Saturday, March 11, 2006

UniCare Option for "Young Invincibles"

UniCare's new plan for young adults, who are uninsured students or just starting out as professionals, is outlined in the following press release...

UniCare Launches New Option for Uninsured in Texas, Illinois
Sound™ Designed for “Young Invincibles” Lifestyle and Budget

Chicago, III.—This is not your father’s health insurance policy.
UniCare has unveiled an innovative health insurance plan called Sound™, which caters to the unique needs of adults between the ages of 19 and 29 in Texas and Illinois. There are an estimated 1.2 million uninsured people between the ages of 19-29 in Texas alone. And nationwide, nearly half of all full-time workers in this age group lack employer-based health benefits.
Sound™ has the potential to reduce the number of uninsured, by offering affordable access to quality medical care.

Between school and the beginning of their professional careers, “young invincibles” are often no longer covered by their parents’ insurance policy and are less likely to have employer-provided health coverage. Statistics indicate these individuals have one of the highest uninsured rates in the nation.

“Sound is designed with the lifestyle and attitude of the ‘young invincible’ in mind,” said Mike Murphy, UniCare Regional Vice President for Individual and Small Group sales. The insurance plans are simplified, focusing on the benefits young people are looking for. There is an easy, online application and automated underwriting. “Too often young adults risk their financial futures by going without health insurance because they don’t understand it or don’t think they need it,” said Murphy. “Sound™ provides affordable coverage for everyday preventive needs like doctor’s visits as well as for situations that require hospitalization.”

Sign-up is available with the click of a mouse at If approved, applicants will be notified within minutes and can print out a flashy, colorful Sound identification card right on the spot. Once approved, coverage is effective immediately. No paperwork, no hassles. Applicants can choose from three different plans: Gravity Bender, Curb Jumper and The Cruiser. Premiums start as low as $68 a month, depending on the plan selected, age, medical history and where the applicant lives. Basic dental and vision benefits, traditionally sold as separate policies, are included with Sound™.
UniCare is committed to increasing access to health insurance.

In recent months, UniCare has introduced six new plans for individuals and families and three new plans for small businesses in Texas and Illinois.

For Individuals and Families -
The Individual FIT portfolio includes six different insurance plans with deductibles ranging from $500 to $5,000. Each FIT plan offers vital doctor, hospital and surgical coverage; first dollar preventive care, unlimited office visits with a $30 co-payment and drug benefits at in-network providers.
“UniCare is pleased to offer affordable access to quality medical services at discounted fees with our new, easy to understand FIT plans,” said Mark Gastineau, General Manager for Individual and Small Group at UniCare. “UniCare members benefit from our recognized record of reliability and may choose from an extensive network of independently contracted doctors, hospitals and surgical centers.”

For Small Businesses -
As health costs increase nationwide, nearly 50 percent of small businesses do not offer employer-sponsored health benefits. To help small business owners afford group health insurance, UniCare introduced its Small Group Pathways Plans. Three distinct Pathways insurance plans feature low premiums, first dollar accidental injury coverage and preventive care benefits, and unlimited office visits at in-network providers. With UniCare’s Defined Contribution options as low as $30, budget conscious employers will know with certainty what their group health expenses will be each month. Further, the employer’s share of the premium may be tax deductible. “UniCare understands the challenging economic times facing small businesses,” said Gastineau. “Pathways is an affordable answer for small businesses who want to offer health insurance to their employees.

The Defined Contribution option makes budgeting more predictable for the employer by taking the month-to-month variation out of group health care costs. The coverage not only protects employees from the costs of health emergencies, but helps to shield the employer from the costs associated with lost time and decreased productivity.”

Thursday, March 09, 2006

Kaiser Foundation Health Plan - Membership Growth

Kaiser Foundation Health Plan and Hospitals Sees Membership Growth and Increases Investments in Integrated Care Delivery

Oakland, CA - Kaiser Foundation Health Plan Inc., Kaiser Foundation Hospitals and their subsidiaries (KFHP/H) reported that total revenue for 2005 increased to $31.1 billion from $28 billion in 2004. Capital spending aimed at enhancing KFHP/H's health care systems, technology, facilities, and health programs and services also increased, growing to $2.5 billion from $2.2 billion in the prior year. The operating margin for the year ended December 31, 2005, was reported at 2.6 percent, compared to an operating margin of 5.3 percent in 2004.

