San Francisco (Vocus) July 20, 2010

Today the non-profit Integrated Benefits Institute (IBI), released its analysis of the health and productivity management (HPM) practices of 450 U.S. employers indicating that HPM has a positive impact on their health and productivity goals. This analysis is a follow up to an IBI report released earlier this year finding broad adoption of prevention, wellness, disease management and disability-management/return-to-work (RTW) initiatives by employers.

“That employers are sustaining and adding to their HPM programs despite a general lack of empirical data on the outcomes of these efforts suggests the increasing prominence of workforce health as a business strategy,” said Thomas Parry, PhD, president of IBI. “Weight management efforts meet both the medical/pharmacy cost savings goal as well as reducing the lost-productivity costs of ill health, making adoption of weight management a best practice for many employers. Other such best practices help employers achieve multiple goals including savings in medical/pharmacy costs, health-related lost productivity and sick-day/disability absences.”

Additional research findings include:

• HPM practices have a particularly strong, positive impact on employee satisfaction. While employee satisfaction is not a traditional health and productivity outcome, this finding is a significant indicator that a health and productivity program is an important investment for employers interested in attracting and retaining key workers by building a culture of health.
• Several practices have high impact across several outcomes. Six practices – nurse case management, transitional RTW, health risk coaching, on-site providers, participation incentives and weight management – have positive impacts on at least two important health and productivity outcomes and therefore should be considered an essential part of an effective and efficient HPM program.
• No single HPM program area has a lock on high-impact practices. Among the top 10 high-impact practices, four are associated with disability management/return to work, four are related to health promotion and two are associated with disease management.

A summary of the report is available to the public at ibiweb.org. The full report also is available to IBI members.

About the Integrated Benefits Institute

The Integrated Benefits Institute (IBI) provides employers and their supplier partners with resources for demonstrating the business value of health. As a pioneer, leader and nonprofit supplier of health and productivity research, measurement and benchmarking, IBI is a trusted source for benefits performance analysis, practical solutions, and forums for information and education. IBI’s programs, resources and expert networks advance understanding about the link between – and the impact of – health-related productivity on corporate America’s bottom line. For additional information visit: ibiweb.org.

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For the original version on PRWeb visit: http://www.prweb.com/releases/prweb2010/07/prweb4280684.htm

It’s an important measure, funded in part by federal tax dollars, that will allow people to get care while the nation moves toward implementing the health insurance overhaul passed by Congress this year.

While we did criticize the reform package, we do believe this plan will provide care for people who would otherwise end up in emergency rooms around the state, a sad turn of events that ends up costing everyone too much in the end.

States have been given the flexibility to create their own programs so long as they meet basic requirements, or they could opt to allow the federal government to run it. Colorado is among 29 states and the District of Columbia that decided to run their own plans.

We are glad to see Colorado’s pool was created in partnership with Rocky Mountain Health Plans, a locally owned, not-for-profit that has a reputation for providing access to quality, affordable health care.

Colorado will receive a $90 million portion of $5 billion that has been earmarked for extending health insurance coverage to those unable to get health insurance because they’ve got serious pre-existing conditions, such as cancer, AIDS or diabetes.

Read full story

(PRWEB) July 9, 2010

HealthSmart is proud to announce that Khoi Nguyen and Dennis McDowell have joined their executive sales staff in the Houston market. Khoi is a trained underwriter with 20 years of sales experience and was highly recommended by the top 3 brokerage firms in Houston: USI, AJG and BCI. He has proven sales experience and has consistently exceeded annual sales and renewal objectives. Khoi achieves success by developing and cementing strong business and personal relationships. He is self motivated and exhibits a high level of personal and professional integrity.

Dennis has over 24 years of experience in managed healthcare and will be a truly valued addition to the HealthSmart Houston sales team where the Company has made a strong commitment to growth. His career has included positions with Prudential, Humana and Cigna. As an experienced strategic planner who works well in a collaborative team environment, Dennis is able to facilitate strategic plans that consistently produce optimum results. Dennis is characterized as a motivator and team builder and he has solid, long term relationships with the broker, consulting and client communities.

Chief Sales Officer, Alex Arnet said, “Khoi and Dennis will be great additions to our executive sales staff in Houston. Based on their previous production results, we expect great things from them.”

The Houston area has terrific potential for HealthSmart due to recent Accel Network contracts with most of the influential hospitals and providers. Accel is the Company’s top tier network with the best rates along with unbeatable benefits for the employers, their members and providers.

