Archive for September, 2010

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Texas Hospital System Threatens 52 Texas Employer Groups

Monday, September 27th, 2010

A Texas hospital system has threatened 52 employers by demanding cash upfront on all non-emergency hospital admissions.

Affected employers who sponsor group health insurance for their employees are angry. They plan a concerted effort against the hospital system to include legal action, legislative intervention and publicity.

Regarding the later, public opinion will be an important element in their overall strategy to expose core issues to what is wrong with our current healthcare delivery system.

For the first time the general public will understand why health care costs are out of control.  That is a good thing.

Details will be posted on this website later this week as this story unfolds. We expect the national press will run with this.

Editor’s Note: ERISA mandates that Plan Sponsors  have a fiduciary responsibility to pay only fair and reasonable fees. Are hospital fees fair and reasonable? Should a hospital charge $12,000 for an MRI when their cost is less than $300? What is fair and reasonable, and who decides?

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Carriers Under Assault From Politicians – Big Government Dictates Status Quo

Monday, September 27th, 2010
 
Lawmakers Warn Insurers About Blaming Reform Bill For Costs
 

Sens. Max Baucus (D-Mont.) and John D. Rockefeller IV (D-W.Va.) on Monday sent a letter to the
largest health insurers warning them about raising premiums and blaming it on the health reform
law.
 
 WellPoint, UnitedHealthcare, Aetna, Health Care Services Corporation, and CIGNA received the
letter. Despite the requirement to add additional benefits under the law, the senators said the
costs should only increase premiums by 1 to 2 percent.
 
The lawmakers’ letter mimicks one sent to the industry September 9th by HHS Secretary Kathleen Sebelius that said the agency will have “zero tolerance” for insurers that blame premium increases on the reform law.
  

 

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Sunday, September 26th, 2010

September 26, 2010

Memo to all employees

editor’s note

The following memorandum was leaked to us by someone who wishes  anonymity for himself and the firm in question.  
Dear employees:
Great news — you will receive a 15% raise in 2011!!!  If you are one of those “hope and change” types, you will be pleased to learn that your raise will be applied to our health insurance premiums to pay for the medical care of a brain dead illegal immigrant in a permanent vegetative state due to injuries sustained in a shoot-out with police.  If this seems unfair to you, or if you frankly are just sick of working, you may want to consider quitting this job and taking advantage of the federally mandated 99 weeks of unemployment payments.  Don’t worry about the cost — we paid for that too.  If you would like to keep your job and your 15% raise, please express that desire on November 2.
ps.  the new employee in the back office was hired to complete the 50 to 100 1099′s we will have to fill out starting in 2012 to send to every vendor with whom we spend more than $600.  We anticipate hiring more such employees in the future as additional nuggets buried in the health care bill come to light.
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70% of South Texans Are Obese

Sunday, September 26th, 2010

Most costly medical condition? Obesity, doctors say

September 25, 2010 9:45 PM

Local physicians say the most costly chronic condition isn’t hypertension or diabetes.

It’s obesity.

Seventy percent of the people who live in the 19-county South Texas region are overweight or obese, a rate four percentage points higher than the state as a whole, according to the Texas Department of State Health Services. If current trends continue, 75 percent of Texas adults would be overweight or obese by 2040, costing as much as $39 billion in unnecessary health care costs.

But despite Dr. Benjamin Bujanda’s best efforts to counsel his patients on health complications from being overweight, many are unwilling or unable to change.

“Ultimately, the patient needs to be responsible,” he said, showing a handout he gives to patients that lists 30 complications from obesity, including diabetes, high blood pressure, heart disease and cancer. “We can provide the education that they need to stay healthy but it all depends on them.”

That’s the crux of preventive care: Physicians can try to educate patients on how to live a healthy lifestyle, but success is determined solely by what the patient does at home.

Still, some suggest that investing in proven programs can pay dividends. A 2008 report by Trust for America’s Health, a nonprofit group that focuses on disease prevention, found Texas could save $1 billion annually within five years if it invested $10 per person in community-based programs to increase physical activity, improve nutrition and prevent smoking and tobacco use.

