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Product
News
Items are listed in chronological order,
with the most recent appearing first.
(As of April 13, 2009)
- Blue Cross and Blue Shield of South Carolina and Palmetto
Primary Care Physicians will launch a year-long patient-centered "medical
home" pilot project that they say could become a model for South
Carolina. The project, unveiled April 6, will focus on diabetic
patients who are members of Blue Cross and Blue Shield of South Carolina,
BlueChoice HealthPlan of South Carolina and the State Health Plan.
The medical home concept places the primary care doctor in charge
of a team of caregivers (e.g., social workers, pharmacists, wellness
coordinators, nurses, disease managers and clinical diabetic educators)
all working together to proactively reach out and develop an individual
treatment plan for patients. Case managers, hired recently by Palmetto,
will help reduce gaps in care, such as missed appointments with specialists,
lack of transportation, and medication noncompliance, according to
a prepared statement. The project will use electronic medical records
to integrate information received from the health plan, case manager
and local emergency rooms. Palmetto also has created a portal on its
Web site where pilot participants can schedule an interactive "e-visit"
with their physicians, create their own personal health records, upload
and chart their own blood glucose results and pay their bills.
- Humana Inc. says its new HumanaOne product can help "fill
the gap" for people who temporarily lose their health coverage. The short-term medical coverage, the insurer says, is aimed
at students who are about to graduate; people who are between jobs;
part-time, temporary or seasonal employees; the unemployed and recent
retirees who are waiting for Medicare coverage to begin. The HumanaOne
product is initially being offered in Alabama, Arizona, Colorado,
Louisiana, Michigan, Nebraska, Ohio and Wisconsin. Plan design varies
somewhat by state, Humana says. Coverage can run from 30 days to as
long as one year, depending on the state. The plans have a $2 million
maximum benefit and include prescription drug coverage. They do not
cover pre-existing conditions. Visit www.humana-one.com.
- Wal-Mart Stores, Inc. is rolling out a pharmacy benefit program
to employers and health plans that it says will greatly simplify the
drug-pricing system and eliminate up to 20% of the waste in the current
pharmaceutical supply chain, according to AIS's Drug Benefit
News. Some industry observers say the new program could pressure
PBMs on pricing, but others are skeptical. The new offering stems
from a pilot program that Wal-Mart launched with Caterpillar Inc.
last September. A key feature of the program is the elimination of
the average wholesale price (AWP) methodology used by most PBMs in
contracts with clients, the companies have said. In place of AWP,
the program calculates drug costs based on the "real invoice
price" paid by Wal-Mart plus a percentage for overhead and profit
margin. One of the goals of the Wal-Mart/Caterpillar pilot was to
push Rx pricing transparency up the pharmaceutical supply chain to
the point of the manufacturer, and bypass many of the middlemen.
(As of March 23, 2009)
- Blue Cross & Blue Shield of Rhode Island (BCBSRI) said
March 19 that it has expanded eligibility guidelines for its "Direct
Pay" plans. The insurer says the strategy will help people
who have extended a former employer's coverage through COBRA to enroll
in BCBSRI plans. Under the new guidelines, people who are covered
or eligible to be covered by COBRA, or who have exhausted their COBRA
eligibility, can enroll in one of BCBSRI's Direct Pay plans. The insurer
will allow people to switch coverage without medical underwriting
or waiting for the annual open-enrollment period. BCBSRI says the
new eligibility guidelines will provide additional options to individuals
who are not eligible for the recently enacted federal COBRA subsidy.
The insurer offers four health plans and a dental plan directly to
individuals and families.
- Aetna Inc. has added cost information for eight health care
professions and has expanded physician and facility cost and quality
information for four states as part of its Aetna Navigator transparency
tools. The professions for which cost information has been
added are audiologists, chiropractors, occupational therapists, optometrists,
physical therapists, podiatrists, speech pathologists and speech therapists.
Aetna also has added more cost and quality information for facilities
and providers in New Jersey, New York, Pennsylvania and Rhode Island.
- MVP Health Care/Preferred Care and Excellus BlueCross BlueShield
say they will invite up to 20 internal medicine and family physicians
to participate in a three-year "medical home" project. In a medical home, physicians acquire new resources, such as the help
of a new care manager, to coordinate all of their patients' health
care needs as a way to optimize patients' health care throughout their
lifetime. The goal of the initiative is to enhance patient care, help
maintain or reduce health care costs and to improve physicians' job
satisfaction. The project will be conducted in a six-county area in
upstate New York. The initiative will cover the cost of hiring a care
manager to work with the physician to make sure patients are properly
managing their chronic conditions and don't have gaps in care. Up
to 20 physicians who already use electronic medical records will be
accepted into the initiative. They will receive a grant to cover their
startup costs and funds to cover the cost of a care manager. Physicians
also will be eligible to receive enhanced reimbursements.
- SureScripts-RxHub, which operates a large e-prescribing network,
has launched The E-Prescribing Resource Center, where doctors, pharmacists,
payers, hospitals, policymakers and software vendors can go to find
information and advice about e-prescribing. Some of the resources
featured on the new Web site include a place where you can enter your
ZIP code to find out what physicians and pharmacies e-prescribe in
your community; an area where you can view the latest state and national
data that track e-prescribing growth and read about progress at both
levels; and step-by-step guides on how to establish a connection to
the SureScripts network whether you are a technology vendor, physician,
payer or pharmacy.
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