RxPG News : Medicare

Fitness club memberships help insurance plans to enrol healthier patients

Thu, 12 Jan 2012 02:15:42 PST

( from http://www.rxpgnews.com ) Because healthy enrollees cost them less, Medicare Advantage plans would profit from selecting seniors based on their health, but Medicare strictly forbids practices such as denying coverage based on existing conditions. Another way to build a more profitable membership is to design insurance benefits that attract the healthiest patients. In a study published in the Jan. 12, 2012, edition of the New England Journal of Medicine, Brown University researchers report that plans have managed to do just that by offering fitness club memberships as a covered benefit.

"Offering a fitness membership does not mean that you are denying people coverage, but you are changing your benefits to appeal selectively to people who are healthy," said co-author Amal Trivedi, a Brown public health professor and a physician at the Providence VA Medical Center. "Policymakers intended for Medicare Advantage plans to compete on the basis of improving quality and reducing costs, rather than on their ability to attract healthier patients. What we found in the study is that offering coverage for fitness membership is a very effective strategy to attract a much healthier population."

That conclusion comes from Trivedi's and lead author Alicia Cooper's rigorous statistical comparisons among thousands of patients in 22 Medicare Advantage plans — 11 "case" plans that added fitness club memberships in 2004 or 2005 and 11 similar "control" plans that didn't. They looked at when each plan member enrolled, when plans started offering the benefit, and what each plan member said about his or her health in the Medicare Health Outcomes Survey from 2006 to 2008.

One analysis compared the self-reported health of seniors who enrolled in case plans before the fitness club benefit was offered to the health of those who enrolled after the benefit was offered. While 29.1 percent of the seniors who enrolled before the benefit was available described themselves to be in excellent or very good health, 35.1 percent of the seniors who enrolled after it became available reported that level of health. In the before group, 56.1 percent reported some limitation to their physical activity but only 45.7 percent in the after group did. Also, a third of the before group reported difficulty walking compared to just a quarter in the after group.

Once the Medicare Advantage plans started covering health club memberships, they enrolled healthier enrollees with fewer physical limitations. In the control plans, which did not offer the benefit, self-reported health levels over the same timeframe changed only slightly. In comparison to the control plans, eight of the 11 case plans (the ones that added fitness club coverage) enrolled seniors with better overall health, 10 of the 11 case plans enrolled seniors with fewer restrictions in physical activity, and nine of the 11 case plans enrolled seniors that had less difficulty walking.

An increasing practice

Trivedi and Cooper studied the benefit structures of 101 Medicare Advantage health plans between 2002 and 2008 to select plans for comparison. What they found is a rapid growth in the number of plans offering fitness club memberships, from 14 in 2002 to 58 in 2008.

"This trend suggests that offering fitness memberships may be an attractive business strategy for Medicare plans," Trivedi said.

Trivedi acknowledged that if every plan offered the fitness benefits, it would no longer be an effective way of selecting for the healthiest members. However, given the continued incentive to enroll more profitable enrollees, he said, insurers may employ other related tactics to cherry-pick desirable enrollees.

"In general, policymakers have regulated the Medicare Advantage insurance market to prevent the ability of private plans to select the healthiest enrollees," Trivedi said. "If Medicare plans do engage in favorable selection, then unhealthy enrollees can be concentrated in a small number of plans or in the traditional Medicare program, driving up the costs for those enrollees and the tax-payers that fund the Medicare program."

Medicare patients have higher risk of death after bariatric surgery

Wed, 19 Oct 2005 20:09:00 PST

( from http://www.rxpgnews.com ) Medicare patients have a substantially higher risk of early death following bariatric surgery than previously suggested, and the risk of death is higher among men, older patients, and patients of surgeons who perform lower numbers of bariatric procedures, according to a study in the October 19 issue of JAMA.

In the United States, most adults are overweight or obese, and obesity is soon to become the leading cause of death, according to background information in the article. Bariatric surgical procedures (surgery on the stomach and/or intestines designed to promote weight loss) are the only interventions that consistently help patients achieve significant and sustained weight loss and improvements with co-existing medical conditions. As a result, there has been dramatic growth in bariatric surgery over the last decade. Balanced against these beneficial effects, however, are the risks of perioperative death and short-term adverse outcomes, which have been poorly defined in the community at large.

