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.

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.”

“Ohio’s health insurers are concerned about the health and wellness of those they insure and also with the health and vitality of their communities,” said Kelly McGivern, President and CEO of the Ohio Association of Health Plans. “In addition to supporting a variety of beneficial community projects throughout the year, Ohio’s health plans and their employees continue their charitable giving and service during the holiday season.”

“During these tough economic times, when more and more Ohioans are struggling just to provide the basic necessities, we appreciate the efforts that Ohio’s health plan employees have made to provide food, clothing and other essential items to their fellow Ohioans,” said Lisa Hamler-Fugitt, Executive Director of the Ohio Association of Second Harvest Foodbanks.

Some of the programs and projects that the Ohio Association of Health Plans’ member companies are supporting this holiday season include:

• Aetna’s Columbus-area employees collected food items and monetary donations for  the local food bank with an emphasis on Thanksgiving.
• In lieu of company-wide holiday celebrations, Anthem Blue Cross and Blue Shield is making a donation to Feeding America on behalf of all of its associates. Anthem’s donation, along with all other plans through its parent company, Wellpoint, will help provide more than two million meals to those in need in local communities throughout several states including Ohio. Additionally, Anthem’s parent company is making a donation to the USO to provide care packages and other support services to military personnel being deployed. Anthem associates will also participate in various holiday activities throughout its Ohio locations, supporting organizations that include Adopt-a-Family, food and/or clothing drives, Toys for Tots, Adopt-a-Charity, and donations to the homeless.
• AMERIGROUP Community Care employees donated boxes of food and gently used clothing to Matthew 25 Ministries during the month of November. Additionally, employees are participating in the Salvation Army’s Angel Tree to provide toys and clothing for families in need.
• AultCare employees raised funds for 15 children in the BackPack program which sends food home for needy families in children’s backpacks.
• AultCare is also working in conjunction with Aultman Hospital’s blood bank to raise blood donations and food for the needy. A $10.00 donation to Stark County Hunger Task Force will be made for every blood donation AultCare employees make through the end of November.
• CareSource employees are undertaking a “Save the Foodbanks” campaign from Dec. 7-11, with the goal of collecting over 10,000 lbs. of food for the Cleveland Foodbank, Mid-Ohio Foodbank (Columbus), and The Foodbank (Dayton) with an emphasis on healthy foods.
• The Health Plan was a food collection site for the Boy Scouts’ “Scouting for Food” project. In addition, the Health Plan sent 100 filled stockings to U.S. troops overseas and is collecting items for needy families to support the Belmont County Salvation Army’s Angel Tree Project.
• MediGold employees are participating in Mt. Carmel’s Angel Tree Project which benefits needy families on the east side of Columbus.
• Molina Healthcare of Ohio, Inc. employees are holding a pajama drive – collecting new pajamas, stuffed animals and children’s books to donate to shelters for victims of domestic violence. In addition, Molina is making monetary donations to the following groups: Life Enrichment Center (Dayton); Reach Out of Montgomery County (Dayton); The Homeless Families Foundation (Columbus); Jackson Area Ministries (Jackson); Miami Valley Youth Career Center (Dayton); Helping Young Mothers Mentor (Cincinnati).
• Paramount annually adopts between 4-6 low-income families who are enrolled in our Paramount Advantage plan. At Christmas, each family is given toys, clothing and food for the holiday. Paramount also adopts a nursing home and at Christmas donates socks, lotions, playing cards and games for the residents’ use. Additionally, Paramount Advantage provides funds and volunteers to the following sponsorships: Thanksgiving Families-Meijer dinners – one Allen County and one Lucas County family; Innkeepers Annual Thanksgiving Dinner (Defiance County); Cheryl Allen Breakfast with Santa (Allen County); Toledo Day Nursery Christmas Party.
• Unison Health Plans of Ohio’s employees are collecting new socks for the Hannah’s Socks project in Toledo and providing turkeys for the Salvation Army in Athens.
• UnitedHealthcare of Ohio and Unison Health Plan employees are participating in a United Day of Service on December 9, collecting food and helping out at the Mid Ohio Food Bank, and emphasizing the importance of childhood obesity prevention

“Ohio’s health plans and their employees recognize that with the rocky economy, lending a helping hand this holiday season is more critical than ever,” added McGivern. “We encourage others to look for ways to help make a difference in the lives of those less fortunate.”

The Ohio Association of Health Plans joined with physicians, hospitals, business leaders, and statewide health advocates to support the Healthy Choices for Healthy Children legislation that was introduced today in both the Ohio House of Representatives and Ohio Senate.

“Ohio’s health plans fully support this effort to improve the health and wellness of our most precious resource – Ohio’s kids.  By coming together with health and business leaders to drive this initiative, we will not only make great strides in improving the health and quality of life for Ohio children but also begin to address the long-term health care costs that are straining our health care system,” said Kelly McGivern, President and CEO of the Ohio Association of Health Plans.

