DinnerTime has signed an agreement with Johns Hopkins HealthCare to provide Johns Hopkins Employer Health Programs (EHP) members with free access to DinnerTime’s personalized meal planning and sale-smart shopping service. As of January 1, 2016, Johns Hopkins EHP members can sign up for DinnerTime free-of-charge when using their EHP membership number and referral code as part of their EHP benefits package. [Read more…]

WellCare Health Plans, Inc. (NYSE: WCG) announced that it will release its financial results for the fourth quarter and full year of 2015 on Tuesday, February 9, 2016, at approximately 6:30 a.m. Eastern time. The company will also host a conference call at 9:30 a.m. Eastern time that morning to discuss its financial results. [Read more…]

The HealthWell Foundation®, an independent non-profit that provides a financial lifeline for inadequately insured Americans, has announced it has opened a new fund to provide financial assistance to Medicare patients suffering from renal cell carcinoma (RCC). Through the fund, HealthWell will provide grants up to $10,000 to assist RCC patients with copayments and premiums. Patients who are on Medicare and have annual household incomes up to 500% of the federal poverty level are eligible for the fund.

According to the National Kidney Foundation, RCC is the most common type of kidney cancer in adults. About 30 percent of people who are diagnosed with RCC develop advanced (metastatic) disease, in which the cancer spreads to other parts of the body— most often the bones or lungs. Kidney cancer is usually treated with a combination of nephrectomy (surgical removal of all or part of the kidney), radiation therapy, immunotherapy, chemotherapy and hormone therapy. Kidney cancer can often be cured if found and treated before it has spread.

Senior Health Insurance Company of Pennsylvania (SHIP) has announced that it has executed a reinsurance transaction with Teachers Protective Mutual, a mutual insurance company, for SHIP to reinsure all of Teacher’s long-term care business.

Founded in 1912, Teachers Protective Mutual offers a variety of insurance coverage including accident, health, life and disability. The company offered individual long-term care products from 1992-2005 to residents in Ohio, Pennsylvania and Virginia.

As part of the transaction, SHIP will initially provide 100 percent coinsurance of the block of long-term care policies Teachers Protective Mutual holds, and will seek to assume the Teachers policies into SHIP in 2016. The transaction has obtained all required regulatory approvals necessary to proceed.

WellStar Health System is deploying an innovative solution to improve the patient experience while providing better patient care. WellStar’s electronic medical record patient portal, WellStar MyChart, will provide patients with round-the-clock access to their providers’ notes in addition to instructions, next steps, medication lists and test results from outpatient medical visits. WellStar is the first Georgia-based health system to offer this service to its patients. [Read more…]

hCentive, the leader in health insurance exchange solutions, announced recently that the company has added new health and ancillary insurance carriers and benefits administrators to its WebInsure Benefits marketplace. WebInsure Benefits is a single cloud-based platform for brokers to efficiently manage their employer group and individual business and simplify administration. The platform provides employers control to shop, enroll and manage health insurance, ancillary benefits, and consumer-directed accounts while delivering an intuitive online experience for consumers.

WellCare Health Plans, Inc. (NYSE: WCG), a leading provider of managed care services for government-sponsored health care programs, announced recently that it honored its high-performing network physicians in New York by making them the first inductees into WellCare of New York’s new All-Star Quality Team.

WellCare of New York launched the All-Star Quality Team to recognize the instrumental role that physician providers play in helping its members live better, healthier lives. The 25 physicians selected demonstrated excellence in caring for members per federal metrics called Health Care Effectiveness Data and Information Set® (HEDIS) and were recognized for their HEDIS 2015 results. These measures gauge how effectively WellCare manages its members’ chronic diseases, such as asthma and rheumatoid arthritis, and ensures that members receive preventive care, such as immunizations and health screenings.

WellCare now ranks fourth highest out of 16 plans in providing quality care for Medicaid recipients in New York. The ranking is based on health care quality metrics, member and provider satisfaction, and regulatory compliance measurements as determined by New York’s Office of Health Insurance Programs.

The National Association of Professional Insurance Agents (PIA) has hailed passage of the Policyholder Protection Act. The measure was included in the omnibus appropriations agreement that was passed 316-113 in the House and 65-33 in the Senate on December 18.

