Saturday, February 18, 2006

Humana Press Release 1/31/2006

LOUISVILLE, KY - Jan 31, 2006 - Humana Inc. (NYSE: HUM) today announced the launch of its integrated real-time claims adjudication process that will simplify administrative tasks and help physicians obtain payment for services from patients more quickly.
This solution comes as high-deductible health plans (HDHPs) continue to gain popularity with employers. Humana's real-time claims adjudication integrates a number of partners and technologies that submit claims and return the adjudicated claim by calculating the exact dollar amount of most health plan members' financial responsibility before the member leaves the doctor's office.
"This new capability is a much more realistic and efficient approach than any other options that are available to physicians today," said Bruce Perkins, Humana's senior vice president for national contracting. "It replaces other alternatives that involve time-consuming administrative office hassles, such as duplicative, manual keying of claims information, with one-time entry, followed by an instant swipe of a debit card."
Those other alternatives require the patient information to be manually keyed twice, first into a computer or card terminal - much like each grocery item's bar code would have to be keyed in -- then into the practice management system. That method is often time-consuming and can lead to errors in data entry.
Currently, physicians send claims to Humana either electronically or through the mail. The claims process has to be "adjudicated," which takes into account the specific member's benefits and health plan discounts. Once the claim is paid, doctors must then bill the member for the balance, resulting in delays of weeks or months before the physician gets final payment from the member.
"Until now, the problem doctors had with using real-time claim solutions has been the hassle factor," said Bruce J. Goodman, senior vice president and chief service and information officer. "No one wants to enter the same information twice and into two different systems. But, by using Availity and partnering with practice management and other vendors to form an integrated solution, Humana can deliver the information they need and without any added steps. We're using our advanced technology to simplify the use of high-deductible plans for members and removing worry about cash flow for their providers of care."
For most of its members who hold the HumanaAccess Visa debit card, Humana's real-time claims adjudication offers a more simplified administrative approach than available options today. Providers using one of the participating practice management solutions enter the claim once in the practice management system. The claim is submitted electronically to Availity, LLC, Humana's primary gateway for the submission of claims. Availity immediately sends the claim to Humana for adjudication. Humana's system returns the adjudicated claim through Availity to the provider's office. Within 30 seconds, the provider's office knows exactly what to charge the Humana member. It can be instantly deducted from his/her health care savings account (HSA), health reimbursement arrangement (HRA) and/or flexible spending account (FSA) using the HumanaAccess Visa card. Humana's portion of the claim is paid in the normal weekly cycle for electronic claims submission.
Humana is currently working with MacGregor Medical Center in San Antonio, along with others, to provide the primary care practice with real-time claims adjudication capabilities.
"There's no doubt that we have seen cash flow benefits," said Terri Foose, CFO of MacGregor Medical Center. "But in addition to that, we have seen improvements in patient satisfaction and in our ability to communicate with them. We are also realizing a savings in the cost of sending statements, rebilling and talking to patients about charges over the telephone. It (Humana's real-time claims adjudication solution) has made for a much more efficient operation."
As the adoption of HDHPs grows, providers have faced difficulty with knowing how much money to collect from patients at the time of service. Because these plans include deductibles, providers need to know whether the patient has met his/her deductible in order to know the portion of the claim for which the member is responsible.
"The idea of real-time claims adjudication initiative is a step in the right direction," said William Jessee, MD, FACMPE, president and chief executive officer of Medical Group Management Association (MGMA). "It is a start toward a much-needed solution to one of the greatest problems faced by medical group practices' administrative complexity in the payment system. We support national, multi-payer solutions to this problem, and we appreciate Humana's leadership."
Throughout 2006, Humana will roll out real-time claims adjudication to other providers across the country. To encourage acceptance of this opportunity, Humana is also working with ZirMed, Inc. to develop solutions that provide real-time claims adjudication capabilities without costly integration with the providers' information or practice management system.

