Health Plans/Managed Care

Health care solutions and benefits management for employers and HR teams. Providing direction on health care consumerism and population health and wellness.
Catalyst Rx New Sales Top $250 Million Annually; Company Completes Strategic Acquisition
Catalyst Rx announced today that it secured new PBM business cumulatively representing more than $250 million in annualized revenues and acquired Total Script, a PBM based out of Broomfield, Colorado.

Consumer Health Technologies and My Wellchoice+ Announce Strategic Alliance
onsumer Health Technologies, Inc. and My Wellchoice+ have joined forces to provide third-party administrators, payers and financial institutions a one stop destination for interactive fitness, nutrition, and emotional assistance programs as well as other wellness services.

Employers Recognize Potential Impact of Employee Health Management on Future Plan Costs
Financial Incentives Rank High In Developing Better Health Care Consumers

What’s Working: Managing Retiree Health Benefits
Employer-sponsored retiree medical plans are re-emerging as a top corporate priority as employers struggle to balance cost-cutting mandates, new marketplace opportunities, and the retirement of older workers.

Allsup Medicare AdvisorSM Offers a Way to Guide Employees from Group Health Plans to Medicare
Human resources and benefit plan administrators now have a convenient, comprehensive solution for coordinating Medicare coverage for retirees, workers 65-plus and inactive employees with disabilities covered under company group health plans

Doctor Numbers Don't Add Up for Universal Healthcare Plan
Universal health care can diminish access to health care

Voluntary Benefits Plans Find Resurgence in CDHC Scenarios
There’s no doubt that consumer-directed health plans (CDHP) are here to stay, which can leave employees potentially exposed to new areas of risk.

Transparency and Communication: Keys to a Successful Benefits Strategy
Garden Fresh Restaurant Corp. shares it's experience in implementing a CDHC plan design.

A New Chapter in Retiree Health Care
The exploding costs of health insurance and medical care, coupled with the devastating impact of the recession, have employers facing a new world of constraints when it comes to retiree benefits.

Fringe Benefit Group Adds Nationwide Investment Platform to The Contractors Plan
Retirement Solution Now Available to Contractors Working on ARRA Projects

Employers Prefer Incremental Approach to Health Care Reform
New Mercer survey reveals strongest support for quality measures and market reform

National Survey Finds Americans Want Choice in Health Insurance
Many opposed to government run health care system

OptumHealth, American Well Provide First Service Offering Consumers 24/7 Online Access to Physicians
Two Innovative Technologies, Powered by Real-time Information, Allow Individuals to Reach Doctors When Needed, and Doctors to Deliver Better-Informed Care

COBRA Survey Finds Recession Takes Hold: More Eligible, Fewer Signed Up, Costs Stay High
Spencer’s Benefits Reports COBRA Survey Finds Recession Takes Hold: More Were Eligible, Fewer Signed Up, Costs Stay High

Mayo Clinic and Microsoft Deliver a Powerful and Personalized Consumer Solution For Managing Health
Mayo Clinic Health Manager, Powered by Microsoft HealthVault, Helps You and Your Family Become Better Organized, Better Informed

Account-Based Plans Are Commanding Major Attention
Trends, Utilization and Costs of Consumer Driven Health Care Accounts

CheckPoint HR Rebrands Benefits Arm to Deliver Complete HR and Benefits Solution


Two Prescription Solutions Executives Named to Prestigious Health Care Boards
John Jones Elected to Academy of Managed Care Pharmacy and Dr. Brian Solow Appointed to the Pharmacy & Therapeutic Society

Despite Escalating Costs, Employee Healthcare Benefits Aren’t on the Chopping Block
Employers Continue to Regard Healthcare Benefits Programs as Vital to Maintaining a Healthy, Productive and Loyal Workforce during a Down Economy

The Temporary COBRA Subsidy – What Employers Need to Know
April/May 2009

Difference Between Limited Medical Plans
A breakdown of Limited Medical Plans

Self-Funded Health Plans Can be Cost-Effective, Member-Friendly
Being a self-funded employer gives you flexibility and creativity in benefit plan design, the perfect combination for a successful CDHC plan.

Health Care Costs Make Limited Medical Benefit Plans More Attractive
Limited medical benefit plans might be the flexible, affordable solution that employees want and need.

