Friday, September 28, 2012

Walgreens Hits Up Employer Market With Extension of Rx Savings Club

Reprinted from DRUG BENEFIT NEWS, biweekly news, proven cost management strategies and unique data for health plans, PBMs, pharma companies and employers.
By Lauren Flynn Kelly, Editor
September 21, 2012 Volume 13 Issue 18
As part of an ongoing effort to reach employers, Walgreen Co. is seeking to boost enrollment in its “new and improved” Prescription Savings Club by offering memberships to the discount program in bulk to small and mid-sized employers. The new business-to-business (B2B) product offers discounts on the card’s membership fee based on how many employees sign up. But enrollment in the program, which was launched for employers late last year, has been somewhat slow going, and a consultant warns that it’s difficult for retailers to gain traction with an offering that’s historically been aimed at consumers.
Walgreens’ discount pharmacy program was revamped earlier this year to include more than 700 “value-priced” generics — up from about 400 products offered before — and features savings tiers, with $10, $20 and $30 copays on a 90-day supply of those selected generics. Members who pay the $20 annual enrollment fee ($35 for families) also will receive discounts on several other in-store services, such as 10% off visits to Take Care clinics, 5% to 20% discounts on immunizations, and rebates on Walgreens’ brand front-end products. And smaller discounts are available on other generics and single-source brands. Walgreens plans to integrate the club with its new loyalty program, Balance Rewards, in the future.
Jay Bernstein, product manager at Walgreens, explains that the product is a good fit for small and mid-sized employers that may be looking for an alternative to prescription drug coverage as they determine whether they can afford the penalties imposed by health care reform. Beginning in 2014, certain employers with at least 50 full-time employees will be subject to a $2,000 penalty per employee if at least one worker receives a premium credit through a health insurance exchange. “For them, the Prescription Savings Club might be a really nice alternative, almost kind of to save face with their employees,” suggests Bernstein.
David Dross, managed pharmacy practice leader at Mercer, says he has not seen interest among his own mid-sized employer clients in a program like this, but that doesn’t mean there’s not a market for it. “There may be a need at some point in the future, particularly regarding exchanges, if people start to move away from providing plan sponsor coverage,” he observes. “However, I have to wonder, if plan sponsors are going to make the decision to exit, then they’re going to exit rather than support their employees with this kind of offering.”
“I always tell my sales team the Prescription Savings Club is not for everybody,” maintains Bernstein. “If you’re going into a large employer and they have coverage, they’re not going to want the Prescription Savings Club, quite frankly. It’s not a program for those who have insurance.” The product may, however, be ideal for large employers with part-time employees who do not have drug coverage, he asserts. Walgreens even included its own part-time employees in a pilot last November.
Of its 250,000 part-time and full-time employees throughout the country, Walgreens enrolled more than 80,000 workers in the pilot, although Bernstein estimates around 200,000 people are using it including family members. Results from that pilot are not yet available as it has not been a full year, he says. That discount program is separate from the employer’s drug benefit, which is managed by Catamaran Corp. through a pre-existing agreement with Catalyst Health Solutions, Inc. Catalyst acquired Walgreens’ PBM, Walgreens Health Initiatives, prior to merging with SXC Health Solutions Corp. to form Catamaran.
Program Could Supplement Full Coverage
For some, a program like the Prescription Savings Club is also “filling in the gap” between what a person is able to obtain through employer-sponsored drug coverage and what they actually want or need. “Even though we’re Walgreens and we control the drugs that we sell, we still have a formulary like others do and there are still things that end up on the third tier or may end up not being covered at all, so folks like me and folks that I’ve spoken to who are full timers are signing up for the club,” says Bernstein.
The fee structure is based on how many employees enroll in the program. The discount ranges from 5% for groups with between 500 and 2,500 enrollees to 25% for groups with 100,000 members or more. The employer has a choice of whether they want to pass that discounted enrollment fee onto the member, split it with the member or cover it in full. Bernstein adds that the company is looking to improve the discount structure as interest in the program grows.
Walgreens now has one client enrolled, fewer than half a dozen in the contract stage and two very large employers that are interested. Walgreens’ hope is that as plans get closer to the implementation of health care reform requirements, more groups will sign up. “As I’m going out and promoting the program, I’m probably getting at least two inquiries a week from my sales team and that’s been picking up quite a bit lately,” reports Bernstein.
The only difference between the B2B and business-to-consumer (B2C) offering is that Walgreens’ consumer customers are guaranteed to save at least their enrollment fee through the Prescription Savings Club, while B2B customers are not promised the savings guarantee.
“We feel that the Prescription Savings Club is the most comprehensive discount program out there. I don’t know of any other program that has the tiered discount structures,” adds Bernstein. “Target [Corp.], Wal-Mart [Stores, Inc.], the grocers, they all do the same thing. They have a list of 300-plus generics that they discount for $4, but that’s what it’s limited to.”
“There are a lot of different discount cards out there right now. Some are driven by pharmaceutical manufacturers, some by the retailers. Honestly, for lack of a better term, it’s kind of a noisy, confusing space,” observes Dross. “It’s really hard for any of the entities to get traction. Really, a lot of the activity that I’ve seen has been not in the B2B space but rather in B2C. I have not seen plan sponsors that I work with expressing interest in this, but part of that might be that they haven’t marketed it that much yet.”