The Policyholder Protection Act prohibits federal regulators from using assets designated to pay out insurance claims to “prop up” an affiliated bank. [Read more…]

Thirty-two hospitals in 15 states agreed to pay more than $28 million to settle a whistleblower lawsuit brought by Phillips & Cohen LLP alleging that the hospitals overcharged Medicare for a type of back surgery known as kyphoplasty. [Read more…]

WellCare of Iowa, a subsidiary of WellCare Health Plans, Inc. (NYSE: WCG), announced today that the company will aggressively contest the order issued by Janet Phipps, director of Iowa’s Department of Administrative Services, which overturned the state’s original decision to award a Medicaid contract to WellCare of Iowa.

“This decision does not accurately reflect the facts, the integrity of Iowa’s procurement process or Iowa law,” said Lauralie Rubel, state president, WellCare of Iowa. “WellCare intends to use every avenue available within the legal system to correct this erroneous outcome. We will immediately seek an injunction that maintains the status quo to allow WellCare of Iowa to continue its participation in the program while this matter is appealed in a court of law.”

PROCEPT BioRobotics, a privately held medical device company based in Silicon Valley, announced today the closing of $42 million in a venture round of equity financing led by Novo A/S. New investor CPMG, Inc. and existing investors also participated in the round.

PROCEPT’s AquaBeam System combines image guidance and robotics to deliver Aquablation, a novel minimally invasive waterjet ablation therapy that enables targeted, controlled, and heat-free removal of tissue for the treatment of lower urinary tract symptoms.

PROCEPT will use the proceeds from the financing for a limited commercial launch of AquaBeam in targeted international markets and to conduct the WATER study (Waterjet Ablation Therapy for Endoscopic Resection of prostate tissue), a randomized blinded controlled clinical trial. PROCEPT has received conditional approval from the FDA for an investigational device exemption trial in the United States to evaluate the safety and effectiveness of Aquablation.

Hemp Health Inc., maker of cannabidiol (CBD) products, today introduced THC Buzzkill, a patent-pending CBD supplement that counteracts the ‘high’ of marijuana. Sold as an oral spray, THC Buzzkill absorbs into the bloodstream rapidly and lessens the psychoactive effects of THC using all-natural ingredients. THC Buzzkill is the first supplement designed for marijuana users who need to sober up quickly.

THC Buzzkill’s primary ingredients come from high-CBD, low-THC cannabis. Kosher, vegan and non-GMO, the cannabis is sourced from sustainable farms in Germany, Denmark and other European countries. THC Buzzkill is legal all 50 states and 42 countries.

THC Buzzkill pilot users report that the tincture lessens the effects of marijuana within 15 minutes. The supplement does not remove chemical traces of THC from the human body, and it does not make it safe for the marijuana user to drive an automobile or operate machinery. Taking THC Buzzkill prior to consuming marijuana will not block the effects.

THC Buzzkill is sold in a 1 ounce or 2 ounce bottle. Users can expect roughly 40 applications per ounce. The supplement will be sold online at www.hemphealthinc.com and at marijuana dispensaries, smoke shops and health stores nationwide. In states that permit recreational marijuana use, residents can expect to find THC Buzzkill at convenience stores and gas stations.

To learn more about THC Buzzkill, visit https://hemphealthinc.com

The twenty-first annual BIO-Europe® international life science partnering conference will be held in Munich, Germany, November 2–4, 2015. Organized by EBD Group, the event is co-hosted by BioM Biotech Cluster Development, the Bavarian Ministry of Economic Affairs and Media, Energy and Technology, and Cluster Biotechnology Bavaria.

Bavaria is an ideal location because it is home to a broad spectrum of high-capacity industries including life sciences and is a leading business region in Europe. There are 270 life science companies in the Munich biotech cluster, characterized by innovative small and medium-sized biotech companies and a focus on new therapeutics and diagnostics, “omics”-technologies, personalized medicine and biomarker research.

BIO-Europe is Europe’s largest partnering conference serving the global biotechnology industry and is facilitated by EBD Group’s partneringONE®, the gold standard one-to-one networking solution for the life sciences.

