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AXA unveils its TotalAssure Critical Illness Series to comprehensively protect customers against 135 illnesses. (From left to right) Janet Lee, Chief Life and Health Insurance Officer, AXA Hong Kong and Macau; Sally Wan, Chief Executive Officer, AXA Greater China; Grace Chan Hoi-lam, renowned actress; and Jonathan Li, Chief Distribution Officer, AXA Greater China, team up to promote early detection and treatment of illnesses at the launch ceremony.Discover how AXA’s new insurance series prioritizes early detection and comprehensive support to safeguard your health
In a groundbreaking move to elevate health protection, AXA Hong Kong and Macau have launched the TotalAssure Critical Illness Series. This innovative insurance product aims to provide extensive coverage for 135 illnesses, emphasizing early detection and intervention for conditions linked to colorectal cancer, breast cancer, and heart disease. By offering proactive care, the new series promises to enhance the overall well-being of its insured members.
Addressing Critical Health Concerns in Hong KongA recent study by AXA revealed that nearly 90% of Hong Kong residents are unaware of their health conditions, putting them at a higher risk of critical illnesses. Shockingly, over 60% do not undergo annual health checkups, and 61% delay seeking medical advice upon noticing health problems. Financial concerns also play a significant role, with 77% of respondents indicating that their choice of treatment would depend on the financial burden, and 84% worried about affording treatment and rehabilitation.
Comprehensive Coverage and Continuous SupportThe TotalAssure Critical Illness Series is designed to meet these challenges head-on. Janet Lee, Chief Life and Health Insurance Officer at AXA Hong Kong and Macau, highlighted the innovative aspects of the new series. “Our new TotalAssure Critical Illness Protection Series not only includes continuous compensation for strokes but also offers advanced protection for early-stage risks associated with the three most common critical illnesses. This ensures our customers receive comprehensive support before, during, and after the onset of serious diseases,” she explained.
Key features of the TotalAssure Series include:
- Enhanced Protection for Early Risk Conditions: The series covers early risk conditions that require specific surgeries, such as precancerous breast lesions, early colorectal cancer risks, and early dilated cardiomyopathy. This early intervention aims to protect customers before their conditions worsen.
- Extended Coverage for Surgeries: The coverage has expanded to include 51 critical surgeries, ensuring support for a wide range of medical interventions.
- Multiple Continuous Claims: The TotalAssure Series offers continuous coverage for common critical illnesses with high recurrence rates, such as cancer, heart attacks, and strokes. This includes a Continuous Cancer Payout for up to 111 months and additional financial support during the recovery period.
Innovative Maternity and Pediatric CarePart of the new series, TotalAssure Plus – BabyPro, offers expectant mothers protection from as early as 18 weeks into pregnancy. BabyPro covers pregnancy complications, postpartum depression for both parents, and provides newborns with double protection during their first policy year.
Addressing Special Educational NeedsRecognizing the unique challenges faced by children with Special Educational Needs (SEN), the TotalAssure Series includes special education support for conditions such as ADHD, autism, and visual or hearing impairments. This ensures insured children receive the necessary support throughout their educational journey.
Mental Health and WellnessThe series also integrates mental health services, providing free mindfulness classes, art workshops, and yoga sessions. This holistic approach ensures the insured and their carers receive comprehensive support following a critical illness diagnosis.
A Commitment to Continuous ImprovementSally Wan, Chief Executive Officer at AXA Greater China, emphasized the company’s commitment to improving health outcomes. “Our goal is to protect and support our customers through every stage of their health journey. With the TotalAssure Series, we are setting new standards in health protection, ensuring our customers receive the best possible care,” she said.
ConclusionWith the introduction of the TotalAssure Critical Illness Series, AXA Hong Kong and Macau are pioneering a new era of health protection. By focusing on early detection and comprehensive support, AXA aims to provide its customers with peace of mind and enhanced health outcomes. For more information on the TotalAssure Series, visit AXA Hong Kong.
Don’t wait to safeguard your health. Learn more about AXA’s TotalAssure Critical Illness Series today and take the first step towards comprehensive health protection.
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Federal Court Approves Largest Settlement Against Clark County School District in History
In a landmark decision, the United States District Court for Nevada has approved a historic $9.95 million settlement against the Clark County School District (CCSD). This settlement, the largest ever against the school district, stems from a case involving severe physical and emotional abuse of a student with autism.
Details of the CaseThe case, originally filed in 2019, was brought forward by the parents of J.W., a non-verbal, autistic child who attended Harley Harmon Elementary School between 2016 and 2018. The lawsuit alleged numerous claims, including assault, battery, negligence, intentional infliction of emotional distress, and violations of the Americans with Disabilities Act (ADA).
“After years of litigation, the family is grateful that the legal aspect of this matter is now at an end,” said Gregg Hubley of Arias Sanguinetti, the law firm representing J.W.’s family. “The trauma and pain that J.W. and his parents had to endure, not just from the abuse but from the foot dragging by the school district will last for years to come, however. We hope the district will put a plan in place so that this harm never comes to another family ever again.”
The AllegationsAccording to the lawsuit, J.W.’s parents initially raised concerns in 2017 about their son not receiving food and water sent from home and being returned with a full diaper. These concerns were ignored, and J.W.’s parents were insulted and castigated by school officials. They removed him from school temporarily but re-enrolled him for the 2017/18 school year.
During that school year, J.W.’s parents noticed bruises on his body. When questioned, the teacher and aides attributed the bruises to playground falls. In May 2018, a substitute aide reported witnessing severe physical and verbal abuse by J.W.’s regular teacher, including hitting J.W. with a pointer stick, wedging him into tight spaces, and forcing him to lie under the teacher’s desk.
The report was handed to the principal, who notified the CCSD Police and Child Protective Services (CPS). An investigation revealed that the teacher admitted to much of the alleged abuse. However, the school district concealed the substitute aide’s full report from J.W.’s parents for years, only disclosing the extent of the abuse after a federal court order.
Legal and Emotional Impact“I’m proud our firm once again stood for justice on behalf of a family that had no place else to turn,” said Mike Arias, managing partner at Arias Sanguinetti. “This child never should have been subjected to any form of abuse, and this family should not have had to jump through so many hoops to get the answers they deserved.”
The case, J.W. v. Clark County School District, underscores the need for stringent measures to protect vulnerable students and ensure accountability in educational institutions.
Arias Sanguinetti, with offices in Las Vegas, Los Angeles, and the Bay Area, has a strong track record of representing individuals who have suffered due to negligence and abuse. The firm has secured over $1 billion for clients and is recognized for its commitment to justice in Nevada, California, and across the nation. Their Las Vegas office specializes in personal injury, medical malpractice, and elder abuse cases.
This settlement represents a significant step towards justice for J.W. and his family. It serves as a crucial reminder of the importance of safeguarding the rights and well-being of students, particularly those with disabilities. As the largest settlement in CCSD’s history, it highlights the need for systemic changes to prevent such incidents from occurring in the future.
For more information on this case and Arias Sanguinetti’s work, visit Arias Sanguinetti.
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Cone Health, a leading healthcare network in North Carolina, is set to join Risant Health, a nonprofit organization established by Kaiser Foundation Hospitals. This strategic move aims to significantly enhance the delivery of value-based care, expanding access and improving health outcomes for millions of people.
Transforming Healthcare for the BetterThe definitive agreement between Cone Health and Risant Health marks a transformative step towards reshaping the future of healthcare. By integrating with Risant Health, Cone Health will benefit from the combined expertise and resources of the network, which also includes Geisinger, the first health system to join Risant earlier this year.
“Cone Health’s impressive work for decades in moving value-based care forward aligns so well with Risant Health’s vision for the future of healthcare,” said Dr. Jaewon Ryu, CEO of Risant Health. “Their longstanding success and deep commitment to providing high-quality care to North Carolina communities make them an ideal fit to become a part of Risant Health.”
Cone Health’s Legacy of ExcellenceFounded in 1953, Cone Health serves over half a million people in the Piedmont Triad area. With more than 13,000 employees and 700 physicians, the network includes four acute care hospitals, a behavioral health facility, and an accountable care organization (ACO). Cone Health’s Triad HealthCare Network (THN) manages care for nearly 200,000 patients across multiple counties.
“Becoming part of Risant Health presents a unique opportunity to shape the future of healthcare in the Triad, the state, and across the nation,” said Dr. Mary Jo Cagle, president and CEO of Cone Health. “As part of Risant Health, Cone Health will build upon its long track record of success, making evidence-based healthcare more accessible and affordable for more people.”
Continued Commitment to Quality CareCone Health will retain its brand, name, and mission, continuing to operate with its existing board, CEO, and leadership team. Patients will see no changes in their care providers or services. “Cone Health customers will see the same doctors, the same nurses, and the same staff in the same locations they do today,” reassured Dr. Cagle.
Enhancing Care Through CollaborationAs part of Risant Health, Cone Health will gain access to advanced technology, services, and capabilities designed to deliver superior health outcomes and lower the total cost of care. This integration aims to foster a more efficient, equitable, and effective healthcare system.
Greg Adams, chair of the Risant Health board of directors, emphasized the significance of this partnership: “Risant Health refuses to accept that fragmented, episodic, fee-for-service care should define the future of healthcare. Models like that of Kaiser Permanente, Cone Health, and Geisinger will help make that possible.”
A Milestone for Cone Health“This is an important milestone on our ‘success to significance’ journey,” said Mae Douglas, chair of the Cone Health board of trustees. “After more than a year of work involving teams of physicians, executives, and others, the Cone Health board of trustees voted to become part of Risant Health.”
The transaction is subject to regulatory approvals and customary closing conditions. Once completed, this collaboration promises to elevate the standard of care, ensuring that North Carolina communities continue to receive high-quality, accessible healthcare.
For more information about Cone Health and its services, visit Cone Health. To learn more about Risant Health, visit Risant Health.
Cone Health is a not-for-profit healthcare network serving people in Alamance, Forsyth, Guilford, Randolph, Rockingham, and surrounding counties. Their brand promise, “We Are Right Here With You,” is shared by over 13,000 employees, 1,800 physician partners, and 1,000 volunteers.
Risant Health is a nonprofit, charitable organization with a vision to improve the health of millions by increasing access to value-based care. Created by Kaiser Foundation Hospitals, Risant Health brings together nonprofit community-based health systems to deliver better health outcomes through innovative, value-based approaches.
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Houston’s Baylor St. Luke’s Medical Center faces two new lawsuits alleging severe surgical errors during heart transplants, marking the latest in a series of legal challenges and investigations against the institution. The suits, filed last week in Harris County District Court, bring the total number of malpractice complaints involving the hospital’s heart transplants to five since a ProPublica and Houston Chronicle investigation last year exposed critical issues in the program.
The federal government previously cut off Medicare funding for heart transplants at St. Luke’s in August due to the hospital’s failure to implement necessary improvements. The hospital is currently appealing this decision.
Case Summaries1. Lazerick Eskridge: Eskridge claims that during his heart transplant in February 2017, Dr. Jeffrey Morgan, a surgeon at St. Luke’s, accidentally sewed a major vein closed, causing blood to back up into his head and necessitating an emergency repair. This error led to serious complications and a three-month hospital stay. 2. Ronald Coleman: Coleman alleges that during his heart transplant in October 2016, Dr. Morgan mistakenly sutured his colon to his diaphragm. This error caused his abdomen to fill with feces, resulting in severe infections and multiple follow-up surgeries. According to the lawsuit, this mistake nearly cost Coleman his life.
Both patients survived but continue to experience significant complications. St. Luke’s, Dr. Morgan, and Baylor College of Medicine have declined to comment on the lawsuits. However, they have previously defended the quality of care provided to heart transplant patients at the hospital.
Background and RepercussionsThese lawsuits come in the wake of several high-profile incidents and a comprehensive investigation by the federal Centers for Medicare and Medicaid Services (CMS) into the hospital’s practices. This includes a recent case where a patient died after receiving a transfusion of the wrong blood type, prompting St. Luke’s to replace its president, chief nursing officer, and a top physician.
Dr. Morgan’s role as the leader of the heart transplant program was effectively ended in October when the hospital announced the hiring of two new heart surgeons. Despite this, Morgan remains on the faculty at Baylor and retains his surgical privileges at St. Luke’s.
The lawsuits accuse Dr. Morgan of technical mistakes and allege that he omitted critical details from operative reports, violating medical protocols and complicating subsequent treatments. Additionally, they accuse St. Luke’s of “malicious credentialing” for allowing Morgan to continue operating despite complaints from other physicians about his surgical skills. Some cardiologists reportedly began referring patients to other hospitals due to their concerns.
Despite the challenges, the hospital claims improved outcomes in recent years, partly because patients like Eskridge and Coleman survived at least one year post-transplant—a key metric in calculating transplant program success rates.
For further details, refer to the original article by ProPublica and the Houston Chronicle here.