David R. Flum, M.D., M.P.H., of the University of Washington, Seattle, and colleagues conducted a study to determine the risk of all-cause early postsurgical death among Medicare beneficiaries undergoing open bariatric surgery. The study examined early (30-day, 90-day, and 1-year) death figures for all U.S. fee-for-service Medicare beneficiaries who underwent bariatric procedures from 1997-2002.

A total of 16,155 patients underwent bariatric surgical procedures (average age, 48 years; 75.8 percent women, with 90.6 percent younger than 65 years). A total of 61.2 percent of cases were claims for the bariatric surgical procedure Roux-en-y gastroenterostomy (RYGB) and 19.9 percent were for RYGB with small intestine reconstruction to limit absorption. There was more than a 3-fold increase in the number of procedures performed from 1997 (n=1,464) to 2002 (n=4,814).

The researchers found that among all patients, the rates of 30-day, 90-day, and 1-year death were 2.0 percent, 2.8 percent, and 4.6 percent, respectively. Advancing age and male sex were associated with early death after bariatric surgery, with the highest rates of early death among older men. Overall, men were more likely to die after bariatric surgery than women (3.7 percent vs. 1.5 percent, 4.8 percent vs. 2.1 percent, and 7.5 percent vs. 3.7 percent for men and women at 30 days, 90 days, and 1 year, respectively). Death rates were greater for those aged 65 years or older (n=1,517) compared with younger patients (4.8 percent vs. 1.7 percent, 6.9 percent vs. 2.3 percent, and 11.1 percent vs. 3.9 percent at 30 days, 90 days, and 1 year, respectively).

After adjustment for sex and co-existing illness index, the odds of death within 90 days were 5-fold greater for older Medicare beneficiaries (aged 75 years or older; n=136) than for those aged 65 to 74 years (n=1,381). The odds of death at 90 days were 1.6 times higher for patients of surgeons with less than the median surgical volume of bariatric procedures (among Medicare beneficiaries during the study period) after adjusting for age, sex, and co-existing illness index.

"There may be several reasons for these findings. Older patients do not tolerate surgical stress as well as younger patients and may also have less benefit after surgery than younger patients because much of the impact of obesity on organ systems, such as the heart, may have occurred by the time of the operation. It also remains to be seen if surgical weight loss in older patients decreases utilization of health care resources, improves functional status and quality of life, or extends survival as has been suggested in studies of younger patients," the authors write.

"In conclusion, this study found that the risk of early postsurgical death among Medicare beneficiaries undergoing bariatric surgery was considerably higher than prior case series have suggested and was strongly associated with advancing age, male sex, and lower surgeon volume. Those considering the role of bariatric procedures in older patients should balance this population-level risk of adverse outcomes against the anticipated benefits of the procedure. Directing care of older patients to surgeons who perform higher volume of bariatric procedures in Medicare beneficiaries might be expected to improve outcomes in this high-risk population," the researchers write.

Aetna Introduces Medicare Advantage Plans in Bexar County

Fri, 09 Sep 2005 17:32:00 PST

( from http://www.rxpgnews.com ) Aetna (NYSE: ΑET) announced today that it is offering new health care coverage options for Medicare beneficiaries in Bexar County, Texas. Aetna is offering Medicare Advantage plans that provide beneficiaries with additional choices, flexibility and value.

Plans currently being marketed include the Aetna Golden Medicare Plan® (HMO) and Aetna Golden Choice Plan.

"Aetna is continuing to expand its participation in the Medicare Advantage program in 2005," said Frank G. McCauley, head of Aetnas Retiree Markets. "We are committed to offering a broad portfolio of health benefits solutions for retirees, and we are pleased to have the opportunity to expand our coverage into Texas." Aetna expects to more than double the number of states in which it plans to offer its Medicare Advantage plans, from 5 today to 13 by 2006, pending federal approval.

The Aetna Golden Medicare Plan (HMO) in Bexar County features:

* No additional plan premium.
* Prescription drug coverage.
* No copayments for preventive services. Members can obtain routine physicals and other preventive care services, including cancer screenings, without copayments.

