Showing posts with label Program. Show all posts
Showing posts with label Program. Show all posts

Friday, 16 August 2013

WellPoint rolls out program with cost ceilings for procedures

Indiana employers, desperate to curb the cost of their workers’ health benefits, are taking a new look at an old idea.

Indianapolis-based WellPoint Inc. rolled out an initiative in late June called reference-based benefits. The program helps employers establish a maximum fee they will pay for certain tests and procedures. If workers go to health care providers charging more than that price, the employees have to pay the difference.

WellPoint has partnered with San Francisco-based Castlight Health, which provides an easy-to-use software program to provide a company’s workers with price and quality information for health care providers.

Reliable price and quality information has never really been available before. But Castlight’s tool, which has already been adopted by more than a dozen of Indiana’s largest employers, gives the reference-pricing idea a better chance of working now.

“Who’s interested? The answer is, everybody,” said Dave Kelleher, executive director of the Employers Forum of Indiana, a consortium of large employers, hospitals and health insurers.

He added, however, that the large employers he’s talked with are being cautious and aren’t likely to sign up this year.

WellPoint is touting that reference pricing saved the California Public Employees Retirement System 19 percent on joint-replacement surgeries in a one-year trial. It thinks it can achieve similar savings for employers in the 14 states in which it operates Blue Cross and Blue Shield plans, including Indiana.

“Reference-based benefit designs allow employers to preserve a large network and high-quality care options for their employees while also enabling the employer to achieve significant savings on benefit costs,” Rob Hillman, president of WellPoint’s Indiana subsidiary, Anthem Blue Cross and Blue Shield, wrote in an email.

He noted that Castlight’s software tool has “shined a light” on health care prices that can vary wildly within the same city—and even within one insurer’s network.

“This wide variation is a growing source of frustration among employers,” Hillman wrote. “All of these factors combine to make reference-based benefits attractive to employers right now.”

WellPoint has also been pushing to get lower costs from hospital systems by forming networks that exclude some of them. But such “narrow network” health plans will be a tough sell with employers, because they fear the restriction of choice would spark a worker backlash.

Reference pricing may be a way to achieve lower prices without restricting workers’ choices—provided that employers communicate the idea effectively to employees before they get surprised by a huge bill because they went to a higher-cost provider.

The reference pricing concept has been used by several state-run health plans in Europe for 20 years. It has also been used by some American health insurers to hold down costs on prescription drugs.

Going even further back, reference pricing is similar to the “scheduled benefits” that were central to health insurance plans from the 1950s to the 1970s.

Such plans gave their members a list of the amounts the insurer would pay for various procedures. Any charges from doctors and hospitals that exceeded that amount had to be borne by the patient.

The system worked then, because hospitals and doctors could quote prices fairly easily. But now, after the federal Medicare program and private health insurers have erected an indecipherable system of ICD-9, CPT and DRG codes between providers and patients, getting price information is nearly impossible.

Castlight Health saw potential to revive the reference-pricing idea after the success achieved with reference pricing by California-based grocer Safeway. Then Castlight conducted market research that showed a huge number of employers were considering trying the same thing.

Castlight is now talking to as many as 50 employers about implementing reference pricing, including some in Indiana, said Peter Isaacson, the company’s chief marketing officer. He said employers can do reference pricing on more than 900 types of medical services, but most focus initially on lab tests and imaging scans.

“We think it’s going to become increasingly common over the next few years. Because it’s an obvious way to continue to drive savings,” Isaacson said.

Sheri Alexander, director of employee benefits at Indianapolis-based insurance brokerage Gregory & Appel, thinks WellPoint and Castlight will attract some reference-pricing customers in time to launch in 2014. The first prospects may be midsize employers that have already signed up for Castlight’s pricing software.

“In concept, when I’ve discussed reference-based benefits with employers, they are very intrigued provided employees have the tools to evaluate prices.”

Larger employers are more likely to wait until 2015, she said.

Denny Darrow, deputy director of personnel for the state of Indiana, which rolled out Castlight’s service on June 1, said the state intends to get its employees using the service first, before taking a serious look at reference pricing.

“We are always looking at options to spend health care dollars in the most meaningful way, and referenced-based benefits certainly show a lot of promise,” he wrote in an email.


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Saturday, 27 July 2013

SIBS Program teaches brothers and sisters how to build positive relationships

Main Category: Pediatrics / Children's Health
Also Included In: Psychology / Psychiatry
Article Date: 26 Jul 2013 - 1:00 PDT Current ratings for:
SIBS Program teaches brothers and sisters how to build positive relationships
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Little is known about how sibling relationships impact child and family functioning, but Penn State researchers are beginning to shed light on intervention strategies that can cultivate healthy and supportive sibling relationships.

Parents frequently rank their children's sibling rivalry and conflict as the number one problem they face in family life.