Medical Malpractice and Its Implications in HealthcareMedical malpractice occurs when a healthcare professional deviates from the standards of their profession, causing harm to a patient. It encompasses a range of errors, from surgical mistakes to misdiagnosis, and often leads to legal actions against the responsible parties. The consequences of medical malpractice can be devastating, resulting in prolonged suffering, additional medical procedures, and sometimes even death. The field is heavily regulated, with stringent laws and procedures to ensure that victims receive justice and that medical standards are upheld.
Relating to the St. Luke’s Heart Transplant Cases
The recent lawsuits against Baylor St. Luke’s Medical Center in Houston highlight severe instances of alleged medical malpractice. In these cases, the patients claim that Dr. Jeffrey Morgan, a surgeon at St. Luke’s, committed significant surgical errors during heart transplants. Lazerick Eskridge’s lawsuit alleges that Morgan sewed a major vein closed, leading to severe complications and an extended hospital stay. Ronald Coleman’s lawsuit asserts that Morgan sutured his colon to his diaphragm, resulting in life-threatening infections and multiple surgeries.
These allegations, if proven, reflect a grave deviation from accepted medical standards. Such errors not only harm the patients involved but also undermine public trust in the healthcare system. The cases at St. Luke’s also highlight the broader implications of medical malpractice, including the impact on a hospital’s reputation, potential financial liabilities, and the necessity for systemic changes to prevent future occurrences.
The investigation and subsequent legal actions against St. Luke’s underscore the critical importance of maintaining high standards in medical care and the serious repercussions when these standards are not met. The hospital’s ongoing efforts to address these issues, including leadership changes and hiring new surgeons, demonstrate the significant steps institutions must take to restore trust and improve patient outcomes following allegations of malpractice.
Health Insurance and Medical Malpractice CoverageHealth insurance typically covers the costs of medical care, including doctor visits, hospital stays, surgeries, and prescription medications. However, it does not usually cover costs associated with medical malpractice directly. Instead, the financial responsibility for medical malpractice typically falls under medical malpractice insurance, which is purchased by healthcare providers.
Medical Malpractice Insurance:1. Coverage for Healthcare Providers: Medical malpractice insurance is designed to protect healthcare professionals and institutions from the financial risks associated with being sued for malpractice. This insurance covers legal fees, settlements, and any judgments awarded to the plaintiff. Most doctors, surgeons, and hospitals carry this type of insurance as a standard part of their practice. 2. Patient Compensation: When a patient files a malpractice lawsuit and wins, the settlement or judgment amount is usually paid out by the healthcare provider’s malpractice insurance. This ensures that patients receive compensation for their injuries, medical expenses, lost wages, and pain and suffering without bankrupting the provider or institution. 3. Indirect Patient Impact: While health insurance does not cover the costs of malpractice lawsuits directly, it can indirectly affect patients. High malpractice insurance premiums can lead to increased healthcare costs overall, which might be passed down to patients through higher fees or insurance premiums.
Relating to the St. Luke’s Heart Transplant CasesIn the case of Baylor St. Luke’s Medical Center, the lawsuits filed by Lazerick Eskridge and Ronald Coleman for surgical errors during their heart transplants would likely fall under the hospital’s medical malpractice insurance. If the court rules in favor of the plaintiffs, the financial compensation awarded would be paid by the malpractice insurance carried by Dr. Jeffrey Morgan, St. Luke’s, and potentially Baylor College of Medicine.
Patients affected by medical malpractice, such as Eskridge and Coleman, typically do not bear the financial burden of their legal battles if they win their cases. Instead, their compensation comes from the healthcare providers’ malpractice insurance, which is specifically intended to address such incidents and ensure that patients receive fair compensation for their suffering and additional medical costs incurred due to malpractice.
Thus, while health insurance does not cover medical malpractice claims, medical malpractice insurance provides the necessary financial protection and compensation mechanisms to address such unfortunate events.
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AARP Pennsylvania has released its first 2024 election survey, revealing that women aged 50 and older are poised to be a decisive force in the upcoming elections. With nearly one-third of likely voters overall and more than half of likely voters aged 50 and older, these women could significantly influence the election outcome.
The poll shows that Pennsylvania women 50+ are narrowly favoring President Joe Biden over former President Donald Trump by 48% to 47%. In the U.S. Senate race, they prefer Senator Bob Casey over Dave McCormick by an 11-point margin. The survey highlights key issues that matter most to these voters: immigration and border security, inflation and rising prices, and reproductive issues. Social Security and the economy are also top priorities.
Key Concerns and Voting Influence
Bill Johnston-Walsh, AARP Pennsylvania State Director, emphasized the critical role of these voters: “At AARP, we know that the election is coming at a time when women 50+ are worried and feeling stretched to the limit. With inflation and the rising costs of living squeezing Pennsylvania households, women are feeling the pinch directly. But women 50+ consistently vote, and their message is clear: candidates need to understand and provide solutions to the issues that are significantly impacting their lives.”
The survey indicates that women 50+ are particularly concerned about utilities (51%), food (48%), and healthcare/prescription drugs (44%). Among suburban women voters, healthcare/prescription drugs and food prices are the most pressing concerns, tied at 51%, followed by utilities at 47%. These issues resonate across party lines, with majorities of Democratic and Republican women 50+ identifying them as critical.
Support for Candidates Who Address Key Issues
The poll reveals strong support for U.S. Senate candidates who prioritize certain policies:
- 92% are more likely to vote for a candidate who ensures workers receive the Social Security they have paid into.
- 81% favor candidates dedicated to providing support for family caregivers.
- 77% support candidates advocating for paid leave for unpaid family caregivers.
Additionally, 67% of women voters 50 and older believe the country is headed in the wrong direction, aligning closely with the 68% of likely voters 50+ who share this sentiment.
Survey Methodology
AARP commissioned a bipartisan team from Fabrizio Ward & Impact Research to conduct the survey, interviewing 1,398 likely Pennsylvania voters, including a representative sample of 600 likely voters and an oversample of 470 voters aged 50 and older, along with an additional oversample of 328 Black voters aged 50 and older. The interviews were conducted from April 24-30, 2024, via landline, cellphone, and SMS-to-web, with a margin of sampling error of ±4.0% for the statewide sample and ±3.5% for the 50+ sample.
For the full survey results, visit AARP Pennsylvania Polling.
AARP is the nation’s largest nonprofit, nonpartisan organization dedicated to empowering Americans 50 and older to choose how they live as they age. With a nationwide presence, AARP advocates for health security, financial stability, and personal fulfillment. The organization also provides trusted news and information through its publications, AARP The Magazine and AARP Bulletin.
For more information on voting in Pennsylvania, visit AARP Pennsylvania Votes. Read more about the influence of women aged 50 and older on the election in the blog by Nancy LeaMond and Nora Dowd Eisenhower: “Women Age 50-plus are the Voters to Watch in Pennsylvania.”
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Wellcare of NCIn a monumental step towards supporting victims of domestic violence, WellCare of North Carolina and the Centene Foundation have announced a $1.95 million investment in The Umbrella Center, a new family justice center in Charlotte. This three-year investment will aid in developing the center at 4822 Albemarle Road, which is set to open in the summer of 2026, and provide essential services to those impacted by domestic violence, sexual assault, elder abuse, human trafficking, and child abuse.
A Beacon of Hope for the Charlotte Community
The Umbrella Center is poised to be a game-changer for families in Charlotte. As a comprehensive family justice center, it will offer a holistic range of services under one roof, including legal support, healthcare, and advocacy. Troy Hildreth, CEO of WellCare of North Carolina, highlighted the center’s mission: “For people impacted by interpersonal violence who are seeking protection and a safe haven in the Charlotte community, The Umbrella Center will serve as a one-stop-shop to offer necessary resources and support. We are proud to partner with the Centene Foundation and many other local organizations to uplift families and the Charlotte community.”
Collaborative Efforts for Lasting Impact
This initiative is a collaborative public-private partnership involving Mecklenburg County, the City of Charlotte, WellCare, Pat’s Place Child Advocacy Center, and Safe Alliance. Andrew Oliver, CEO of Pat’s Place, underscored the center’s significance: “Family justice centers are designed to help those impacted by interpersonal violence in their recovery and regain well-being – all in one place. Establishing and building our network in Mecklenburg County will serve hundreds of families seeking support after experiencing abuse. The Umbrella Center will provide services and resources during their time of need.”
Proven Model for Reducing Violence
Family justice centers like The Umbrella Center have a proven track record of improving victim survival rates and reducing instances of violence and homicide. Recognized as national best practices by the Department of Justice, these centers streamline the process of accessing critical support services, thereby mitigating barriers and enhancing the recovery process for victims.
Economic and Social Benefits
Domestic violence has significant economic impacts, costing Charlotte-Mecklenburg nearly $50 million annually in healthcare and criminal justice expenses. Mental health costs associated with domestic violence in Mecklenburg County amount to $6.7 million annually. By investing in The Umbrella Center, WellCare and the Centene Foundation are not only providing vital support to victims but also contributing to the economic wellbeing of the community by reducing these costs.
Commitment to a Healthier Future
This investment further cements WellCare and the Centene Foundation’s commitment to providing healthcare access and support to those affected by domestic violence and abuse. The Umbrella Center aims to serve over 10,000 individuals annually, co-locating 15 partner organizations to streamline case investigations and support survivors’ healing.
About The Umbrella Center
The Umbrella Center is an innovative public-private collaboration designed to provide holistic services for those impacted by various forms of abuse. It will revolutionize each step of a victim’s experience, from police response to medical care, advocacy, and legal support, ensuring a comprehensive support system for recovery.
Umbrella CenterCentene FoundationAbout the Partners
- The Centene Foundation: A philanthropic arm of Centene Corporation, focusing on investing in underserved communities to improve health equity.
- WellCare of North Carolina: A provider of government-sponsored managed care services, committed to helping people live healthier lives.
- Safe Alliance: An organization dedicated to providing hope and healing for those impacted by domestic violence and sexual assault.
- Pat’s Place Child Advocacy Center: A center coordinating the investigation, prosecution, and treatment of severe child abuse cases in Mecklenburg County.
This investment marks a significant milestone in the fight against domestic violence and the support of affected families in Charlotte, demonstrating a robust commitment to fostering a safer, healthier community for all.
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In an inspiring gesture to honor Pride Month, Blue Cross Blue Shield of Massachusetts (“Blue Cross”) has introduced 100 rainbow-themed Bluebikes to Greater Boston’s bikeshare system. This colorful initiative is aimed at promoting LGBTQIA+ equality and will see the “Proud Bikes” in action throughout June. These vibrant bikes will be on display in the Boston Pride Parade on Saturday, June 8, adding a splash of color and a message of inclusivity to the event.
Blue Cross is not only showcasing its support visually but is also making a tangible impact by donating $1 to Fenway Health for every ride taken on a Pride-themed pedal or ebike in June. This partnership underscores Blue Cross’s dedication to enhancing the health and wellbeing of the LGBTQIA+ community. Fenway Health is renowned for its commitment to providing innovative, equitable, and accessible health care, supportive services, and transformative research and education.
Jeff Bellows, vice president of corporate citizenship and public affairs at Blue Cross, emphasized the company’s commitment to diversity and inclusivity: “Blue Cross is deeply committed to building a health care ecosystem centered on diversity and inclusivity. As we reintroduce our ‘Proud Bikes’ into the Bluebikes system for the fifth year in a row, we are thrilled to support communities coming together to champion LGBTQIA+ rights. This initiative enhances the visibility of this important movement and actively contributes to Fenway Health’s crucial work in ensuring equitable health care access and gender-affirming care.”
Adrianna Boulin, Fenway Health’s Director of Racial Equity, Social Justice & Community Engagement, expressed gratitude for Blue Cross’s ongoing support: “We are grateful for Blue Cross’ steadfast commitment to the health and prosperity of the LGBTQIA+ community in Boston. Blue Cross remains a pivotal supporter of our essential healthcare, educational, and advocacy efforts. As we commemorate Pride Month, we hope everyone will demonstrate their solidarity and support for the LGBTQIA+ community by hopping on a ‘Proud Bike’ during this celebratory month.”
Blue Cross has been the title sponsor of Bluebikes since May 2018 and has significantly contributed to its growth and success. Over the past six years, the bikeshare system has doubled in size, adding more than 200 stations, 400 pedal bikes, and 750 next-generation ebikes. Blue Cross recently extended its sponsorship through 2031, ensuring continued support for this sustainable and accessible public transportation option.
With approximately 475 stations and 4,000 bikes, including ebikes, across thirteen municipalities in eastern Massachusetts, Bluebikes offers an efficient and eco-friendly way to navigate the city. Since its inception in 2011, Bluebikes has facilitated over 22 million trips, cementing its role as a key player in Boston’s public transportation network.
As Pride Month kicks off, Blue Cross and Bluebikes invite everyone to join the celebration by riding a “Proud Bike,” showing support for LGBTQIA+ rights, and contributing to the vital work of Fenway Health. For more information about Bluebikes and to find a station near you, visit bluebikes.com.
