Aetna and Landmark Health working together to bring in-home health services to Medicare Advantage members in New York
Collaboration addresses the ongoing health needs of Aetna Medicare Advantage members with chronic conditions
NEW YORK CITY, NY — Aetna®, a CVS Health® company (NYSE: CVS), and Landmark Health and its affiliated medical groups (Landmark) announced today a new relationship to bring physician-led services into the homes of Aetna Medicare Advantage members living in New York with chronic health conditions. Service areas will be focused in the New York City boroughs and Long Island and further extend to Albany, Rochester, and Buffalo.
Members who are eligible for the program will receive access to health services in their homes. Examples of the types of care they can get are acute and urgent services such as wound care, lab draws, catheter maintenance and adherence to medication therapies, as well as medication management, home safety checks, and health screenings. The personalized services also include member access to 24/7 availability from a dedicated Landmark health care provider. Ongoing nutrition, medication therapy, emotional and mental health support will help ensure members receive a comprehensive continuum of care. As part of that care, in-home providers will also share data with members’ primary care physicians.
"This new approach identifies members with multiple chronic conditions and provides stronger in-home physician support in addition to their current primary care physician relationship,” said Lauren Casalveri, Aetna vice president and chief Medicare officer in New York. “This collaboration allows members to remain safely in their homes and provides optimal treatment for their conditions.”
"Landmark saw our first patient seven years ago in upstate New York,” said Michael Le, MD, Landmark co-founder and chief medical officer. “It’s tremendous to see that, with the Aetna relationship, nearly 40,000 New Yorkers who need advanced in-home geriatric care have access to it."
The alliance reflects one of the key goals of value-based care, which is to drive better health outcomes at lower costs. Landmark has seen widespread demand for its home-based primary care services across the Medicare population. Since inception in 2014, Landmark Health has grown to 48 cities in 15 states. And it’s accountable for over 114,000 patients with chronic conditions.
"Access to care, especially for the aging population, is a critical need which has been amplified by the COVID-19 pandemic," said Casalveri. "These expanded services connect chronically ill members with enhanced solutions specific to their health needs."
Aetna, a CVS Health business, serves an estimated 34 million people with information and resources to help them make better informed decisions about their health care. Aetna offers a broad range of traditional, voluntary and consumer-directed health insurance products and related services, including medical, pharmacy, dental and behavioral health plans, and medical management capabilities, Medicaid health care management services, workers' compensation administrative services and health information technology products and services. Aetna's customers include employer groups, individuals, college students, part-time and hourly workers, health plans, health care providers, governmental units, government-sponsored plans, labor groups and expatriates. For more information, visit www.aetna.com and explore how Aetna is helping to build a healthier world.
Aetna Medicare is a HMO, PPO plan with a Medicare contract. Our SNPs also have contracts with State Medicaid programs. Enrollment in our plans depends on contract renewal. Plan features and availability may vary by service area. Participating physicians, hospitals and other health care providers are independent contractors and are neither agents nor employees of Aetna. The availability of any particular provider cannot be guaranteed, and provider network composition is subject to change. The provider network may change at any time. You will receive notice when necessary. Other physicians/providers are available in our network.
About Landmark Health
Landmark Health and its affiliated medical groups (Landmark) deliver comprehensive in-home medical care to older adults, 24/7 – 365 days a year. Specialized in complex chronic care, Landmark’s physician-led multidisciplinary teams work with patients’ existing healthcare networks to bring medical, behavioral and palliative care, along with social services, to individuals where they reside. Most critically, Landmark is bending the cost curve in health care by reducing avoidable ER visits and hospital admissions, while extending lives of patients. www.landmarkhealth.org
CHARLESTON, West Virginia — Aetna Better Health of West Virginia, a CVS Health company (NYSE: CVS), today announced that the West Virginia Department of Health and Human Resources (DHHR) has awarded the company a statewide Medicaid contract through the Mountain Health Trust managed care program. The Mountain Health Trust program serves most Medicaid eligible groups, including Temporary Assistance for Needy Families (TANF), pregnant women, Children with Special Health Care Needs (CSHCN), Supplemental Security Income (SSI), the West Virginia Health Bridge Medicaid expansion population, and beginning in early 2021, the West Virginia Children's Health Insurance Program (WVCHIP).
Aetna Better Health has been committed to providing quality care to Medicaid beneficiaries in West Virginia for more than 23 years. Last November the company was awarded the sole contract for the state's new Mountain Health Promise program. Through this program, Aetna Better Health provides physical and behavioral health managed care services on a statewide basis to more than 20,000 children and youth in the foster care system and individuals receiving adoption assistance.
"Providing high-quality health care to our members is critical to our mission. As a company with a long history of caring for West Virginians, we are proud to serve Medicaid beneficiaries in all 55 counties across the state," said Todd White, CEO, Aetna Better Health of West Virginia. "We remain committed to our strong partnerships with the state, our providers, and community-based organizations to deliver on our goal of providing better health outcomes to our valued members."
Aetna Better Health of West Virginia currently serves 160,000 members across the state through the Mountain Health Trust and Mountain Health Promise managed care programs. The new Mountain Health Trust contract term begins July 1, 2020 and runs through June 30, 2021.