About HealthSmart
HealthSmart is an innovative healthcare benefit solutions company serving more than 1.75 million members and managing more than $3.2 billion in claims through service operations around the country. HealthSmart provides integrated solutions, on a single administrative platform, to over 8,500 employer groups and partners through its wholly owned healthcare related subsidiaries. The Company’s products and services include employee benefit and workers compensation administration, nationwide preferred provider networks, predictive population management and wellness programs, prescription benefit management, on-site primary care clinics and stop-loss management. HealthSmart’s mission is to improve member health, reduce costs and deliver “smarter” healthcare benefit solutions.

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For the original version on PRWeb visit: http://www.prweb.com/releases/prweb2010/07/prweb4238684.htm

(PRWEB) July 9, 2010 — HealthSmart is proud to announce that Khoi Nguyen and Dennis McDowell have joined their executive sales staff in the Houston market. Khoi is a trained underwriter with 20 years of sales experience and was highly recommended by the top 3 brokerage firms in Houston: USI, AJG and BCI. He has proven sales experience and has consistently exceeded annual sales and renewal objectives. Khoi achieves success by developing and cementing strong business and personal relationships. He is self motivated and exhibits a high level of personal and professional integrity.

Dennis has over 24 years of experience in managed healthcare and will be a truly valued addition to the HealthSmart Houston sales team where the Company has made a strong commitment to growth. His career has included positions with Prudential, Humana and Cigna. As an experienced strategic planner who works well in a collaborative team environment, Dennis is able to facilitate strategic plans that consistently produce optimum results. Dennis is characterized as a motivator and team builder and he has solid, long term relationships with the broker, consulting and client communities.

Chief Sales Officer, Alex Arnet said, “Khoi and Dennis will be great additions to our executive sales staff in Houston. Based on their previous production results, we expect great things from them.”

The Houston area has terrific potential for HealthSmart due to recent Accel Network contracts with most of the influential hospitals and providers. Accel is the Company’s top tier network with the best rates along with unbeatable benefits for the employers, their members and providers.

About HealthSmart
HealthSmart is an innovative healthcare benefit solutions company serving more than 1.75 million members and managing more than $3.2 billion in claims through service operations around the country. HealthSmart provides integrated solutions, on a single administrative platform, to over 8,500 employer groups and partners through its wholly owned healthcare related subsidiaries. The Company’s products and services include employee benefit and workers compensation administration, nationwide preferred provider networks, predictive population management and wellness programs, prescription benefit management, on-site primary care clinics and stop-loss management. HealthSmart’s mission is to improve member health, reduce costs and deliver “smarter” healthcare benefit solutions.

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For the original version on PRWeb visit: http://www.prweb.com/releases/2010/07/prweb4238684.htm

Saint Augustine, FL (PRWeb/Vocus) July 2, 2010 — Q1Medicare.com now has the 2011 Medicare Part D Defined Standard Benefit parameters online along with a comparison of how these parameters have increased from 2006 through 2011. Internet users can view a chart of the annual prescription drug plan coverage changes at: Q1Medicare.com/2011.

Each year, the Centers for Medicare and Medicaid Services (CMS) release the Medicare Part D Defined Standard Benefit parameters and in 2011 these model parameters will represent a 0.31% increase over current 2010 values. The CMS Defined Standard Benefit parameters include the standard Initial Deductible, as well as the Initial Coverage Limit (ICL) and the Out-of-Pocket Threshold (TrOOP). The ICL and TrOOP together form the boundaries of the Donut Hole or Coverage Gap.

“In past years, we have seen the standard Part D plan parameters increase over 7.5% between years,” notes Dr. Susan Johnson, Technical Director of the Q1Medicare.com website. “However, next year we will only see a slight increase over current 2010 standard values.”

Medicare beneficiaries enrolling in a 2011 Medicare Part D prescription drug plan modeled after the CMS Defined Standard Benefit will find their 2011 initial deductible unchanged at $310. Medicare beneficiaries whose monthly retail drug costs are over $237 will enter the 2011 Donut Hole; that is, when their total negotiated retail drug costs reach $2,840, only $10 more than this year’s Initial Coverage Limit of $2,830. The 2011 Donut Hole exit point or Out-of-Pocket threshold remains unchanged from the current 2010 value of $4,550. Finally, the Retiree Drug Subsidy (RDS) cost threshold and cost limit for qualified retiree prescription drug plans will remain unchanged in 2011 at their current 2010 values of $310 and $6,300 respectively.