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In a monumental shift, the Centers for Medicare & Medicaid Services (CMS) have expanded Medicare coverage for allogeneic hematopoietic stem cell transplants (HCT) for eligible patients over 65 suffering from myelodysplastic syndromes (MDS). This landmark decision is the culmination of decades of research led by the Medical College of Wisconsin (MCW) Cancer Center, in collaboration with the Blood and Marrow Transplant Clinical Trials Network (BMT CTN) and key advocacy groups including the American Society of Hematology (ASH), the American Society for Transplantation and Cellular Therapy (ASTCT), and the National Marrow Donor Program (NMDP).
The Battle Against MDSMyelodysplastic syndromes are a group of cancers that impair the body’s ability to produce healthy blood cells. For patients with MDS, allogeneic HCT stands as the only curative therapy. Until now, Medicare did not cover this vital treatment for patients 65 and older, largely due to a lack of clinical evidence supporting the benefits of transplantation for older adults. This gap in coverage left many older patients without access to potentially life-saving transplants.
Dr. Douglas Rizzo, Senior Scientific Director of the Center for International Blood and Marrow Transplant Research (CIBMTR) and Cancer Service Line Director at Froedtert & the Medical College of Wisconsin, highlighted the previous challenges. “Older adults were overlooked as candidates for transplant because they did not have Medicare coverage for the procedure,” Dr. Rizzo explained. “We used our expertise in transplantation and the CIBMTR and BMT CTN research platforms to develop trials that provided the necessary evidence to inform Medicare payment policy.”
Pioneering Research and Transformative OutcomesBy enrolling Medicare beneficiaries in observational and interventional trials, researchers were able to demonstrate the effectiveness and safety of HCT for older patients. This led to a significant policy change, allowing thousands of older Americans with MDS to receive life-saving transplants. “In the first three years after Medicare agreed to provide coverage conditional on participating in approved studies, the number of transplants more than quadrupled,” noted Dr. Rizzo. “We started to see lifesaving outcomes that proved our belief that older patients would benefit from transplantation, just the same as younger patients.”
The impact of this research is profound. Since the initial policy change, nearly 6,000 Americans over 65 have received allogeneic HCT. Studies presented at ASH meetings and published in the Journal of Clinical Oncology revealed that these patients experienced a significant survival advantage and improved quality of life compared to those who did not receive the transplant.
Collaborative Efforts and AdvocacyThis groundbreaking change was made possible through the collaborative efforts of MCW, NMDP, ASH, and ASTCT. The recent National Coverage Analysis Decision Memo by CMS deems the treatment “reasonable and necessary under section 1862(a)(1)(A) of the Social Security Act.” This decision ensures that more seniors will have access to the life-saving treatment they need.
“We are proud to be part of this important work to bring greater HCT access to people on Medicare with MDS,” said Mohandas Narla, ASH President and distinguished scientist at New York Blood Health Enterprises. “This would not have been possible without the dedicated research and collaboration from Dr. Rizzo, CIBMTR, and our other partners. We will continue to work together to expand access and improve care and outcomes for people on Medicare.”
Looking AheadThe expanded Medicare coverage is a significant step forward in providing equitable healthcare access to all patients, regardless of age. The Medical College of Wisconsin Cancer Center and its partners remain committed to advancing research and improving the lives of those affected by MDS. With ongoing studies and continuous advocacy, they aim to ensure that every patient has the opportunity to benefit from the best possible care.
For more information about the expanded coverage and the impact of this decision, visit the Medical College of Wisconsin Cancer Center website.
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In a comprehensive new report, the National Institute for Public Employee Health Care Policy shines a spotlight on the increasingly critical role of Medicare Advantage Employer Group Waiver Plans (MA-EGWPs) in providing health coverage for retirees in the public sector. As health care costs continue to rise, this report comes at a pivotal moment for public sector employers seeking cost-effective and reliable options for their retired employees.
A Growing Trend in Health CoverageMedicare Advantage plans have surged in popularity, with over half of all eligible Medicare beneficiaries now enrolled. Between 2018 and 2022, MA-EGWP enrollment saw a notable 27% increase, rising from 4.1 million to 5.2 million beneficiaries. This growth underscores the plan’s appeal as public sector employers—including those covering teachers, firefighters, and law enforcement officers—turn to MA-EGWPs to manage both immediate healthcare costs and long-term financial liabilities.
“MA-EGWPs provide employers with a coverage tool that delivers lower costs, flexible benefits, and protects retiree health and financial security,” said Marta Green, Executive Director of the Institute and former Chief of Health Plan Research and Administration at the California Public Employees’ Retirement System. “As policymakers continue to refine plans to address the long-term affordability and funding of Medicare, there is a pressing need for further research to comprehend the current role of MA-EGWPs and the potential ramifications of proposed policy changes.”
The Benefits of MA-EGWPsThe report delves into the multifaceted advantages of MA-EGWPs, highlighting several key benefits:
- Robust Coverage and Supplemental Benefits: MA-EGWPs offer comprehensive coverage that often includes additional benefits not typically found in traditional Medicare plans. These can range from dental and vision care to wellness programs, providing a more holistic approach to retiree health.
- Cost Savings and Financial Stability: By leveraging MA-EGWPs, public sector employers can achieve significant cost savings. These plans help reduce both immediate out-of-pocket expenses for retirees and long-term liabilities for employers, creating a more sustainable financial model.
- Advancements in Health Equity: MA-EGWPs play a crucial role in addressing social risk factors and promoting health equity among retirees. The plans are designed to cater to diverse populations, ensuring that all retirees have access to the healthcare they need.
- Payment Stability for Plan Sponsors: With more predictable and stable payments, MA-EGWPs provide financial security for plan sponsors, allowing them to better manage budgets and plan for the future.
A Call for Continued ResearchWhile the report offers a detailed overview of the current landscape of Medicare Advantage and EGWP, it also emphasizes the need for ongoing research. Future studies will focus on the specific experiences of public sector employees with their EGWPs and the broader impact on beneficiaries. This research is essential for understanding how these plans can be further optimized to meet the needs of retirees.
The Institute’s commitment to enhancing public understanding of MA-EGWPs is evident in its ongoing efforts to conduct research, develop policy papers, and educate policymakers. As Marta Green highlighted, “Understanding the full scope of MA-EGWPs’ impact is crucial for informed decision-making and policy development.”
The National Institute for Public Employee Health Care Policy is a non-profit, nonpartisan organization dedicated to improving the healthcare plans available to public sector employees, retirees, and their beneficiaries. The Institute’s work includes conducting research, publishing issue briefs, and hosting events aimed at educating the policy community in Washington, D.C.
For more information and to access the full report, visit healthcarepolicy-institute.org.
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Screenshot of Sage Transparency’s new Legislator tab, which allows users to see hospital price and quality data from every state and federal legislative district in the country. This screenshot is an example of hospital data from IN-07, the congressional district centered around Indianapolis.The Employers’ Forum of Indiana has unveiled a significant upgrade to its innovative hospital price and quality dashboard, Sage Transparency. Launched at the National Healthcare Price Transparency Conference, Sage Transparency 2.0 introduces an array of new features, backed by the latest data from the RAND Employer Hospital Price Transparency study, designed to empower employers, policymakers, and the public with unprecedented insights into healthcare costs.
A Comprehensive Tool for Price and Quality TransparencySage Transparency 2.0 builds on the original dashboard, first released in 2022, by integrating new data covering hospital prices from 2020 to 2022 for over 4,000 hospitals and 2,000 ambulatory surgery centers (ASCs) across the United States. This update also introduces drug price data for physician-administered medications, a critical addition for understanding the full scope of healthcare expenses.
“Since its inception, Sage Transparency has been instrumental in bringing multiple vast data sets into one user-friendly platform,” said Gloria Sachdev, President and CEO of the Employers’ Forum of Indiana. “With over 37,000 user sessions, our tool has already influenced healthcare purchasing decisions, policy making, and media coverage. Sage Transparency 2.0 enhances this capability, making even more data accessible for employers, policymakers, academics, and journalists.”
Key Features and Enhancements1. New Legislator Tab: A standout feature of the update is the legislator tab, which allows elected officials and their teams to access hospital price and quality data for every state and federal legislative district. This geocoded information, provided by data science consultants January Advisors, makes it easier for legislators to craft informed policies based on precise, localized data.
“I found Sage Transparency to be a critical tool for understanding hospital service prices and quality in Indiana,” noted Representative Donna Schaibley of the Indiana House of Representatives. “The ability to see this data at the district level is a tremendous resource for legislators nationwide.”
2. Expanded Data Sets: The latest round of the Employer Price Transparency study reveals, for the first time, the average prices paid for physician-administered medications like chemotherapy. This addition highlights a key area of growing concern for employer-sponsored insurance plans, with commercial insurance prices for these drugs averaging 208% of the average sales price (ASP), compared to Medicare’s 106% of ASP.
3. Enhanced Quality Metrics: The updated dashboard now includes additional quality metrics from the Centers for Medicare & Medicaid Services (CMS) and profitability data from the National Academy for State Health Policy (NASHP). Users can explore hospital readmissions, patient safety, and mortality rates, alongside quality rating trends over the past three years. NASHP’s commercial breakeven price metric further allows users to understand the reimbursement rates hospitals need from commercial payers to cover expenses without profit.
Empowering Stakeholders with Vital InformationSage Transparency 2.0 is designed to be a comprehensive tool for diverse stakeholders. Whether you are an employer looking to manage healthcare costs, a policymaker crafting health legislation, or a journalist reporting on healthcare economics, this dashboard offers the detailed, actionable data needed to make informed decisions.
“While hospital prices account for the largest portion of employer-sponsored insurance plans, prescription prices are the fastest growing segment,” added Sachdev. “Our goal with Sage Transparency 2.0 is to provide real transparency into these costs, enabling users to make informed decisions based on the best available data.”
Join the Movement for Transparent Healthcare PricingThe Employers’ Forum of Indiana invites all stakeholders to explore Sage Transparency 2.0 and take advantage of its enhanced features. By providing a clearer picture of healthcare pricing and quality, Sage Transparency 2.0 is a crucial step toward more informed, equitable healthcare purchasing and policy-making.
For more information or to access Sage Transparency 2.0, visit Sage Transparency or call 866-228-4347.
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In a heartwarming celebration of motherhood, the Inland Empire Health Plan (IEHP) launched the first of its three-part Maternal Wellness Event series on May 9 at the Riverside Community Wellness Center (CWC). This inaugural event, designed to support and educate moms and moms-to-be, kicked off a month-long focus on maternal health, coinciding with Maternal Health Awareness Month.
A Community-Centered ApproachIEHP’s Maternal Wellness Events are a testament to their commitment to maternal and infant health. By collaborating with local community agencies that specialize in prenatal and postpartum care, IEHP provides essential resources and support to mothers. These events cover crucial aspects of motherhood, from the importance of regular wellness visits for babies to offering practical support through raffle prizes and diaper giveaways.
Laurisa Castañeda, a Riverside resident and expectant mother, expressed her gratitude for the event. “This is like an early Mother’s Day and baby shower combined,” Castañeda shared. “When you come from nothing and you don’t have anything, it’s really helpful to have a resource like this.”
Holistic Support for New MomsIEHP’s Wellness Centers are more than just venues for events; they are community hubs that respond to the specific needs of their local populations. The centers offer free information, classes, and resources, ensuring that every mom has access to the support she needs. “Support from the center and the community shows our moms they know of people who have their back,” said Ruth Villalpando Albarran, an IEHP behavioral health care manager.
Upcoming EventsFollowing the success of the Riverside event, two more Maternal Wellness Events are scheduled. On Tuesday, May 14, from 2-5 p.m., the second event will take place at 805 W. Second St., Suite C, in San Bernardino. The final event is set for Tuesday, May 21, from 10 a.m.-1 p.m., at 12353 Mariposa Road, Suites C-2 and C-3, in Victorville. These events promise to offer the same level of comprehensive support and community engagement as the first.
How to ParticipateExpectant mothers and new moms are encouraged to register for the upcoming events to take advantage of the invaluable resources and support available. For more information or to register, visit IEHP’s website or call 866-228-4347.
Founded in 1996, the Inland Empire Health Plan (IEHP) is dedicated to healing and inspiring the human spirit. As one of the top 10 largest Medicaid health plans and the largest not-for-profit Medicare-Medicaid public health plan in the United States, IEHP serves over 1.5 million residents in Riverside and San Bernardino Counties. With a mission to provide optimal care and vibrant health to its communities, IEHP’s network includes quality doctors and nearly 4,000 team members committed to this vision.
In 2024, IEHP expanded its services to include Covered California plans, further ensuring healthcare access for residents. For three consecutive years, IEHP has been recognized as A Great Place To Work®, highlighting its positive impact on both its members and its team.
To learn more about IEHP and its initiatives, visit IEHP’s website.
IEHP’s Maternal Wellness Event series is more than just a series of gatherings; it’s a lifeline for many mothers in the Inland Empire. By placing moms at the heart of their mission, IEHP is fostering a supportive community where mothers feel valued and empowered. As these events continue, they stand as a beacon of hope and support, ensuring that no mom has to navigate the journey of motherhood alone.