Thursday, February 16, 2006

Cigna Press Release 2/2/2006

CIGNA Choice Fund(SM) Study Provides New Insights on Consumer Decision-making in Consumer-Driven Health Plans
BLOOMFIELD, Conn., Feb. 2, 2006 /PRNewswire-FirstCall/ -- A CIGNA HealthCare analysis of 42,200 first-time users of consumer-driven health plans found these consumers generated an eight percent reduction in medical costs and made positive changes in health behavior, such as increasing their use of medications to treat chronic health care conditions.
"These study results show that given greater choice and control, the right incentives and actionable decision support, CIGNA Choice Fund members are becoming more involved in their health care and health care decision-making, while not compromising needed care," said Michael Showalter, vice president of consumerism for CIGNA HealthCare.
CIGNA's national study is one of the largest and most comprehensive analyses of consumer-driven health plans conducted to date. The medical claims study included two separate analyses: the first comparing the claims experience of 42,200 continuously enrolled members before and after their switch in 2005 from a traditional HMO or PPO plan to one of CIGNA HealthCare's HRA or HSA plans, and the other comparing this group's health care costs and utilization patterns to a control group of 140,200 members enrolled in a traditional HMO or PPO plan from the same employer groups' populations.
Managing Medical Costs
Total medical costs excluding prescription drug expenses for those enrolled in a CIGNA Choice Fund plan declined by approximately eight percent compared to the prior period, while costs for those enrolled in a traditional HMO or PPO plan increased by approximately four percent.
Changes in health care spending were driven by a reduction in both inpatient and outpatient facility costs, which declined approximately five percent and 12 percent respectively, when compared to the prior period. Inpatient and outpatient facility costs for CIGNA Choice Fund enrollees were also lower when compared to costs for the control group who were enrolled in a traditional plan. Importantly, while overall costs decreased for these services, the actual number of admissions increased compared to the prior period, showing that consumers received needed care in cost-effective ways.
The study released today is also one of the first to provide early data comparing cost among groups of consumers who had similar levels of claims in the prior period --- classified in the study as low, medium or heavy users of health care services -- to examine changes in decision-making after enrollment in a consumer-driven health plan.
The analysis showed that cost savings were observed across all categories, with the most pronounced savings occurring among medium and heavy users of care - those with medical (non-pharmacy) claims of $1,000-$8,000 and in excess of $8,000.
"This early data suggests that the change in health care decision-making encouraged by a consumer-driven plan doesn't end once a consumer satisfies the deductible or reaches the out-of-pocket maximum," Showalter said. "It also signals that health advocacy programs like health coaching, along with access to information tools and consumer advisors, are essential components of a consumer-driven health plan," Showalter said, noting that the goal of these programs is to help members improve their health, which, in turn, controls costs.
Improving Medication Compliance
The study indicated that when compared to the prior period, CIGNA Choice Fund members who had prescription drug coverage through CIGNA HealthCare significantly increased their usage of medications used to control diabetes (+18%), asthma (+8%), high cholesterol (+23%) and to prevent heart attacks (+18%). They were more discerning in their use of some types of prescription medications for which alternatives are available over-the-counter, such as medications for migraines (-4%) and anti-ulcer drugs (-7%).
Notably, the total days supply of prescription drugs obtained by CIGNA Choice Fund members increased compared to the prior period, but the cost per day for the medications decreased, suggesting that CIGNA Choice Fund members did not skip medications but instead made more cost-effective decisions.
"CIGNA Choice Fund members appear to be taking advantage of the many decision support resources available, such as CIGNA's pharmacy-specific online price quote tool, to make more cost-effective decisions," Showalter said. "But in this process, they are improving their compliance with medication therapy, which helps lead to better health and reduced costs for other types of services."
Costs for prescription drugs for CIGNA Choice Fund members, while increasing compared to the prior period, were five percent less than the costs for the control group of members enrolled in a traditional plan.
About the Study
The study included two separate analyses. First, it examined the claims experience of 42,200 continuously enrolled members who switched from a traditional HMO or PPO plan to one of CIGNA HealthCare's HRA or HSA plans in 2005. The analysis compared this group's claims for the six-month period January 2005 to June 2005 to their claims from the same period in 2004. To examine pharmacy costs and utilization, the study reviewed the claims experience of 29,577 CIGNA Choice Fund members who also had pharmacy coverage through CIGNA HealthCare.
In addition, the study also compared this group's health care costs and utilization patterns to those of 140,200 members enrolled in a traditional HMO or PPO plan from the same employer groups' populations during the same January-June 2005 time period. To examine pharmacy costs and utilization, the study reviewed the claims experience of 130,550 members enrolled in traditional plans who also had pharmacy coverage through CIGNA HealthCare.
The study drew upon data from 44 different employer groups offering CIGNA HealthCare's consumer-driven health care plans to employees. Total medical cost as used in the study represents overall medical (non-pharmacy) costs for both consumers and employers. Costs for catastrophic claims totaling more than $50,000 in either period for all populations were excluded from the analysis to reduce random variation and improve the reliability of the results.
About CIGNA HealthCare
CIGNA HealthCare, headquartered in Bloomfield, CT, provides medical benefits plans, dental coverage, behavioral health coverage, pharmacy benefits and products and services that integrate and analyze information to support consumerism and health advocacy. "CIGNA HealthCare" refers to various operating subsidiaries of CIGNA Corporation (NYSE: CI). Products and services are provided by these operating subsidiaries and not by CIGNA Corporation.