Moleculera Labs today announced the receipt of a two-year, $300,000 matching grant from the Oklahoma Center for the Advancement of Science and Technology (OCAST). This grant supports the development and clinical validation of new diagnostic testing panels to identify autoantibodies directed against neuronal antigens in patients experiencing neuropsychiatric disorders such as depression, bipolar disorder and schizophrenia. Such panels are intended to assist physicians in identifying the subset of patients whose symptoms may actually be caused by underlying treatable infection-triggered autoimmune and inflammatory responses.

Research by Madeleine Cunningham, Ph.D., Moleculera’s co-founder and Chief Scientific Officer, and her collaborators has led to development of the Cunningham Panel™, which measures relevant anti-neuronal antibodies and neuronal cell-activating antibodies circulating in the patient’s blood, as well as the activity of a key enzyme in the brain involved in the up-regulation of many neurotransmitters including dopamine. This test panel aids physicians in identifying individuals with PANDAS or PANS, thus enabling those children to receive appropriate anti-infective and/or immunological treatment that often results in a dramatic reduction or resolution of symptoms, without resorting to symptomatic control with neuropsychiatric drugs alone.

Equifax Workforce Solutions, a leader in human resource, analytics and verification services, and a business unit of Equifax Inc. (NYSE: EFX), has achieved a major milestone in Affordable Care Act (ACA) management for employers. The company’s ACA Management Platform, a software application that automates ACA administrative tasks and helps employers reduce their potential for penalties, is now used to manage compliance for over 10 million employees.

The Equifax ACA Management Platform, which has been recognized as a leading technology by Human Resource Executive® Magazine, Ventana Research, and the Brandon Hall Group, has seen the adoption rate for ACA-related services grow exponentially since the final versions of Internal Revenue Service (IRS) reporting forms 1094 and 1095 were released. These forms, which require detailed monthly information regarding the coverage offered and provided to employees and their dependents, will be used by the IRS to assess fines under both the individual and the employer mandate.

In addition to releasing the IRS Reporting module to automate the preparation and fulfillment of forms 1095 and 1094, the company recently released additional features, including the Appeals Management module that streamlines the process of storing and responding to subsidy notifications from the exchanges.

Following the Supreme Court’s ruling on King v. Burwell, in favor of Burwell, the government has taken another step in the longevity of the ACA and its impact on employers. The much anticipated decision upheld the legality of Premium Tax Credits, or subsidies, for health insurance provided under the federal Marketplace. Because subsidies trigger penalties for employers, this decision had the potential to significantly impact the Pay or Play mandate. To help employers understand the impact of the Court’s ruling and the next steps they should take in the ACA compliance journey, Equifax is hosting a webinar on July 7, 2015.

The Medical Tourism Association® and Beijing Great-Idea Business Resources Company Ltd. have partnered to hold the World Medical Tourism and Global Healthcare Congress Asia-Pacific 2015, Nov. 14-16, 2015, in Guilin, China.

Renée-Marie Stephano, President of the Medical Tourism Association®, said the multi-year event will also include a five-day, three-city B2B and B2G trade mission with top Chinese executives. To register, go to www.asiamedicaltourismcongress.com/

Asia-Pacific will also be a major focus — including several sessions dedicated to health and wellness in the region — at the World Medical Tourism and Global Healthcare Congress, Sept. 27-30, 2015, in Orlando, Fla.

The World Medical Tourism & Global Healthcare Congress attracts some 3,000 key stakeholders – hospital administrators, doctors and clinicians, employers, government policy makers, insurance executives, facilitators, and hospitality and tourism interests – from across the globe to share their experiences and identify and solve issues that bear significantly on the industry. Participants, sponsors and invited speakers can keep abreast of Congress updates or register at www.MedicalTourismCongress.com

PDI, Inc. (NASDAQ: PDII) subsidiary Interpace Diagnostics announced that effective June 2015, ThyGenX™,i the company’s genetic mutation panel, has been approved by Aetna for assessing fine needle aspiration (FNA) samples from indeterminate thyroid nodules. Aetna’s coverage decision now means that ThyGenX is considered medically necessary. Aetna covers 46 million lives and its positive coverage decision brings the total number of lives covered for ThyGenX to more than 100 million.