The Healthy Choices for Healthy Children legislation introduced by Senators Kevin Coughlin and Eric Kearney and Representatives John Carney and Lynn Wachtmann, does the following:

• Raises the bar to ensure children have access to nutritious foods in the school setting;
• Builds physical activity into the daily school routine and focusing on the importance of quality physical education to children leading healthy lifestyles;
• Measures and reports progress through routine screenings and communication with parents;
• Creates a council of experts, appointed by the Governor and the Ohio General Assembly, to shape school-based solutions to childhood obesity.

“By building good health habits for our kids early in life, we can help them become more healthy adults,” added McGivern.

Employees from the member companies of the Ohio Association of Health Plans are participating in a wide variety of Make a Difference Day Ohio activities October 23-24 in order to lend a helping hand to those in need in their communities.

Health insurance employees from all corners of Ohio are a participating in this statewide effort of voluntary service to their communities. The projects they will participate in range from holding a blood drive, helping with free health clinics, collecting food for the BackPack program and other food banks, to painting a computer lab at a transitional housing program for homeless and jobless families.

“Ohio’s health insurance companies and their employees care deeply about their neighbors and their communities,” said Kelly McGivern, President and CEO of the Ohio Association of Health Plans. “By sharing their time, talents and giving generously, health insurance employees have demonstrated their commitment to their fellow Ohioans and have made a positive difference.”

Make A Difference Day is the nation’s largest day of citizens volunteering to make communities stronger.  Founded by USA Weekend Magazine and the Points of Light Institute, Make A Difference Day is the largest national day of helping others. Make a Difference Day Ohio (MDDO) was created to promote participation by Ohioans in the national effort. Since 2000, when MDDO was established, Ohio has led the nation in the number of service projects.

Ohio’s First Lady Frances Strickland and OSU Football Head Coach Jim Tressel are the honorary co-chairs for this year’s MDDO.

Following is a list of Ohio Association of Health Plans’ companies and the projects they are participating in:

• Aetna – Columbus-area employees are collecting food items and monetary donations for the local food bank with an emphasis on Thanksgiving.
• AultCare – collecting food for the BackPack program that helps fill backpacks with food that children take home on weekends and holidays in Stark County
• Buckeye Community Health Plan – Employees participated in a dress down day with proceeds benefiting the United Way
• Molina Healthcare of Ohio- Columbus employees will take part in a blood drive to benefit the American Red Cross
• SummaCare – Akron employees will have the opportunity to support Hattie Larlham. Representatives from the organization will be selling their unique items at SummCare’s offices, including: artwork, candles, coffee and salsa. Hattie Larlham provides services to children and adults with disabilities through community homes, respite/private duty home care, foster care services, an integrated day care, animal programs and vocational training.
• The Health Plan – employees from St. Clairsville area worked in free clinic for United Way Day of Caring; Run/Walk events earned monies for Catholic Charities, Sam Mumley scholarship fund, American Cancer Society, The Debbie Green Memorial fund, Race for Grace, and the Wheeling YMCA.
• United Health Care- Columbus-area employees are collecting items for food bank with partners with a focus on childhood obesity
• Unison Health Plan – sponsoring Jackson County Make a Difference Day activities and employees are walking in the Making Strides against Breast Cancer walk
• WellCare of Ohio – painting a computer lab at a transitional housing program for homeless and jobless families in Cleveland.

Seniors in Medicare Advantage spent fewer days in a hospital, were subject to fewer hospital re-admissions, and were less likely to have “potentially avoidable” admissions, for common conditions ranging from uncontrolled diabetes to dehydration, a recent study has shown. 

More benefits; lower cost

In addition, many participants in Medicare Advantage have better access to preventive care and disease management than they otherwise would have. Because Medicare Advantage enhances benefits at lower cost, seniors also receive a great value “an average $56 a month more in benefits for fee-for-service plans and an average $71 a month more for managed care options, compared to the original Medicare program. Overall savings for seniors enrolled in Medicare Advantage is an estimated $100 a month.

Medicare Advantage plans have unique service options for seniors, including: prescription drug coverage, vision, and dental coverage. Some Medicare Advantage plans even include health club memberships and other health and wellness services. 

For Ohioans interested in enrolling in a Medicare Advantage plan, click here for a list of the 147 Medicare Advantage plans serving seniors in our state.  Online open enrollment begins November 15, 2009 and goes through December 31. Coverage secured during this open enrollment period will begin January 1, 2010.

Those who need enrollment assistance (starting November 15) and/or information about financial assistance programs can call the Ohio Department of Insurance’s OSHIIP program at 1-800-686-1578 Monday through Friday, 7:30 a.m. to 5 p.m., or Medicare at 1-800-MEDICARE (1-800-633-4227), 24 hours-a-day, seven days-a-week.  In addition, seniors can click here for a guide from the insurance industry for help in choosing a Medicare plan and help choosing one with prescription drug coverage.

“Working collaboratively to find ways to simplify administrative processes for providers and patients is a priority for the member companies of the Ohio Association of Health Plans” said Kelly McGivern, President and CEO of the Ohio Association of Health Plans. ”This innovative project will help streamline and accelerate insurance eligibility and payment processes, saving time for both providers and patients. We are pleased that Ohio was chosen for this pilot and hope the results can advance programs in other states.”

