ODJFS submits final proposal to CMS to integrate care for Medicaid and Medicare enrollees and may click here to preview the final proposal.

HHS Proposes HIPAA Standard for A Unique Health Plan Identifier
A proposed rule announced today by the Department of Health and Human Services (HHS) would establish a unique health plan identifier (HPID) under Health Insurance Portability and Accountability Act of 1996 (HIPAA) standards for electronic health care transactions and may click here to preview the full announcement.

Ohio’s Medicaid Care Coordination plans are launching a new campaign that aims to educate Ohioans most in need about good health habits that can prevent potential problems.

“’Get Your Well On,’ is a collaboration of Ohio Medicaid’s seven care coordination plans under their Health Care Home approach,” said Kelly McGivern, President and Chief Executive Officer of the Ohio Association of Health Plans.

The Health Care Home’s “Get Your Well On” campaign will promote healthy behaviors and encourage visits with a primary care physician.

“Giving patients simple, eye-catching information on how to maintain good health can make a dramatic difference.  We feel that we can improve the health of Ohio families and the cost of health care,” said Linda Post, M.D., Medical Director for Unison Health Plan of Ohio.  “This campaign will reach out statewide to Ohioans in need and provide them with simple ways to eat well, move well and think well in order to be well.”

“The campaign’s central themes of preventive care and wellness are important factors to help reduce expenditure growth for Medicaid services related to the treatment of chronic conditions,” Said Tracy J. Plouck, State Medicaid Director.

The Medicaid Care Coordination plans are working with The Ohio Benefit Bank, Ohio’s Family and Children First Council, the Ohio Association of Second Harvest Food Centers, the Ohio After School Program, the Ohio Child Care Reference and Referral Agency, the Ohio Council of Churches, YWCA Columbus and  Special Olympics of Greater Cleveland to distribute information about the Health Care Home’s “Get Your Well On” campaign. Those documents are available on the project’s website, www.ohiohealthcarehome.com, which features local search options families can use to find health plans and local community resources.

“Early screening and detection are critical in receiving better, more affordable care,” McGivern said. “We hope the Health Care Home’s ‘Get Your Well On’ campaign will guide families who are searching for those resources.”

Governor Strickland has declared that September 2010 is “Get Your Well On” month in Ohio. Click here for a copy of the press release and the proclamation.

About Medicaid Care Coordination:

The State of Ohio contracts with private Care Coordination (formerly known as Managed Care) Plans. Care Coordination Plans are held accountable for coordinating virtually all aspects of members’ health, as proactively coordinating health care can better prevent the need for expensive health care treatment and contribute to lower health care costs.

Ohio’s Care Coordination Plans believe that to better coordinate a member’s health, it is critical to have access to social service support that can improve the member’s quality of life. Partnering with groups including the Ohio Benefit Bank and other service organizations has helped to link Medicaid Care Coordination consumers with those needed services.

Medicaid Care Coordination has delivered measured results, including a 28% decrease in infant emergency room visits, and a 50% decrease in very low birth-weight babies.

The “Health Care Home” approach is a collaboration of Ohio’s seven Medicaid Care Coordination Plans:

Amerigroup Community Care, Buckeye Community Health Plan, CareSource, Molina Healthcare,
Paramount Advantage, Unison Health Plan, and Wellcare of Ohio, Inc.

Click here for an article by Gongwer News Service.

With new laws in place permitting young adults to remain on their parent’s insurance policy until the age of 28, the Ohio Department of Insurance and the Ohio Association of Health Plans (OAHP) have partnered to educate one of the state’s largest uninsured populations about the importance of securing health insurance. As part of an outreach campaign to cover more young adults, a special website has been launched with information on how parents can secure the dependent age coverage through their employer or insurer.

“The goal of this campaign is to make young adults aware that without health insurance the ensuing bills from a medical emergency could saddle them with economic distress for years down the road,” Ohio Department of Insurance Director Mary Jo Hudson said. “Another important message is that parents can simply add their adult child to their policy through their employer or by contacting their insurer for a fee that can range in price.”