Guardian Enhances Medical Plans with New Wellness Benefits
New Initiatives Help Plan Members Better Manage Healthcare Needs and Spending

Guardian Launches comprehensive, Consumer-Driven Healthcare Program
New Program Pairs Medical Plan with Health Savings Accounts and Supplemental Coverage for Critical Illnesses and Hospital Stays

While We’re Waiting for Health Care Reform … Things We Can Do Now to Control Rising Costs
It’s easy to complain about the rising cost of health care — everybody does. But what can be done about the problem?

New Research from EBRI: Many Support Lower Cost Sharing to Change Health Care System Use
Many Americans support the use of lower cost sharing as an incentive to change the way individuals use the health care system

FieldMedia Announces Convergence of Successful Web Communities With Launch of EmployersWeb.com


CIGNA First to Offer Quicken Health Expense Tracker
Online Tool to Improve the Way Individuals Manage Their Health Finances

New CIGNA Website Educates and Serves Customers


Adoption of Consumer-Driven Health Plans Accelerated by Recession, Study Says


American CareSource Holdings Signs New Client Agreement With Principal Financial Group


Benefit Informatics Introduces Executive Summary to Save Time, Resources for Health Plan Analysis
New service combines multiple data analysis and reporting functions in one application

Solutions Outlook: Doing Nothing is the Most Expensive Option


Solutions Outlook: Employers Can’t Afford to Wait for Washington to Fix Health Care
Purchasers must be the change agent for long-term, sustainable health care reform

Concentra’s Health Care Solution Can Bring Relief to Weakened Auto Industry


The Future of CDHC 2008
What will it take to transform the US into a truly consumer-driven system?

Consumer-Directed Health Care Plans vs. Traditional Plans
A nagging question for human resource decision-makers: How do CDHC plans, which are usually high deductible health plans paired with innovative programs, compare with traditional health insurance plans? It’s not always easy to explain, but consultant Jay Savan, a principal at Towers Perrin, spells out how they compare in this interview. Savan, who has been on the forefront of the consumer-directed health care movement since 1998, believes that account-based consumer-directed health care is “the way health insurance is going to right itself.” He’s been in the industry, primarily advising employers, since 1985 and has worked for A. Foster Higgins & Co. (now part of Mercer) and Arthur Andersen, among others.

Playing Hide & Seek With the Health and Wealth Info Consumers Want and Need
Metavante investigates challenges consumers face when it comes to managing their health plans and tax-advantaged benefits accounts online.

Getting People Moving
Health plans are discovering that they have a role to play in engaging people and assisting them to manage their health. Humana’s leaders have challenged the company to be consumer-oriented and the industry to be smarter about a comprehensive health strategy. Here’s what its Innovation Center is implementing and the results it is seeing.

Humana’s New National Care Center Takes Consumer-Focused Health Care To The Next Level
Humana nurses, social workers provide personalized telephonic and field care management to improve health and quality of life for Humana members nationwide

The ROI for Targeted Therapies: A Strategic Perspective Assessing the Barriers and Incentives for Ad
Produced by the Deloitte Center for Health Solutions

Adoption of Personalized Medicine May Yield Significant ROI
Time to Achieve Benefit Varies Among U.S. Health Care Stakeholders, According to Deloitte Greatest ROI opportunity for consumers in shortest period of time

Consumer-Directed Health Care From the Ground Up
Hear from various stakeholders who speak to what this emerging paradigm needs in order to reach its potential to transform health care.

Presidential Candidates’ Health Care Platforms: Who is on the Side of the Employer?


Reduce Costs and Improve Quality With a Myriad of Alternative Care Choices
Inside this special supplement: * Onsite Health Clinics: Not Our Parents’ Doctors’ Office. * Onsite Health Clinics: Tips for Combining With Integrated Care Solutions. * Online Doctor Visits * Second Opinions and Decision-Making Solutions

Swiss Re's Employer Stop Loss Product Offers US Companies Cost Savings
Swiss Re's Employer Stop Loss Product Offers US Companies Cost Savings for Self-Funded Health Insurance Plans

What Employers Want From Health Insurers--Now
In 2008, PriceWaterhouseCoopers' research team surveyed senior executives at more than 100 large US-based multinational companies and more than 250 privately held small companies. The large companies each have an average of 8,000 employees and revenue of about $3 billion. The small employers each have a workforce of about 200 and less than $50 million in revenue. In addition, PwC surveyed more than 500 human resources executives separately on benefit plan design issues. This white paper discusses the results of this survey.

