Aetna MA Q1 Insights Newsletter

Communication produced by Aetna on 2/23/21:

Aetna Insights for consultants and brokers:

News you can use:

• Breaking News: Leadership announcement
• Top Story: CVS Health® and Aetna®: Where you want us to be — Caring, Connected and Closer to Home
• Legislative Update
• COVID-19 Update: Supporting you and your clients through the next phase of the pandemic
• Local Focus:
o CVS® HealthHUB™ expansion continues in the Ohio and Kentucky market
o Learn about Aetna Whole Health – Cleveland Clinic plan

 

BREAKING NEWS:

Daniel Finke named President of Health Care Benefits Segment
Daniel Finke is now Executive Vice President, CVS Health® and President, Health Care Benefits Segment, Aetna. His appointment was effective February 1. He takes over from Karen S. Lynch, current President and CEO of CVS Health. She stepped into that position after Larry Merlo’s retirement in early February.

“It’s an honor to lead the Health Care Benefits segment and to support our customers, members, providers and colleagues,” said Finke. “I’m committed to simplifying the health experience for members using digital solutions and bringing to market CVS Health integrated products that demonstrate our unique ability to serve the needs of our customers.”

Finke brings more than 25 years of diverse health care experience to the company. He joined Aetna in 2014. Most recently he was leading the Commercial Business and Markets organization. He also held leadership roles in network and clinical services and was a key leader on the transformation team during the integration with CVS Health.

Before joining Aetna, Finke served as President and Chief Operating Officer of EmblemHealth. He previously spent more than a decade at Anthem in various national executive roles in healthcare operations, government programs and pharmacy benefit management.

 

CVS Health® and Aetna®: Where you want us to be — Caring, Connected and Closer to Home
Both CVS Health and Aetna separately have long-standing commitments to their customers and members. We put them at the center of everything they do. Together, we’re showing how CVS Health and Aetna can reimagine the health care experience.

Leveraging the assets of both CVS Health and Aetna has created unique benefits and advantages for customers and members that show the value of an integration of these two companies. These include:
• A more personalized, simplified member experience that meets people where they are
• More connected care that offers better end-to-end solutions, improved outcomes and lower costs
• Unmatched engagement that promotes behavior change
We are bringing solutions to the market that deliver a health experience that is more caring, connected and closer to home.
Caring: Reinventing the member experience
We’re transforming the way members manage their health like never before. We make it more seamless and relevant at every stage of their health journey. We do so by combining retail convenience, face-to-face engagement, expanded telehealth care and bundled products and services. Taken together, we deliver an improved health care experience that fits our members’ individual needs and lifestyles.
Connected: More connected care
We’re connecting care for both members and providers throughout the health journey. We use innovative technology that connects our data and expertise. This means we can offer end-to-end solutions that help members manage their care, and costs, in ways that no one else can. With deeper connectivity and richer data exchanges among Aetna, CVS Pharmacy and members’ own providers, we can create a more holistic awareness of member health, helping providers have access to the same electronic medical records. Driven by rich data and analytics, we can identify health opportunities. At the same time, members have an entirely seamless, connected interaction.
Closer to home: Unmatched engagement for our members
Combining CVS Health and Aetna means making care more accessible. When this happens, we can better engage members. This empowers behavior change, resulting in better health outcomes earlier for members. Over 4.5 million Americans engage with our enterprise daily. With nearly 10,000 CVS Pharmacy stores, Americans have access to thousands of community-based CVS pharmacists who can provide face-to-face clinical advice.

With unique channels that are both in-person and virtual, no one can engage members like we do.
Why it matters: For you and your clients
The integration of medical and pharmacy benefits continues to yield savings. Our 2020 study confirms savings of $6 to 11 per member per month each year. That’s an average of $95 per member per year. And that’s a savings of 1.5 to 3 percent annually.1

Our medical cost savings from integrated pharmacy benefits grew due to our unique approach to member engagement. This is especially true for members with chronic conditions such as behavioral health, diabetes and COPD.

Key capabilities and expertise from both Aetna and CVS fuel innovations and enhancements in how we support Specialty patients and manage Specialty spend. Full adoption of Specialty Rx programs, and PrudentRx for further copay optimization, can mean up to 27 percent in total savings across specialty medical and pharmacy.2

CVS Health and Aetna also has the power to go beyond just pharmacy and medical integration. Together, we can see a total cost-of-care savings for plan sponsors of as much $50 per member, per month.3

CVS Health and Aetna aren’t waiting for the future ¬. We’re defining it today. And we’re willing to prove it. Ask your Aetna Account team about our Integrated Value Guarantee.*

 

Legislative Update

New year, new president, new administration and congress. We expect a wave of health care related changes this year. Efforts to curtail the ongoing pandemic will likely take the spotlight.

The Biden administration has proposed, and Congress is actively considering the America’s Recovery Plan stimulus plan. This plan proposes an increase of the Affordable Care Act (ACA) Premium Tax Credit. It will cap enrollee payments at no more than 8.5 percent of income for coverage. Subsidies are currently capped at 400 percent of the federal poverty level. In addition, the administration proposes to extend subsidies for people to afford their COBRA insurance though the end of September 2021. In general, CVS Health® supports strengthening employer sponsored insurance and promoting affordable access to coverage.

Longer term, the new administration’s health care agenda also includes pushing for broader access to health care. The goal is to improve the ACA marketplace and strengthen Medicaid services. President Biden has signed Executive Orders expanding the enrollment period for ACA. He’s also urged agencies to review and rescind policies that make enrolling in ACA and Medicaid programs more difficult.