Approximately 15-30% of the 525,000 thyroid FNA’s performed on an annual basis are indeterminate based on standard cytological evaluation, and thus are candidates for ThyGenX. ThyGenX has been validated in a prospective, clinical study involving over 600 patients and has a specificity rate of 89%.ii

Guidelines from the National Comprehensive Cancer Network (NCCN) indicate that molecular diagnostic approaches may be useful in the evaluation of thyroid FNA samples that are indeterminate to assist in patient management, including identifying patients who are appropriate candidates for surgery and those for whom surveillance is appropriate.

GuideWell Mutual Holding Corporation (GuideWell) has entered into a strategic partnership with Alignment Healthcare, LLC (Alignment Healthcare), a population health management company with technology-enabled clinical integration at its core. The new relationship is intended to improve clinical outcomes for Medicare Advantage members in Florida and positively impact overall health care costs.

Together, GuideWell and Alignment Healthcare will create senior-focused clinics in regions of Florida and feature an innovative, technology-enabled, patient-centered model of care, designed to reduce hospitalizations and improve clinical outcomes for medically needy elderly patients.

Utilizing proprietary technology, teams of physicians trained to manage the unique care needs of the most vulnerable patients in the community, will work in partnership with nurse practitioners, physician assistants, and nurse care managers. They will act as advocates and care navigators for their patients, and manage the delivery of health care across multiple disciplines and treatment settings in coordination with primary care physicians.

To further serve the aging population in Florida, GuideWell has acquired BeHealthy America, Inc., a Florida-based Medicare Advantage Health Maintenance Organization (HMO). This acquisition further complements the Medicare Advantage offerings currently available through GuideWell’s health insurance businesses. The new HMO product will combine an attractive benefits design with Alignment Healthcare’s unique care delivery model, providing a more comprehensive level of care for a growing segment of Florida’s Medicare Advantage customer base.

The prevalence of chronic conditions presents one of the greatest risks to the U.S in terms of population health and well-being. However, many serious conditions such as hypertension or hyperlipidemia can be successfully managed if the patient follows a clearly documented treatment plan. To that end, changes to the chronic care management model by the Centers for Medicare and Medicaid Services (CMS) offers an out-of-the-box approach to improve the outcomes for patients with two or more chronic conditions. Medical practitioners can bill non-face-to-face communications with Medicare beneficiaries, reducing the need for costly direct evaluations when a simple instruction may be all that is needed.

Recent analysis from Frost & Sullivan, CMS Changes in Chronic Care Management: Is it Really a Bridge to Value-based Care?(http://www.frost.com/q294859662), finds that despite a list of cons, the potential merits of this program demonstrate value. Even though it falls short of the new payment taxonomy and true telehealth, this approach to chronic care management is a transitional phase, beginning in the old world of Medicare while possessing the potential to evolve with changing demands.

EHE International, the recognized leader in preventive medicine and annual physical exams, today announced that the Prime Healthcare, Avon, CT office has been named an EHE-certified preventive care center. Through Prime Healthcare, Avon, EHE members in the Avon region now have greater access to its preventive care program to help them proactively maintain their health.

“EHE is proud to add Prime Healthcare in Avon to its growing private provider network. Prime Healthcare is eager to contribute to the wellness of its local community,” said Deborah McKeever, president of EHE International. “EHE members will benefit from the expertise and experience of Prime Healthcare’s doctors who have met our high professional and practice standards earning them the ‘EHE Certified’ status.”

“EHE’s continued expansion in the Avon area and across the United States is a sign that more and more employers are realizing the benefits of standardized clinical protocols in preventive health and annual exams,” added McKeever. “It is well-recognized that a focus on prevention helps control future healthcare costs, improves productivity and allows employees to proactively manage their own health. EHE has a century of experience in caring for employers’ greatest asset, its employees.”