About Aetna Medicaid
Aetna Medicaid Administrators LLC (Aetna Medicaid), a CVS Health business, has over 30 years of experience managing the care of the most medically vulnerable, using innovative approaches and a local presence in each market to achieve both successful health care results and effective cost outcomes. Aetna Medicaid has particular expertise serving high-need Medicaid members, including those who are dually eligible for Medicaid and Medicare. Currently, Aetna Medicaid owns and/or administers Medicaid managed health care plans under the names of Aetna Better Health and other affiliate names. Together, these plans serve approximately 2.4 million people in 16 states, including Arizona, California, Florida, Illinois, Kansas, Kentucky, Louisiana, Maryland, Michigan, New Jersey, New York, Ohio, Pennsylvania, Virginia, West Virginia, and Texas. For more information, see www.aetnabetterhealth.com.
For many of us, the concept of finding family members often involves searching on a genealogy site or signing up for an at-home DNA testing kit. There is an element of fun and intrigue, inspiring individuals to better understand their family roots. For many young children and teens in foster care, however, locating family members isn’t a pastime, but a necessity for daily living. These connections will help them grow and thrive.
Recently, more than 100 child welfare professionals in Kansas participated in the Family Finding Boot Camp, led by child and family welfare expert Kevin Campbell. Aetna Better Health of Kansas, the Kansas Department of Children and Families (DCF), and Casey Family Programs sponsored the four-day event. As the founder of the Family Finding model, Campbell spoke about key methods and strategies to locate and engage relatives of children currently living in out-of-home care. The goal of Family Finding is to connect each child with a family or a “network” (blood relative or not), so that every child may benefit from the lifelong connections that a family would typically provide.
Healing Children and Families
Over the years of developing Family Finding, Campbell found that most foster children have a large extended family, and if they could connect with five to eight adults who would make a “permanent relational commitment” to the child, it could change outcomes significantly.
“The training is really about how do you heal children who have had such harm done to them? And how do you heal the whole family? Because this kind of generational experience has to stop somewhere,” said Campbell.
Kellie Hans Reid, foster care coordinator with Aetna Better Health of Kansas, affirmed, “Research shows that traumatic experiences affect children’s health, like metabolic and cardiac health. We also know that we build our lifelong health in childhood. Yet, if we start early enough, there is so much we can do to alleviate the effects of childhood trauma, prevent reoccurrences, and hopefully improve long-term health and disease outcomes.”
Expanding Safety Networks
During the boot camp, Campbell empowered attendees with information on how each of them can help extend the overall safety networks of the children they work with — meaning family, friends or acquaintances that genuinely care about the child and who can serve as a relational resource. Campbell also discussed how to facilitate a community of unconditional love and healing to combat and lower the toxic stress and loneliness these children and their families are experiencing — improving mental and physical health outcomes.
Organized into 27 teams, social welfare professionals collaborated throughout the week to apply the Family Finding model to their current cases. Based on a series of criteria, they prioritized the children who were their biggest worry. By the end of the training, participants reported locating an average of 19 contacts per child, for a total of 500 contacts across all teams combined — this was an increase of 84 percent from the beginning of the week. This number broke the American record for the average number of relatives identified in a Family Finding Boot Camp, which typically averages 14 connections per child.
Attendees expressed how the boot camp training had an immediate impact on their practice with families and their individual outlook. Sample words used to describe experiences included: hopeful, moved, excited, inspired, connected, empowered, optimistic, transformative, motivated, challenged, refreshed, and appreciative, among others.
Looking to the Future
“This work has huge implications for connection, healing, improved health outcomes and combating loneliness in Kansas and beyond, potentially reducing the reliance on foster homes and congregate care,” said Josh Boynton, a member of the Medicaid Growth team focused on complex populations strategy.
David Livingston, CEO of Aetna Better Health of Kansas, added, “This week’s Family Finding training represented preliminary efforts to empower local communities to take action and create meaningful changes in the lives of young individuals. As we look ahead to 2020 planning efforts, our goal is to continue investing both significant time and resources to improve the health and wellbeing of children and their families throughout Kansas.”
About Aetna Better Health of Kansas
Aetna Better Health of Kansas believes that members should have the opportunity to be leaders in their care. Aetna Better Health uses a model of care management that empowers members to decide what their health goals are, and then the plan works with them, their families, providers and caregivers to help them achieve their goals. The payoff to our members comes in the form of increased quality of care and quality of life. Aetna Better Health services individuals who qualify for KanCare in the State of Kansas.
For more information about CVS Health’s efforts to improve care across the nation, visit our News & Insights page and the CVS Health Impact Dashboard. To stay informed about the latest updates and innovations from CVS Health, register for content alerts and our Leaders in Care newsletter.
ST. LOUIS — Centene Corporation (NYSE: CNC) (“Centene”) and CVS Health (NYSE: CVS) announced today that, in connection with the previously announced merger agreement between Centene and WellCare Health Plans, Inc. (NYSE: WCG), Centene has entered into a definitive agreement under which CVS Health will acquire Centene’s Illinois health plan subsidiary, IlliniCare Health Plan, Inc. (“IlliniCare”). The transaction entails the sale of Centene’s Medicaid and Medicare Advantage lines of business in Illinois.