An estimated 55,500 additional “Young and Invincibles” now have access to health care coverage, due to the dependent age increase. This new dependent benefits kicks in either when a policy is issued or at the policy’s date of renewal. Previously, only dependents up to age 19, or up to 23 years old if they were still in school, were eligible to receive coverage under their parents’ policies.

“Ohio’s insurers are enthusiastically supporting this effort to reach young adults and their parents to inform them of changes in the law,” said Kelly McGivern, President and CEO of the Ohio Association of Health Plans. “Young people often feel they’re healthy and don’t need health insurance coverage, when this could not be further from the truth. Younger people are not invincible.  For example, young adults have the highest rate of injury-related emergency department visits among all age groups.”

Other components of the push to cover more young adults, includes: distributing posters to college and university campuses, a statewide email campaign targeting young adults, a YouTube video campaign, a Facebook account and a Twitter page. The website, at www.youngandinvincibles.com, also contains stats, stories, and video testimonials, about the need for young adults to have insurance.

The new federal law requires dependent coverage be made available until a child reaches age 26. The new state law requires coverage be offered to a child from age 26 until age 28. State law does not require the employer to pay for this added benefit, federal law does.

Ohioans with questions concerning health insurance, such as the dependent age increase, and other new health care reforms, are encouraged to contact the Ohio Department of Insurance by calling 1-800-686-1526. Free information can also be obtained at www.healthcarereform.ohio.gov and www.insurance.ohio.gov.

For a PodCast about the campaign and the change in the law click here.

Did you know that?

• 15 of Ohio’s health plans were listed in U.S. News and World Report’s Best Health Plans rankings for Commercial, Medicare Advantage and Medicaid Plans

• 85% of the Ohio Association of Health Plans member companies offer products accredited either by the National Committee for Quality Assurance or URAC

• Ohio is one of two states in the nation that are part of a web portal project linking insurers and physician offices in real time

• Insurers are using the latest technology, including smart phone apps to connect with customers 24/7

• Ohio’s health plans rank above the national average in consumer satisfaction according to JD Power and Associates

Anthem Blue Cross and Blue Shield is a co-winner with Humana in the Business and Operational Programs category for the Availity Initiative.  The Availity Initiative is a partnership between Ohio health insurance plans and health care providers which optimizes the information exchange between multiple health care stakeholders through a single, secure network.  The online network helps providers conduct administrative functions, including claims inquiries, billing, pre-authorizations and eligibility inquiries for Ohio health plans. Ohio is one of two states in the nation participating in this pilot effort.

Anthem received the Pinnacle Award in the Community Outreach and Partnerships category for its Radio Disney “Move It!” Program, promoting healthy lifestyles to kids to help combat the obesity epidemic. Anthem sponsored Radio Disney’s “Move It” program ,and it is estimated for the fall School Challenge, kids “moved” for 21,150,000 minutes.

Paramount Health Care was the winner in the Health Care Programs category for its renal management program “Aggressive Steps 2 Reduce the Burden of Chronic Kidney Disease.”  The program identifies and intervenes early, resulting in significant decreases in acute care utilization rates an annual cost savings of over $4,000,000 a year. The most important results achieved were no disease progression in 84% and disease regression in 7% of members.

AultCare was a Meritorious Award winner in the Health Care Programs category for its Education Kit Referral Program.  The program decreased emergency room visits 10%, inpatient claims 37% and inpatient days 33%.

“Ohio’s health plans have long played a vital role in improving quality of care and health outcomes for Ohioans,” said Kelly McGivern, president and CEO of OAHP. “Ohio’s health plans have created and implemented innovative initiatives that have improved quality in internal practices and administration, clinical disease management, delivery of programs and services and community outreach.”