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In a heartwarming display of solidarity and inclusivity, eleven schools across Texas joined forces with Superior HealthPlan and the Centene Foundation to champion No One Eats Alone® Day for the eighth consecutive year. This transformative initiative, dedicated to combating social isolation among students, has emerged as a beacon of hope, fostering a culture of belonging and acceptance in schools statewide.
Mark Sanders, President, and CEO of Superior HealthPlan, expressed the organization’s unwavering commitment to supporting the well-being of Texas youth. “At Superior, we’re committed to supporting the health and well-being of children all across Texas, and that includes providing them with the skills and resources they need to support each other,” Sanders remarked. “We are proud to partner with Beyond Differences to celebrate No One Eats Alone Day and shine a light on the social issues that affect students in Texas and beyond.”
The twelve participating schools, spanning from Austin to Wichita Falls, set the stage for meaningful interactions and heartfelt connections:
- Ojeda Middle School, Austin
- Dobie Middle School, Austin
- Cunningham Middle School, Corpus Christi
- Sam Houston Elementary, Houston
- Boys and Girls Club of Deep East Texas, Lufkin
- Cavazos Elementary, Odessa
- Arnold Elementary, San Antonio
- Robert R. Rojas Elementary, Socorro
- Communities in Schools, Waco
- Rudy Silva Elementary, Weslaco
- All Hands Community Center, Wichita Falls
Social isolation among children has garnered increasing attention in public health research, with studies linking it to detrimental effects on mental well-being. Beyond Differences®, the nonprofit behind No One Eats Alone, has been at the forefront of this battle, empowering students to foster connections and create a welcoming environment for all.
Laura Talmus, Co-founder, and Executive Director of Beyond Differences, shed light on this year’s theme, “Let’s Grow: Planting New Connections,” inspired by the U.S. Surgeon General’s Advisory on social connection. “Our curriculum dives deep into recognizing emotions, understanding social isolation, and gives students tools to be social isolation disruptors and ambassadors of belonging,” Talmus explained.
Activities throughout the day encompassed in-class lessons, interactive exercises, and a creative art project aimed at nurturing social connections. With over a million students expected to participate nationwide, No One Eats Alone Day epitomizes the collective effort to cultivate empathy, understanding, and unity within school communities.
Superior HealthPlan, a stalwart in Texas healthcare, remains dedicated to transforming communities and fostering a brighter future for the state’s youth. Through partnerships with organizations like Beyond Differences and the Centene Foundation, they’re paving the way for a more inclusive and compassionate society.
The impact of initiatives like No One Eats Alone Day reverberates far beyond school walls, shaping a generation empowered to embrace diversity and champion belonging for all.
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In a game-changing partnership aimed at revolutionizing maternal and infant health in the Lone Star State, Blue Cross and Blue Shield of Texas (BCBSTX) has joined forces with the Texas Pediatric Society (TPS). Through BCBSTX’s innovative Special Beginnings initiative, they’re set to empower primary care providers and pediatricians across Texas with specialized training and invaluable resources.
Supported by a generous grant from BCBSTX, TPS is embarking on a groundbreaking journey, establishing an advisory committee for the brand-new Clinical Series Program. This initiative is poised to be a game-changer, as it focuses on developing pediatric healthcare resources tailored to maternal and infant health, including an array of interactive videos and enlightening webinars. The program, set to kick off in 2024, will initially zero in on critical areas such as postpartum depression screenings and nurturing infant care following stays in Neonatal Intensive Care Units (NICUs).
Dr. Mark Chassay, VP, and Chief Medical Officer at BCBSTX, expressed excitement about the partnership, stating, “We look forward to developing this Clinical Series Program with TPS to equip providers who are also invested in improving outcomes for Texas moms and babies with the extra support they need all across the state.”
The cornerstone of the Clinical Series Program lies in its Project ECHO® training sessions, spanning 3 to 6 months. This innovative approach fosters collaborative medical education and care management, offering participants a virtual platform to engage with specialists and discuss challenging cases. It’s a dynamic blend of continuous learning and peer support, aimed at fortifying frontline providers with the expertise needed to navigate complex maternal and infant health scenarios effectively.
Dr. Alice Gong, President of the Texas Pediatric Society, highlighted the pressing need for such initiatives, explaining, “Due to pediatric subspecialist shortages, primary care pediatricians are expected to manage more complex needs and conditions. In order to manage these cases, primary care pediatricians need access to specialized resources, education, and support.”
Texas providers eager to tap into these invaluable resources can find them at https://txpeds.org/. For those hungry for further insights, a visit to the BCBSTX Newsroom promises a deeper dive into this transformative collaboration.
As the state’s largest provider of health benefits, BCBSTX’s commitment to driving positive change in maternal and infant health, coupled with the Texas Pediatric Society’s dedication to promoting the well-being of the state’s children, heralds a promising new era in Texas healthcare.
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In a groundbreaking move to address racial disparities in maternal health, leaders from Independence Blue Cross (IBX) took center stage before the Philadelphia City Council today. The focus? Tackling the alarming rates of severe maternal morbidity (SMM) disproportionately affecting Black and brown communities.
Councilmember and Public Health Committee Chair, Nina Ahmad, Ph.D., spearheaded the hearing, calling on Rev. Dr. Lorina Marshall-Blake, President of the Independence Blue Cross Foundation (IBX Foundation), and Dr. Seun Ross, Executive Director of Health Equity for Independence Blue Cross, to share their insights and strategies.
The discussion delved into the crucial role of systemic racism in exacerbating maternal health disparities. Recent studies underscore the urgent need for action, revealing stark contrasts in maternal morbidity rates across racial lines.
Marshall-Blake and Ross outlined a comprehensive approach aimed at reshaping maternal health care in Philadelphia. At the heart of their testimony was the IBX Foundation’s resolute commitment, exemplified by the $15 million Institute for Health Equity launched in 2022. This initiative champions evidence-based programs designed to uplift maternal care quality while dismantling racial barriers.
“The IBX Foundation Institute for Health Equity is engaging in strategic partnerships with community and clinicians to promote maternal health equity through several initiatives,” Marshall-Blake emphasized.
Key among these initiatives is the advancement of culturally congruent care through support for maternal wellness and birthing centers. Additionally, IBX has taken proactive steps to address clinical biases, convening the Regional Coalition to Eliminate Race Based Medicine, which scrutinizes decision-making tools to ensure equitable outcomes for all.
But the efforts don’t stop there. IBX remains steadfast in its support for organizations combatting maternal health disparities, such as Cayaba Care and Cocolife.black. Moreover, they offer essential programs like the high-risk pregnancy condition management program and Baby BluePrints®, providing crucial education and support for expectant mothers.
Looking ahead, Marshall-Blake stressed the importance of collective action and foresight in tackling maternal health inequities. “Our health care system can sometimes be reactionary – meaning we don’t address something until it’s a problem,” she noted. “When leaders and conveners come together to address and change these issues, they’re often playing catch up.”
The leaders outlined a roadmap for Philadelphia, advocating for programs to combat bias in health care, elevate community partners and care providers, and engage policymakers at all levels.
“At IBX, we are passionate about our mission to enhance the health and well-being of the people and communities we serve,” Ross affirmed. “Addressing the root causes of health inequity and creating healthier outcomes for every person in every community we serve is a focus of our mission.”
As Philadelphia takes decisive steps towards equitable maternal health care, the spotlight shines on a city committed to fostering a future where every mother receives the care she deserves.
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In a groundbreaking move, QBE has just rolled out its latest digital home insurance offering in Macau, and it’s a game-changer! The Home Plus Protection Package (HPPP) isn’t just your run-of-the-mill insurance – it’s an all-in-one solution for homeowners, tenants, and landlords, and yes, it includes coverage for your beloved pets!
What’s the Buzz? Today, QBE announced the launch of the Home Plus Protection Package (HPPP), available on their sleek new online platform. This move is part of QBE Asia’s commitment to providing customer-centric products and an effortless digital experience. With a focus on addressing local market demands, QBE aims to enhance protection for homes in Macau.
Covering All Bases: Not only can you purchase the Home Plus Protection Package with a few clicks, but it also comes with comprehensive coverage tailored to meet your every need. QBE understands the importance of safeguarding your property, contents, and personal liabilities in a worry-free fashion.
Pet Lovers Rejoice! What sets HPPP apart is its unique coverage for pets. If your building becomes unfit for its intended purpose, worry not – QBE has got your furry friends covered. From temporary boarding costs to accidental death or theft, your pets are in safe hands.
More Than Just Insurance: HPPP doesn’t stop at the basics. It caters to big risks like burglary, fire, typhoon, and personal liabilities, along with everyday mishaps like spoilage of frozen food, key and lock replacement, and even protection for domestic helpers’ personal effects.
Insights and Stats: In a move backed by data from the Macau Fire Services Bureau, highlighting a 2.45% rise in fire incidents in 2023, HPPP is poised to reassure owners, tenants, and landlords alike.
What QBE Executives Have to Say: Paul Li, General Manager of QBE Macau, expressed excitement about the new product, particularly emphasizing its potential benefits for landlords facing unforeseen incidents with rental properties. Lei Yu, CEO for North Asia and Head of Asia Distribution, echoed the sentiment, emphasizing QBE’s commitment to delivering protection and convenience to Macau consumers.
Revolutionizing Digital Experience: QBE’s new online platform in Macau isn’t just about purchasing policies; it’s a comprehensive hub for managing policies and claims. Reflecting QBE Asia’s award-winning, customer-centric approach, this platform aims to make the insurance process seamless and user-friendly.
QBE’s Macau Legacy: Having established its presence in Macau since July 1985, QBE has grown to become one of the region’s major general insurers. Supported by a network of committed intermediaries and solid partnerships, QBE Macau offers a broad range of insurance products across personal, business, and corporate sectors.
Act Now – Protect What Matters Most! As homes are considered among the most valuable assets, QBE’s Home Plus Protection Package is here to give you peace of mind. Don’t miss out on this revolutionary insurance offering – click now to secure your home and pets with QBE!
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UNITED STATES OF AMERICABefore theSECURITIES AND EXCHANGE COMMISSION
ADMINISTRATIVE PROCEEDING
File No. 3-20932
In the Matter of Health Insurance Innovations, Inc., now named Benefytt Technologies, Inc., and Gavin D. Southwell, Respondents.
PLAN NOTICE OF HEALTH INSURANCE INNOVATIONS, INC. FAIR FUND
TO: Individuals and entities, or their lawful successors, who purchased and/or acquired shares of Health Insurance Innovations, Inc. under the symbol HIIQ (“HIIQ” or “Security”) during the period from March 2, 2017 through March 12, 2019, inclusive (the “Relevant Period”).
If you fall within the group above, you must submit a completed Claim Form with the documentation substantiating your claim so that it is postmarked (or if not sent by U.S. Mail, received) by March 28, 2024 (the “Claims Bar Date”), to be considered for eligibility to receive a Distribution Payment from the Health Insurance Innovations, Inc. Fair Fund (“Fair Fund”).
You may be eligible for a Distribution Payment from the Fair Fund.
A Fair Fund has been established in the Securities and Exchange Commission administration proceeding set forth at the top of this Notice. You can read more about the proceedings, and view and download the Plan at: https://www.sec.gov/files/litigation/admin/2023/34-98936-dp.pdf or www.HealthInsuranceInnovationsFairFund.com.
Eligibility Criteria
To qualify for a payment from the Fair Fund, you must satisfy certain eligibility criteria that are described in detail in the Plan. The Plan is available on the Fair Fund website atwww.HealthInsuranceInnovationsFairFund.com and on the Commission’s public website at https://www.sec.gov/files/litigation/admin/2023/34-98936-dp.pdf. You can also request a copy of the Plan by calling the Fund Administrator at 1-877-676-3395 or by emailing info@HealthInsuranceInnnovationsFairFund.com.
You are excluded from participation in the Fair Fund if you are an Excluded Party as defined in the Plan (available at https://www.sec.gov/files/litigation/admin/2023/34-98936-dp.pdf).
Claim Forms
THE DEADLINE TO SUBMIT A CLAIM FORM AT THE ADDRESS BELOW IS MARCH 28, 2024, ALSO REFERENCED HEREIN AS THE “CLAIMS BAR DATE”. PLEASE NOTE: THIS IS A FIRM DEADLINE. IF YOU FAIL TO SUBMIT A COMPLETED CLAIM FORM ELECTRONICALLY OR POSTMARKED ON OR BEFORE MARCH 28, 2024, YOU MAY BE BARRED FROM RECEIVING A PAYMENT FROM THE FAIR FUND. THE CLAIM FORM AND APPROPRIATE SUPPORTING DOCUMENTS FOR EACH TRANSACTION LISTED IN PARTS II–III OF THE CLAIM FORM MUST BE SUBMITTED BEFORE THE CLAIMS BAR DATE.