Centene will retain IlliniCare’s Medicare-Medicaid Alignment Initiative (“MMAI”) business and IlliniCare’s statewide YouthCare foster care contract, set to commence in February 2020. Centene’s Ambetter business in Illinois is not affected. The companies are committed to ensuring that there is a smooth transition for members.
“We are continuing to make progress towards completing our transaction with WellCare and the divestiture of our IlliniCare Health plan is the next step in that process,” said Michael F. Neidorff, Centene’s Chairman, President and Chief Executive Officer. “Our employees in Illinois have done an exceptional job serving our communities in the state. We are pleased to enter this agreement with CVS Health, under which these employees can continue helping members achieve better health outcomes while delivering benefits to providers. We will work closely with CVS Health to ensure a smooth transition of this business for members, employees and providers.”
“Expanding our Medicaid and Medicare Advantage presence in Illinois will allow us to serve more members with our proven holistic approach that addresses physical, behavioral and social determinants of care,” said Karen S. Lynch, Executive Vice President, CVS Health and President, Aetna. “We look forward to working with Centene on a seamless transition and developing a deeper relationship with the state and local providers.”
The closing of the transaction with CVS Health is subject to U.S. federal antitrust clearance, receipt of Illinois state regulatory approvals and other customary closing conditions, as well as the closing of the Centene – WellCare transaction.
As previously announced on March 27, 2019, Centene and WellCare agreed to combine in a transaction that will create a premier healthcare enterprise focused on government-sponsored healthcare programs and a leader in Medicaid, Medicare and the Health Insurance Marketplace. The combination has received approvals from insurance and health care departments from 26 states. Completion of the Centene – WellCare transaction remains subject to clearance under the Hart-Scott-Rodino Act, receipt of required state regulatory approvals and other customary closing conditions.
Centene and WellCare continue to expect that the Centene – WellCare transaction will be completed by the first half of 2020.
The financial terms of this transaction will not be disclosed and the impact to CVS Health earnings once closed is expected to be immaterial.
Additional information about the Centene – WellCare transaction can be found at centene-wellcare.com.
Centene Corporation, a Fortune 100 company, is a diversified, multi-national healthcare enterprise that provides a portfolio of services to government sponsored and commercial healthcare programs, focusing on under-insured and uninsured individuals. Many receive benefits provided under Medicaid, including the State Children’s Health Insurance Program (CHIP), as well as Aged, Blind or Disabled (ABD), Foster Care and Long-Term Services and Supports (LTSS), in addition to other state-sponsored programs, Medicare (including the Medicare prescription drug benefit commonly known as “Part D”), dual eligible programs and programs with the U.S. Department of Defense. Centene also provides healthcare services to groups and individuals delivered through commercial health plans. Centene operates local health plans and offers a range of health insurance solutions. It also contracts with other healthcare and commercial organizations to provide specialty services including behavioral health management, care management software, correctional healthcare services, dental benefits management, commercial programs, home-based primary care services, life and health management, vision benefits management, pharmacy benefits management, specialty pharmacy and telehealth services.
Centene uses its investor relations website to publish important information about the company, including information that may be deemed material to investors. Financial and other information about Centene is routinely posted and is accessible on Centene’s investor relations website, http://www.centene.com/investors.
About CVS Health
CVS Health is the nation’s premier health innovation company helping people on their path to better health. Whether in one of its pharmacies or through its health services and plans, CVS Health is pioneering a bold new approach to total health by making quality care more affordable, accessible, simple and seamless. CVS Health is community-based and locally focused, engaging consumers with the care they need when and where they need it. The Company has approximately 9,900 retail locations, approximately 1,100 walk-in medical clinics, a leading pharmacy benefits manager with approximately 102 million plan members, a dedicated senior pharmacy care business serving more than one million patients per year and expanding specialty pharmacy services. CVS Health also serves an estimated 38 million people through traditional, voluntary and consumer-directed health insurance products and related services, including rapidly expanding Medicare Advantage offerings and a leading standalone Medicare Part D prescription drug plan. The Company believes its innovative health care model increases access to quality care, delivers better health outcomes and lowers overall health care costs. Find more information about how CVS Health is shaping the future of health at https://www.cvshealth.com.
Cautionary Statement on Forward-Looking Statements of Centene
All statements, other than statements of current or historical fact, contained in this communication are forward-looking statements. Without limiting the foregoing, forward-looking statements often use words such as “believe,” “anticipate,” “plan,” “expect,” “estimate,” “intend,” “seek,” “target,” “goal,” “may,” “will,” “would,” “could,” “should,” “can,” “continue” and other similar words or expressions (and the negative thereof). In particular, these statements include, without limitation, statements about Centene’s future operating or financial performance, market opportunity, growth strategy, competition, expected activities in completed and future acquisitions, including statements about the impact of Centene’s proposed acquisition of WellCare Health Plans, Inc. (the “WellCare Transaction”), Centene’s recent acquisition (the “Fidelis Care Transaction”) of substantially all the assets of New York State Catholic Health Plan, Inc., d/b/a Fidelis Care New York (“Fidelis Care”), investments and the adequacy of Centene’s available cash resources.