If you would like to learn more about EHE International’s physician network, please contact:

Mike Pokrywka
Director, Provider Markets
EHE International
Office: (212) 332-3025
Mobile: (203) 507-5609
Fax: (212) 332-1170
Email: [email protected]

To expedite payment reform across the U.S., the non-profit Health Care Incentives Improvement Institute (HCI3) has partnered with key stakeholders to support the transformation to a health care system based on quality and affordability. HCI3 partners include health plans, providers and purchasers who are actively working toward payment reform implementations, and technology and consulting firms offering services to support these efforts.

Organizations working with HCI3 to implement evidence-based incentive and payment reform programs include:

Aver
Blue Cross and Blue Shield of North Carolina
Cigna
Community Health Choice
HealthQx
Horizon Healthcare Services, Inc.
KPMG
McKesson
McKinsey & Co
TriZetto
xG Health Solutions™

MTBC (NASDAQ: MTBC), a leading provider of fully-integrated, web-based healthcare IT and revenue cycle management solutions has commenced beta testing of MTBC SameDay Funding™ (MTBC SDF™), which will ensure that healthcare providers receive advanced insurance reimbursement as patient encounters are completed and claims submitted.

MTBC SDF, which is now in beta testing, leverages MTBC’s proprietary data sets and algorithms to estimate its participating clients’ claim level insurance reimbursements. Once these pre-adjudication estimations are made, MTBC will advance funds to its clients, in the amount of the anticipated reimbursement, and then recoup the advanced funds as the respective payer completes the adjudication and payment process.

Governor Tom Wolf has announced that Highmark will continue to cover pregnancy and related care at Magee-Womens Hospital of UPMC in 2015, despite it no longer being in their network of providers. Coverage for these services will be at in-network rates.

“Any woman who became pregnant and sought treatment in 2014 and has Highmark insurance will have in-network access to Magee-Womens Hospital in 2015,” said Governor Tom Wolf. “The needs of patients must always come first and I am pleased that we have reached a swift and necessary resolution in this matter.”

Under Governor Tom Wolf’s administration, the Pennsylvania Department of Insurance and the Pennsylvania Department of Health will work diligently to continue to enforce the consent decree between Highmark and UPMC.

“We are pleased that expectant mothers will continue to receive the access to the care they need,” said Acting Insurance Commissioner Teresa Miller. “Ensuring greater access to care and transparency for Western Pennsylvania patients is a top priority for this administration.”

The resolution on maternity care:

Considers pregnant women in continuity of care if treatment began prior to Dec. 31, 2014.
Covers patients who have retained Highmark insurance coverage, either individually or though group plans.

Information for health-care consumers with questions on Highmark and UPMC is available at www.StayInformed.pa.gov.

The Academy of Managed Care Pharmacy (AMCP) applauds two crucial provisions in draft legislation issued this week by the House Energy and Commerce Committee that combat the abuse of controlled substances and payment fraud in the Medicare Part D prescription drug benefit program.

AMCP Chief Executive Officer Edith A. Rosato, RPh, IOM issued the following statement:

The Academy is pleased the Committee’s bill includes Sec. 4281, which calls for creating safe pharmacy networks in Part D to prevent the abuse and diversion of controlled substances, and Sec. 4282, which authorizes Part D plans to suspend payment of claims to pharmacies suspected of a credible allegation of fraud.

While we are still analyzing these provisions in detail, we are gratified to see they are part of the larger discussion on improving patient health and ensuring the integrity of our health care system. These are issues that AMCP has taken the lead on for years. In the coming weeks, we will be offering lawmakers on the Committee in-depth recommendations on how these proposals might be modified to have the biggest positive impact.

The nearly 400-page draft bill, which stems from the Committee’s bipartisan 21st Century Cures initiative last year, aims to accelerate discovery, development and delivery of new drugs and therapies. It also includes reforms of various health care programs such as Medicare Part D. The Committee said it hopes to present legislation to President Obama by the end of the year.

The Academy has developed detailed positions on both Part D topics.

On controlled substances, AMCP’s position includes amending current law to allow Part D prescription drug plans and Medicare Advantage prescription drug plans to limit patients with a history of abuse to a single prescriber and/or pharmacy (or chain of pharmacies), similar to what already occurs in the private market and the Medicaid program..
On anti-fraud, AMCP’s position includes amending current law to allow health plans to withhold payments to pharmacies that are suspected of fraud in the program. This solution would allow plans to combat suspected fraud before payments are made, instead of attempting to recover the payments after the fact, which is often a difficult, if not impossible, task.