Today's Datapoint

$1.5 billion … would be paid by BCBS of Michigan over 18 years to establish a nonprofit foundation under Michigan Governor Rick Snyder’s proposal to convert the company to a nonprofit mutual.

Thursday, September 27, 2012

Younger Americans More Receptive Than Seniors To GOP Medicare Plan

KHN Staff Writer
Sep 27, 2012
The Republican proposal to change Medicare that has been championed by GOP vice presidential candidate Paul Ryan remains unpopular with Americans, although younger people are more receptive to it than older ones, according to a new poll
Only 37 percent say that the program should be changed to a "premium support" system in which the government provides beneficiaries with a fixed amount of money to buy coverage, either from traditional Medicare or private insurers, the poll by the Kaiser Family Foundation found. (KHN is an editorially independent part of the foundation.) Fifty-five percent support keeping Medicare as it is today, with a guaranteed set of health benefits. Only a quarter of Americans aged 55 or older want the program to change, and even a majority of older Republicans opposed the proposal backed by the GOP-controlled House.
However, the poll found that younger Americans are less resistant. Among adults between 18 and 54, 50 percent favor keeping Medicare as it is, and 44 percent believe it should switch to the premium support model, which is also called a defined contribution. Even among Democratic adults under 55, 41 percent supported the Republican approach; the survey question did not indicate that it’s a GOP plan.
The age gap is somewhat ironic, because those who are most opposed to the proposed new system would be least affected. Ryan’s plan would exempt those over 55 and allow them to remain in traditional Medicare, a feature supported by Mitt Romney, the GOP presidential candidate. Nonetheless, this carve out has not won over the elderly -- who are among the most reliable voting blocs -- the poll shows.
The poll found that many voters on both sides switch their views depending on how the program is described to them. For instance, when told about the exemption for people over 55, 19 percent of Americans said they were “more interested” in making the change—giving the premium support side a 53 percent majority.
"It’s important to note that opinion on the defined contribution plan, as is often true when it comes to major policy changes that are difficult to explain, is still quite malleable," the pollsters wrote.
Supporters of traditional Medicare were most likely to reconsider when told that changing to a premium support system was needed to sustain Medicare for future generations.
The poll found that Democrats also have influential arguments for those Americans leaning toward supporting the change. Between 14 percent and 19 percent said they were less interested in making the change after being told either that it would shift the cost from the government to seniors; that it would give the insurance industry "too much influence" over seniors’ health care; that it would turn Medicare into a “voucher” program or that it would end “traditional Medicare as we know it.” The cost shift argument was the most persuasive of those tested by the pollsters.
Overall, most voters believe the federal deficit can be dealt with without reducing Medicare spending, but they also believe some sort of changes will be necessary for Medicare for its long-term sustainability.
The poll found that many Americans were not even familiar with the terms used in this debate. Less than a quarter of people knew what either "premium support" or "defined contribution" means. Half of voters recognized the term "voucher," which Democrats have been using pejoratively to describe the program.
The poll found that Medicare remains an important issue for voters: less critical than their concerns about the economy and the budget deficit but more pressing than any other topic, including the 2010 health care law. The poll also found that generally the public trusts President Barack Obama on health issues more than Mitt Romney, although elderly voters are about evenly split on which candidate would do a better job with Medicare. Independent elderly voters thought Romney would do a better job guiding the program’s future.
The poll continued to find the public split on the health law. This month, 45 percent favored it and 40 percent didn’t. Older Americans are more negative than younger ones. The poll found that knowledge of what’s in the law remains weak: Less than half of those polled knew about components such as closing the Medicare prescription drug "doughnut hole" and making more affluent people pay more in premiums and payroll taxes for Medicare. Only 39 percent are confident that the law does not include government "death panels" that make decisions about end-of-life care.
The survey of 1,534 adults was conducted between Sept. 13 and 19. It has a margin of error of +/- 3 percentage points.