These forward-looking statements reflect Centene’s current views with respect to future events and are based on numerous assumptions and assessments made by us in light of Centene’s experience and perception of historical trends, current conditions, business strategies, operating environments, future developments and other factors Centene believes appropriate. By their nature, forward-looking statements involve known and unknown risks and uncertainties and are subject to change because they relate to events and depend on circumstances that will occur in the future, including economic, regulatory, competitive and other factors that may cause Centene’s or its industry’s actual results, levels of activity, performance or achievements to be materially different from any future results, levels of activity, performance or achievements expressed or implied by these forward-looking statements. These statements are not guarantees of future performance and are subject to risks, uncertainties and assumptions.
All forward-looking statements included in this filing are based on information available to us on the date of this communication. Except as may be otherwise required by law, Centene undertakes no obligation to update or revise the forward-looking statements included in this communication, whether as a result of new information, future events or otherwise, after the date of this filing. You should not place undue reliance on any forward-looking statements, as actual results may differ materially from projections, estimates, or other forward-looking statements due to a variety of important factors, variables and events including, but not limited to, the following: (i) the risk that regulatory or other approvals required for the WellCare Transaction may be delayed or not obtained or are obtained subject to conditions that are not anticipated that could require the exertion of management’s time and Centene’s resources or otherwise have an adverse effect on Centene; (ii) the possibility that certain conditions to the consummation of the WellCare Transaction will not be satisfied or completed on a timely basis and accordingly the WellCare Transaction may not be consummated on a timely basis or at all; (iii) uncertainty as to the expected financial performance of the combined company following completion of the WellCare Transaction; (iv) the possibility that the expected synergies and value creation from the WellCare Transaction will not be realized, or will not be realized within the expected time period; (v) the exertion of management’s time and Centene’s resources, and other expenses incurred and business changes required, in connection with complying with the undertakings in connection with any regulatory, governmental or third party consents or approvals for the WellCare Transaction; (vi) the risk that unexpected costs will be incurred in connection with the completion and/or integration of the WellCare Transaction or that the integration of WellCare will be more difficult or time consuming than expected; (vii) the risk that potential litigation in connection with the WellCare Transaction may affect the timing or occurrence of the WellCare Transaction or result in significant costs of defense, indemnification and liability; (viii) a downgrade of the credit rating of Centene’s indebtedness, which could give rise to an obligation to redeem existing indebtedness; (ix) unexpected costs, charges or expenses resulting from the WellCare Transaction; (x) the inability to retain key personnel; (xi) disruption from the announcement, pendency and/or completion of the WellCare Transaction, including potential adverse reactions or changes to business relationships with customers, employees, suppliers or regulators, making it more difficult to maintain business and operational relationships; and (xii) the risk that, following the WellCare Transaction, the combined company may not be able to effectively manage its expanded operations.
Additional factors that may cause actual results to differ materially from projections, estimates, or other forward-looking statements include, but are not limited to, the following: (i) Centene’s ability to accurately predict and effectively manage health benefits and other operating expenses and reserves; (ii) competition; (iii) membership and revenue declines or unexpected trends; (iv) changes in healthcare practices, new technologies, and advances in medicine; (v) increased healthcare costs, (vi) changes in economic, political or market conditions; (vii) changes in federal or state laws or regulations, including changes with respect to income tax reform or government healthcare programs as well as changes with respect to the Patient Protection and Affordable Care Act and the Health Care and Education Affordability Reconciliation Act, collectively referred to as the Affordable Care Act (“ACA”), and any regulations enacted thereunder that may result from changing political conditions or judicial actions, including the ultimate outcome of the District Court decision in “Texas v. United States of America” regarding the constitutionality of the ACA; (viii) rate cuts or other payment reductions or delays by governmental payors and other risks and uncertainties affecting Centene’s government businesses; (ix) Centene’s ability to adequately price products on federally facilitated and state-based Health Insurance Marketplaces; (x) tax matters; (xi) disasters or major epidemics; (xii) the outcome of legal and regulatory proceedings; (xiii) changes in expected contract start dates; (xiv) provider, state, federal and other contract changes and timing of regulatory approval of contracts; (xv) the expiration, suspension, or termination of Centene’s contracts with federal or state governments (including but not limited to Medicaid, Medicare, TRICARE or other customers); (xvi) the difficulty of predicting the timing or outcome of pending or future litigation or government investigations; (xvii) challenges to Centene’s contract awards; (xviii) cyber-attacks or other privacy or data security incidents; (xix) the possibility that the expected synergies and value creation from acquired businesses, including, without limitation, the Fidelis Care Transaction, will not be realized, or will not be realized within the expected time period; (xx) the exertion of management’s time and Centene’s resources, and other expenses incurred and business changes required in connection with complying with the undertakings in connection with any regulatory, governmental or third party consents or approvals for acquisitions, including the Fidelis Care Transaction; (xxi) disruption caused by significant completed and pending acquisitions, including, among others, the Fidelis Care Transaction, making it more difficult to maintain business and operational relationships; (xxii) the risk that unexpected costs will be incurred in connection with the completion and/or integration of acquisition transactions, including, among others, the Fidelis Care Transaction; (xxiii) changes in expected closing dates, estimated purchase price and accretion for acquisitions; (xxiv) the risk that acquired businesses, including Fidelis Care, will not be integrated successfully; (xxv) the risk that, following the Fidelis Care Transaction, Centene may not be able to effectively manage its expanded operations; (xxvi) restrictions and limitations in connection with Centene’s indebtedness; (xxvii) Centene’s ability to maintain the Centers for Medicare and Medicaid Services (CMS) Star ratings and maintain or achieve improvement in other quality scores in each case that can impact revenue and future growth; (xxviii) availability of debt and equity financing, on terms that are favorable to us; (xxxix) inflation; and (xxx) foreign currency fluctuations.
