Beruflich Dokumente
Kultur Dokumente
This document is copyright material of Global Healthcare Research Institute (GHCRI), Cognizant Technology Solutions. The circulation is restricted to internal audience only. Sharing outside Cognizant network is strictly prohibited
CONTENTS
ABOUT GHCRI ......................................................................................................................................................................3 TEAM OF CONTRIBUTORS ........................................................................................................................................................4 ACO ..................................................................................................................................................................................5
HBX in News ........................................................................................................................................................................ 6 EHB IN NEWS ......................................................................................................................................................................... 6 HBX & EHB Payer Updates ............................................................................................................................................... 6
HEALTH INTELLIGENCE .............................................................................................................................................................7
Aetna in News ................................................................................................................................................................... 10 Cigna in News .................................................................................................................................................................... 10 Humana in News ............................................................................................................................................................... 10 UnitedHealth Group in News ............................................................................................................................................ 11 WellPoint in News ............................................................................................................................................................. 11
ABOUT GHCRI
Cognizants Global HealthCare Research Institute (GHCRI) provides global thought leadership with market insights, perspectives and fact-based research that supports decision making for industry executives across the healthcare value chain. GHCRI contributes to the transformation of the healthcare industry, by helping actively promote and advance dialog amongst leading international healthcare organizations. We endeavour to leverage our Healthcare industry and technology insights, to aid stakeholders navigate change from intelligence including emerging trends, challenges and opportunities in the healthcare industry. The Institute is part of Cognizant Business Consultings initiative to bring together industry expertise to partner with orga nizations as a thought leader and trusted advisor.
Contact Us
Cognizants Global HealthCare Research Institute Share your feedback with us: GHCRI@cognizant.com
TEAM OF CONTRIBUTORS
TOPIC ACO & Humana HBX/EHB & Cigna Health Intelligence & WellPoint Medicare/Medicaid & UHG SMAC & Aetna CORE TEAM MEMBER Ramu, Harish Pereira, Renato Antony Athaley, Chaitanya Naik, Leena Mohanty, Prashanti VOLUNTEER
Singh, Pankaj Gupta, Saurabh Gupta, Amritansh Koul, Rahul Sinha, Shwetabh
ACO
ACO in News
Privia Health joins hands with AthenaHealth to produce more effective ACO
The collaboration between Privia Health and AthenaHealth will connect their technologies and the business operations which in turn will result in an effective ACO. Privias in-house developed care management software will be integrated with the AthenaClinicals cloud-based electronic health records system. Privia Medical Group represents 161 physicians and serves more than 300,000 patients. Read more
providing better care and improving health for members with multiple chronic conditions. The program is supported by 12 providers across California. In ACO's first year, participants witnessed an increase in preventive care and appropriate prescribing. With the partnership, Anthem plans to improve care co-ordination. Read more
National Rural ACO contracts with Lightbeam Health to deliver end-to-end population health platform
Lightbeam Health Solutions announced that it has contracted with National Rural ACO to deliver the Lightbeam Health population health platform to serve its developing network of ACOs. National Rural ACO is a network of rural-based healthcare organizations that benefit largely from shared care coordination and healthcare technology. Read more
but over the phone, via paper applications or insurance agents. Read more
EHB IN NEWS
Top 10 healthcare services excluded under Obamacare
Medical services excluded in the insurance coverage of the preobamacare remain excluded under Obamacare except for a few minor changes which are less significant as per the study by Head of Research & Data at HealthPocket. Read more
California takes down online health insurance exchange for small businesses
California's health insurance exchanges are temporarily halting the online marketplace for small businesses to implement a series of redesigns to achieve better performance. Even though the online enrollment will cease immediately small employers can still buy plans through the small business health options program (SHOP),
HEALTH INTELLIGENCE
Health Intelligence in News
Avatar improves healthcare patient satisfaction with Information Builders' intelligence, integration, and integrity solutions
Due to increased importance of patient satisfaction and employee satisfaction surveys, Avatar solutions declared to use Information Builders WebFOCUS business intelligence platform. The platform automates data management processes, develops comprehensive data governance procedures and intuitive metric dashboards thereby enabling efficient reporting. Read more