Sunday, February 12, 2006

Medica Press Release 2/2/2006

Medica Foundation Awards $50,000 GrantTo The St. Paul Red Cross For Local Services
ST. PAUL, MInn., February 2, 2006 — The St. Paul Area Red Cross has received a $50,000 grant from the Medica Foundation to fund preparedness and disaster relief that the local chapter provides in the east metro area. The Medica grant acknowledges the need to fund local Red Cross services in the wake of the unprecedented 2005 hurricanes and the generous support of the national relief effort by area donors. “This grant recognizes the need to support our local Red Cross as they assist local victims of house fires and other disasters that don’t get national attention, but are no less devastating to the lives of their victims,” said Rob Longendyke, executive director of the Medica Foundation. “The grant also supports the daily work of local Red Cross chapters to make our communities healthier and safer -- the lifeguards they train to protect our children, the co-workers they teach to perform CPR, the first aid Red Cross volunteers provide at sporting events.” “We are fortunate to have a partner like the Medica Foundation that understands that the capacity of the Red Cross to help people to prevent, prepare for, and cope with emergencies depends upon strong local chapters with adequate financial resources,” said David Therkelsen, chief executive officer of the St. Paul Area Red Cross. “We thank all area donors for their tremendous support of the Red Cross’ national hurricane relief efforts and are grateful to Medica and others who are also providing additional support to their local Red Cross chapters.” The American Red Cross of the St. Paul Area is a non-profit, non-governmental agency that offers emergency social services and education programs to residents of Ramsey, Dakota, and Chisago counties, and parts of Washington County. The Medica Foundation is a non-profit, charitable grant-making foundation and a sister organization to Medica Health Plans, a Minnesota-based non-profit HMO. The Foundation generally seeks to fund community-based programs and initiatives that can provide sustainable, measurable improvements in the availability, access and quality of healthcare. Medica ( is Minnesota's largest HMO, largest PPO and leading non-profit and independent provider of health plans. Medica has 1.2 million members and nearly 27,000 providers in a regional health care network service area that is available to 98 percent of Minnesotans and a growing number of adjoining counties in Wisconsin, North Dakota and South Dakota. Medica also offers national network coverage to employers who also have employees outside the Medica regional network. Medica has the highest accreditation, Excellent, from the National Committee for Quality Assurance (NCQA®) for the commercial health plans it provides to Minnesotans and North Dakotans and for Medicaid HMO plans. Medica's vision is to become the community's health plan of choice, trusted for its integrity, respected for its service, and admired for its commitment to innovation and efficiency.