This list of important factors is not intended to be exhaustive. We discuss certain of these matters more fully, as well as certain other factors that may affect Centene’s business operations, financial condition and results of operations, in Centene’s filings with the Securities and Exchange Commission (the “SEC”), including the registration statement on Form S-4 filed by Centene with the Securities and Exchange Commission on May 23, 2019 (the “Registration Statement”), and Centene’s Annual Report on Form 10-K, quarterly reports on Form 10-Q and current reports on Form 8-K. Due to these important factors and risks, Centene cannot give assurances with respect to Centene’s future performance, including without limitation Centene’s ability to maintain adequate premium levels or Centene’s ability to control its future medical and selling, general and administrative costs.
Important Additional Information and Where to Find It
In connection with the WellCare Transaction, on May 23, 2019, Centene filed with the SEC the Registration Statement, which included a prospectus with respect to the shares of Centene’s common stock to be issued in the WellCare Transaction and a joint proxy statement for Centene’s and WellCare’s respective stockholders (the “Joint Proxy Statement”). The SEC declared the Registration Statement effective on May 23, 2019, and the Joint Proxy Statement was first mailed to stockholders of Centene and WellCare on or about May 24, 2019. Each of Centene and WellCare may file other documents regarding the WellCare Transaction with the SEC. This communication is not a substitute for the Registration Statement, the Joint Proxy Statement or any other document that Centene or WellCare may send to their respective stockholders in connection with the WellCare Transaction. INVESTORS AND SECURITY HOLDERS OF CENTENE AND WELLCARE ARE URGED TO READ THE REGISTRATION STATEMENT, THE JOINT PROXY STATEMENT AND ANY OTHER RELEVANT DOCUMENTS (INCLUDING ANY AMENDMENTS OR SUPPLEMENTS THERETO) FILED WITH THE SEC CAREFULLY AND IN THEIR ENTIRETY WHEN THEY BECOME AVAILABLE BECAUSE THEY CONTAIN OR WILL CONTAIN IMPORTANT INFORMATION ABOUT CENTENE, WELLCARE, THE WELLCARE TRANSACTION AND RELATED MATTERS. Investors and security holders of Centene and WellCare are able to obtain free copies of the Registration Statement, the Joint Proxy Statement and other documents (including any amendments or supplements thereto) containing important information about Centene and WellCare through the website maintained by the SEC at www.sec.gov. Centene and WellCare make available free of charge at www.centene.com and ir.wellcare.com, respectively, copies of materials they file with, or furnish to, the SEC.
No Offer or Solicitation
This communication is for informational purposes only and does not constitute, or form a part of, an offer to sell or the solicitation of an offer to sell or an offer to buy or the solicitation of an offer to buy any securities, and there shall be no sale of securities, in any jurisdiction in which such offer, solicitation or sale would be unlawful prior to registration or qualification under the securities laws of any such jurisdiction. No offer of securities shall be made except by means of a prospectus meeting the requirements of Section 10 of the Securities Act of 1933, as amended, and otherwise in accordance with applicable law.
HARTFORD, Conn. – The State of Kansas notified Aetna that it has awarded a Medicaid managed care contract to Aetna Better Health℠ of Kansas.
Starting on January 1, 2019, Aetna Better Health of Kansas will offer Medicaid benefits to enrollees statewide in the KanCare Medicaid managed care program. KanCare serves parents, pregnant women and children, individuals with intellectual/developmental or physical disabilities and individuals over the age of 65 with a comprehensive benefit package that includes long-term services and supports and behavioral health care.
"We are excited to partner with the State of Kansas in providing health care solutions for the state's most vulnerable populations," said Janet Grant, vice president of Aetna Better Health's Great Plains Region. "We appreciate the State's fair and thorough evaluation process and we’re confident we can deliver improved health status, better access to coordinated care and greater emphasis on prevention and education. We are known nationally for our ability to establish collaborative relationships with health care providers and community leaders that focus on making members healthier and improving their health care experience."
Aetna is one of the nation's leading diversified health care benefits companies, serving an estimated 40.3 million people with information and resources to help them make better informed decisions about their health care. Aetna offers a broad range of traditional, voluntary and consumer-directed health insurance products and related services, including medical, pharmacy, dental and behavioral health plans, and medical management capabilities, Medicaid health care management services, workers' compensation administrative services and health information technology products and services. Aetna's customers include employer groups, individuals, college students, part-time and hourly workers, health plans, health care providers, governmental units, government-sponsored plans, labor groups and expatriates. For more information, see www.aetna.com.