Melissa Nitti, a spokeswoman for the U.S. Department of Health and Human Services, said obesity is widely recognized as a major driver of health care expenditures.

If providers can prevent and reduce obesity in child patients, they may cut the incidence of adult health conditions that are expensive to treat, such as diabetes, hypertension and adult obesity, she said. A recent study estimated that a 1 percentage point drop in obesity among 12-year-olds would save $260 million in total medical expenditures.

Bujanda, a family practice physician in McAllen, holds free seminars each month where he counsels people on how to prevent and avoid acute and chronic illnesses.

He estimates that 30 to 40 percent of his hospitalized patients could have stayed out of the hospital if they followed advice from his free seminars.

“It would save lives and complications,” Bujanda said. “We’re just treating the ill people.

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Trucking Firm Begs Federal Government to Keep Existing Health Plan

Tuesday, September 21st, 2010
 
We just delivered our first post 23 Sept. renewal on a long-haul trucking firm. They have a mini-med plan for their employees.
 
The owner will ask (beg) the federal government to allow him to keep his plan as is. We should get the government’s answer in the next 30 days.
 
If his request is rejected, we are going to put out a full page advertisement in the Corpus Christi Caller Times thanking Solomon Ortiz (our Lily Livered Socialist Congressman) for voting for ObamaCare and thus causing this trucking firm to cancell all insurance for their employees.
 
We gave the owner of the trucking firm various insurance quotes that comply with ObamaCare. His costs would go up by 500% and more. This is not an option he can afford.
 
The trucking industry is struggling to keep afloat, with over 900 independent trucking firms in the nation going out of business in just the first quarter of 2010.
 
Editor’s Note: Fire Congress on November 2!
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Monday, September 20th, 2010

 

latest news    select news    web meetings of interest     feedback
September 2010
Latest News
Welcome to The Big Picture

CIGNA® welcomes all brokers and consultants to our new The Big Picture newsletter. The Big Picture covers topics for CIGNA business enterprise-wide, so you may find that details in the “Latest News” updates may not always be relevant to your business. For Select Segment specific updates please see the CIGNA Select Segment News section of this newsletter. 

Reform Swings into Action

Health care reform sets in motion this fall as the initial provisions take effect. From 100 percent coverage for preventive care to the expansion of dependent coverage to age 26, to big decisions about grandfathering, the Affordable Care Act is changing U.S. health care. Clients, customers and consultants have questions about the provisions listed above plus the dozen or so others that are already impacting business. CIGNA’s reform website, informedonreform.com, continues to be a trusted, highly used resource. Check back often for breaking news and updates.

Election Update: Impact of Health Care Reform

In less than 60 days, the public will go to the polls to elect all 435 Members of the U.S. Congress, 36 members of the U.S. Senate, 37 Governors, and many state and local officials. For the national elections, many key issues of the first two years of President Obama’s Administration will play a large role in determining election outcomes – especially the volatile health care issue.

Read more information here.

Empowering Customers with Tools and Resources to be Better Informed

Customers today are being asked to take more accountability and control of their health – and their health spending. Not surprisingly, they expect to have the information and tools* to make smart decisions. CIGNA’s award-winning suite of decision support tools does just that. We’ve collected cost and quality information, simplified the language, redesigned the tools, and added new features that make it easier than ever for individuals to choose and use health care wisely.

Take a look at the experience our customers can expect.

* MyCIGNA.com® and CIGNA.com resources discussed in the linked information do not apply to all health plans. Please contact your CIGNA representative if you have questions.

Health and Wellness at Work

Bringing health and wellness programs directly to the workplace is the work of CIGNA Onsite Health®, which has built an extensive suite of onsite capabilities as an integral part of the health management programs CIGNA provides to employers and their workers. CIGNA now offers onsite health centers, pharmacy services, one-on-one health coaching, health promotion, health improvement programs, educational seminars, biometric screenings and flu shots.

Read more information here.

Health Care Reform Impacts on HRA, HSA, FSA Plans

Health care reform has specific impacts on health plan spending accounts that clients and customers will want to know. The impacts may change the way customers plan for and use their HRAs, HSAs or FSAs. Specifically, there are a number of changes related to over-the-counter eligibility for reimbursement, penalties on HSA distributions and reimbursement for expenses of dependents.