Medicare beneficiaries should be reminded that the small changes in the 2011 Medicare Part D Defined Standard Benefit do not mean that their current 2010 Medicare Part D plans will remain the same in 2011. “Seniors and other Medicare beneficiaries must be prepared to review their prescription drug plan options each year to ensure that they are receiving the most complete and affordable coverage,” adds Dr. Johnson. “Plan formularies and cost-sharing can change significantly from year-to-year.”

Q1Medicare.com also released their updated 2011 PDP-Planner tool (or Donut Hole Calculator) utilizing the 2011 CMS Defined Standard Medicare Part D prescription drug plan benefit parameters. The 2011 PDP-Planner allows users to enter their estimated retail prescription costs, initial deductible and monthly Part D plan premiums to preview their 2011 Medicare Part D expenses. The 2011 PDP-Planner can be found at: PDP-Planner.com/2011.

About the Website Q1Medicare.com
Q1Medicare.com is one of the largest independent online resources for Medicare Part D prescription drug plan information. Q1Medicare.com offers online tools, Frequently Asked Questions, a free monthly Medicare Part D Newsletter and tutorials all designed to help Medicare beneficiaries, caregivers, advocates, advisors, and insurance agents navigate the Medicare prescription drug program. Q1Medicare.com is operated by Q1Group LLC (Saint Augustine, Florida).

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For the original version on PRWeb visit: http://www.prweb.com/releases/2011_Medicare_Part_D/Defined_Standard_Benefit/prweb4217254.htm

Mount Prospect, IL (Vocus) July 1, 2010 — Lee Sacks, M.D., chief executive officer of Advocate Physician Partners (APP) and Rick Wesslund, chairman of BDC Advisors today announced the formation of CI-Now™, a new company that will assist health care organizations in building and successfully managing a clinically integrated hospital-physician network.

The new joint venture will market a set of tools, technologies, best practices and support infrastructure to hospital systems or physician groups seeking to accelerate the design and creation of a clinically integrated network as they begin the work of becoming an Accountable Care Organization (ACO).

“A clinically integrated network is the fundamental backbone of any hospital system or acute care hospital wanting to evolve into an Accountable Care Organization,” said Sacks. “CI-Now™ will enable operationalization of a network – a key strategic step for some systems as competition for contracts heats up.”

The goal of an ACO is to deliver coordinated and efficient care by creating collaboration among hospitals, physician and payers, a design seen by many lawmakers as an important step in health care reform.

Advocate Physician Partners (APP), is a joint venture between 3,400 plus employed and independent physicians and the Advocate Health Care network, which includes ten hospitals. APP operates as a clinically integrated network and its physician members currently serve nearly 1 million people in Chicagoland. Over the past seven years of operation, the APP network has demonstrated its value to the community through improvement in health outcomes and cost savings created by widespread adoption of evidence-based practices by network physicians.

“Advocate Physician Partners’ success in driving improvement in health care by creating collaboration among hospitals, physicians and payers has made it a leader in demonstrating the value of an integrated provider network for a community,” said Wesslund. “The processes and insights that APP has gained during their seven-year network development can be invaluable to health systems in their journey towards clinical integration and becoming an Accountable Care Organization.”

BDC Advisors is a health care consulting firm that has been working with leading organizations to design and build hospital-physician networks for 20 years.

“BDC has participated in the development of some of the most successful networks in the United States,” said Sacks. “It has proven its ability to provide organizations with the road map to clinical integration and becoming an Accountable Care Organization.”

CI-Now has offices in Mount Prospect, Ill. and Miami. CI-NOW representatives can be reached at 847-390-3510, or by e-mail at dale(dot)anderson(at)bdcadvisors(dot)com, neal(dot)hogan(at)bdcadvisors(dot)com, or marty(dot)manning(at)advocatehealth(dot)com.

About Advocate Physician Partners (APP)
Advocate Physician Partners (APP), the care management and managed care contracting joint venture between the Advocate Health Care system and more than 3,400 physicians on the medical staffs of the nine Advocate hospitals. Operating as a Clinically Integrated Network (CIN) for the past seven years, APP physician members currently serve nearly 1 million people in greater metropolitan Chicago. Advocate Physician Partners corporate office is located in Mount Prospect, Ill.