About Aetna Medicaid
Aetna Medicaid Administrators LLC (Aetna Medicaid) has over 30 years of experience managing the care of the most medically vulnerable, using innovative approaches and a local presence in each market to achieve both successful health care results and effective cost outcomes. Aetna Medicaid has particular expertise serving high-need Medicaid members, including those who are dually eligible for Medicaid and Medicare. Currently, Aetna Medicaid owns and/or administers Medicaid managed health care plans under the names of Aetna Better Health and other affiliate names. Together, these plans serve 2.8 million people in 15 states, including Arizona, California, Florida, Illinois, Kentucky, Louisiana, Maryland, Michigan, New Jersey, New York, Ohio, Pennsylvania, Virginia, West Virginia, and Texas. For more information, see www.aetnabetterhealth.com.
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For millions of Americans, hunger is a constant reminder of food insecurity and the challenges they face from it on a daily basis. To win the war on hunger, food banks and their partners understand that one way to solve it is to ease the stigma associated with food assistance programs.
To fight back against this stigma, Aetna Better Health® of Florida (ABHFL), a Medicaid Managed Care Plan, in partnership with the Second Harvest Food Bank of Central Florida, recently sponsored their annual Partnership Networking Conference in the city of Orlando with a $10,000 donation. The conference brought together over 300 partner agencies and local organizations whose main mission is to distribute healthy foods to needy families in Central Florida. These agencies distribute food at the neighborhood level and partnering with them is a great way to meet Medicaid members where they are. ABHFL was the first Medicaid health plan ever invited to attend this annual conference.
During the conference, there were several speakers addressing the issue of food insecurity and community outreach, including RJ Briscione, senior director, Aetna Medicaid Business Development. RJ discussed Aetna’s work on social determinants of health and food insecurity at the local level, including how the health plan serves Medicaid members in Central Florida.
According to RJ, “With the help of dedicated partners like Second Harvest, Aetna Better Health aims to raise awareness and understanding of the complex issues related to food insecurity, and to develop effective strategies to combat hunger and the health effects that come with it.”
“The conference also provided the health plan a unique opportunity to network with food pantry providers and distribute ABHFL promotional items,” said Carl Lee, ABHFL manager of Community Development and Outreach. “We were able to hand out ABHFL branded posters for attendees to display at their agency locations. Participants praised our presence at the conference and complemented us for being good stewards to the community.”
About Aetna Better Health of Florida
Aetna Better Health of Florida uses an integrated physical and behavioral health approach to the administration of benefits for the Medicaid Managed Care, Florida Healthy Kids, and Managed Long Term Services and Supports populations. The health plan works with members and their families, caregivers, providers, advocates, peer and family organizations and community groups to help them achieve better health outcomes.
New collaboration with Unite Us and additional programs further company’s commitment to building healthier communities and improving people’s health
WOONSOCKET, R.I. — Approximately 60 percent of a person’s life expectancy is influenced by their everyday activities outside of the doctor’s office our individual behaviors, as well as social and environmental factors. To address this issue and help people improve their health outside of a clinical setting, CVS Health today announced the first in a series of business programs with an enhanced focus on addressing social determinants of health.
The platform also includes the investments being made at the community level as part of the recently announced Building Healthier Communities initiative, which is a $100 million commitment being funded over five years by CVS Health and the CVS Health and Aetna Foundations intended to make community health and wellness central to the company’s corporate social responsibility platform Better Health, Better Community, Better World.
“Out of about 6,000 waking hours in a year, most people only spend a handful in a doctor’s office or hospital - you spend the vast majority of your time in your community,” said Karen S. Lynch, Executive Vice President, CVS Health and President, Aetna. “CVS Health is a part of nearly 10,000 communities across the country, so by going beyond our significant philanthropic efforts and addressing social determinants of health through the products and programs our company develops, we have an unprecedented opportunity to improve the health of individuals and communities across America.”
As part of this effort, CVS Health will collaborate with Unite Us, the leading social care coordination platform, to help some of Aetna’s most vulnerable Medicaid and Dual eligible members more easily access social services within their community. Selected Aetna members will be able to use Unite Us’ aggregated network of social care providers, which they can find on their own through a proprietary technology resource developed by Unite Us. Members can also be referred by a community health provider or Aetna nurse case managers who will receive information through this platform. The two companies are also exploring integration through various CVS Health retail assets.
“Our mission is to connect individuals and families across the United States to the services they need through collaboration with local service providers, shared infrastructure, and an inclusive approach for those in need,” said Taylor Justice, Unite Us Co-Founder and President. “Working with CVS Health, we will foster a community of care and a local support system to empower community members to make the most of the services available to them.”
CVS Health and Unite Us will make these programs and services available to Aetna Medicaid members in Louisville, Kentucky during the second half of the year. During this same time, the programs and services will also be available to Aetna’s Dual-Eligible Special Needs Plan members (DSNP—people eligible for both Medicaid and Medicare) in Tampa, Florida and Southeastern Louisiana.
Helping Employers Identify and Address Social Determinants of Health
In addition to being a community health issue, an inability to address social determinants of health can also result in higher health care costs and reduced worker productivity for employers, particularly businesses with a significant number of low-wage workers. To help employers better understand this connection, Aetna has developed an analytics tool that will quantify the probable impact of social determinants of health on an employer’s health plan results. The first release of the tool with initial functionality is scheduled for this month, with additional capabilities planned for the next release, scheduled for early 2020.