New Program to Increase Quality in Nursing Facilities


FOR IMMEDIATE RELEASE                                    Contact: CMS Media Relations
September, 27, 2012                                                                      (202) 690-6145

New Program to Increase Quality in Nursing Facilities
Seven Organizations Partnering with 145 Nursing Facilities Selected to Implement the Initiative to Reduce Avoidable Hospitalizations among Nursing Facility Residents 
The Centers for Medicare & Medicaid Services (CMS) today announced seven cooperative agreement awards partnering with 145 nursing facilities to implement the Initiative to Reduce Avoidable Hospitalizations among Nursing Facility Residents. The initiative will test models to improve the quality of care and help reduce avoidable hospitalizations among nursing facility residents by funding organizations that provide enhanced on-site services and supports to nursing facility residents.  
Nearly two-thirds of nursing facility residents are enrolled in Medicaid, and most are also enrolled in Medicare.  These Medicare-Medicaid enrollees are among the most fragile and chronically ill individuals served by the programs. Research found that approximately 45 percent of hospitalizations among Medicare-Medicaid enrollees receiving either Medicare skilled nursing facility services or Medicaid nursing facility services could have been avoided. Total costs for these potentially avoidable hospitalizations for Medicare-Medicaid enrollees for 2011 were estimated to be between $7 and 8 billion.
“We are excited about this partnership and the programs these seven organizations are putting in place to work with nursing facilities to ensure the best possible care for their residents.” said Acting Administrator Marilyn Tavenner.  “We view this initiative and the enhanced level of collaboration it will generate among a variety of providers as the key to reducing costly and avoidable hospitalizations for this population that often has the most complex health care needs.”
Through the Initiative, CMS will partner with seven organizations to improve care for long-stay nursing facility residents. These organizations will collaborate with nursing facilities and State Medicaid programs to provide better quality of care in nursing facilities.
Implementation of the initiative will begin later this year at 145 nursing facilities in seven states in partnership with the following organizations:
  • Alabama Quality Assurance Foundation (Alabama)
  • Alegent Health (Nebraska)
  • The Curators of the University of Missouri (Missouri)
  • Greater New York Hospital Foundation, Inc. (New York)
  • HealthInsight of Nevada (Nevada)
  • Indiana University (Indiana)
  • UPMC Community Provider Services (Pennsylvania)
All selected organizations will have on-site staff to partner with the existing nursing facility staff to provide preventive services as well as improve assessments and management of medical conditions. Participants will also work toward more seamless beneficiary transitions of care, and leverage use of emerging technologies, among many other activities. Each model will be subject to a rigorous external evaluation.
The Initiative will be run collaboratively by the CMS Medicare-Medicaid Coordination Office and the Center for Medicare and Medicaid Innovation, both created by the Affordable Care Act to improve health care quality and reduce costs in the Medicare and Medicaid programs. CMS issued a Request for Applications on March 15, 2012. More information about this initiative is available at:

Today's Datapoint

11%… of Americans have a high degree of understanding of the provisions of the Affordable Care Act, according to a survey of 2,500 adults conducted by the consulting group TNS.

Wednesday, September 26, 2012

Today's Datapoint

10% … will be the decline in Medicare Advantage premiums by 2013 since the Affordable Care Act was enacted in 2010, with enrollment soaring by 28%, based on forecasts and data from the just-completed bidding process, CMS announced on Sept. 19.

Quote of the Day

“While Republicans are rhetorically committed to ACA repeal, it is not clear to me that when they look at what it involves they will really want to do it. Nor is it clear that they can do it, as a lot of it is hugely popular and much of it is already in place. An additional and important reason why repeal of the ACA and of exchanges would be problematic for Romney is the ‘if you break it, you fix it’ principal. If the ACA is repealed, the number of uninsured will keep going up, health care costs will keep going up, and the Medicare Hospital Insurance Trust Fund will run out of money eight years sooner…. That is not a set of problems of which a man as bright as Mitt Romney would like to take ownership.”

— Henry Aaron, a senior fellow at the left-leaning Brookings Institution in Washington, D.C., told AIS’s Inside Health Insurance Exchanges.