CIGNA Study: Americans with CDHPs Cut Medical Costs Without Cutting Care
Study Shows CDHP Cost Savings Can Help in an Ailing Economy

RedBrick Health Expands Services for Hannaford Bros. Co. Associates
Leading regional supermarket operator supports its workforce with smart solution to rising health care costs

Strategic Flexibility for the Health Plan Industry
The Next Move for Growth & Innovation in an Uncertain Market

Opportunities for Health Plans in a Consumer-Driven Market
A Point of View Based on Deloitte’s 2008 Survey of Health Care Consumers

Health consumerism
Health consumerism is a movement which advocates patients’ involvement in their own health care decisions.

Joint Commission International (JTI)
The Joint Commission (International) is a private sector United States-based non-profit organization. It is the best known of a large number of active healthcare accreditation groups in the USA

Formulary
A formulary is a list of prescription drugs covered by a particular drug benefit plan.

Scheduled health insurance
Scheduled health insurance plans may provide benefits for hospitalization and surgical, but these benefits will be limited. Scheduled plans are not meant to be effective for catastrophic events.

Comprehensive health insurance
Comprehensive health insurance pays a percentage of the cost of hospital and physician charges after a deductible.

Coinsurance
With coinsurance, instead of paying a fixed amount up front (a copayment), the policy-holder must pay a percentage of the total cost. For example, the member might have to pay 20% of the cost of a surgery, while the health plan pays the other 80%. Because there is no upper limit on coinsurance, the policy-holder can end up owing very little, or a significant amount, depending on the actual costs of the services they obtain.

Capitation
Capitation is an amount paid by an insurer to a health care provider, for which the provider agrees to treat all members of the insurer.

Out-of-pocket maximums
Out-of-pocket maximums are similar to coverage limits, except that in this case, the member's payment obligation ends when they reach the out-of-pocket maximum, and the health plan pays all further covered costs. Out-of-pocket maximums can be limited to a specific benefit category (such as prescription drugs) or can apply to all coverage provided during a specific benefit year.

Premium
A premium is the amount the policy-holder pays to the health plan each month to purchase health coverage.

Medical Savings Account (MSA)
A Medical Savings Account (MSA) is an account, generally associated with self-employed individuals, in which tax-deferred deposits can be made for medical expenses.

High Deductible Health Plan (HDHP)
A High Deductible Health Plan (HDHP) is a health insurance plan with lower premiums and higher deductibles than a traditional health plan.

Limited medical benefit plans
Limited medical benefit plans pay for routine care and do not pay for catastrophic care.

Discount medical card
Discount medical cards are not insurance policies, but provide access to discounts from participating health care providers.

Employer-sponsored health insurance
Employer-sponsored health insurance is paid for by businesses on behalf of their employees as part of an employee benefit package.

Managed care
The term "managed care" is used to describe a variety of techniques intended to reduce the cost of providing health benefits and improve the quality of care.

Single-payer health care
Single-payer health care is an American term describing the payment for doctors, hospitals and other providers of health care from a single fund.

Universal healthcare
Universal health care is health care coverage that is extended to all eligible residents of a governmental region. Universal health care often covers medical, dental, and mental health care.

Medical underwriting
Medical underwriting is an insurance term referring to the use of medical or health status information in the evaluation of an applicant for coverage (typically for life or health insurance).

Consumers/Employers Paying Almost $90 Billion Due to Under-Payments by Medicare and Medicaid
‘Hidden tax’ leads to higher premiums for families and employers

SIIA’s Letter Defends Employer-based System
SIIA Chief Operating Officer Mike Ferguson provided an aggressive defense of the employer-based self-insured health care system in his letter-to-the-editor published in today's Wall Street Journal that rebutted the op-ed article in the Journal by Dr. Ezekiel J. Emanuel of the National Institutes of Health and Senator Ron Wyden (D-OR) that was published on Dec. 10, 2008. Mike’s letter is reprinted here in full...

PwC Names Top Nine Issues for Health Industries in 2009
PricewaterhouseCoopers Identifies the Top Nine Issues for Health Industries in 2009 Financial Crisis, New Administration to Accelerate Health Reform Changes Ahead

New Short-Term Health Care Coverage Offered for Unemployed
AmWINS Group Benefits’ BridgeCare makes temporary medical coverage readily available to 9.5 million unemployed Americans

Aetna Introduces i.Choose Voluntary Benefits
Expanded suite of offerings allows employees to choose what benefits are most important to them and gives employers an affordable way to offer coverage

Medical Care Finally Embraces the Internet
Online medical care is the latest addition to many benefits packages.