IBM content analysis software helps to identify patients at risk for developing heart failure
IBM uses natural language processing technique, content analytics and predictive modelling to identify high risk patients with 85% accuracy. IBM, Epic, Carilion clinic were involved in this pilot project. Read more
How GIS and analytics can improve the U.S. health care system
The major constraints in healthcare industry are operations, logistics, resource allocation, customers, and management. Geospatial information system along with data analytics is expected to meet these constraints by impacting areas like strategic planning, market analysis, capital planning and operational analysis. Read more
Spin systems creates HIPAA 5010 ICD-10 standard compliant referral exchange, a major part of the HITECH act, in nine months
Spin systems, working with UHG, Humana and Health Net, has created HIPAA 5010 ICD-10 standard compliant referral exchange. The data collection and sharing platform is enabled by service oriented architecture. Read more
Predictive analytics role in improved outcomes highlighted in new issue brief from Health Fidelity
Health Fidelity considers predictive analytics to be crucial since the healthcare industry is moving towards value-based payment model. Predictive analytics enables tracking of current performance metrics, performs data mining thereby driving decision making process for clinical quality and costs. Read more
MEDICARE/MEDICAID
Medicare/ Medicaid in News
New York to get $8 billion Medicaid waiver
New York has reached a tentative agreement with the Federal govt. officials for a waiver of $8 billion saved by the State Medicaid reforms. The amount is, though, less than the $10 billion the State sought 18 months ago in its original Medicaid waiver request. The waiver would be used to fund healthcare programs with the ultimate aim to improve the overall State healthcare. Read more
SMAC
SMAC in News
Premier Inc. adopts enterprise-wide analytics solution for operational excellence
Leading healthcare improvement company Premiere Inc. has introduced an enterprise-wide analytics solution enabling hospitals to easily access, integrate and interpret their data. The solution, called PremiereConnect Enterprise, helps providers to improve operational excellence and patient care by the use of integrated data and analytics. Read more
expects to expand its footprint in the personalized healthcare space, taking a consumer-centric approach. Read more
Carestreams imaging app for Samsung and Apple devices get go-ahead from FDA
FDA has provided its nod for VUE Motion, a mobile radiology viewing and reading software that can be accessed on mobile devices and tablets. The clarity of image allows the radiologists to read as well as make clinical reports based upon them. Healthcare providers are increasingly using their own personal devices at work and FDA nod has provided a big boost to the mobile technologies and BYOD phenomenon. Read more
Next-Gen messaging capabilities to protect privacy of patient information on mobile devices unveiled
Marble Security Inc, a mobile security cloud service has extended its Marble Messenger capability to protect sender and receiver information. It is a secure messaging service that enables healthcare firms to protect information through encryption. Read more
Leading big data healthcare company GNS Healthcare secures funding for major market expansion
Leading provider of big data analytics products and services, GNS Healthcare, received $10M series B funding to fuel its expansion across the healthcare industry. With this funding, the company
Aetna has announced a $1.2 million grant to promote digital technologies such as mHealth for minority populations. This is as part of the $4 million that Aetna Foundation has committed over a period of 3 years for evaluation and implementation of technology to address public health concerns. The grants will go to a diverse group of 23 organizations across 13 states. Read more
PAYER UPDATES
Aetna in News
A. New revenue streams
Aetna has added Walmart to Preferred Pharmacy Network of the CVS/pharmacy Prescription Drug Plan. Due to this arrangement, the plan members will have to pay $2 less copayment for nearly 800 preferred generics and $1 less copayment for common specialty generics. Read more Aetna has entered into a strategic alliance with GNP to enhance the international health coverage in its GNP healthcare plans for Mexico residents. The alliance will give members access to Aetnas network of more than 1 million healthcare providers in U.S. and an additional 100,000 providers across the globe. Read more
Cigna in News
A. New revenue streams
Cigna announced the launch of its ownprivate retail exchange which will cater to the needs of the employers in cost-saving opportunities, easy administration and provide employee with multiple choice of plans. Currently the private exchange is available to smaller employers in Atlanta, Dallas, Washington, D.C. metro area, and San Francisco, and will expand its footprint to other markets and larger employer groups throughout 2014. Read more
B. New initiatives
Cigna's Supplemental Benefits division introduced two new mobile capabilities for agents selling its Cigna Medicare Supplement Solutions and Cigna Supplemental Solutions insurance products insured by American Retirement and Loyal American Life Insurance Companies. Read more Cigna has continued its expansion in Collaborative Accountable Care with a tie-up with Beacon Health, a subsidiary of EMHS (Eastern Maine Healthcare Systems) to improve patient access to health care, enhance care coordination, and achieve the triple aim of improved health, affordability and patient experience st which will be effective from January 1 2014.Read more
B. New initiatives