"We are investing our membership dollars to extend and improve our ability to broaden access and provide affordable and quality care," said KFHP/H Chairman and Chief Executive Officer George C. Halvorson. "The health care landscape is changing and we are committed to rounding out our care delivery capabilities and product offerings, and building new facilities and renovating existing ones to satisfy the direct and increasingly complex needs of our members."

Every year, KFHP/H's earnings also fund a variety of community benefit programs to serve communities through research, community-based health partnerships, direct health coverage for low-income families and collaboration with community clinics, health departments and public hospitals.
KFHP/H's membership grew by nearly 208,000 members in 2005, increasing by 2.5 percent from 2004. "We are pleased that more than 8.4 million members in our communities choose us to meet their health care needs," said Halvorson. A broader array of new products contributed to an increase in total membership, which supported the growth in revenue.

While revenue grew last year, continued investment in KFHP/H's care-delivery capabilities, health services and programs, and an increase in operating expenses resulted in net income of $1 billion in 2005, compared to $1.6 billion in 2004. Similarly, the expanded investment in KFHP/H's integrated health care system and higher expenses impacted fourth quarter 2005 results. KFHP/H reported a net loss of $211 million on operating revenues of $7.9 billion in the fourth quarter of 2005, compared to net income of $302 million on operating revenues of $7.1 billion in the same period last year.
"Our strong financial position tempered our fourth quarter results, which include expenses associated with our work to put into place an infrastructure that will lower the cost and improve the quality of care we offer our members in the long term," said Senior Vice President and Chief Financial Officer Kathy Lancaster.

"Providing the best care possible has always been one of our essential goals," added Halvorson. "By making investments in our community benefit programs and state-of-the-art tools like KP HealthConnect, we are promoting a partnership with our members and the communities we live in together to improve health in a sustainable way."

KP HealthConnect is an industry-leading integrated medical record system that combines comprehensive patient records with best clinical practices, appointments, registration, and business systems. KFHP/H is currently in the process of implementing KP HealthConnect nationwide.
"To fulfill our mission, we rely on the dedication and skills of our physicians, nurses and caregivers who are supported by their technical, administrative and clerical team members," added Halvorson. "The strength of our labor management partnership continues to be one of our key competitive advantages."

Except for historical information contained herein, the matters discussed in this media release are forward-looking statements that involve risks and uncertainties. Actual results may vary significantly based on a number of factors including, but not limited to: the impact of competitive products and pricing; government regulations; health care legislation; changing membership requirements, and the change in economic conditions of the various markets the organization serves.

Tuesday, March 07, 2006

PacifiCare Offers New Health Plan Options

PacifiCare's new Small Business Choice Series offers Nevada small businesses a host of health plan options

Portfolio of health plan options to meet each employee’s individual health care and financial needs

CYPRESS, Calif. – Feb. 6, 2006 – Committed to offering affordable and flexible health care options in the face of rising health care costs, PacifiCare, a UnitedHealthcare Company, launched the Small Business Choice Series for small businesses in Nevada.
The new Choice Series offers a range of health plan options designed to provide greater flexibility and choice for small businesses and their employees. More than 10 health plans – including PacifiCare SignatureOptions and Health Savings Account-compatible plans as well as PacifiCare SignaturePOS and PacifiCare SignatureFreedom – are available. Employers can even mix and match to offer a portfolio that best suits their employees’ health care and financial needs. Multiple options of similar plans, such as high- and low-deductible PPO plans, can be offered by one employer to best meet the varying needs of individual employees.
The PacifiCare Small Business Choice Series is available now to small businesses in Nevada with 10 to 50 actively enrolled employees.
According to the U.S. Small Business Administration (SBA) Office of Advocacy, small businesses are vital to the financial well-being of Nevada’s economy and essential to economic growth since they comprise nearly all of the state’s employer firms in the state.
Of the more than 51,000 Nevada-based firms with employees, approximately 95 percent, or more than 49,000, are small businesses. In addition, small-business income increased nearly 7 percent, from $4.7 billion in 2002 to $5 billion in 2003, according to the U.S. Department of Commerce.
"When it comes to quality, affordable health care coverage, small businesses want more than just a ‘one-size-fits-all’ solution; they want their employees to have the same kind of customized, flexible options that employees with large companies have," said James Frey, chief executive officer, Pacific Region, UnitedHealthcare. "With the new Choice Series, small businesses and their employees can select from a host of different PacifiCare plans – from a high-deductible plan that offers tax savings to a more affordable plan with lower out-of-pocket costs."
Small Business Choice Series plans offer many other PacifiCare programs, including behavioral health care, dental and vision coverage and a tiered pharmacy benefit. In addition, members can enroll in any of PacifiCare’s award-winning disease management programs, including those for diabetes and congestive heart failure, as well as enroll in HealthCredits®, an innovative suite of services that provides consumers with tools to make better health care decisions and a rewards system for those who take active steps to improve their health.