Centene Corporation (NYSE: CNC) today announced that its wholly-owned Florida subsidiary, Sunshine Health, was elevated to Commendable Accreditation by the National Committee for Quality Assurance (NCQA) for its Medical Managed Assistance and Child Welfare programs. NCQA evaluates how well a health plan manages all parts of its delivery system – physicians, hospitals, other providers, and administrative services in order to continuously improve the quality of care and services provided to its members.

Sunshine Health serves 400,000 Medicaid members under its Managed Medical Assistance and Child Welfare programs statewide.

NCQA is a private, nonprofit organization dedicated to improving health care quality. NCQA accredits and certifies a wide range of health care organizations. It also recognizes clinicians and practices in key areas of performance. NCQA is committed to providing health care quality information for consumers, purchasers, health care providers and researchers.

Aon Hewitt, the global talent, retirement and health solutions business of Aon plc (NYSE: AON), has announced that employers and individuals participating in the Aon Active Health Exchange are seeing notable reductions in health care spend for the third straight year.

More than 600,000 employees and their dependents enrolled in health benefits through the Aon Active Health Exchange for the 2014 calendar year. All of the 18 companies that participated in 2014 are returning to the Aon Active Health Exchange in 2015. Across those companies, rates for medical coverage increased an average of 5.3 percent. This is lower than the industry average and includes costs associated with the Affordable Care Act. According to Aon Hewitt’s estimates and several other organizations,1 average health care cost increases in 2015 for large U.S. employers with self-insured arrangements are projected to be between 6.52 percent to 8.0 percent3 before employers make changes in deductibles and copays. Based on employer and employee feedback, plan designs in the Aon Active Health Exchange for 2015 will once again remain unchanged.

Companies participating in the Aon Active Health Exchange also reduced their overall health care cost for medical coverage by more than $750 per employee compared to their expected 2014 spending. These numbers factored in the savings delivered through the exchange model, the impact of employee choices to buy less rich coverage and the impact of employees who chose to purchase richer—and often more expensive—medical plans. Average health care costs were $8,342 per employee, down from $9,098 per employee. These savings were shared with employees through reduced payroll contributions, as well as through offering a range of more affordable health care coverage options.

Thousands of Pennsylvanians receive medical services every day from local health care systems. Each of these facilities has its own physicians and practitioners with their own specialized knowledge gained from their own experience providing care. But what if they came together to compare notes? What if they shared what they know about what works best for patients? What if, cooperatively, they focused on improving specific categories of care?

That is exactly the purpose of a new collaborative brought together by Capital BlueCross and the Health Care Improvement Foundation (HCIF). A first-of-its-kind for the central Pennsylvania and Lehigh Valley regions, the collaborative is focusing on improving health care safety, outcomes, and the overall patient experience by zeroing in on one important health initiative at a time.

The first area of focus that the collaborative’s health care system participants have agreed to work on with Capital BlueCross and HCIF is palliative care.

The aim of the collaborative is to advance the care and support of patients with advanced illness and their families across the region. Over the course of the collaborative, organizations will work together to improve the awareness and use of POLST (Pennsylvania Orders for Life Sustaining Treatment) by promoting advanced care planning conversations between health care providers and patients with advanced illness and their families, fostering shared decision-making about individualized goals of care, and ensuring the implementation of individualized health care goals across care settings.

A Regional Palliative Care Steering Committee is being formed to provide input into collaborative goals, metrics, and the curriculum for an in-person conference this fall. The committee will continue to work together to ensure that program activities best support participating organizations and that patient outcomes are met and sustained.

Success of the initiative will be monitored and measured by the Pennsylvania Health Care Quality Alliance. The Pennsylvania Health Care Quality Alliance is a non-profit that seeks to improve the quality of patient health through alliances between hospitals, physicians, health plans and other stakeholders who are dedicated to promoting responsible public reporting of health care information. More information can be found at www.pahealthcarequality.org.