2013 Is Fine, but Will CMS Still Love MA ‘Tomorrow’?

By James Gutman - September 20, 2012
It sounded a little bit like CMS was taking a victory lap — perhaps deservedly — when it unveiled on Sept. 19 the summary premium and cost-sharing results from the Medicare Advantage bidding process for 2013. Average MA premiums will be up only slightly, access to plans will be improved, enrollment is expected to rise 11%, and benefits and cost sharing will be basically stable, according to the agency.
The gains, suggested Jonathan Blum, director of CMS’s Center for Medicare, in the news conference about the data, relate partly to the fact that “we are operating the program differently than it was operating in the past.” Among the differences, he added, is that “we are negotiating [with MA plans] much more aggressively.” He attributed part of the success to the health reform law, and both Blum and other CMS officials produced figures on the decline in MA premiums since the statute was enacted in 2010. It was exactly the message a presidential administration would like to get out a month and a half before the elections that would decide its future.
How bright that future is for MA, though, is in doubt. For one thing, medical services utilization seems once again on the rise, albeit still relatively low. For another, the bulk of MA plan payment cuts under the reform law hasn’t yet taken effect, nor has the “fee” on insurers that begins in 2014. And perhaps most importantly, the huge CMS stars bonus demonstration for quality, which brings sizable rewards even for three-star plans, ends in 2014, although a more modest program with rewards for only high-rated plans continues after that.
Do you think the outlook for the MA program will change after this year’s elections? If so, how? Will CMS’s support be as strong in the possible second Obama administration as it is currently? CMS and the MA industry seem to share many of the same short-term goals now, but will they still be “bedfellows” over the longer term?

Tuesday, September 25, 2012

CMS NEWS: Medicare Advantage remains strong

Wednesday, September 19, 2012

Medicare Advantage remains strong

Enrollment in the Medicare Advantage (MA) program is projected to increase by 11 percent in the next year and premiums will remain steady, Health and Human Services Secretary Kathleen Sebelius announced today. Since the Affordable Care Act was passed in 2010, Medicare Advantage premiums have fallen by 10 percent and enrollment has risen by 28 percent.

"Thanks to the Affordable Care Act, the Medicare Advantage and Prescription Drug programs have been strengthened and continue to improve for beneficiaries," said Secretary Sebelius. "Since the law was enacted in 2010, average premiums have gone down, enrollment has gone up, and new benefits and lower drug costs continue to help millions of seniors and people with disabilities."

For the third year in a row, the Centers for Medicare & Medicaid Services (CMS) used authority provided by the Affordable Care Act to protect beneficiaries from significant increases in costs or cuts in benefits. Access to supplemental benefits remains steady and beneficiaries’ average out-of-pocket spending remains constant.

The average MA premium in 2013 is projected to increase by only $1.47 from last year, coming to $32.59. However, if beneficiaries choose lower cost plans at the same rate in 2013, as they did in 2012, the average premium is expected to increase by only 57 cents. Access to the Medicare Advantage program will remain strong, with 99.6 percent of beneficiaries having access to a plan. Additionally, the number of plan choices will increase by 7 percent in 2013.

Last month, CMS announced that the average estimated basic Medicare prescription drug plan premium was projected to be $30 in 2013, holding steady from last year. Today's projections show that access to a Medicare prescription drug plan will remain strong in 2013. Everyone with Medicare will have access to a wide range of plan choices.

As a result of the Affordable Care Act, coverage for both brand name and generic drugs in the Part D donut hole coverage gap will continue to increase until 2020, when the donut hole will be closed. This year, people with Medicare received a 50 percent discount on covered brand name drugs and 14 percent coverage of generic drugs in the donut hole. In 2013, Medicare Part D’s coverage of brand name drugs will begin to increase, so people with Medicare will receive approximately 53 percent off the cost of brand name drugs, and coverage for 21 percent of the cost of generic drugs, in the donut hole.

Since the law was enacted, 5.4 million people with Medicare have saved over $4.1 billion on prescription drugs in the donut hole. An estimated 37 million people with Medicare received a preventive benefit free of charge in 2011.