The Aetna Golden Choice Plan (PPO) provides beneficiaries with greater flexibility, enabling them to go to doctors, specialists and hospitals in or out of network. Referrals are not needed for in-network services.

"Aetna is very pleased to be able to offer Medicare Advantage plans to beneficiaries living in Bexar County," said Gary Culp, head of Aetnas Medicare business in Aetnas Southwest Region. "Our Medicare Advantage plans offer choices that do not exist with original Medicare, including prescription drug coverage and full coverage of preventive health care services."

In addition, Aetna has filed applications with the Centers for Medicare & Medicaid Services (CMS) to offer the new Medicare Part D prescription drug plan (PDP) to individuals and employers on a national basis, except the territories, in 2006. Application and bid filings for each PDP region are subject to CMS approval with contracts to be awarded in September.

Aetna Introduces Medicare Advantage Plan in Fresno County

Fri, 09 Sep 2005 17:32:00 PST

( from http://www.rxpgnews.com ) Aetna (NYSE: ΑET) announced today that it is offering new health care coverage options for Medicare beneficiaries in Fresno County, Calif. Aetna is selling Medicare Advantage plans that provide both medical and prescription drug benefits, including preventive care services with no copayment, broadening the Medicare Advantage plan options for beneficiaries.

The Aetna Golden Medicare Plan (HMO) options available in Fresno County include:

* Unlimited coverage of generic drugs.
* No copayments for preventive services. Members can obtain routine physicals and other preventive care services including cancer screenings without copayments.
* Full coverage of health education and disease management services. Services available to beneficiaries at no additional charge include health education classes, nutritional training, smoking cessation, and disease management programs including a congestive heart failure program.
* Optional supplemental prescription drug coverage. Beneficiaries have the option to purchase coverage for Formulary Preferred Brand and Non-formulary Brand drugs for an additional monthly premium.
* Optional supplemental dental benefits. For an additional monthly premium, beneficiaries have a choice of two dental plans, one that covers preventive services and one that provides more comprehensive coverage.
* Instant access to health information 24 hours a day through toll-free phone and online resources.

"Aetna is very excited to be able to offer Medicare Advantage plans to beneficiaries living in Fresno County," said Gary Culp, head of Aetnas Medicare business in Aetnas West region. "Our Medicare plans offer choices that do not exist with traditional Medicare, including prescription drug coverage and full coverage of preventive health care services."

Aetna currently offers the Aetna Golden Medicare Plan in five California counties: Kern, Los Angeles, Orange, Riverside and San Bernardino.

In addition, Aetna has filed applications with the Centers for Medicare & Medicaid Services (CMS) to offer the new Medicare Part D prescription drug plan (PDP) to individuals and employers on a national basis, except the territories, in 2006. Application and bid filings for each PDP region are subject to CMS approval with contracts to be awarded in September.

Aetna Introduces Medicare Advantage Plans in Arizona

Fri, 09 Sep 2005 17:32:00 PST

( from http://www.rxpgnews.com ) Medicare beneficiaries in Arizona now have new options from Aetna (NYSE: ΑET) for health care coverage that provides them with additional choices, flexibility and value. Aetna has introduced individual Medicare Advantage plan options, including the Aetna Golden Medicare Plan® (HMO) and Golden Choice Plan (PPO), in Maricopa County and parts of Pinal County.

The announcement of these new plans marks Aetnas return to Arizonas Medicare Advantage market. Aetna currently offers three Medicare supplement insurance policies under the Aetna Individual Medicare Supplement PlanSM in Arizona.

"Aetna is continuing to expand its participation in the Medicare Advantage program in 2005," said Frank G. McCauley, head of Aetnas Retiree Markets. "We are committed to offering a broad portfolio of health benefits solutions for retirees, and we are pleased to have the opportunity to expand our coverage into Arizona." Aetna expects to more than double the number of states in which it plans to offer its Medicare Advantage plans, from 5 today to 13 by 2006, pending federal approval.

"Aetna is very pleased to be able once again to offer Medicare Advantage plans to beneficiaries living in Arizona," said Gary Culp, head of Aetnas Medicare business in the West Region. "The addition of the Medicare Advantage plans broadens Aetnas portfolio of health benefits products available to Medicare eligible beneficiaries in Arizona, providing them with additional choices and price options."