Get the details.

CIGNA Pharmacy Management® / Merck Outcome-Based Contract a Proven Success

In April 2009, CIGNA Pharmacy Management and Merck & Co., Inc. entered into the country’s first national outcome-based contract between a pharmaceutical company and a pharmacy benefit management company. 

Check out the results of this agreement.
CIGNA Select Segment News
(51-250 Employees)
Welcome to the Big Picture
We’re excited to welcome you to The Big Picture, your new source for CIGNA Select quarterly news. The Big Picture covers CIGNA markets enterprise-wide, so if your business takes you beyond the 51 to 250 employees segment, you’ll now find all your updates in one place. Big Picture’s general news items may contain details at times that are not relevant to the Select segment. Be sure to also scroll to this section each issue for Select-specific business updates.

Please contact your CIGNA representative if you have questions.

Importance of GWH-CIGNA Network Designation

Because CIGNA has multiple networks, it’s important for your Select segment self-funded clients to know their plan is paired with the GWH-CIGNA network. We’re now also including a message on the back of each GWH-CIGNA ID card in bold red font. Please review the ID card with clients to help them avoid any confusion with health care professionals and pharmacy guidelines.

CIGNA Establishes New Legal Entity

CIGNA is creating a legal entity with a name that more clearly describes what we do for your clients – CIGNA Health and Life Insurance Company (CHLIC).

Read about impacts to your Select clients.

Bend the Cost Curve with CIGNA’s CDHP

As of January 2010, approximately ten million people were covered by HSA/HDHP products, an increase of 25 percent since last year.* In fact, more and more clients are turning to CIGNA’s simple-to-administer consumer-driven health plans to achieve consistent cost reductions compared to traditional health plans.

* Center for Policy and Research, America’s Health Insurance Plans, January 2010 Census Shows 10 Million People Covered by HSA/High-Deductible Health Plans, May 2010, www.ahipresearch.org.

The numbers prove it. Read more. 

Why Onsite Wellness?
Helping people stay healthy makes good business sense.

Offering onsite health and wellness programs is one of the most convenient, effective ways clients can help employees understand their health risks and support them in making healthier lifestyle choices.

Read about an opportunity for new Select cases.

New Web Address for Client Reporting

Changes planned for the client reporting website will take effect on Sept. 20, 2010. Beginning on that date, the website (formerly the customer reporting portal) will feature a new web address: https://reports.CIGNAforhealth.com/workspace.

Get the full details.

More Funding Options than Any Other Carrier

If you’re frustrated with the limited funding choices offered by other health insurance companies, you’ll be interested to know that CIGNA provides more funding options for your clients than any other carrier.

Read about two unique funding alternatives.        

Free CE and More at CIGNASelect.com

If you haven’t dropped by lately, CIGNASelect.com may yield a few surprises to make a visit worth your while: Free CE, a video or two to view, a new tool and more.

Learn more.

CIGNA Pharmacy Management Receives Prestigious Industry Accreditation for Meeting Strict Quality Standards

CIGNA Pharmacy Management was granted full Pharmacy Benefit Management accreditation from URAC, a Washington, DC-based health care accrediting organization that establishes quality standards for the health care industry. The accreditation for the commercial market promotes industry best practices, encourages quality improvement, and protects and empowers consumers.

Read more information.

CIGNA Tel-Drug Becomes CIGNA Home Delivery Pharmacy

CIGNA Tel-Drug® will now be known as CIGNA Home Delivery PharmacySM. CIGNA Home Delivery Pharmacy’s dedication to providing accuracy, service and reliability will remain the same.

Read more information.

What’s In a Name? CIGNA Establishes a Legal Entity with Clarity in Mind

CIGNA is committed as a global health service company to being helpful, easy to understand, clear and concise. In support of this commitment, we’re introducing a legal entity with a name that more clearly describes what we do for your clients – CIGNA Health and Life Insurance Company (CHLIC). Best of all, the change will be seamless for your clients and their employees.

Read more.