YOU MUST COMPLETE AND SIGN THE CLAIM FORM AND SUBMIT IT TO THE FUND ADMINISTRATOR ELECTRONICALLY THROUGH THE FAIR FUND’S WEBSITE. IF YOU SUBMIT YOUR CLAIM BY MAIL, IT MUST BE RECEIVED OR POSTMARKED NO LATER THAN MARCH 28, 2024, AT THE ADDRESS LISTED BELOW IN ORDER TO BE CONSIDERED FOR ELIGIBILITY TO RECEIVE A DISTRIBUTION PAYMENT FROM THE FAIR FUND:
Health Insurance Innovations, Inc. Fair FundFund AdministratorPO Box 4349Portland, OR 97208-4349
Additional Information
Additional information regarding the Fair Fund may be found at www.HealthInsuranceInnovationsFairFund.com. Additional Claim Forms and Plan Notices may also be downloaded at the Fair Fund’s website. You may obtain additional information or request copies of Claim Forms and Plan Notices by calling the Fair Fund’s toll-free number at 1-877-676-3395, or by emailing info@HealthInsuranceInnnovationsFairFund.com.
PLEASE CHECK THE WEBSITE WWW.HEALTHINSURANCEINNOVATIONSFAIRFUND.COM FREQUENTLY FOR UPDATES.
URL// www.HealthInsuranceInnovationsFairFund.com
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In a strategic move to supercharge growth across its global health empire, The Cigna Group (NYSE: CI) has just dropped the bombshell of leadership changes. Brace yourselves for a wave of transformation that promises to reshape the landscape of Evernorth Health Services and Cigna Healthcare.
At the forefront of this seismic shift is Brian Evanko, the seasoned Chief Financial Officer of The Cigna Group. Evanko, a Cigna veteran since 1998, is not only holding the fort as CFO but is also stepping into the shoes of the new President and Chief Executive Officer of Cigna Healthcare. This means he’ll be steering the ship for all Cigna Healthcare businesses, from U.S. Commercial to International Health and U.S. Government. His track record in overseeing the U.S. Government business and delivering on earnings objectives speaks volumes.
Adding a fresh face to the mix, Ann Dennison, former EVP and CFO at Nasdaq, is set to join The Cigna Group as Deputy Chief Financial Officer. With a stellar background overseeing global corporate finance, treasury, and more, Dennison brings a wealth of financial prowess to the team.
Meanwhile, current U.S. Commercial President Mike Triplett is set to retire by the end of 2024. But fear not, as Bryan Holgerson, a 22-year veteran of the company, steps up to fill the void. Holgerson’s extensive experience in shaping and executing business growth strategies positions him perfectly to take on the role of President of U.S. Commercial for Cigna Healthcare.
But that’s not all – Eric Palmer is expanding his role, not just as President and CEO of Evernorth Health Services but also as Executive Vice President for Enterprise Strategy at The Cigna Group. Palmer, with a remarkable 26-year career at Cigna, will be the mastermind behind long-term growth strategies, M&A activities, and innovation through Cigna Ventures.
David M. Cordani, chairman and CEO of The Cigna Group, expressed confidence in the new leadership, stating, “With them at the helm of our two growth platforms, alongside their seasoned leadership teams, we believe we are well positioned to deliver on our strategy with clarity and purpose.”
This leadership shakeup is poised to be a game-changer, promising not just growth but a redefined future for Cigna. Click here to get an exclusive peek into the strategic maneuvers shaping the next chapter for this global health giant.
About The Cigna Group:
The Cigna Group (NYSE: CI) isn’t just a global health company; it’s a force committed to building a better future for every individual and community. With products and services under Evernorth Health Services, Cigna Healthcare, and subsidiaries, it operates in over 30 countries, boasting more than 165 million customer relationships worldwide. Stay tuned for the latest in health innovation at thecignagroup.com.
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Looking to become your best self in 2024? Inland Empire Health Plan’s (IEHP) all-new wellness program is here to help. Introducing “Healthy Living: My Best Self” – a personalized program where you can set goals, follow a routine and achieve a healthy weight.Inland Empire Health Plan (IEHP) is on a mission to help individuals discover their “Best Self” in the year 2024 with the launch of an exciting and free wellness program – “Healthy Living: My Best Self.”
The program, developed by IEHP health educators, is designed to guide participants in cultivating healthy lifestyle habits. From setting personal goals to establishing routines that support both body and mind, and achieving a healthy weight, IEHP is offering a comprehensive approach to well-being, all at no cost.
Rosalina Nava-Bermundez, IEHP’s manager of health education, promotion, and prevention, expressed the program’s focus on providing essential tools and education to individuals with a body mass index outside of normal standards. The goal is to reduce health issues associated with unhealthy lifestyle choices.
Open to both IEHP members and non-members, participants can monitor their progress through a guidebook filled with valuable tips, an online program portal, and in-person nutrition and exercise classes available at various locations, including Community Resource Centers in San Bernardino, Victorville, Riverside, the First 5 Family Resource Center in Perris, Mecca, Desert Hot Springs, and an upcoming location in Ontario.
“We expect members will discover new areas of support in hopes of achieving a healthy weight,” Nava-Bermundez shared. This includes making healthy choices based on knowledge and adopting habits such as stress management and physical activities.
IEHP members can register for the program via the IEHP Member Portal at iehp.org by clicking on “Member Login” and selecting “Health and Wellness.” Non-members can register through the “Events” tab at iehp.org or by visiting any class site.
For those looking to embark on a journey towards optimal health and well-being, this program is not to be missed. Get ready to unleash your best self in 2024 with IEHP’s revolutionary wellness initiative.
For more information or to register, contact IEHP Member Services at 1-800-440-IEHP (4347).
About IEHP
Inland Empire Health Plan (IEHP) stands as one of the top 10 largest Medicaid health plans, the largest not-for-profit Medicare-Medicaid public health plan in the country, and has been certified as A Great Place To Work® for the third consecutive year. With a 27-year legacy, IEHP supports over 1.4 million Riverside and San Bernardino County residents enrolled in Medicaid or IEHP DualChoice. Boasting a network of nearly 6,800 providers and a dedicated team of over 3,000 members, IEHP remains steadfast in its commitment to ensuring communities enjoy optimal care and vibrant health. To learn more, visit iehp.org.
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In a bid to safeguard the rights of seniors in New York State, the New York StateWide Senior Action Council (StateWide) has unmasked the latest scheme preying on unsuspecting individuals during Medicare’s annual enrollment period (AEP). Termed the “Medicare Fraud of the Month,” this revelation sheds light on Medicare Marketing Violations occurring from October 15 through December 7, 2023.
The StateWide Fraud of the Month initiative forms a crucial component of the Senior Medicare Patrol (SMP), an invaluable resource empowering New York State’s seniors and caregivers to identify, prevent, and report healthcare fraud, errors, and abuse. Serving as the state’s grantee/administrator for this Federal Program, StateWide remains at the forefront of advocacy for the elderly.
Maria Alvarez, Executive Director of StateWide, emphasized the significance of the AEP, a period when individuals can modify their Medicare and prescription drug selections. To aid seniors in making informed decisions, StateWide offers free and confidential services through their Managed Care Consumer Assistance Program (MCCAP) certified outreach counselors.
During the AEP, seniors are bombarded with advertisements from various insurance companies, presenting their plans for the upcoming year through television commercials, mail, online ads, and more. Unlike Original Medicare, Medicare Advantage Plans (Part C) and Part D are managed and marketed by private insurance companies. Agents and brokers are expected to adhere to strict regulations when engaging in marketing activities.
Some common marketing violations that seniors should be vigilant about during this open enrollment period include being approached in public areas, receiving unsolicited emails or calls even after opting out of communication, and attempts to collect personal information or sell plans at educational exhibits. StateWide advises seniors to report such violations promptly.
Seniors or their caregivers can report marketing violations by contacting the NYS Senior Medicare Patrol at 800-333-4374, providing details such as the name of the person, insurance company, date, location, and other relevant information about the incident.
To further assist seniors, StateWide offers free and confidential appointments with Outreach Counselors to discuss situations, review plan options, and address Medicare-related queries, plan comparisons, appeals, billing issues, fraud, and patient’s rights. Seniors can reach out to StateWide at 800-333-4374 for assistance.
The unveiling of these Medicare marketing violations comes at a crucial time, considering that Medicare fraud costs taxpayers over $60 billion annually nationwide. StateWide, committed to combatting this illicit industry, initiated the Fraud of the Month program in 2022 to expose scams targeting the state’s seniors. Stay informed, stay protected!
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Changing Medicare Plans? Watch out for phone scams.As the annual Medicare Open Enrollment Period (OEP) swings into action, millions of Medicare beneficiaries across the United States are facing a barrage of marketing tactics aimed at persuading them to switch plans. Lasting from October 15 to December 7 each year, OEP allows Medicare beneficiaries to review and choose the Medicare plans that best suit their needs. This includes beneficiaries enrolled in Original Medicare who can explore and change their prescription drug plans (Part D) and Medigap plans.
The Senior Medicare Patrol (SMP) is on a mission to ensure that everyone on Medicare is well-informed about the marketing frenzy that unfolds during OEP. Marketing efforts encompass a multitude of channels, from television and social media ads to radio spots and a deluge of mailings. The aim is to catch beneficiaries’ attention and potentially steer them toward a particular plan. However, caution is advised.
“To get your attention, ads may mislead you into thinking one plan is better for you than another. It’s important to understand what agents aren’t allowed to do so you’ll be prepared if someone tries to contact you this OEP,” warns Nicole Liebau, Senior Medicare Patrol Resource Center Director.
Key points to bear in mind include the fact that agents cannot set their own deadlines for enrollment. Beneficiaries have until December 7 to make their choices, with the new plan coming into effect on January 1. There are no extra incentives for signing up early.
Furthermore, agents are prohibited from making threats to withdraw benefits if you do not enroll in their plan. Offering gifts as an inducement for signing up is also against the rules. It’s essential to recognize that no plan or agency can claim an endorsement from Medicare, and they cannot assert they are affiliated with or sent by Medicare, Social Security, or Medicaid.
Another no-go for agents is discussing Medicare products or other insurance types, such as life insurance, without prior consent from the beneficiary through the Scope of Appointment form. They cannot contact you without any prior relationship, and they are not allowed to leave promotional materials like flyers or door hangers without your prior consent.
Importantly, agents should not mislead you regarding prescription coverage or services. Additionally, it’s vital to understand that you cannot maintain both a Medigap plan (supplemental insurance) and a Medicare Advantage (MA) plan concurrently.
With a plethora of choices and information to sift through, comparing plans and determining the best fit for one’s needs can be overwhelming. The good news is that free and unbiased assistance is available for comparing Medicare plans through the State Health Insurance Assistance Programs (SHIPs). You can easily locate your local SHIP by visiting www.shiphelp.org or by calling their toll-free hotline at 877-839-2675.
The SMPs, operating in all 50 states as well as Puerto Rico, Guam, The U.S. Virgin Islands, and the District of Columbia, aim to empower and assist Medicare beneficiaries, along with their families and caregivers, in preventing, detecting, and reporting healthcare fraud, errors, and abuse. To report any instances of Medicare fraud, errors, or abuse, visit www.smpresource.org or call 1-877-808-2468.
Stay informed and vigilant during this OEP season to make the best decisions for your Medicare coverage and benefits.
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In a significant move, Blue Cross Blue Shield of Michigan and Blue Cross Blue Shield of Vermont have gained formal approval from the Vermont Department of Financial Regulation to solidify their affiliation, marking a groundbreaking collaboration between nonprofit Blue companies.
The affiliation is set to usher in a new era of cooperation between these two stalwart organizations, allowing them to pool their resources and expertise to enhance the health plan and service offerings available through Blue Cross Blue Shield of Vermont.
Daniel J. Loepp, the President and CEO of Blue Cross Blue Shield of Michigan, expressed his enthusiasm for this pioneering collaboration: “We are pleased to partner with Blue Cross Blue Shield of Vermont to launch this pioneering approach to collaboration between nonprofit Blue companies. Our affiliation enables us to leverage our combined resources and expertise to improve the services we provide, while maintaining the local operations in each of our respective states that are key to delivering high-value, convenient, and accessible care to our members.”
Blue Cross Blue Shield of Vermont, a trusted nonprofit organization with a mission-driven focus for over four decades, shares in the excitement. Don George, President, and CEO of Blue Cross Blue Shield of Vermont, affirmed the affiliation’s significance: “This affiliation enables us, as a Vermont-based health plan, to continue serving the needs of Vermonters in the decades to come. Sharing expertise and technology with Blue Cross Blue Shield of Michigan, we will improve solutions for our members, customers, provider partners, and communities here in Vermont.”
Both organizations remain firmly rooted in their local communities, emphasizing their commitment to advancing local community health and investing in community well-being. This affiliation reinforces these commitments, ensuring that health insurance decisions and premium dollars are managed locally, community investments are safeguarded, and the organizations are better positioned to continue their invaluable work within the community.