Beyond helping employers understand how social determinants of health are affecting their employee population, this tool will also help guide CVS Health across all lines of business to determine how the organization can most effectively deploy the right interventions to the plan sponsors and individuals that are most likely to benefit. These interventions could include plan sponsor activities like plan design changes, provider network adjustments and refinements to clinical outreach. Other actions could include collaborating with community organizations that are already working on addressing social determinants of health and determining the best way to leverage the presence of CVS stores in the community. These types of interventions are currently being tested in pilot programs with several large employers.
Impact Investments How Housing Can Help Improve Health
With a focus on addressing housing insecurity in key markets, CVS Health is making significant investments, totaling more than $50 million by the end of this year, in affordable housing across the country to help provide support for underserved and at-risk populations.
In the past seven months, CVS Health and Aetna have closed on commitments to invest $40.5 million in affordable housing that will help construct or rehabilitate over 1,600 affordable housing units in 19 communities in six states. These investments include over 100 permanent supportive housing units reserved for people requiring mental health service; are homeless or at risk of homelessness; have HIV/AIDS diagnoses; have substance abuse issues; or have long-term chronic health conditions.
In addition to developing these housing units, the company and its investment partners are working with community organizations to provide access to services such as independent living skills, cooking and nutrition, financial literacy, health information classes, resident outreach and engagement, client centered treatment plans and social support.
“It’s hard to focus on your health when you are worried about your housing situation. Research has shown that providing safe and secure housing options can help improve health outcomes, particularly for individuals with chronic health conditions,” said Dr. Garth Graham, Vice President, Community Health & Impact, CVS Health and President, Aetna Foundation. “Our continued investment in affordable housing and ongoing collaboration with community groups can support those individuals that need it the most and help improve their health and well-being.”
Since 1997, Aetna, a CVS Health company, has invested more than $1 billion in affordable housing and community investments. These investments have led to the building and renovation of over 92,000 affordable rental units, positively impacting hundreds of thousands of low-income individuals, families, and seniors.
About CVS Health
CVS Health is the nation’s premier health innovation company helping people on their path to better health. Whether in one of its pharmacies or through its health services and plans, CVS Health is pioneering a bold new approach to total health by making quality care more affordable, accessible, simple and seamless. CVS Health is community-based and locally focused, engaging consumers with the care they need when and where they need it. The Company has more than 9,900 retail locations, approximately 1,100 walk-in medical clinics, a leading pharmacy benefits manager with approximately 94 million plan members, a dedicated senior pharmacy care business serving more than one million patients per year and expanding specialty pharmacy services. CVS Health also serves an estimated 38 million people through traditional, voluntary and consumer-directed health insurance products and related services, including rapidly expanding Medicare Advantage offerings and a leading standalone Medicare Part D prescription drug plan. The Company believes its innovative health care model increases access to quality care, delivers better health outcomes and lowers overall health care costs. Find more information about how CVS Health is shaping the future of health at https://www.cvshealth.com.
About Unite Us
Unite Us is an outcome-focused technology company that builds coordinated care networks of health and human service providers. The company empowers both medical and social service providers to work together, integrating health and social care. With Unite Us, providers across sectors can send and receive secure referrals, track every person’s total health journey, and report on tangible outcomes across a full range of services in a centralized, cohesive, and collaborative ecosystem. This social infrastructure helps communities transform their ability to track outcomes, improve health, and measure impact at scale. Follow Unite Us on LinkedIn, Facebook, Instagram, and Twitter.
WOONSOCKET, R.I., Aug. 14, 2018 /PRNewswire/ -- CVS Health (NYSE: CVS) is actively working with its Ohio Managed Medicaid clients to restructure its contracts to implement the Ohio Department of Medicaid's new "pass-through" pricing model requirement, effective January 1, 2019. Contrary to an inaccurate news report in The Columbus Dispatch, which was later picked up on social media, the pharmacy benefit managers (PBMs) servicing Ohio's Managed Medicaid Plans have not been "fired."
PBMs have saved Ohio taxpayers $145 million annually through the services they provide to the state's Medicaid managed care plans. CVS Health will continue to help its Ohio Medicaid clients manage their drug costs and improve their members' health outcomes in 2019 and beyond.
About CVS Health
CVS Health is a pharmacy innovation company helping people on their path to better health. Through its more than 9,800 retail locations, more than 1,100 walk-in medical clinics, a leading pharmacy benefits manager with approximately 94 million plan members, a dedicated senior pharmacy care business serving more than one million patients per year, expanding specialty pharmacy services, and a leading stand-alone Medicare Part D prescription drug plan, the company enables people, businesses and communities to manage health in more affordable and effective ways. This unique integrated model increases access to quality care, delivers better health outcomes and lowers overall health care costs. Find more information about how CVS Health is shaping the future of health at https://www.cvshealth.com.
SOURCE CVS Health
Across our CVS Health enterprise, our goal is to help reduce overall health care costs and improve health outcomes. As part of that, CVS Caremark, our pharmacy benefit management (PBM) business, is committed to finding ways to lower drug costs for the payors and patients we support, including our Ohio Medicaid managed care clients. This is increasingly important as the list price of drugs continues to rise. CVS Health believes it is important that you have all the facts regarding our role as a PBM and the value we provide to the state. These facts are a critical part of the full story when it comes to the PBMs that help support Ohio Medicaid:
According to a report commissioned by the Ohio Department of Medicaid, PBMs have saved Ohio taxpayers $145 million annually by servicing the state’s Managed Medicaid plans, even as the drug prices set by the manufacturers have continued to rise.