OAHP member plans are invited to participate in the annual Pinnacle Awards, which provides health plans an opportunity to demonstrate what they are doing to provide exemplary care and service for their members and community. A panel of health professionals judged the submissions and selected the winners.

More than one in five children in the U.S. have insufficient access to nutritional and affordable food today, the result of a challenging economy that continues to affect low-income Americans.

The initiative will offer support and creative resources for families with children between the ages of 2 and 5 to cope with “food insecurity,” defined by the U.S. Department of Agriculture (USDA) and the U.S. Department of Health and Human Services as “households where there is a lack of access to enough food to fully meet basic needs at all times due to lack of financial resources.” There is growing concern that food insecurity could contribute to childhood obesity rates, which over the past three decades have tripled to nearly one in three children in America being overweight or obese.

Program outreach will include bilingual (English and Spanish) Healthy Habits kits with an original DVD starring the Sesame Street Muppets and a documentary of families along with their children using a variety of strategies for maintaining Healthy Habits for Life despite limited financial resources.

The kits will also include child-friendly recipes, activity cards and a parent/caregiver guide with information about healthful eating and ways to make nutritional and economical food choices for the entire family. In addition, AmeriChoice will send Healthy Habits for Life messages and information to low-income and vulnerable populations in public sector health care programs via the Web, physician mailings, and member mailings and newsletters that will go to 3 million members.

According to the USDA, more than 49 million people, including nearly 17 million children, live in households that experienced hunger multiple times throughout the year. In response, both the federal government and Congress are taking strong stances to improve children’s health.

In February, First Lady Michelle Obama announced her “Let’s Move” initiative to address childhood obesity and promote healthier food options to low-income neighborhoods. In addition, Congress and the USDA have made reauthorizing the Child Nutrition Act a priority this year. With few resources addressing the issue of food insecurity, today’s announcement represents a key effort to fill an unmet need for children and their families.

“With the Healthy Habits for Life partnership, AmeriChoice and Sesame Workshop have a tremendous opportunity to help parents and caregivers gain a greater understanding of the relationship between healthful food habits and children’s healthy growth,” said Rick Jelinek, chief executive officer of AmeriChoice. “We are committed to supporting low-income parents and their children with quality health care every day, and we are pleased to partner with Sesame Workshop to make a positive difference in children’s well-being and quality of life.”

“This is an opportunity for Sesame Street to continue to harness its power to help families and their children make healthful, nutritional decisions despite a limited income, at a time when nurturing children’s overall development is so critical and the subsequent positive effects can last a lifetime,” said Gary E. Knell, president and chief executive officer of Sesame Workshop. “AmeriChoice’s outreach and quality care in low-income communities makes them the ideal partner in this effort.”

Packed with great speakers and outstanding informational sessions, the 2010 OAHP Convention will help you in”Navigating a New Landscape” in healthcare. Register now by clicking here.

In addition, the OAHP Annual Convention and Trade Show offers the following continuing education credits:

• This activity has been reviewed and is acceptable for up to 8.0 elective credits by the American Academy of Family Physicians.
• This course has been approved for 8 Ohio Insurance Continuing Education Credits.
• This activity has been approved for 4.75 total CLE hours instruction.

The Fourth Annual CIGNA Choice Fund Experience Study is the latest evidence that more than any health reform proposal currently on the table, these innovative free market plans have been consistently proven to deliver actual quality, accessible health coverage at substantially lower costs.

“The empirical data is in and it’s undeniable: when health plans provide incentives for people to be engaged, their health care quality goes up and costs go down,” said CIGNA President and Chief Operating Officer, David M. Cordani. “CIGNA’s study shows that the incentives offered by consumer-driven plans — such as lower premiums, freedom of choice, and the ability to build up health savings — result in an immediate and sustained improvement in health care quality and lower costs.”

Key findings of the Fourth Annual CIGNA Choice Fund Experience Study include:

•Immediate and sustainable cost savings: CDHP medical costs are 14% less than traditional plans the first year, cumulative cost savings rise to 19% in the second year, 23% in the third year and 26% in the fourth year.

