To Doreen Salek, a director at Geisinger Health Plan, the math is pretty simple. Hire 3,000 registered nurses — if you can find them — to staff a full RN case management model for a large accountable care organization (ACO). Or invest in a telemonitoring system that can cut your staff needs in half, and target a much smaller number of living, breathing nurses for the patients most in need of case management. Computerized interactive voice response (IVR) technology can help ACOs prioritize... Read more

Aetna Inc. has an offer for its work force: $300 for each year they stave off obesity. The insurer has targeted a wellness incentive program for weight management to its 35,000 employees — not an easy group to design health interventions for, according to Nancy Novo Lusignan, benefits manager of employee wellness and work/life programs at Aetna. “That’s 35,000 employees who are all constantly telling us what we should be doing because they’re all experts,” she quipped. Lusignan reported on... Read more

Although the Medicare Shared Savings Program (MSSP) is open only to providers operating in the traditional Medicare fee-for-service program, that hasn’t stopped Medicare Advantage plan operator Universal American Corp. from getting involved. The insurer, which has a long history of collaborating with provider groups in the MA market, has launched a subsidiary that provides financial and other support to providers participating in the MSSP. Already, CMS has selected 16 providers partnered with... Read more

Health insurers this morning are watching another upheaval in their pharmacy supply chain, as major retail pharmacy Walgreen Co. said it would buy a majority stake in Alliance Boots GmbH. Health insurers’ pharmacy partners have been consolidating at a rapid rate. After the two largest PBMs, Express Scripts Inc. and Medco Health Solutions, Inc., combined earlier this year, many pharma watchers had been expecting Walgreens to make a major strategic move, in the continuing effort to stabilize... Read more

There must have been a certain amount of schadenfreude among providers watching Health Net, Inc. report a $27 million first-quarter 2012 loss, triggering a 25% drop in its share price. After all, Health Net attributed blame for its woes partly on an inability to comply with updated 5010 electronic transaction standards under the Health Insurance Portability and Accountability Act (HIPAA). When CMS set a Jan. 1, 2012, deadline for providers and insurers to comply with these updated standards,... Read more

Way back in 1957, “Blue Cross” was already synonymous with “health insurance” for many people. In the Warner Brothers animated short Show Biz Bugs, Daffy Duck was already looking for the familiar cross and shield in his wallet. Sure, most of us don’t get sawed in half by Bugs Bunny as part of performance art gone wrong. But when Daffy realizes that Bugs’ magic trick actually worked, the Looney Tunes character tells the audience, “Good thing I got Blue Cross!” Today, though, Blues plans are... Read more

When the White House said its proposed 2013 budget calls for more than $350 billion in cuts to HHS over 10 years, health insurers could be excused for assuming the worst, after getting a major hit in fees via the health reform law. But perhaps payers have suffered enough already. In the 2013 budget, “Pain is felt by pharma, providers, states and the ‘rich,’” say equity analysts Tom Carroll and Mark Kelly at Stifel Nicolaus. That may indicate that “regulators continue to be satisfied with the... Read more

Ten years ago, Managed Care Week — the predecessor to Health Plan Week — reported that PPOs were losing market share to HMOs as employers searched for more affordable coverage. In 2012, the opposite is true, as employers and insurers boost cost sharing using the coinsurance and deductibles in PPO-type products to reduce medical cost trend. The Jan. 21, 2002, issue of MCW reported that although PPOs still were insurers’ strongest-selling products, they “may be losing their luster due to... Read more

XLHealth Corp. is a well-regarded operator of Medicare Advantage special needs plans for chronic illnesses, but neither the company nor the product line is a household name. That may soon change, however, as the Baltimore-based MA plan is the subject of a bidding war among giant health insurers and as costs associated with beneficiaries with these conditions have risen. Aetna Inc., UnitedHealth Group and WellPoint, Inc. are among the insurers said to be in the running to purchase XLHealth,... Read more