About BDC Advisors
BDC Advisors is a national health care consulting firm that has been working with leading organizations to design and build hospital-physician networks for 20 years. Founded in 1991, the firm has offices in Boston, Chicago, Dallas, Denver, Miami, San Francisco, and Washington DC.

Contact:
Kate Kalthoff
Manager, Communications
Advocate Physician Partners
630-990-5610

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For the original version on PRWeb visit: http://www.prweb.com/releases/CI-Now/APP/prweb4215874.htm

(PRWEB) July 2, 2010 — HealthSmart hosted its first symposium for clients, prospective clients and brokers on June 23- 24, 2010 near the home office in Irving, Texas. About 150 attendees from all over the country turned out for the “Forum on National Healthcare Reform and Trends” and were joined by the Company’s top executives, sales representatives and other key client-facing team members.

The Forum topics covered developments in healthcare reform and factors influencing cost trends. The keynote speaker on the first day was Jim VandeHei, Executive Editor and Co-founder of POLITICO, a nonpartisan media company covering national politics. On the second day Scott McFarland, President of the Wellness Enterprise for the Cleveland Clinic delivered the keynote address on Creating a Culture of Wellness.

Several informational panels discussed strategies to improve member health and ways to reduce cost. HealthSmart team members and other experts on managed healthcare presented the educational aspect of the Forum focusing on political, legal and economic issues as well as how the new federal healthcare reform legislation and the regulations implementing it directly impact networks, pharmacy benefits, care management and wellness.

HealthSmart’s Executive Chairman, Daniel D. Crowley said, “This was a terrific event. Everyone who attended came away impressed by the caliber of the speakers and the rich content of the sessions.”

About HealthSmart

HealthSmart is an innovative healthcare benefit solutions company serving more than 1.75 million members and managing more than $3.2 billion in claims through service operations around the country. HealthSmart provides integrated solutions, on a single administrative platform, to over 8,500 employer groups and partners through its wholly owned healthcare related subsidiaries. The Company’s products and services include employee benefit and workers compensation administration, nationwide preferred provider networks, predictive population management and wellness programs, prescription benefit management, on-site primary care clinics and stop-loss management. HealthSmart’s mission is to improve member health, reduce costs and deliver “smarter” healthcare benefit solutions.

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For the original version on PRWeb visit: http://www.prweb.com/releases/2010/07/prweb4213614.htm

(PRWEB) July 1, 2010 — After a hotly contested national debate, healthcare reform legislation was passed in the spring of 2010. The legislation contains many long-term benefits for the pharmaceutical industry, but the industry must continue to play an active role in legislation implementation to ensure those benefits are realized.

Through the new laws, there are both wins and losses for the pharmaceutical industry, such as changes effecting Medicare/Medicaid, health insurance coverage expansion & protection, taxation and patent protection. However, on balance most changes hold significant long-term potential for the industry.

While pharma played a very important role in promoting health reform during the debate over change, the work is not done. Many of the greatest potential benefits of the legislation – including extending healthcare coverage to 32 million more Americans – will come down the road. Thus, it is crucial for pharma to remain involved with the healthcare reform roll-out going forward.

Use CBR Pharma Insights’ new report, “The New Era of Healthcare Reform - Supporting Revenue Growth through Understanding and Adaptation” to:

• Analyze the possible impact that the new healthcare reform legislation could have on your company’s future growth potential
• Assess the role pharmaceutical companies need to play to best ensure that all potential benefits are actually realized
• Learn the pitfalls for the pharmaceutical industry to avoid as the new legislation is rolled-out
• Identify the opportunities for growth in the new reform environment
• Understand the ways the new healthcare reform bill can help change how healthcare is delivered in the United States

For more information about this report, please go to: http://www.cbrpharmainsights.com/inner/StrategicVisionProducts/CBRSV014pg.html

About CBR Pharma Insights - CBR Pharma Insights is a strategic market research firm whose mission is to empower companies to make the best business decisions possible through providing them with quality, innovative market research solutions. www.cbrpharmainsights.com

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For the original version on PRWeb visit: http://www.prweb.com/releases/2010/07HealthcareReform/prweb4211594.htm

Hanover Park, IL(PRWEB) June 24, 2010 — ERISAclaim.com announced the nation’s first New Health Reform Law Appeal Process Certification class, PPACA Appeal Certification (PAC), for hospitals in order to meet the compliance deadline for Sept. 23, 2010, as required by new Federal Health Reform Law, Patient Protection And Affordable Care Act, PPACA, signed into law by President Obama on March 23, 2010, as the most significant healthcare law changes in the past 45 years since Medicare was created. Since HHS, DOL and IRS released the first set of Interim Final Rules on June 17, 2010 for implementing PPACA by Sept. 23, 2010, Federal government has practically initiated enforcement historical clock envisioned by President Obama. About 5,815 Hospitals without PPACA compliance by Sept. 23, 2010 will be found in violation of PPACA with unexpected claim denials by health plans under PPACA.