Aetna has taken up the initiative of fighting prescription drug abuse by the use of integrated pharmacy, medical programs and behavioral health. Abuse of prescription painkillers is a growing problem in the US and this adds billions of dollars to healthcare and criminal justice costs each year. Read more Aetna has committed itself to promote personalized weight-loss options by helping members find their best weight-loss approach. It has started providing information and access to lifestyle management programs, surgical options and prescription medications. Read more Aetna CEO Mark Bertolini and Academy Award Winning Actress Goldie Hawn will launch Mindful Works during the World Economic Forum in Davos. Mindful Works is collaboration between Aetna and The Hawn Foundation which works to improve health and wellness of people around the world. Read more
C. Performance
Cigna has reported a strong full year 2013 results and have raised their outlook for 2014. The consolidated revenues for 2013 were $32.4 billion, an increase of 11% over 2012. Revenues reflected growth in premiums and fees of 9% in Global Health Care, 27% in Global Supplemental Benefits and 10% in Group Disability and Life, primarily driven by continued growth in Cigna's targeted customer segments. Read more
Humana in News
A. New Initiatives
Humana has joined hands with CoverMyMeds to implement an electronic prior authorization model. This will expedite patients access to the medications due to streamlining of prescription authorization requests. This new model will save time for both provider and patients by removing several steps from existing prior authorization process. The website is more user-friendly and both providers and patients can check the status of the prior authorization online. Read more Kentucky Employee Health Plan (KEHP) and Humana have come together to address plans costs associated with chronic diseases. They have designed LivingWell Promise which will be part of KEHPs LivingWell health plans. Consumer-driven health plans are gaining popularity as KEHP experienced a fivefold increase in employees who selected a consumer-driven health plan. Read more
C. Performance
Aetna has tied up with Vitality Re V for a five-year reinsurance arrangement as part of its long term capital management strategy. This reinsurance arrangement will improve Aetnas capital efficiency and reduce its weighted average cost of capital. Read more Aetna has announced the fourth quarter and full year result for 2013. Results showed the y-o-y operating earnings to be $5.85 per share and a net income of $5.33 per share. The company also saw a 22% y-o-y increase in medical membership, which stood at 22.2 million. The fourth quarter operating revenue also saw a jump of 47% over the same period last year to $13.1 billion. Read more
10
WellPoint in News
A. New revenue streams
WellPoint has collaborated with Healthways to provide access to Dr. Dean Ornish program for reversing heart disease to its plan members across 14 states. The program provides qualitative assessment, tracking and management of key factors such as eating patterns, stress responses, physical activity levels of members who suffer cardiac problems. Read more
B. New initiatives
To enhance the member experience for visually impaired health plan members, WellPoint announced that it will make its website, mobile applications and print information more accessible and inclusive. It has adopted web content accessibility guidelines (WCAG) and enhanced its system for providing information in braille, large print, electronic and audio versions. Read more WellPoint along with other companies and former senate members is planning to push telehealth policy. The goal is to provide better access to qualitative and efficient healthcare facilities and lift geographic restrictions for Medicare reimbursement for remotely delivered care. Read more
C. Performance
Humana declared a cash dividend to stockholders of $0.27 per th share payable on April 25 , 2014 to stockholders of record as of the close of business on March 31, 2014. Read more Humana announced fourth quarter and full year 2013 financial results. It has reported a loss per share for the quarter ended st December 31 , 2013 (4Q13) of $0.19, compared to diluted earnings per common share (EPS) of $1.19 for the quarter ended st st December 31 , 2012 (4Q12). For the year ended December 31 , 2013 (FY13) the company reported EPS of $7.73 compared to st $7.47 for the year ended December 31 , 2012 (FY12). Read more
C. Awards
Latina style magazine recognized WellPoint to be among top 50 workplaces that provide best opportunities for professional Latinas. Some of the parameters used for evaluation were involvement of Hispanic women as executives and board members, Hispanic community outreach, employee benefits etc. Read more Patient safety first, a statewide collaborative with WellPoints California affiliated health plan, has been awarded John M. Eisenberg patient safety and quality award. The award has been bestowed for improving patient safety, healthcare quality, reducing infections and deaths, and thereby reducing significant healthcare costs. Read more
B. New initiatives
Optum Labs adds 7 new partners to their research collaborative. Optum Labs is currently involved in nearly 20 major research projects and aims to drive innovation in wellness and health care. Optum, along with its new partners, hopes to accelerate the pace of innovation and research in order to improve patient outcomes and care delivery by developing effective treatment methods. Read more
D. Performance
WellPoint declared an increase of more than 15% operational revenue but a decrease of 68% in profits, due to impairment costs, in its fourth quarter results. It expects an increased enrollment in individual and government health plans under ACA which will drive its revenue growth. Read more
C. Performance
UnitedHealth Group board has authorized the payment of quarterly dividend to its shareholders. A dividend of $0.28 per share will be paid on March 25, 2014 to the shareholders after UHG had announced an overall profit in the financial results declared last month. Read more
11