CIGNA’s Smarter Phone Process Yields Strong Results

Employees who need to take a disability or other leave want a simple and supportive experience. Employers want claim performance that’s effective, provides great service, and helps employees quickly get back to work. CIGNA’s phone claim reporting process delivers all this and more.

Find out more.

Life Insurance Awareness Month:Resources for You and Your Clients

Life Insurance Awareness Month is the perfect opportunity to contact your CIGNA representative or visit cigna.com/liam for more details about our life insurance plans. Don’t forget to take advantage of our Academy by CIGNA continuing education program, which offers a life insurance course for CE credit at times and locations convenient to you.

Read more information.

Web Meetings of Interest
Trust is a Must

Helpful. Easy. Personal. Not the adjectives most people would use to describe their health plan. Learn why health plans must change and why trust is a must with customers to drive behavior change, improve health and lower costs. See what’s possible when the customer experience is redefined to create more active individuals and how that translates into a healthier workforce – and a healthier bottom line.

Register now.
Feedback
We welcome your feedback. Let us know what types of articles you would like to see in this newsletter. Just send an email to HealthCareDirections@CIGNA.com.

Thank you.
839049 09/10 © 2010 CIGNA

 

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Rural Hospital Seeks Cost-Plus Reimbursement

Monday, September 20th, 2010

By Dave Ranney
KHI News Service
Sept. 9, 2010

ULYSSES — The hospital here wants to take part in a Medicare initiative designed to test the merits of letting rural hospitals switch to a system of cost-based reimbursement.

The Centers for Medicare and Medicaid Services last week announced its intent to add up to 20 hospitals to its Rural Community Hospital Demonstration program. Ten hospitals already are in the program.

Most rural hospitals are critical access facilities, a federal designation that allows them to bill Medicare for 101 percent of their outpatient, inpatient, laboratory, physical therapy, and post-acute care costs.

Grant County Hospital is not a critical access facility.

“A mistake was made based on incorrect information or an incorrect understanding,” Frable said. “The (hospital) board did not go for critical access designation when it had the opportunity to do so – prior to January 2009.”

If the hospital is one of the 20 added to the demonstration program, Medicare reimbursements for its inpatient services would be figured using a cost-plus formula.

Currently, Medicare pays the hospital a predetermined rate that may or may not cover the hospital’s actual costs.

If Grant County Hospital had been part of the demonstration project last year, Frable said, it would have collected an additional $869,000 from Medicare.

Approximately 60 percent of the hospital’s patients, he said, are on Medicare.

“The biggest problem for the rural hospitals is that for (the current) payment system to work, you have to have a certain number of patients to come out ahead,” Frable said. “We don’t have the volume we need to make it work.”

The Ulysses hospital was the first in Kansas to express interest when queried about the program by the Kansas Hospital Association.

Editor’s Note: Cost Plus makes sense. In the Ulysses Hospital example, had Cost Plus been in place last year, their revenue would have increased by almost $1 million.

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Several Seton Hospitals Accept Cost Plus

Saturday, September 18th, 2010

According to information obtained from http://www.raconline.org/ , Seton Highland Lakes and Seton Edgar B. Davis Hospitals, members of the Seton family of hospitals, are designated critical access hospitals. As such, each hospital has agreed to cost-plus 1% reimbursement from Medicare. According to this website, this cost-plus 1% reimbursement from Medicare is “intended to improve financial performance.”

There are over 1,300 hospitals across the United States that participate as critical access hospitals. While we like the cost-plus approach, we wonder how a hospital can expect to “improve financial performance” with only a 1% margin. We think a 12% margin is more fair and reasonable.

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Protected: Cost Plus Versus Billion Dollar Hospital System and Their “Partners” – PPO Networks – WWIII Has Begun

Friday, September 17th, 2010

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Is Blue Cross of Texas Being Held Hostage?

Friday, September 17th, 2010

Is Blue Cross of Texas under threat by government officials? Why have they suspended all sales activities and renewals? The answer remains elusive. We have been informed that BCBS employees are not even permitted to send out emails on the subject. A strict silence, it seems, has been imposed on their entire work force.

Molly Mulebriar is investigating.

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