Hail, Not Frail! MA's Wellness Reach Expands.

There was a time when insurers were accused (often rightly) of using wellness to lure healthier beneficiaries into MA. Now, the issue is whether wellness can help health plans manage medical spending. "To the degree they do minimize medical spending, the beneficiaries will presumptively be better off healthwise," says Joseph Newhouse of Harvard.

Thanks to CMS Rule Change, MA Takes SDOH to a Whole New Level.

CMS and insurers talked about what needed to be done to better address the social determinants of health (SDOH) for beneficiaries. That led to a policy, implemented last year by CMS, that allows for the provision of daily maintenance care using nonskilled in-home providers, the kind of services usually given in assisted-living facilities.

A Conversation with Jennifer Graff, National Pharmaceutical Council VP. Real-World Evidence Might Take a Decade to be Fully Established.

"The private sector will play an important role in the 10-year time frame. Patients are downloading their data from patient portals and sharing their information between their specialists. Provider groups and clinical societies will become more adept at using data to inform care pathways."

Ah, Look at All the Lonely People (And Resultant Health Problems Thereof).

Robin Caruso, the chief togetherness officer at CareMore, knows that acute loneliness results in poor outcomes, increasing the risk of someone's mortality by 45%. Her team engages in "organic" conversations with CareMore's elderly beneficiaries to make them more engaged in their care, more socially connected, and more likely to exercise.

The App as a Remedy for Health Care's Inbetweenies.

Harvard Pilgrim Health Plan offers some beneficiaries an app that allows them to stay in contact with the health plan's nurse practitioners. It seems tailored-made for patients with chronic conditions, but it can be applied to almost everything a person might need to go to the hospital for.

Opioid Deaths Among Women Not Getting the Attention They Warrant.

Deaths of women from opioid addiction spiked 400%, according to CDC data. Alison Colbert of Duquesne University argues for a gender-specific approach.

Karl Brown's Hardscrabble Roots Prepared Him for His Medicaid Mission.

The CMO of Molina Healthcare of Utah grew up, let's say, not rich. He says that and a varied background-including a stint in the Air Force-helps him deal with changing policies involving a challenging population.

Harvard Pilgrim's Patrick Cahill Tries To Make Sense of It All.

The 40-year-old vice president of regional markets for eastern Massachusetts wants enrollees and, especially, employers to know that there will continue to be a lot of public policy change as the ACA evolves. His course? Keep strengthening ties with providers.

Optum's Lisa Tseng Keep Entrepreneurial Ball Rolling.

The 37-year-old has a title: executive vice president of Optum. But she wears many hats, including running a division that sells affordable hearing aids.

HIV/AIDS treatment drastically reduces mortality and helps limit transmission.

Death rates from HIV/AIDS plummeted in the United States from 41,699 in 1995 to 6,456 in 2015. Today, people newly diagnosed with HIV who take their medicine can survive for decades, not just months or years. It's one of medicine's great achievements.

Why the new opioid bill won't really change the way insurers approach the epidemic.

Not that plans won't be taking a close look at some innovative approaches such as addiction recovery medical homes. One model includes bundled payments and performance bonuses, nationally recognized quality metrics, and the placement of treatment and recovery providers close to where patients with substance use disorder live.

Cigna's Eva Borden Champions 'The Stepchild': Behavioral Health.

The insurer's general manager of behavioral and EAP services wants to make mental health care more mainstream. Only 17% of American adults function with optimal mental health. "We talk about it as if it's them over there, but 83% of us have a need."

Theresa Blanco Often Manages Beyond Molina's Benefits Package.

For instance, say something a patient needs is not covered by Medicaid or an ACA plan. Blanco helps members find what they need by working with Molina's Community Connectors (community health workers) who help connect members to local community and not-for-profit organizations.

Anthem's Geoffrey B. Crawford Wants To Fix Wellness Programs.

The 35-year-old medical director of the plan's office of medical policy and technology assessment has broad interests, but he's particularly keen on wellness because it "ties into the evidentiary component of my position-evaluating the scientific literature to support evidence-based medicine." His take: Rely less on active patient participation.

Possible Employee Wariness Stifles Telehealth's Acceptance.

A lot hinges on this question: Do you feel comfortable getting a diagnosis or being treated for a condition by someone on a screen?

Integrated Plans Fertile For Real-world Evidence.

But most insurers are taking a wait-and-see attitude even though in some clinical areas, such as diabetes, real-world evidence (RWE) has been a true game-changer. Payers have a pessimistic view that RWE can help them. It doesn't help that respected voices in health care agree.