Ohio’s Medicaid expenditure per prescription is more than 13% below the collective average cost of states that manage their own program versus using a PBM.
Government-mandated rebates in the Medicaid program are shared by the states and the Medicaid program. PBMs do not receive and, therefore, do not keep any of those mandated rebates. CVS Caremark also passes 100% of any negotiated supplemental rebates to our Ohio Managed Medicaid clients and do not keep any amount of drug manufacturer rebates for Medicaid prescriptions in Ohio.
Moving the Ohio Medicaid drug benefit to a fee-for-service model, and away from the current spread pricing model, would cost the State of Ohio more than $500 million over two years.
According to a recent estimate by the Ohio Department of Medicaid
Additionally, recent reporting from the Columbus Dispatch has skewed important information. Learn more about how we’re Reimbursing Independent Pharmacies Fairly in Ohio.
Drug manufacturers alone set prices for prescription drugs
In just the first 7 months of 2018, prices had increased on more than 4,400 brand-name drugs.
Source: Associated Press, https://www.apnews.com/b28338b7c91c4174ad5fad682138520d
Prices for the top 10 drugs in the US have increased more than 100 percent since 2011.
Source: Reuters, https://www.reuters.com/article/us-usa-healthcare-drugpricing/exclusive-makers-took-big-price-increases-on-widely-used-u-s-drugs-idUSKCN0X10TH
David Palombi, Senior Vice President, CVS Health, Providence RI
Opinion, published in The Cleveland Plain Dealer, August 5, 2018
David Palombi is senior vice president and chief communications officer at CVS Health.
In recent months, there has been a lot of misinformation, skewed facts, and unfounded allegations circulating about the role pharmacy benefit managers (PBMs) play in helping to manage the costs of prescription drugs for Ohio Medicaid. It is time to sort through the inaccuracies and provide some balance to the discussion.
The truth is, when PBMs function well, drug-cost inflation is low and patient health improves through the appropriate use of medications and related health care programs.
A recent report commissioned by the Ohio Department of Medicaid to measure PBM effectiveness estimated that CVS Caremark's involvement in the program saves taxpayers and the state $145 million annually as compared to other models.
That same ODM-commissioned report shows that CVS Caremark reimburses independently owned pharmacies at a higher rate, and pays these pharmacies a higher dispensing fee, than we do for CVS Pharmacy, effectively silencing unfounded allegations of anti-competitive behavior.
Overall, Ohio's Medicaid expenditure per prescription is more than 13 percent below the collective average costs of states that manage their own program versus using a PBM, according to the Ohio Association of Health Plans last year.
These facts paint a clear picture that PBMs benefit the state of Ohio and Ohio taxpayers by effectively managing Medicaid expenditures.
In an era of rising pharmaceutical costs, it is important to remember that pharmaceutical manufacturers set the price of prescription drugs. It is our job at CVS Health to negotiate with those manufacturers to secure the drugs at a lower cost.
We are measured on our ability to hold down prescription drug costs. Our effectiveness in this area allows plan sponsors to apply these savings to help keep the amount their patients have to spend out of pocket, to cover their share of health insurance costs, affordable.
When it comes to transparency, the ability to effectively serve our clients and patients while competing in the market - as with any business - involves a certain amount of proprietary information. In our role supporting Ohio Medicaid plans, we work hard to balance the need to protect our business-critical information with the public's right for transparency into how their tax dollars are being spent.
CVS Caremark participated in a transparent, open, and competitive bidding process to win the right to service the Ohio Medicaid plans, the details of which are publicly accessible. Also, along with most managed-care companies that contract with the state Medicaid program, we comply willingly with new requirements to report the difference between the amount the PBM is paid by the managed-care plan and the amount the PBM pays pharmacies for all prescriptions filled under Medicaid.
However, when it comes to the proprietary rates and formulas we use to negotiate for lower drug prices or cost-effective dispensing within our pharmacy network, making those figures public (as the release of the full report commissioned by ODM would do) only hurts our ability to negotiate the lowest rates and fees in a highly competitive market, which would ultimately cost the state and the taxpayers more.
Some have questioned the CVS operating margin as being too high or out of scope as compared with other companies. However, as reported by the Ohio Department of Medicaid, a significant portion of that "spread" is not profit to CVS Caremark.
Instead, in lieu of separate administrative fees, this margin funds vitally important benefit management services we provide to clients, such as clinical and customer support, programs to improve medication adherence, and management of the drug formulary, among others. In 2017, CVS Caremark's net profit margin for all PBM services nationally was just 3.5 percent; in the first quarter of this year, it was only 2.4 percent.
Ohio has developed a sound strategy that involves partnerships with PBMs to serve the prescription needs of those on Medicaid. While we agree it is only prudent that Ohioans consider how to continue improving a system responsible for the health care of about 3 million people at the cost of $3 billion, we remain committed to continuing to work together with the state and the managed-care plans to improve the system, keep drug-price inflation to a minimum and serve the health care needs of Ohioans.