The Annual Open Enrollment Period for health and drug plans begins on October 15 and ends December 7. Each year plans change what they cost and what they cover. To find helpful Medicare tools and information, and compare the cost or benefits of 2013 Medicare health plans in your area, please visit:

2012 Fall Med Supp Rate Increases 20% Lower

Recent analysis from CSG Actuarial indicates Fall 2012 Medicare Supplement premium rate increases (to date) have been 20% lower than Medicare Supplement premium rate increases during the corresponding time period a year ago. We attribute these lower premium rate increases to improved Medicare Supplement claims experience throughout 2012, driven by less guarantee issue business written during 4th qtr 2011 and lower Medicare cost trends in 2012.

The Medicare Supplement market continues to expand. As previously reported, CSG Actuarial is projecting more than $23 billion of premium in the Medicare Supplement market in 2012, up 5% from 2011. Also, more than 5 companies have entered or re-entered the Medicare Supplement market in 2012 and 3 other companies have re-priced their premium rates to get more competitive in the market.

Call 855-861-8776 or email to learn more about CSG Actuarial’s Market Analytics™ services and tools.

Friday, September 21, 2012

Through the Affordable Care Act, Americans with Medicare will save $5,000 through 2022

5.5 million seniors saved money on prescription drugs and 19 million got free preventive care in 2012
Because of the health care law – the Affordable Care Act – the average person with traditional Medicare will save $5,000 from 2010 to 2022, according to a report today from the U.S. Department of Health and Human Services. People with Medicare who have high prescription drug costs will save much more – more than $18,000 – over the same period.

HHS Secretary Kathleen Sebelius also announced that, because of the health care law, more than 5.5 million seniors and people with disabilities saved nearly $4.5 billion on prescription drugs since the law was enacted.  Seniors in the Medicare prescription drug coverage gap known as the donut hole have saved an average of $641 in the first eight months of 2012 alone. This includes $195 million in savings on prescriptions for diabetes, over $140 million on drugs to lower cholesterol and blood pressure, and $75 million on cancer drugs so far this year.  Also in the first eight months of 2012, more than 19 million people with original Medicare received at least one preventive service at no cost to them.

“I am pleased that the health care law is helping so many seniors save money on their prescription drug costs,” Secretary Sebelius said.  “A $5,000 savings will go a long way for many beneficiaries on fixed incomes and tight budgets.”

The health care law includes benefits to make Medicare prescription drug coverage more affordable. In 2010, anyone with Medicare who hit the prescription drug donut hole received a $250 rebate. In 2011, people with Medicare who hit the donut hole began receiving a 50 percent discount on covered brand-name drugs and a discount on generic drugs. These discounts and Medicare coverage gradually increase until 2020, when the donut hole will be closed.

The health care law also makes it easier for people with Medicare to stay healthy. Prior to 2011, people with Medicare had to pay for many preventive health services. These costs made it difficult for people to get the health care they needed. For example, before the health care law passed, a person with Medicare could pay as much as $160 for a colorectal cancer screening.  Because of the Affordable Care Act, many preventive services are now offered free to beneficiaries (with no deductible or co-pay) so the cost is no longer a barrier for seniors who want to stay healthy and treat problems early.

In 2012 alone, 19 million people with traditional Medicare have received at least one preventive service at no cost to them.  This includes 1.9 million who have taken advantage of the Annual Wellness Visit provided by the Affordable Care Act – almost 600,000 more than had used this service by this point in the year in 2011.  In 2011, an estimated 32.5 million people with traditional Medicare or Medicare Advantage received one or more preventive benefits free of charge.

For state-by-state information on savings in the donut hole, please visit:

For state-by-state information on utilization of free preventive services, please visit:

For more information on the estimate that the average Medicare beneficiary will save $5,000 from 2010 to 2022 as a result of the health care law, please visit:

Tuesday, September 18, 2012

Today's Datapoint

16 million…Americans who take medication for high blood pressure still do not have their condition under control, according to a new report from the CDC.