About Blue Cross Blue Shield of Michigan
As a nonprofit mutual insurance company, Blue Cross Blue Shield of Michigan has been delivering health benefits to nearly 5.2 million members. The organization’s unwavering commitment revolves around offering affordable healthcare products through a diverse range of plans tailored for businesses and individuals. Established in Detroit since 1939, BCBSM actively supports impactful community initiatives and provides leadership in enhancing healthcare standards throughout Michigan. BCBSM operates independently as a licensee of the Blue Cross and Blue Shield Association. For additional information, visit bcbsm.com and MiBluesPerspectives.com.
About Blue Cross Blue Shield of Vermont
For over three decades, Blue Cross Blue Shield of Vermont has played a pivotal role in enhancing the health and well-being of Vermonters by offering innovative plan options for individuals, older Vermonters, and businesses. The dedicated team continuously explores new ways to support high-quality care, programs, and events promoting wellness. Blue Cross Blue Shield of Vermont functions as an independent licensee of the Blue Cross and Blue Shield Association. For further information, visit bluecrossvt.org.
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Gravie (one of the fastest-growing innovators in health benefits) has annonced that Andrew Reeves has been hired as Gravie’s first senior vice president and General Manager of Gravie ICHRA. Reeves was appointed at a time that the HRA Council reported that ICHRA adoption had tripled since 2020.
Reeves’ new role will allow him to leverage Gravie’s leadership in the ICHRA market and expand into key markets throughout the country. Reeves will also oversee efforts to improve ICHRA for employers and employees, including implementing a payment system that simplifies contribution strategies and developing the company’s advisory and plan-support service called Gravie Care(r).
Reeves led the global commercial team at Virgin Pulse before joining Gravie. Reeves held several senior industry leadership positions in the past, including Chief Commercial Officer for BioIQ, an population health testing platform, and Senior Sales Leader at Cigna Health Group Medicare Advantage.
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Evernorth Care Group, a nationally recognized provider of medical services, is now in-network for Devoted Health’s 13,000 Medicare (MA) members. Devoted Health MA Members can access Evernorth Care Group primary, specialty, and virtual care at 20 health centers throughout the Valley. They also have access to its onsite pharmacies and labs, vision and hearing centres, urgent care centers, and outpatient surgery centers.
Devoted Health, one of the fastest-growing MA providers in the area, has earned a 4-star rating for their MA health plans. Health plans that have received four- or five-star ratings are able to meet the criteria of providing high-quality health care.
Evernorth Care Group, which has been providing health care in the Valley since more than 50 year has received a 96 per cent patient satisfaction rating. The medical services group’s open model allows it to partner with different health plans in order to provide quality care to more patients.
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Findhelp has been given a contract by the Tennessee Medicaid Agency (TennCare), as part of Health Starts Initiative, to assist Tennesseans in finding the non-medical care they require. Findhelp, a technology firm, connects people in need of social care with providers through a closed-loop referral system (CLRS) that is easy to use and efficient.
Findhelp will provide technology to allow TennCare assess non-medical risks factors of individuals who are in need, using a unified method, and refer these people to community-based organisations that can meet their requirements, tracking the outcomes. Rural Health Association of Tennessee team members are prepared to work with communities and organizations in order to reduce non-medical risks for TennCare patients by removing social barriers and improving access to quality and compassionate care.
TennCare, the managed care Medicaid agency of Tennessee, currently serves over 1.7 million people. This includes low-income individuals, such as pregnant mothers, children, caregiver relatives of young children and adults with disabilities. The CLRS will link TennCare with community-based organizations in Tennessee and TennCare’s managed care organizations. This will increase care coordination and support for TennCare Members and streamline data collection.
Findhelp has worked with over 570 of America’s largest health plans and hospital systems as well as educational institutions, municipalities, government agencies, and other organizations that work to improve social determinants. Findhelp’s platform allows customers in all industries to connect patients, students, constituents and communities with social care.
Findhelp is active in Tennessee, since 2015. Our customers include TennCare’s three Medicaid managed care vendors, as well as several others such Regional One Health Baptist Memorial Hospital and HCA Healthcare. Findhelp has created a network of community-based organizations in Tennessee, which includes 5,727 programs at the local, county, and state levels. In 2022, over 265,000 Tennesseeans searched for and connected to social care through the findhelp platform.
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Blue Cross and Blue Shield of Minnesota has announced that it had access to $160,000 of Affordable Housing Program (AHP), funds, through its membership in the Federal Home Loan Bank of Des Moines. Blue Cross and Twin Cities Habitat for Humanity have entered into an agreement to allow the charitable non profit to serve as the underwriter and administrator for grants that will be available to qualified first-time Minnesota homebuyers. A grant up to $5,000 can be awarded for down payment assistance and closing costs.
FHLBanks provide AHP funds typically to their member financial institutions who have their own mortgage loan programs. Blue Cross, as a result this collaboration with Twin Cities Habitat for Humanity was structured, has become the FHLB Des Moines’ first health insurance company to have access to AHP funds.
Federal Home Loan Banks (FHLBs) are a system of 11 FHLBanks spread across the United States. Each FHLBank is a separate, government-chartered, member-owned corporation. Commercial banks, credit unions and insurance companies are all members of the FHLBank.
Each FHLBank has its own Affordable housing program and distributes AHP funding to finance the construction or renovation of owner-occupied homes for households with low or moderate incomes (incomes of 80 percent or lower of the median area income). Members can apply for AHP funding on behalf of non-profits, with their applications being evaluated according to a scoring system.
Blue Cross will distribute the funds equally between two FHLB programs that offer down payment assistance: HomeStart, and Native American Homeowner Initiative. FHLB Des Moines’ Affordable Housing Program was launched in 1990. Since then, it has provided more than $844 millions to 124,000 families and individual to afford housing.
More information about Blue Cross and Blue Shield of Minnesota, including the health plan’s commitment to racial and health equity, can be found at bluecrossmn.com/about-us/corporate-social-responsibility.
Visit tchabitat.org for more information on Twin Cities Habitat for Humanity.
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EmpiRx Health applauds Blue Shield of California, a leading value-based PBM, for implementing the same model of pharmacy care. EmpiRx Health, the pioneer of value-based PBMs, announced a Four Point PBM Revolution Plan. The new plan aims to transform the PBM sector by placing the needs of the plan sponsors and members first, with value-driven pharmacy services.
EmpiRx Health’s “value versus quantity” model is built around a clinically-driven pharmacy care approach, which puts the pharmacist at the heart of the model. EmpiRx Health’s pharmacists use AI-powered population analytics to work directly with prescribers and dispensing pharmacy staff in order to coordinate the best possible pharmaceutical care. This customer-first, clinically-driven approach delivers better health outcomes and guarantees cost savings for plan sponsors.
These key operating principles are the foundation of EmpiRx Health’s Four-Point PBM Revolution Plan.
Cost of prescription medications is the primary driver for healthcare expenditures in the US. This trend is driven by several factors including the proliferation and high cost of specialty drugs, the lack of transparency in pricing, and the misalignment between incentives within the pharmaceutical supply chain. According to the Centers for Medicare & Medicaid Services, pharmaceutical spending will increase at a rate of approximately 6 percent per year on average. This is faster than any other area of healthcare.
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Integrity Marketing Group, LLC (Integrity), a leading distributor and provider of retirement and wealth management solutions, has announced that the Integrity Foundation completed the first in a series of community legacy initiatives and support projects to come – building a modern playground for Norfolk, Nebraska, which will benefit future generations of families and children. The playground, located in Norfolk’s Liberty Bell Park was designed for several months, then built on a single day in partnership with KABOOM! Premier Marketing, WealthFirm, and the City of Norfolk. Integrity’s revitalization of this beloved community park will have a positive and long-lasting impact on the health of children and their families.
The Norfolk playground is one of Integrity Foundation’s largest charitable projects. Integrity Foundation was founded in order to create meaningful and sustainable changes that will improve the health and well-being of millions of people across the country. Integrity has an extensive national network of employees, agents and customers, and is able to connect its stakeholders to enriching opportunities to protect life, health, and wealth for people across the nation.
Integrity values service as a core value. The company offers its employees two days paid leave per year to volunteer in the community in various settings. Integrity Foundation relied on the talents, time and dedication of hundreds volunteers to complete the massive and impressive task of building the structure from top to bottom in one day. In a spirit that embodied generosity, Integrity, Premier, and WealthFirm employees and their families joined forces with local community members to build the playground and gathering areas at an unprecedented pace. Volunteers performed physically demanding tasks, such as mixing 13,000 pounds concrete by hand, moving 150 cubic yard of mulch that weighed more than 100,000 pounds and assembling picnic tables and benches.
The playground structure was designed before the historic build date, using the input of more than 550 local kids who submitted drawings depicting their dream playground. More than 200 members of the community reviewed the designs and incorporated them into the final artistic design and functional decisions. The Integrity Foundation also worked alongside the community throughout the process. The playgrounds and picnic areas are intended to serve as gathering places for families, and will increase a sense of pride and belonging for all community members.
Integrity Foundation and its partners are committed to continuing sponsoring local initiatives in support of the key areas of investment for the Integrity Foundation across the United States. To learn more about the Integrity Foundation’s inaugural playground build, visit www.integritymarketing.com/NorfolkPlayground.
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EmblemHealth has announced the results of its study on the awareness level of value-based payments by employers and consumers. Both groups were unsure of the differences between value-based payment and fee-for service payments. However, when given a definition, they strongly preferred this model to deliver the highest-quality care while also reducing costs.
The survey results and the information gathered from our research show that employers and consumers prefer fee-for service payment models to value-based care when they understand their differences, said Karen Ignagni. CEO of EmblemHealth. All stakeholders will need to work together in order to educate the public about the value-based model of care.
This study is a follow-up of the company’s previous Consumer-focused Value-Based Care Study. It surveyed nearly 250 employer health insurance decision makers and over 750 consumers aged 18 and older across the country, with a tristate region as an oversample. The online survey focused on the following: awareness and understanding of fee-for service payments and value-based health care. What consumers think of when they hear value in healthcare.
The study’s key findings include:
- Both employers and consumers are unaware of the concepts of fee-for service and value-based payments. This provides an opportunity for stakeholders and partners to work together on education.
- Only one third of employers could define “value-based” care. Small group employers understood the term less than large groups and were also more likely to not know if value-based coverage is included in their plans.
- Only 26% were familiar with the term “value-based healthcare”. Four out of ten consumers are unsure if value-based health care is available through their plan.
- Employers and consumers believe that health insurers and health providers are the most responsible in adding value to healthcare.
- When it comes to health care, 42% of employers, and 34% consumers, most often associate the quality of care with its value. Out-of-pocket costs are ranked second (22% and 16%).
- Both groups ranked insurers and providers as the most important in terms of adding value.
- Both audiences are aligned towards value-based payment models compared to fee-for service payments.
- 69% of employers (62% for small groups and 74% for large groups) and 61% consumers prefer the value-based model of care to the fee-for service model.
EmblemHealth published a white paper on 2023 Value-Based Care that contains more detailed findings and recommendations about how employers and consumers could be better informed of the differences between the fee-for service and value-based payment models. “
EmblemHealth also has a blog entitled “Understanding value-based care and its importance to stakeholders in the health care system: The experience of a community-based non-profit health plan”.
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Cathay Life Insurance receives fourth Celent Model Insurer Award for its integration of data analysis and AI for multifaceted risk management. (PRNewsfoto/Cathay Financial Holding Co., Ltd.)Celent, a global research and consulting company, has recognized Cathay Life Insurance for its expertise. This is the fifth Model Insurer Award that the company has received. Celent is a leading consulting firm in the financial technology sector, and the Model Insurer award is the highest honor that an industry can receive.
Cathay Life’s Cathay Eye Intelligent risk control model, which is based on innovative digital services, stood out from the competition, which included 260 submissions by 170 financial institutions across more than 50 different countries. It won the award in the category Data, Analytics, and AI. It is the only company in Taiwan that has received an award for 2023.
The Cathay Eye Intelligent Risk Control Model, which is based on data and system, provides a new method of risk classification for the life insurance sector. Cathay Life has been able to use the vast amount of data it has available to expand its scope of application, which includes personal health risks. This allows the company to simplify the marketing, underwriting and product design processes. The new model, which is unique in the global insurance market, can manage and control multi-faceted risk. This allows customers to have a better experience with insurance.
A panel of judges also praised the multi-disciplinary approach to solving business challenges using risk models, the innovative applications of AI in the insurance sector, and the commercial value of AI in the industry.
Cathay Life Insurance is convinced that talent, in an era of digitalization, is key to a sustainable operation. Data-drivenness is not limited to the data analysts; it should encompass all talents across disciplines. Cathay Life, which set out two years ago to train at least 20% its staff to be adept with data within five years, has now achieved this new win. This demonstrates Cathay Life’s commitment to leading industry innovation, helping customers and cementing its position as the top insurance technology company.
By the end last year, Cathay Life had trained 7% of its back-office staff and 129 data analysts to use analytical skills in order to improve their work efficiency and aid in decision-making. Cathay Life is committed to investing in its talent. The company believes that this process will create a stronger foundation for industrial transformation and innovation.
