GlowCaps, and video-consults with providers (one-on-one or in groups) are being found to be cost-effective and quality-productive for both patients and providers.

While health care forecasts for 2012 will be cloudy on many fronts — from health reform certainties to physician and hospital payment amounts — telehealth is one area where we will see take-up approaching a tipping point in the U.S. Outside of the U.S., where payment for health care is more tightly budgeted and constrained, telehealth is already a no-brainer.

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