A Cost and Quality Solution Case Study
An increasing number of employers are focusing on helping employees get the right care as the key to address the quality and cost of medical care by utilizing second opinion specialists.

ConnextionsHealth Click-to-Chat
As consumers of all ages and demographics become more Internet savvy, their expectation of immediate issue resolution at each customer service touch point rises. In response, companies are investing heavily in multi-channel, integrated Member Acquisition Retention and Service (MARS) technologies – that can include self-service, voice, email, and Click-to-Chat, or “Chat.”

Adding HSAs to Your Benefit Plans
Tips first-time buyers can use to add HSAs to their benefit plans like pros. Learn strategies to negotiate the right solutions for your employees. By Scott Harward

CDHC Superstars: Rick L. Gaines
CDHC Solutions Recognizes the Best in Health Care Benefits Design with the 2nd Annual CDHC Superstars

CDHC Superstars: Cyndy Nayer, Shawn Jenkins, E. Craig Keohan
CDHC Solutions Recognizes the Best in Health Care Benefits Design with the 2nd Annual CDHC Superstars

CDHC Superstars: Nita Stella, Jack LeFort, Dave Pickering
"We have changed from health care solutions to really understanding, learning, empowering, and educating employees about what a healthier lifestyle looks like." Dave Pickering, CEO, Preventure

CDHC Superstars
Here is the Highlight of CDHC innovators that have earned awards in their field

2008 CDHC Superstar Awards: Pioneers in CDHC
We've awarded top innovators in health care these coveted honors for excellence and innovation in the rapidly changing world of CDHC. Read about these outstanding companies and the people at their helm as they lead the way with innovative plan design, implementation, and leadership. Inside are the profiles of the winners and finalists in each of the 8 categories.

Is moving to a consumer-directed health care plan as much work as it seems?


Health Maintenance Organizations
Health Maintenance Organizations (HMO's): represent a group of health insurance policy holders in which individuals or their employers allocate a monthly fee for medical services, instead of per service pricing. The monthly HMO dues usually remain fixed, regardless of the type or level of medical service received. Professional Medical Services are performed by certified practitioners and physicians employed by, or under service contract with the Health Maintained Organization. Several types of HMO Insurance companies are available with guidelines on medical facilities and the health treatment services they offer.

Private Fee For Service (PFFS)
Private Fee For Service (PFFS): A Private Fee-For-Service (PFFS) plan is a Medicare Advantage (MA) health plan, offered by a state licensed risk bearing entity, which has a yearly contract with the Centers for Medicare & Medicaid Services to provide beneficiaries with all their Medicare benefits plus any additional benefits the company decides to provide.

Self-Directed Health Care Plans
Self-Directed Health Care Plans (SDH): are health care plans that give the consumer more freedom of choice in making health care decisions.

Pay for Performance
Pay for Performance: an emerging movement in health insurance, in which providers are rewarded for quality of healthcare services

Medicaid
Learn about the medicaid program.

Medicare
What is Medicare? Who qualifies for medicare?

The U.S. Congress and Health Policy
presented by Sheila Burke at kaiserEDU.org

Employers Treat Depression
A Health Intelligence Network white paper about new approaches to managing depression

Agency for Health Care, Research & Quality Launches New Website
New website allows users to learn, share, and adopt new health care service delivery innovations.

Empowering Employees WIth Health Care Incentives
Learn what factors to consider when implementing a health care incentives plan.

Case Study: The State of Colorado


How do McCain and Obama Compare on Health Care?
Obama and McCain’s health care reform plans compared.

Can You Increase Employee Satisfaction While Holding Costs In Check? Yes!
Counteract rising health care costs with active health plan management. Here are three steps.

Counteract Rising Health Care Costs With Active Health Plan Management
Can you Increase Employee Satisfaction While Holding Costs in Check? Yes!

Slash Costs With an Effective CDHC Plan Design
"Does CDHC work? Absolutely, and it works as much for employees as for the employer, but the path is long and one needs to think outside the box when looking for ways to implement it—through careful plan design—and communicate these programs on a regular, consistent basis throughout the year." The City of Arlington, Texas achieves positive results with new CDHC plan design.