"In some other cultures, the roles of older and younger, male and female siblings are better defined, and in those more-structured family relationships, there is not much room for bullying and disrespect," said Mark Feinberg, research professor in the Prevention Research Center for the Promotion of Human Development. "In the United States, and Western culture more generally, there are few guidelines for parents about how to reduce sibling conflict and enhance bonding and solidarity among siblings.

"This is an important issue not only because siblings share a lifetime-long relationship, but also because sibling relations appear to be as important as parenting and peer relations for many aspects of a child's development and well-being."

The SIBlings are Special (SIBS) Program, started by Feinberg and Susan McHale, professor of human development and family studies, addresses relationships between brothers and sisters, which are critical for learning the life skills that can strengthen a child's development.

Results from a randomized trial across 16 elementary schools in Pennsylvania demonstrated that the program shows promise in promoting healthy sibling relationships, improving family life and enhancing children's social, emotional and academic development. The researchers published their findings in the current issue of the Journal of Adolescent Health.

"What we have learned from testing the SIBS program is laying the groundwork for evidence-based programs designed to prevent sibling problems, as well as to foster mutually beneficial relationships," Feinberg said. SIBS consists of 12 after-school sessions for elementary-aged sibling pairs, as well as monthly family nights. The program focuses on ways siblings can share responsibilities and practice making decisions together. Session topics include negotiating win-win solutions to conflict, setting goals together, finding mutually enjoyable activities and understanding each other's feelings. During the program's three family nights, children show parents what they have learned, and parents learn productive strategies for handling sibling relations - which typically have been ignored by most parenting programs.

"Sibling relationships are the only life-long relationships in most people's lives," Feinberg said. "This makes it especially important that sisters and brothers learn at a young age how to work as a team and support each other."

Researchers observed the sessions and administered questionnaires to both the parents and children. Siblings who entered the study were randomly assigned to receive the afterschool SIBS program or to a control condition. Parents of siblings in both the intervention and the control conditions received a popular book about sibling relationships.

Siblings exposed to the intervention demonstrated more positive interactions, increased self-control and demonstrated greater social competence and academic performance. They also experienced decreases in the impact of internalizing problems, such as depression, shyness and worry.

Researchers found that SIBS also enhanced child-mother relationships. Mothers involved in the SIBS program demonstrated increased use of appropriate sibling parenting strategies, such as helping resolve conflicts peacefully and encouraging siblings to work problems out by themselves. These mothers also reported lower levels of depression symptoms after the program was completed compared to mothers in the control condition.

"Overall, the results of the SIBS intervention are promising," said McHale. " Brothers and sisters got along better, learned from each other and liked being around each other more. As individuals, siblings in the study were better off emotionally and academically.

Mothers also accrued benefits, with many reporting being happier about their personal and family life." The National Institute on Drug Abuse, as a part of the National Institutes of Health's American Recovery and Reinvestment Act, funded SIBS, which is a part of the Prevention Research Center at Penn State.

"Everyone has personal stories about their siblings," said Feinberg. "Some are good and some are not so good. So it's obviously an important area to study. This program is playing a large role in identifying how to derive the best and longest-lasting benefits from healthy and enjoyable brother and sister relationships."

Article adapted by Medical News Today from original press release. Click 'references' tab above for source.
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Sunday, 14 July 2013

Physicians for a National Health Program Millions of Chronically Ill Lacking Insurance Cant Get Needed Care

Physicians for a National Health Program : Millions of Chronically Ill, Lacking Insurance, Can't Get Needed Care | Big News Network $(document).ready(function(){$("#twitterBox").nTwitter({userName: "bignewsnetwork",tick: false,tickDelay: 3,prefix: 'nedeco',heading: "nTwitter", numTweets:3,lang: {reply:'reply', retweet:'retweet', favorite:'fav', noData:'This User does not have any Tweets',less_than_a_minute_ago:'less than a minute ago',a_minute_ago:'about a minute ago',X_minutes_ago:'%%X%% minutes ago',a_hour_ago:'1 hour ago',X_hours_ago:'%%X%% hours ago',a_day_ago:'yesterday',X_days_ago:'%%X%% days ago'} });$("#featured").tabs({fx:{opacity: "toggle"}}).tabs("rotate", 5000, true);$("#featured").hover(function() {$("#featured").tabs("rotate",0,true);},function() {$("#featured").tabs("rotate",5000,true);});}); (function(d, s, id) { var js, fjs = d.getElementsByTagName(s)[0]; if (d.getElementById(id)) return; js = d.createElement(s); js.id = id; js.src = "//connect.facebook.net/en_US/all.js#xfbml=1"; fjs.parentNode.insertBefore(js, fjs);}(document, 'script', 'facebook-jssdk'));

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Millions of Chronically Ill, Lacking Insurance, Can't Get Needed Care CHICAGO - August 4 - Over 11 million Americans with chronic physical illnesses like heart disease, diabetes and asthma are not getting the medical care they need because they don

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