ERISAclaim.com’s PPACA Appeal Certification (PAC) Class for Hospitals is an 8-day in 4 sessions, face to face on-site class, with 30-day off-site online support, with complete and comprehensive training on PPACA mandated ERISA Internal Appeal Process and NAIC Model External Appeal Process under PPACA SEC. 2719. Price starts with $50,000 for a group of 5 PPACA Claim Specialists. The PAC training class is on-site and in-house without any travel expenses or hassles for the hospital staff.

PPACA Appeal Certification (PAC) Class is also available to all other healthcare and TPA professions.

According to Dr. Jin Zhou, President of ERISAclaim.com, his company has been teaching weekly and monthly webinars on PPACA ever since PPACA was enacted on March 23, 2010, attended by professionals from every segment of the industry with great success. There have been strong awareness and demand by hospitals for PPACA compliance by Sept 23, 2010, especially when hospitals are faced with new Medicare fee cut and increasingly disappointing reimbursement by managed care payers.

“Compliance with PPACA by hospitals will be the most important investment with reward for mandate compliance, as PPACA Appeal Process will control more than 50% of hospital reimbursement or income for most hospitals in addition to Medicare reimbursement”, said Dr. Jin Zhou, the nation’s top ERISA and Reimbursement expert.

Dr. Jin Zhou also alerted hospital reimbursement professionals and executives that Federal Government, DOL, HHS and IRS have issued new sets of regulations to implement and enforce PPACA, and PPACA federally mandates ERISA appeal process for all group health plans and healthcare providers. More new Federal Regulations are released at DOL and HHS web sites:

“Affordable Care Act Regulations and Guidance” http://www.dol.gov/ebsa/healthreform/

As Dr. Zhou noted from DOL, HHS & IRS PPACA Fact Sheet, The New PPACA on Sept. 23, 2010 will cover about 133 million people under self-insured health plans, 43 million under fully insured plans, and 17 million under individual market. A total of 193 million people will be governed under PPACA on Sept. 23, 2010, and an estimated 32 million more will be covered under PPACA by 2014. No hospital can afford to ignore 193 million people’s healthcare coverage and possible reimbursement, said Dr. Jin Zhou.

DOL Fact Sheet: Keeping the Health Plan You Have: The Affordable Care Act and “Grandfathered” Health Plans (U.S. Department of Labor), June 14, 2010

http://www.healthreform.gov/newsroom/keeping_the_health_plan_you_have.html

HHS Fact Sheet: The Affordable Care Act’s New Patient’s Bill of Rights (U.S. Department of Health & Human Services), June 22, 2010

http://www.healthreform.gov/newsroom/new_patients_bill_of_rights.html

Dr. Zhou further explained that PPACA has adopted ERISA claim regulation, in its entirety, the 35 year old ERISA law and the “established process”, for PPACA internal appeal process, and NAIC Review Model as External Appeal Process that is binding for all health plans.

In the past 10 years in USA, ERISAclaim.com has been the only ERISA Specialized Company offering the most practical and comprehensive ERISA education, consulting and publishing services for healthcare providers in administrative ERISA appeals for real problem oriented denials under the most mysterious 35-year-old federal law, ERISA. Dr. Jin Zhou, the President of ERISAclaim.com has been referred to as “the Godfather of ERISA Claims” for providers in the healthcare industry.

ERISAclaim.com is dedicated to helping hospitals with compliant PPACA and ERISA appeals to get paid legally, for what the working class Americans and their families are legally entitled to under federal law ERISA and health plan provisions, to eliminate billions of dollars in uncompensated care costs for hospitals and prevent working American family from bankruptcies as a result of unpaid medical bills, and to minimize revenue cycle outsourcing dilemmas for hospitals already in financial respiratory failures.

For more information, please visit http://www.erisaclaim.com/Appeal_Department.htm, or contact Dr. Jin Zhou, president of ERISAclaim.com, at 630-808-7237.

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For the original version on PRWeb visit: http://www.prweb.com/releases/2010/06/prweb4180634.htm