Wednesday, September 5, 2012

UCare Finds That Stars Marketing Is Starting to Boost Understanding

Reprinted from MEDICARE ADVANTAGE NEWS, biweekly news and business strategies about Medicare Advantage plans, product design, marketing, enrollment, market expansions, CMS audits, and countless federal initiatives in MA and Medicaid managed care.
By James Gutman, Managing Editor
August 23, 2012 Volume 18 Issue 16
A not-for-profit Medicare Advantage plan operator in Minnesota said it is beginning to have success marketing its high CMS star quality ratings to potential enrollees and is tailoring the media and messages about them to various segments of its audience, according to a top executive of the plan. And Ghita Worcester, senior vice president, public affairs and marketing for UCare, says its providers are helping to get the word out about the importance of the star measures.
Nevertheless, acknowledges Worcester in an interview with MAN, “the average consumer isn’t really looking for or understanding star ratings yet.” Partly with this in mind, she suggests, a portion of UCare’s strategy is to communicate the importance of star ratings in conjunction with preventive care.
UCare is a 28-year-old organization (formed by faculty members at the University of Minnesota) that is the parent of UCare for Seniors, a 4.5-star MA plan with more than 100,000 members in Minnesota and 26 counties of western Wisconsin. The organization also has a four-star MA Special Needs Plan (SNP) that serves more than 9,000 Medicare-Medicaid dual eligibles in a 57-county area of Minnesota as a participant in the state’s Minnesota Senior Health Options program.
In a presentation at the Star Ratings Congress for Medicare Advantage Plans, sponsored by Global Media Dynamics, in Las Vegas last month, Worcester described UCare’s star ratings “communications strategy.” It is designed, she said, to raise awareness for both members and prospective members, and to “integrate the quality message across all communications channels.” She added that UCare seeks to draw a “connection between quality service and quality health outcomes.”
With this in mind, she continued, UCare educates members about star ratings and why they matter, seeks to “engage members in star ratings improvement initiatives” and promotes preventive care.
UCare Sees Need to Change Member Attitudes
The organization faces several challenges in doing this, Worcester tells MAN. For one thing, she explains, consumers see CMS’s Consumer Assessment of Health Providers and Systems (CAHPS) survey and preventive care in general as something for the health plan. UCare in its stars communications strategy needs to convey that this is about how the members themselves access and get care — “it’s not like buying a car,” she says.
Part of what UCare communicates involves print documents, including newsletter articles and messages from the CEO, plus an annual report for members that features its high star ratings. For prospects, notes Worcester, there are direct-mail brochures, including about preventive care, and sales-presentation materials. With the aid of those, UCare is “beginning” to see “a little more savvy consumer” in terms of understanding star ratings, but it will take numerous ratings cycles to foster good understanding and engagement, she suggests.
In light of this, she continues, its member advisory committee recently recommended that a calendar of when preventive services should be obtained would be helpful to distribute.
For the SNP, Worcester adds, “you’re starting at a different point.” Sending flyers won’t work with much of this audience, so UCare for instance might focus on different media, such as a cable television program aimed at the area’s substantial Somali population (MAN 8/2/12, p. 8), she says. The organization seeks and obtains help from providers in fostering awareness of such efforts.
UCare also uses “hold” messages about its star ratings for customers telephoning its customer-service department, but Worcester points out that they are useful only for people calling in, and need to be supplemented with other phone and online efforts. The organization includes star-rating information on its website’s home and product pages and uses star-related data as a “core talking point” during sales and customer-service calls, according to Worcester.
As an additional outreach effort, UCare has morning radio drive-time messages this summer related to its high CAHPS rating in an effort to appeal to baby boomers.
Asked how the organization’s star-related communications efforts will be affected by CMS’s 2013 marketing guidance (MAN 6/21/12, p. 1), which includes requiring updates of star-related promotional materials within 15 days — instead of the previous 30 — of getting the 2013 star ratings, Worcester cites potential problems in getting the new information printed and incorporated in so short a time.
However, she stresses that the changes don’t affect UCare’s overall stars and preventive care communications strategy, and the new requirement to include the overall star rating if any individual-category ratings are used in marketing is in keeping with what UCare already has done.
The organization, she says, conducts well-attended meetings throughout the year just to educate the community about Medicare in general and star ratings in particular. “We’re in that period of time when the eligible beneficiaries are still learning what is involved in star ratings,” Worcester asserts. UCare’s effort to communicate the relationships between stars and quality is important in that, she maintains, and also “it’s the right thing to do.”

Today's Datapoint

18% to 20% … of Medicare beneficiaries are readmitted to the hospital, and readmissions for heart failure, chronic lung disease or ESRD are often 25% to 30%, according to Janet Tomcavage, chief clinical transformation officer at Geisinger Health Plan.

Quote of the Day

“While most benefits offered by our affiliated health plans generally follow our drug formulary, weight-loss drugs are not included in our standard plans and generally are not reimbursed through most of our customers’ benefits. Historically, we have found that weight-loss drugs in general show modest weight loss along with high-risk side effects.”

— Colleen Haines, vice president of clinical pharmacy services at WellPoint, told AIS’s Drug Benefit News.