Need To Know: October 2014

Industry updates in business and health management.

Health Management

A study appearing in Health Services Research by Independence Blue Cross and CTI Clinical Trial and Consulting Services demonstrates fewer emergency department visits for chronically ill patients cared for in a patient-centered medical home. The study-the largest of its kind with claims data from approximately 460,000 Independence beneficiaries enrolled in 280 primary care practices-found that the transition to a medical home was associated with a statistically significant 5% to 8% reduction in emergency department visits. These reductions were most evident among patients with diabetes, who experienced a 9.5% to 12% reduction.  In other Independence news, the insurer won a 2014 Digital Accelerator Award, sponsored by Apigee, in the Best Data Analytics for Digital Business category. Independence uses its big data and predictive analytics to help solve challenging healthcare problems, and to better serve its customers.

Aetna and Baylor Scott & White Quality Alliance have signed a new accountable care collaboration agreement, introducing co-branded Aetna Whole Health plans to members in North Texas. These members will benefit from access to more than 900 primary care physicians, 27 hospitals, 2,800 specialists and six urgent care facilities in the Dallas/Fort Worth Metroplex. The plans were effective for self-insured customers on October 1, 2014, and are anticipated to be available for fully insured customers in early 2015. Additionally, Aetna announced a new accountable care agreement with Weill Cornell Physicians, Cornell University’s physician group, to enhance care for approximately 9,000 of Aetna’s commercial and Medicare members in New York. The accountable care arrangements involve the Weill Cornell Physicians’ 1,237 doctors, healthcare professionals and care managers who work closely with Aetna to coordinate healthcare services and demonstrate high-quality medical care.

Avalere Health examined access to 11 drugs used to treat rare diseases in a subset of bronze- and silver-level exchange plans in the 15 largest states. Results showed that, on average, these drugs were covered 65% of the time across plans; wide variation in plan use of utilization management by drug from 6% to nearly 75%; frequent placement of drugs on the highest tier of four-tier formularies; and greater than 70% of plans using coinsurance ranging from 10% to 50% in silver plans. The analysis was published in September in the Journal of Managed Care & Specialty Pharmacy. Analysis was funded by Novartis Pharmaceuticals.


Four Kaiser Permanente leaders have been named to Diversity MBA Magazine’s Top 100 Under 50 Diverse Executive & Emerging Leaders list. Margaret Lapiz, vice president, Strategy and Integration, The Permanente Medical Group; Rich Smith, vice president, Human Resources, Northwest Region; Julie Stoss, vice president, Government Relations; and Todd Trotter, senior director, National Human Resources, Compliance, and Enterprise Risk Management, were recognized by the publication for their outstanding leadership. Diversity MBA Magazine serves multicultural professionals in corporate America as well as business students and entrepreneurs.

*Estimate is statistically different from estimate for the previous year shown (p<.05).