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Liberty Bankers Insurance GroupLiberty Bankers Insurance Group, a provider of financial, life, and health products, has been named winner of a Gold Stevie Award(r) in the category of New Product and Services, in the 21st Annual American Business Awards (r).
LBIG was recognized for the enhancements made to its On-the-Spot underwriting process (OTS) for Medicare Supplement applications. OTS allows an agent to provide an underwriting decision within three minutes. LBIG improved the OTS product through artificial intelligence to provide a 100% digital application experience and rapid point of sale decisions.
The American Business Awards is the premier business award program in the United States. Nominations are open to all organizations in the U.S.A., public or private, non-profit or for-profit, big and small.
The Stevies, named after the Greek word for “crowned”, will be awarded to the winners during a gala event at the Marriott Marquis Hotel New York on June 13,
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The Cigna Group, a global health company (NYSE:CI), announced today that Dr. Philip Ozuah was appointed to its Board of Directors. His appointment will take effect on June 1, 2023.
Dr. Philip Ozuah is the President and Chief Executive Officer of Montefiore Medicine since 2019. This umbrella organization includes the Albert Einstein College of Medicine, Montefiore Health System and its 13 member hospitals. Dr. Ozuah spent 32 years in Montefiore Medicine, holding positions of increasing responsibility. He was President of Montefiore Health System between 2018 and 2019, and Executive Vice President & Chief Operating Officer between 2012 to 2018. Montefiore Medicine, under his leadership, has established a national reputation for being a leader in the value-based healthcare field. This includes aligning community-based services and organizations with a focus on addressing socioeconomic factors that influence health.
Dr. Ozuah brings a wealth of experience and a wide range of backgrounds to the Board. In the last five years, The Cigna Group Board was refreshed by more than 60% to ensure diversity in skillsets, experiences and viewpoints. In 2022 the Board composition was higher than average in comparison to S&P benchmarks for median age, tenure and gender diversity.
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vybe Urgent Care, the largest independent operator of urgent-care centers in Greater Philadelphia, announced that it now accepts UnitedHealthcare Community Plan for Families (CHIP) and CHIP. The new plans, which are in addition to UnitedHealth Group commercial insurance plans, are available at all of vybe’s locations.
UnitedHealthcare offers healthcare coverage to beneficiaries of Medicaid, and other government-sponsored healthcare programs. These health plans are operated locally under the UnitedHealthcare Community Plan. They strive to improve health by removing barriers such as individual, social, and environmental.
Peter Hotz, CEO and President of vybe Urgent Care, said that the “whole-person” approach to healthcare by UnitedHealth Group fits perfectly with vybe’s mission to help our patients live their healthiest life. “We work to provide a unique, warm and inclusive experience for our communities in Greater Philadelphia.”
Vybe offers walk-in services for consumers, but also provides appointments for urgent care services. Online registration is available in advance for a more efficient appointment. vybe provides convenient telemedicine consultations seven days a weeks for patients who have symptoms but do not want to leave their home. vybe has been a leader in the COVID epidemic and continues to provide diagnostic COVID tests and the updated Moderna bivalent booster vaccine.
vybe has been fully accredited by the Urgent care Association (UCA), the highest distinction available for urgent-care centers. This accreditation ensures a high level of patient safety and satisfaction.
There are 15 Vybe locations throughout Philadelphia, Bucks and Montgomery counties.
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CVS Health (r) has announced that Brian Kane, Executive Vice President and president of Aetna will join the company on September 1, 2023. He will join the executive leadership team of CVS Health and report directly to Karen S. Lynch, President and CEO.
Lynch said that Brian has a proven track record in bringing innovative customer-driven products to market and driving strong operational improvements. His passion for simplifying the health care experience is a great asset to our strategy of improving health, lowering costs and driving higher levels engagement among members.
Kane will be leading Aetna – the health benefits segment of CVS Health. Aetna provides insurance and benefits solutions to individuals, employers and government agencies, and serves nearly 35 million people. Most recently, he served as a consultant for several private equity firms that focus on health care. Kane was Chief Financial Officer at Humana, where he oversaw the primary care business. He played a key role in the formulation of Humana’s strategies during his tenure with the company. Kane worked at Goldman Sachs’ Investment Banking Division for 17 years before joining Humana.
Kane said that CVS Health had a unique set of assets, including Aetna. This collection offers the chance to improve the access to health care quality for all Americans. “My main focus will be to work with talented colleagues throughout the organization to build on existing efforts in order to make health care affordable, simple and personalized.”
Kane succeeds Daniel Finke who is retiring due to health issues. Finke played a key role in the success and growth of Aetna’s businesses during his almost 10-year tenure. Throughout his career, Finke supported the evolution of care that was centered on the consumer and advocated for the company’s efforts in addressing health care disparities. Finke and Kane will work together to ensure that the transition is seamless in September.
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PatientGenie is a consumer-health technology company that has announced the addition of PatientGPT to its healthcare search engine. PatientGPT is a revolutionary AI navigation system. PatientGPT, based on OpenAI’s ChatGPT technology, aims to revolutionize patient navigation by offering seamless and personalized experiences for healthcare organizations and patients.
PatientGPT’s integration into PatientGenie AI search engine allows healthcare organisations to unlock the potential of their digital channels, by providing an efficient, accurate and user-friendly service. This innovative solution allows patients to quickly access information, locate specialists and book appointments. It also allows them to communicate with healthcare providers and book appointments.
PatientGPT AI navigation’s key advantages include:
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Improved Patient Engagement – By offering an intuitive conversational AI interface to patients, PatientGPT improves their engagement and satisfaction. This leads to better relationships between healthcare providers and patients over the long term.
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Streamlined access: PatientGPT’s AI-driven navigation combined with PatientGenie’s patented provider searching capabilities help patients find relevant information quickly, such as specialist recommendations and treatment options. This reduces the time required to navigate complicated healthcare systems.
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PatientGenie’s AI search engine adheres strictly to data security and privacy regulations, protecting sensitive patient information.
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Scalable and Customizable: PatientGenie is easily integrated into existing IT systems for healthcare and can be tailored to meet the needs of each organization. This makes it an ideal solution for all healthcare providers.
Visit patientgenie.com to learn more or schedule a demonstration if you are interested in partnering with or implementing PatientGenie’s AI search engine that includes PatientGPT.
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Fidelis Health is raising awareness of the health disparities that minority populations face. This year’s theme is Better Health Through Better Understanding. emphasizes how meeting cultural and language needs can improve health outcomes.
National Minority Health Month was established by the Office of Minority Health of the U.S. Department of Health and Human Services (OHS) to encourage educational efforts about health issues that currently affect racial and ethnic populations and to eliminate health disparities.
According to the Centers for Disease Control and Prevention,minority group members are more likely than others to suffer from chronic diseases such as obesity, diabetes, and heart disease. Community-based organizations, leaders, health plans, and providers can all work together to address health literacy and linguistic requirements. This will reduce the risk for these conditions, as well as improve health outcomes.
Fidelis Care works with many providers in the state that speak different languages. It is important to be able communicate with your doctor in your native language, and understand the results of a lab test.
Camille Pearte MD, Fidelis Senior Medical Director, said: “National Minority Health Month is an opportunity to address health disparities, inequities, and injustices among minority populations.” “We want to encourage our members’ involvement in their health, wellness and care. We want them to ask questions and get the services and care they need. It is important to deliver care in a manner that respects each individual’s culture or heritage.
Fidelis Care’s staff are not only active in their local communities, but also speak multiple languages. Fidelis Care Marketing staff members, who have a grassroots presence in the state, speak 29 languages, from Spanish to Urdu. Fidelis Care’s strong partnerships with community organizations and providers help to address health disparities through education and community events.
Fidelis Care, for example, recently partnered up with CINQCARE in Buffalo, a community-based, provider-led comprehensive care delivery partner, to discuss culturally sensitive healthcare.
Anthony Welters is the Founder and CEO of CINQCARE. “We are committed to understanding and serving the communities that we serve. That’s why we’re dedicated to creating a healthcare system where it’s not a burden,” he said. We are committed to recruiting and equipping doctors, nurses, practitioners and caregivers to provide better health and care in the communities they live, particularly those who are Black and Brown.
Fidelis Care, beyond National Minority Health Month will continue to focus its efforts on health equity. We want to ensure that our members and communities are able to access the best care. This commitment requires us to continue to address social determinants and health disparities in the state.
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In the last few years, healthcare sharing ministries have seen significant changes, largely due to actions taken in Washington D.C. and many state capitals. Liberty HealthShare (r) has overcome these challenges with its vision to build a healthcare-sharing ministry that is a reflection of Jesus Christ, and empowers Americans in managing their healthcare journey.
All healthsharing ministries have found it difficult to keep up with the transition of the government penalizing those who don’t have insurance and offering them subsidies to pay for their enrollment. Dorsey Morris, the chief executive officer at Liberty HealthShare, said that.
He added, “Despite these challenges and others unique to our ministry we have shown our resolve and perseverance in facilitating a sharing of over $231 million worth of eligible medical expenses in 2022.” “And we did it while reducing by one third our backlog of expenses prior to 2022.”
Liberty HealthShare has shared with its members more than 1,25 billion dollars in eligible medical costs since 2019. The sharing included over 1.6 million medical bills that were submitted by the members and their doctors.
Liberty HealthShare’s members have shared more than 4.5 billion dollars in medical costs since 2014.
Over the last year, the focus has been on strengthening the procedures of the ministry. Liberty HealthShare implemented new, rigorous processes for quality control, auditing, and member resolution to ensure that expenses submitted are not only accurate and eligible, but also fair.
We take very seriously our responsibility to manage their financial contributions, and to provide the best experience possible for members. “We evaluate every program, support process, and vendor contract keeping this in mind,” Morrow said.
Liberty HealthShare is an 501(c), charitable Christian cost-sharing organization that focuses on helping members in times of crisis. The faith-based healthsharing program facilitates nearly 90,000 participants. It is a caring, community of health-conscious families and individuals who support each other and adhere to Christian values.
Liberty HealthShare is open to all year round, and there is no need for any special life event. For more information about its healthcare sharing programs visit libertyhealthshare.org or call (855) 585-4237.
SOURCE Liberty HealthShare
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Health in Tech is an industry-leading insurtech firm that provides disruptive innovation that reimagines self funded health plans. Today, Health in Tech announced that it has partnered with 6 Degree Health, 90 Degree Benefits and created a new level-funded, value-based health plan that will be effective in January 2023.
6 Degree Health is focused on cost containment and payment integrity solutions. They are committed to providing high quality care and transparency. Its Professional Plus program, which combines direct contracts with a physician network and Value-Based Payment (VBP), combines the convenience of a physician network with the savings associated with reference-based pricing.
90 Degree Benefits helps employers create and manage self-funded benefit plans that meet their needs. Employers have a variety of options with 90 Degree Benefits: concierge medicine, direct facility contracts and standard network design.
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Erectile dysfunction (ED), a common problem, affects millions of men across all ages. There are many options for people who want to get relief from this condition. Shockwave therapy is an option in Celina, Texas. Elite Wellness and Anti-Aging is the best provider of shockwave therapy in Celina, TX. This article will give you an overview of shockwave therapy, and the potential benefits.
What’s Shockwave Therapy?Shockwave therapy, a medical treatment that uses sound waves for various conditions, is relatively new. Extracorporeal shockwave treatment (ESWT) is the name of this type of therapy. It can be used to treat many conditions, including tennis elbow, chronic pain, and erectile dysfunction. This therapy is not shock-oriented, despite its name. It is painless and non-invasive. Shockwave therapy is a method that improves erections by increasing blood flow to the penis.
Acoustic wave therapy (AWT), a non-surgical treatment for erectile problems, uses low-frequency sound waves to increase blood circulation and reduce blockages. Unlike shockwave therapy which uses high energy levels, AWT is safer and more effective at treating erectile dysfunction than invasive procedures. Studies have shown that AWT may lead to an improvement in sexual performance for those suffering from ED. This is due to the increased blood flow to the penis tissues following treatment with AWT devices.
What is shockwave therapy?A provider will use a device that generates sound waves that are directed at the area to be treated with shockwave therapy. These sound waves travel through the skin to stimulate tissue and muscles. This stimulation increases blood flow and stimulates the growth new blood vessels.
Shockwave Therapy for ED: BenefitsSome promising results have been shown for shockwave therapy for ED. Shockwave therapy has been shown to be effective in increasing sexual desire and erectile function. It can also increase the size and shape of the penis, according to some studies.
These potential benefits are not only significant, but shockwave therapy is also non-invasive and does not require needles, medication, surgery, or other invasive procedures. The treatment is fast, relatively painless and has few side effects.
Locating a Shockwave Therapy Provider near Celina, TXIt is essential to find a qualified provider if you are interested in shockwave or acoustic therapy for ED. Elite Wellness and Anti-Aging in Celina, Texas offer this treatment. It is called the Z Wave Pro.