Sunday, March 05, 2006

Aetna & Bridges to Excellence Agreement 2/16/2006

Aetna Licenses Bridges To Excellence™ To Help Improve Quality Health Care New programs to reward physicians for performance
HARTFORD, Conn., February 16, 2006 — Aetna (NYSE: ΑET) announced today that it has entered into a licensing agreement with Bridges to Excellence™. The Bridges to Excellence program encourages high quality health care by providing financial rewards to health care providers who demonstrate that they deliver safe, timely, effective, efficient, equitable and patient-centered care.
Bridges to Excellence, founded in 2002, is a non-profit multi-stakeholder coalition of physicians, health plans, quality experts, and some of the nation’s major employers. As a licensee, Aetna plans to join employers and other health plans to implement Bridges to Excellence in various markets across the country.
"The Bridges to Excellence program is a very effective way to identify physicians who care for patients consistent with high standards of care. By engaging physicians to monitor their own performance, the program has recognized potential in improving quality and increasing efficiency of care, which benefits consumers, their employers and doctors," said Charles M. Cutler, M.D., Aetna’s national medical director, Quality Management. "We are pleased to participate in this program, which supports our continuing efforts to encourage improvements in the quality and safety of care delivered to our members."
Bridges to Excellence is based upon physician recognition programs designed by the National Committee for Quality Assurance (NCQA) and its partners, the American Diabetes Association (ADA) and the American Heart Association/American Stroke Association. The pay-for-performance programs operated by Bridges to Excellence are Diabetes Care Link, Cardiac Care Link and Physician Office Link. Both Diabetes and Cardiac Care Links focus on meeting approved high standards for treating chronic conditions, while Physician Office Link provides incentives for improving patient information processing and data management.
"What makes Bridges to Excellence unique is that we are using standard measures of quality for comparative purposes so physicians have a common definition to draw from," says Francois de Brantes, co-founder of Bridges to Excellence. "The rewards help doctors to reinvest in themselves and their practices to adopt the kinds of support systems necessary to deliver truly top-notch care."
Aetna participates in existing Bridges to Excellence markets in Cincinnati, Ohio, and Louisville, Ky., and anticipates joining collaborative efforts in additional markets. Aetna is incorporating Bridges to Excellence methodology into its pay-for-performance strategy and programs.
"In addition to using measures and methodology recognized by physicians and other organizations, Bridges to Excellence provides the flexibility to work with physicians and employers to implement programs that address the specific needs of local markets," Cutler said.
To participate in Bridges to Excellence and be eligible for financial rewards, physicians must meet NCQA’s criteria for its recognition programs: office practice performance assessment program, the Diabetes Physician Recognition Program (DPRP) or the Heart/Stroke Physician Recognition Program (HSRP). In January 2003, Aetna was recognized by the NCQA as the first health plan to highlight recognized physicians in its on-line provider directory, DocFind®.
To date, Bridges to Excellence has distributed more than $4.7 million in rewards to more than 1,600 recognized physicians in five market regions including Ohio, Kentucky, Upstate New York, Massachusetts and the D.C./Maryland area.