•Higher levels of care: People with CIGNA Choice Fund received recommended care at compliance rates that were similar or better than those covered by traditional CIGNA health plans. Key indicators such as use of preventive care, evidence-based care and disease management program participation were measurably better among those in CIGNA CDHPs than those in PPOs and HMOs.

•Less cost for those with chronic conditions: Medical cost trend was substantially less for CIGNA Choice Fund customers with hypertension (27% less), joint disease (21% less), and diabetes (15% less), than for individuals with either of those diseases in traditional CIGNA health plans. According to the study data, these cost savings were achieved without sacrificing care. According to Cordani, if the share of Americans enrolled in a CDHP rose from a current 18% to 50%, and the results of the CIGNA study were applied, the U.S. could achieve $350 billion dollars in savings over 10 years.

Chris Policinski, President and CEO of Land O’Lakes, Inc., noted: “Offering consumer driven health plans to Land O’Lakes employees is helping to keep health care costs in check, while maintaining or improving care quality. For Land O’Lakes, this approach supports our commitment to employees, while at the same time ensuring that we remain highly cost efficient.”

Customer: Engagement is Key

One of the nation’s premier agricultural cooperatives, Land O’Lakes, Inc., offers both CIGNA Choice Fund CDHP and traditional health plans. The company confirms that its employees are increasingly electing to enroll in the CDHP for cost savings – with eight of 10 employees choosing CDHP over traditional managed care plans.

“Since January 1, 2007, when our first CDHP was offered, our company and employees have saved more than $10 million in health plan costs,” said Land O’Lakes Director of Benefits and HR Operations Pamela Grove. “From 2006 to 2007, our health care trend decreased from 13% to negative 5% – a decrease of 18% year over year. Our employees are making smart choices: increasing their use of preventive care and the CIGNA 24-hour nurse line, as well as opting to use less-costly urgent care facilities or convenience care clinics rather than heading to the emergency room for non-emergency events.”

“We attribute this enormously successful enrollment to honest and open communication with employees coupled with consumer-focused information and tools,” said Grove. “That’s a strategy that we will continue to focus on and, so far, it has produced very impressive results.”

Individuals Making the Most of their Health Benefits

Noting the solid clinical compliance among those enrolled in CIGNA Choice Fund plans, CIGNA Chief Medical Officer, Jeffery Kang, M.D. said: “America is a land of smart shoppers, and what our study shows is given the right plans, tools and information, people will make rational, wise and successful health care decisions.”

Individuals enrolled in CIGNA Choice Fund plans continued to receive recommended care at the same or higher levels as those enrolled in traditional plans in an evaluation of compliance with 400 evidence-based measures of health care quality. In fact, first year Choice Fund customers had higher statistical compliance with 11% of evidence-based measures than their counterparts in traditional plans, and 16% higher for Choice Fund customers enrolled for multiple years.

Moreover, individuals with chronic illnesses covered by CIGNA Choice Fund plans are more engaged and more likely to comply with and complete their plan disease management programs. Disease management program follow-through and completion rates are 22% higher among those in CIGNA Choice Fund plans than their counterparts in traditional CIGNA managed care plans.

Preventive care visits for first-year CIGNA Choice Fund customers were an average of 16% greater when compared to traditional plans, with CDHP preventive care visits continuing at higher rates than those in traditional plans in the second year.

The trend in pharmacy costs for new CIGNA Choice Fund customers who also have their pharmacy benefits with CIGNA was cut by more than half when compared to those enrolled in traditional plans.

“CIGNA’s mission is to improve people’s health, well-being and sense of security;” said Dr. Kang. “During the past four years, CIGNA Choice Fund studies have consistently demonstrated that CDHPs are part of the solution for creating a more affordable, accessible, sustainable and high quality healthcare system.”