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Need to Know: March 2013


Health management and business updates


Health Management

Adverse events for patients treated for heart attack and heart failure have declined, according to a study in the New England Journal of Medicine. However, the analysis funded by the Agency for Healthcare Research and Quality (AHRQ), found that there hasn’t been a significant decrease in adverse events for patients being treated for pneumonia and those recovering from surgery. Researchers found that 81,000 adverse events among heart attack and heart failure patients were averted annually in 2010 and 2011 compared with 2005 and 2006. However, some common adverse events in pneumonia and surgical patients (like pressure ulcers and urinary tract infections) did not show improvement. http://1.usa.gov/1n8V7gX


Horizon Blue Cross Blue Shield of New Jersey and 190 network OB/GYNs have created the state’s first Patient-Centered Pregnancy and Delivery Program for better coordination of care for pregnant women. Participating OB/GYNs lead and organize the full-spectrum of care related to a patient’s pregnancy, delivery and post-delivery recovery. 


Cigna and Commonwealth Primary Care ACO in Phoenix launched a collaborative accountable care initiative-Cigna’s model to improve health, affordability and patient experience. The program, which benefits over 7,000 Cigna members, has the same goals as industry ACO models (http://bit.ly/1bLIOHZ). Commonwealth care coordinators will work with Cigna to help individuals navigate the healthcare system. Cigna will compensate Commonwealth physicians for their services and they also may be rewarded through a “pay-for-value” structure if they meet targets for improved quality and lower costs. 

Business updates >>



Blue Cross and Blue Shield of North Carolina (BCBSNC) will now offer family coverage to same-sex married couples. BCBSNC made the change March 1. The announcement came after a report that BCBSNC cancelled family coverage sold to 20 gay and lesbian couples on the exchange. Although North Carolina does not recognize same-sex marriages, the plan recognizes marriages as defined by the federal government for plans on and off the exchanges.


Priority Health is the only health plan in Michigan to receive wellness accreditation from the National Committee for Quality Assurance (NCQA). Priority Health offers customized wellness plans and solutions, such as health assessments and biometric screenings. NCQA measured the number of wellness performance guidelines that Priority Health submitted against a minimum scoring threshold.


WellPoint’s  fourth quarter 2013 net income was $148.2 million. Medical enrollment totaled approximately 35.7 million members as of Dec. 31, 2013, a decrease of 477,000 members, or 1.3%, from 36.1 million at Dec. 31, 2012. Commercial enrollment decreased by 234,000, as attrition in the national and individual markets was partially offset by growth in local group business. Membership in the Medicaid and Medicare businesses declined by 142,000 and 108,000, respectively. Operating revenue exceeded $17.6 billion in fourth quarter 2013, an increase of about $2.5 billion, compared with about $15.2 billion in the prior year quarter. The increase was driven by the inclusion of Amerigroup business for the entire fourth quarter of 2013. The benefit expense ratio was 87.8% in fourth quarter 2013.


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