The Aetna Golden Medicare Plan (HMO) plan in Maricopa County features:

* No additional plan premium.
* Unlimited coverage of generic drugs.
* Optional supplemental brand-name prescription drug coverage. Beneficiaries have the option to increase their coverage for standard (formulary) brand-name drugs and nonformulary brand prescription drugs for an additional monthly premium.
* Optional supplemental dental benefits. For an additional monthly premium, beneficiaries have a choice of two dental plans, one that covers preventive services and one that provides more comprehensive coverage.

The Aetna Golden Medicare Plan in Pinal County features:

* No copayments for preventive services. Members can obtain routine physicals and other preventive care services including cancer screenings without copayments.
* Optional prescription drug coverage.

The Aetna Golden Choice Plan (PPO) in both Maricopa and Pinal counties provides beneficiaries with greater flexibility, enabling them to go to doctors, specialists and hospitals in or out of network. Referrals are not needed for in-network services.

In addition, Aetna has filed applications with the Centers for Medicare & Medicaid Services (CMS) to offer the new Medicare Part D prescription drug plan (PDP) to individuals and employers on a national basis, except the territories, in 2006. Application and bid filings for each PDP region are subject to CMS approval with contracts to be awarded in September.

Quality of care may vary in association with the characteristics of individual physicians

Fri, 29 Jul 2005 04:47:00 PST

( from http://www.rxpgnews.com ) Certain physician characteristics and practice-setting characteristics are associated with Medicare beneficiaries receiving routine preventive services below the national goals, according to a study in the July 27 issue of JAMA.

An emerging body of literature suggests that quality of care may vary in association with the characteristics of individual physicians and their practices, according to background information in the article.

Hoangmai H. Pham, M.D., M.P.H., of the Center for Studying Health System Change, Washington, D.C., and colleagues examined the relationship between attributes of physicians and their practices and the extent to which their Medicare patients received preventive services. The researchers analyzed data from 3,660 U.S. physician respondents to the 2000-2001 Community Tracking Study Physician Survey linked to claims data on 24,581 Medicare beneficiaries 65 years and older who were treated in 2001. Physician variables included training and qualifications and sex. Practice setting variables included practice type, size, sources of revenue, and access to information technology. Analyses were adjusted for patient demographics and multiple diseases, as well as community characteristics.

The researchers determined the proportion of eligible beneficiaries who received each of 6 preventive services: diabetic monitoring with hemoglobin A1c measurement, eye examinations, screening for colon or breast cancer, and vaccination for influenza or pneumococcus.

The researchers found that overall, the proportion of beneficiaries receiving services was below national goals. Physician and, more consistently, practice-level characteristics were both associated with differences in the delivery of services. The strongest associations were with practice type and the percentage of practice revenue derived from Medicaid. For instance, beneficiaries receiving usual care in practices with less than 6 percent of revenue from Medicaid were more likely than those with more than 15 percent of revenue derived from Medicaid to receive diabetic eye examinations (48.9 percent vs. 43 percent), hemoglobin A1c monitoring (61.2 percent vs. 48.4), mammograms (52.1 percent vs. 38.9 percent), colon cancer screening (10.0 percent vs. 8.5 percent), and influenza (50.2 percent vs. 39.2 percent) and pneumococcal (8.2 percent vs. 6.4 percent) vaccinations.

Other variables associated with delivery of preventive services after adjustment for patient and geographic factors included obtaining usual health care from a physician who worked in group practices of 3 or more, who was a graduate of a U.S. or Canadian medical school, or who reported availability of information technology to generate preventive care reminders or access treatment guidelines.

"We found that this shortfall is neither uniform for all beneficiaries nor explained entirely by characteristics of the beneficiaries such as their race or income level. Rather, it appears that some beneficiaries are treated in practice settings or by physicians who deliver preventive services at particularly low rates. Our results suggest that these variations in quality are substantial and seem to be greatly influenced by the structure and revenue sources of physician practices. If we can understand the mechanisms underlying these relationships, it would be much easier to identify the key leverage points for quality improvement," the authors conclude.