Both acoustic and shockwave therapy are viable options for those who want non-invasive and safe treatments for ED. They may be useful in cases where other treatments are not working or unsuitable due personal preferences or health issues. For a complimentary telemedicine consultation, contact Elite Wellness and Anti-Aging if you are located in Celina, TX.
If you are not getting the results you desire, talk to one of our doctors.
Shockwave therapy is a safe and effective way to treat erectile dysfunction. This non-invasive treatment can improve erectile function and increase sexual desire. Elite Wellness and Anti-Aging is available in Celina, Texas, if you are interested to learn more about shockwave therapy for ED.
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Blue Cross and Blue Shield of Minnesota has promoted Bukata Hayes to the position of vice-president, chief equity officer. Hayes, who has been vice president for racial equity and health equity since March 20,21, will assume this new role. She will be responsible to integrate all diversity, equity and inclusion (DEIB), strategies into the Racial & Health Equity department.
Hayes can align the internal representation goals at DEIB and the external facing RHE portfolio initiatives to increase the impact of talent and recruitment efforts. This will allow Blue Cross to maximize its workforce potential to better reflect the increasing diversity of Blue Cross members and the Minnesota population.
Hayes, who will be the chief equity officer, reports directly to the CEO. He also serves as a member the company’s senior leadership.
Hayes served as the executive director for the Greater Mankato Diversity Council nearly 15 years before joining Blue Cross. Hayes has over 20 years experience in organizing and facilitating systemic changes within large and small systems, such as K-12, non-profit, and rural communities.
Hayes earned his bachelor’s degree at the College of St. Scholastica, Duluth. He has been a member of the Blue Cross and Blue Shield of Minnesota Foundation board of directors since 2014.
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Liberty HealthShareLiberty HealthShare, a leading Christian healthsharing ministry in the country, has announced a holiday discount program for new members.
For this holiday fee waiver, call Liberty HealthShare’s enrollment department at (855) 555-84237 until January 31.
Liberty HealthShare offers a range of sharing programs. All options are affordable, and can be tailored to meet the needs of all families. Liberty HealthShare doesn’t require members to use a restricted network. Members can choose doctors and providers they like, but prices are fair.
For singles, couples, and families, the three core Liberty HealthShare programs, Liberty Unite, Liberty Connect, and Liberty Essential, are great options. Singles can participate in sharing programs with a monthly contribution of $159. Monthly shares for couples start at $259. Affordable family programs start from $499 per month. These programs offer both urgent care and mental wellbeing telehealth visits, as well as discounts on prescription drugs, vision care, and Lasik surgery.
The Liberty Assist program offers a low-cost sharing program for Medicare Parts A or B enrolled people aged 65-84. Liberty Assist monthly share amounts start at $85.
The Liberty Rise program is an affordable program for young adults aged 18 to 29 who are just starting out on their own. The monthly share amount is only $119
Liberty HealthShare was established in 1995. It is a non-profit, 501(c), (3) charitable Christian medical cost sharing ministry that focuses on nearly 90,000. Members helping each other in times when they are in need. This faith-based program is a supportive community of people and families with a love for healthcare.
Liberty HealthShare’s programs for medical cost sharing are based upon shared religious and ethical beliefs. They also follow a religious tradition that encourages mutual aid, neighborly assistance, and financial sharing. These programs are for people who live a Christian life, believe in helping others, and make responsible decisions about their health.
Liberty HealthShare enrollment does not require you to have insurance. For more information about its healthcare sharing programs visit www.libertyhealthshare.org.
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Blue Cross Blue Shield of Massachusetts (“Blue Cross”) has announced a significant milestone in its commitment towards ensuring equitable, high-quality and affordable care. Blue Cross Blue Shield of Massachusetts is the first non-profit health plan to establish a financial payment model that rewards health systems and doctors for eliminating racial or ethnic inequalities in care. This will help improve health care for the 2.9 million Blue Cross members.
The agreements, which link financial incentives with improvements in health equity, have been signed by four of the state’s most important health care systems: Steward Healthcare Network (“Steward”), Beth Israel Lahey Health (“BILH”), Mass General Brigham, and Boston Accountable Care Organization, Inc. (“BACO”), which is part Boston Medical Center. These systems together provide care for more than 550,000 Blue Cross members.
New contracts will focus initially on rewarding and measuring equity in care in clinical areas where there are inequalities, such as colorectal and blood pressure control, and care for diabetics. As the payment model develops, additional categories will be added.
Blue Cross’s efforts to improve health equity will be evaluated by the Center for Healthcare Organization and Innovation Research at the UC Berkeley School of Public Health. This evaluation will use qualitative and quantitative methods to evaluate and publish the results.
Steward Health Care NetworkSteward Health Care Network is the physician network for the Massachusetts 10 hospitals that are part the Steward Health Care System. Steward Health Care is one of the largest accountable care organizations in the country and focuses on addressing racial disparities. It specializes in colorectal cancer screenings, high blood pressure control, and other areas.
Beth Israel Lahey HealthBeth Israel Lahey Health has more than 1,000,000 patients who rely on its hospitals, primary and specialty care as well as behavioral and community services. BILH’s partnership with Blue Cross aims to address racial disparities by first addressing two priority areas, comprehensive diabetes care and high blood pressure control.
Mass General BrighamMass General Brigham offers integrated academic health care. It includes two academic medical centers, specialty hospitals, community and specialist hospitals, as well as a health insurance plan, physician network, community health centers and home care. Mass General Brigham created the United Against Racism initiative two years ago. This program laid out a strategy to address the many effects of racism within the organization as well as in the community. These efforts are organized around patient care, community and workforce equity. They are supported by a multimillion-dollar investment.
Boston Accountable Care Organization, Inc.BACO, which is made up of 19 providers organizations, is part of Boston Medical Center. It includes a mixture of community hospitals, academic medical centers and community health centers throughout Greater Boston, Western Massachusetts, and Southern Massachusetts. More than 111,000 people are served by BACO primary care locations, many of whom live in rural areas. BACO’s agreement with Blue Cross will allow it to focus its initial efforts on controlling high blood pressure and colorectal cancer screenings.
Blue Cross is committed to equity in healthBlue Cross collects data annually for over 1.2 million members in Massachusetts each year to fulfill its promise to be a leader in addressing health inequality. These data have revealed inequalities in patient care across many areas. The health plan works in partnership with its network of clinicians to use its data to effect meaningful change and achieve the common goal of eliminating racial disparities within the care Blue Cross members receive.
Blue Cross provided $25 million in Institute for Healthcare Improvement grants for physician practices and hospitals to help them eliminate racial inequalities in healthcare and to share their learning across institutions.
There are also other complementary initiatives to achieve health equity:
— Blue Cross Health Justice Partnership & Grant awards seven organizations to support the company’s mission to ensure that all Massachusetts residents live healthy lives and create more equitable and just communities. This grant provides $35,000 in general support, up to $20,000 pro bono support each year, and a total of $110,000 in financial support over two years.
— The Racial Justice In Health Grants of the Blue Cross Blue Shield of Massachusetts Foundation support grassroots community organizations that are led by people of colour and dedicated to eliminating institutional and structural racism in healthcare.
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EmpiRx Health has announced Ziad Rubaie’s appointment as Chief Growth Officer. This makes EmpiRx Health the only industry-focused pharmacy benefits manager (PBM) that values value. Rubaie joins EmpiRx Health’s leadership team during a period of rapid expansion. He will continue to build on the momentum while plan sponsors search for financially sustainable, clinically-based health benefits.
Rubaie, a respected leader within the healthcare industry with over 27 years of experience building strong strategic partnerships through a network of highly skilled healthcare consultants. After three years at Consociate Health as Chief Business Development Officer, Rubaie joined EmpiRx Health to become the Chief Executive Officer of EmpiRx Health. This boutique TPA has a rapidly expanding national presence.
EmpiRx Health’s exciting year continues with the appointment of Rubaie to CGO. This value-based PBM was recently named a BenefitsPRO luminary for its work in transform the benefits business. It was also included on Fortune’s Best Workplaces In Healthcare(tm), and was awarded Great Place to Work(r), for the third year consecutively. EmpiRx Health published a unique data report entitled “Innovation in Pharmacy benefits: Mental Health is Health” this fall. It found that rising prescriptions for mental health do not necessarily mean higher costs. The findings of the report confirm that the PBM’s value-based, category-defining healthcare model can be balanced with cost and access.
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Superior HealthPlan, located in Texas, today announced a new partnership with MedArrive. MedArrive offers mobile-integrated home care management services. Superior members with complex health needs will benefit from the collaboration. It will close critical care gaps and address non-medical drivers. The partnership will also help at-risk members navigate healthcare systems. Brave Health will offer members better access to virtual behavioral healthcare services.
MedArrive’s care management platform, which is white-labeled, connects Superior members with MedArrive’s field provider network. This includes highly-trained and skilled paramedics and EMTs as well as other healthcare professionals. For members with more complex healthcare needs, the program will be initially offered to around 40,000 people.
Field providers will work closely with the Superior Care Management and MedArrive teams to visit members’ homes and provide a variety of preventive healthcare services, diagnosis, and health assessments. Field providers can connect members to physician-led Telemedicine services when higher-acuity care becomes necessary. They can also address other issues such as mobility challenges, transportation problems, and nutrition assistance.
MedArrive field providers are often local residents and can provide comfort for members who feel lonely or isolated. If more support is required, the team can connect members to Brave Health’s virtual behavioral health services through an integration.
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Gravie, a leader in health benefit innovation, announced today that Dr. Greg Burrell has been appointed chief medical officer. Gravie’s first chief medical officer, Dr. Greg Burrell, will be the clinical thought leader. His focus is on improving quality and cost efficiency of healthcare.
Before joining Gravie Dr. Burrell was vice president of clinical operations & solutions at Accolade. Accolade is a leader in personalized healthcare and serves over 10 million people. As vice president of clinical strategy and product, he also co-founded Carbon Health. This innovative, primary, urgent, and virtual healthcare provider system offers a variety of services. Dr. Burrell earned his medical degree at the University of Chicago and completed his residency at University of California, San Francisco.
Dr. Burrell is Gravie’s chief medical officer. He will be responsible for developing and leading Gravie’s care strategy. Burrell will also create innovative clinical programs, and ensure that members are happier, healthier, and more productive. As he oversees Gravie’s integrated clinical operations, population health and member care, Dr. Burrell will be closely involved with providers and members to ensure the best and most affordable medical services for members.
Gravie has been disrupting healthcare since 2013 with innovative employer-sponsored healthcare benefit solutions. This includes Comfort(tm), the nation’s first-of its-kind healthcare plan that offers 100% coverage for most healthcare services. There are also tax-free options like ICHRA with Gravie.
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Solis Health Plans, a Florida Medicare Advantage Plan is proud to announce Francisco Hernandez’s appointment. As Chief Medical Officer. Dr. Hernandez will be joining the Solis executive team to oversee clinical operations, care management quality improvement, care management, pharmacy, health IT and behavioral health for Solis’ members.
Efrain Duarte CEO of Solis Health Plans said, “I am happy to welcome Dr. Hernandez into the Solis Health Plans Leadership team.” “Dr. Hernandez has a lot of experience as a CMO, and will be able to help Solis continue to develop best-in-class policies to enhance the provider and member experience.”
Solis Health Plans welcomes Dr. Hernandez, who has over 30 years experience in healthcare. Most recently, Dr. Hernandez was the National Director for Endocrinology at ChenMed. He developed clinical guidelines that improved outcomes and cost effectiveness. Before that, he was Chief Medical Officer at Doctors HealthCare Plans.
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HealthPartners has demonstrated its commitment to simplicity, affordability, and a better shopping experience for Wisconsin residents in their health insurance marketplace. HealthPartners’ partnership with Softheon a top cloud-based provider of health insurance exchange technology, will allow Wisconsin residents to shop for and enroll directly on the HealthPartners website.
Softheon supports Phase 3 EDE. This is the highest level of functionality and capability with Centers for Medicare & Medicaid Services (CMS). HealthPartners can confirm eligibility and apply subsidies to 100% of enrollees by investing in a Phase3 EDE solution.
Health plans are focusing on a growing market, which is characterized by an increase in Affordable Care Act (ACA), enrollments and the expansion of subsidies enhancements through 2025 under the Inflation Reduction Act. HealthPartners understood the need of members to have easier access and more affordable health plans.
EDE has been increasingly used by health plan enrollees. 17% of members were enrolled via EDE during 2021 open enrollment. This is a significant increase from 8% in 2020. Softheon predicts that EDE enrollments will continue to rise due to a shift toward a consumer-centric approach in selling and maintaining coverage.
Softheon is one of few Phase3 EDE vendors. Softheon’s close partnership with CMS will allow HealthPartners to quickly respond to evolving regulatory and operational requirements.
Softheon will use its industry knowledge and upstream relationships in order to better serve members of HealthPartners. HealthPartners will be able to offer a more simple enrollment process and remain a leader within a dynamic market.
For more information about Softheon, please visit https://www.softheon.com/
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