Beginning in Ohio later this month, America’s Health Insurance Plans (AHIP) and the Blue Cross Blue Shield Association (BCBSA) will sponsor regional and statewide initiatives to assess how best to offer physicians access to multiple insurers through the same channel of information exchange (e.g., a web portal) in a given region of the country for the purpose of conducting key office tasks. Savings are estimated in the hundreds of billions of dollars as the entire health care system achieves efficiencies through similar moves to automation and consistent business practices.

This landmark initiative addresses the need for one-stop service in electronic transactions that physicians have advocated for strongly, and is a requirement to achieve the level of savings that is ultimately possibly. It replaces a cumbersome system in which physician office staff spend considerable time at considerable expense accessing multiple channels to get the information needed to complete basic requirements for confirming eligibility, billing, and referrals. The ultimate goal is to develop regional services that span the entire country.

The Ohio initiative offers opportunities to simplify the work associated with patient visits and achieving savings, including providing physicians with information in “real-time” that:

• Allows office staff to quickly determine key eligibility and benefit information (e.g., co-pays, co-insurance, and deductibles, and differences in coverage for services provided in- versus out-of-network), minimizing the number of staff needed for such purposes;
• Gives physicians access to current and accurate information on the status of claims submitted by physician offices for payment by insurers. This will minimize the need for follow up steps by office staff or submission of duplicate claims that delay rather than expedite payment in most systems;
• Tests real-time referrals and timely pre-authorization of services; and
• Provides for the online submission of a healthcare claims.

In a recently released poll by CBS News, two-thirds of Americans admitted they were confused about health care reform. This evaluation cuts across party lines, with majorities of both Republicans (69 percent) and Democrats (58 percent) saying the current proposals are confusing.

Health plans want to be clear: we support of comprehensive health care reform to cover all Americans, make care more affordable, and improve quality.  Below are five simple health reform principles our industry has proposed:

• Guaranteed coverage for everyone
• Eliminating pre-existing conditions
• Premiums not based on gender or health status
• Personal coverage requirement so that everyone has health insurance
• Making coverage more affordable

For more information about health reform, click here.

What’s the cost?

The difference between what out-of-network providers charge can be several hundred or even over a thousand percent of the Medicare reimbursement for the same service in the same area.  Click here for a link to a chart with information on some of the differences in Ohio.

When health insurance providers contract with credentialed providers, health plans ensure consumers affordable access to a wide choice of high-quality doctors and hospitals. Nationally, it is estimated that close to 90 percent of providers participate in networks.

Consumers see measurable savings when they visit contracted providers because in-network physicians are generally prohibited from charging patients the difference between billed charges and a negotiated rate.

For a link to the entire study, click here.

(photo courtesy of FotoLink)

Not just for teens anymore–social networking and media tools such as Facebook, Twitter and YouTube are being used by adults to interact with their friends, families and to gain information. Now, Anthem Blue Cross and Blue Shield members can add these tools to the list of ways to interact with their health insurer. In an effort to remain engaged and responsive to its members like never before, Anthem Blue Cross and Blue Shield in Ohio is leveraging highly interactive social media communities as a way to interact with its members, and for members to interact with Anthem.

“At Anthem Blue Cross and Blue Shield, we recognize that more teens, adults and even seniors are logging online to network, blog or even ‘tweet’ about their daily activities and preferences,” said Erin Hoeflinger, president of Anthem Blue Cross and Blue Shield in Ohio. “Tools such as Twitter and Facebook provide an additional means of communicating with our members and all consumers in the communities we serve in a way that’s convenient and of interest for them.”

Currently, Anthem is piloting a program in which it uses Twitter to identify members who may have questions or concerns about their health benefits. Twitter allows Anthem to communicate and stay connected through the exchange of quick, real time conversation, and respond to each tweet about Anthem. Members can follow Anthem on Twitter at www.twitter.com/AnthemHealth.

Twitter is also one component of Anthem’s collaboration with Bob Harper from “The Biggest Loser” to provide information and tools to help members and people in our communities live healthy lives. After only one month since the launch, more than 3,500 people are following Bob’s regular tweets with tips on how to get healthy and stay healthy at www.twitter.com/BobHarperAnthem

Additionally, Anthem is also utilizing Facebook (www.facebook.com/anthemhealthfootprint) to create a community where people can interact with Anthem and with each other, and learn about how our health is connected and how one person’s healthy behaviors can positively affect someone else’s health behaviors. Anthem is also launching a brand channel on YouTube (www.youtube.com/AnthemHealthConnects) to create a vital and viral community around health and wellness.

“Building relationships with our members and showing the human face of our company is critical, especially today when so many rely on online tools and communications for all aspects of their lives, but even more so with something as personal as health care,” said Kate Quinn, vice president of corporate marketing for Anthem’s parent company. “Social media provide a great opportunity for us to engage our members, listen to them and be more responsive.”