CVS Health has a long track record of supporting affordable health coverage for all Americans. We support strengthening the ACA. It has already brought affordable coverage to millions of Americans. This can be done by enhancing federal reinsurance, funding cost-sharing subsidies, providing states with incentives to expand Medicaid, and maintaining protections for those with preexisting conditions.

Also, we are committed to strengthening the employer-based insurance system, particularly during the public health emergency. CVS Health supports preserving coverage by providing subsidies for employer-sponsored coverage during the public health emergency and expanding pre-deductible coverage for primary and preventive care.

We also expect the Biden administration and congress to turn their attention to lowering drug costs. The price of prescriptions is still too high and out of reach for far too many. Lowering drug prices is a prerequisite to controlling health care costs. In turn, drug costs affect affordability, access to care and improving outcomes.

CVS Health believes that lower drug prices can be achieved by:
• More competition in the pharmaceutical marketplace by increasing the number of approved drugs available to patients and removing barriers to market entry for new ones
• Comprehensive reform to the Medicare Part D program that caps Medicare beneficiaries’ out-of-pocket costs and better aligns incentives between manufacturers, plans and the government
• Drug patent reform, including ending pharmaceutical manufacturer gaming of the drug patent system
• Improving access to generic drugs and biologically similar medicines by changing provider reimbursement to give physicians incentives to prescribe and administer lower-cost drugs
CVS Health is actively working with members of congress, their staff, and the new Biden administration to consider policies to help:
• Get the COVID-19 pandemic under control
• Improve access to quality health care
• Lower costs for consumers

 

COVID-19 UPDATE:

Supporting you and your clients through the next phase of the pandemic

Aetna, as part of CVS Health®, remains committed to supporting our consultants, clients and members during the pandemic.

CVS Health® is one of the distribution partners for the vaccine. CVS Pharmacy® will play a prominent role in administering vaccinations across the nation. Aetna®, as part of CVS Health, is staying close to the vaccine developments. And we’re committed to making it easier for your clients and their employees to get the latest information at the right time to help inform their decision making.

The following captures some of our actions that are already underway:

  • On February 11, 2021, CVS Health® began offering COVID-19 vaccinations to eligible populations at a limited number of CVS Pharmacy locations in 11 states. CVS Health will receive about 250,000 doses from the federal government. Click here for more details.
  • Aetna is preparing to support essential worker vaccinations using our national CVS Pharmacy footprint and immunizers. This will follow the vaccination of frontline health care workers and long-term care residents, and prior to the availability to the general population. For employers that meet requirements, an onsite or dedicated COVID-19 vaccine clinic for essential workers may be an option.
  • All Aetna insured and self-funded plans, including Aetna Funding AdvantageSM plans offer members a $0 cost share for the vaccine at both network and out-of-network providers. This approach follows the federal mandate.
  • Access our COVID-19 and vaccine resource page on Aetna.com for frequently asked questions and the latest tools and information. There’s also a state lookup tool that connects members to state resources on vaccine eligibility and rollout phases.

* For more details and client eligibility requirements, contact your Aetna account representative.

For the latest information, visit our COVID-19 support site. You can also check out the CVS Health COVID-19 resource center for information on managing health and well-being.

LOCAL FOCUS

At CVS Health and Aetna, we set out to reimagine what the health care experience could be – we are revolutionizing community-based health care by safely connecting people to care, when and where they need it, with CVS® HealthHUB™. Despite the challenges of COVID-19 last year, our commitment to continue the expansion of CVS HealthHUB locations exceeded our goal for the end of 2020, and since December 2020, an additional 159 locations were opened in 28 states across the country.  We are excited to continue the momentum and reach 1,300 locations nationally by the end of 2021.

Now more than ever, the need for convenient care is paramount.  When health care is coordinated and timely, and data and technology are utilized effectively, people can be better engaged in their care. This can help improve outcomes and reduce health care costs. CVS HealthHUB locations help connect people to care, when and where they need it, by:

  • Serving as a channel for member engagement and personalized care support with a professional care team and our consumer-centric model that ensure your supported every step of the way
  • Delivering on the continued need for convenient and affordable care that’s available 7 days a week, including evenings, virtual or in-person
  • Supplementing the in-store experience for consumers with integrated digital and telephonic resources

To learn more about our approach to community-based health care delivery, and see what’s behind the scenes at a CVS HealthHUB, watch this quick video watch this quick video  and experience how we’re revolutionizing community-based health care.

CVS HealthHUB locations in the Ohio and Kentucky market

The Ohio and Kentucky market has 58 open CVS HealthHUB locations and 6 additional planned openings through second quarter 2021.

Recently opened locations:
ADDRESS CITY STATE ZIP
1949 West Market Street
Akron
OH
44313
418 East Main Street
Ashland
OH
44805
1331 North Fairfield Road
Beavercreek
OH
45432
7230 Market St.
Boardman
OH
44512
601 East Main Street
Canfield
OH
44406
16801 Chillicothe Rd.
Chagrin Falls
OH
44023
1495 West 5th Ave.
Columbus
OH
43212
7470 Sawmill Rd.
Dublin
OH
43016
60 N. Stygler Rd.
Gahanna
OH
43230
3761 Massilon Rd.
Green
OH
44685
4961 Roberts Road
Hilliard
OH
43026
111 South Memorial Drive
Lancaster
OH
43130
1443 Richmond Rd.
Lyndhurst
OH
44124
900 Coshocton Ave
Mount Vernon
OH
43050
1339 N. Main St.
North Canton
OH
44720
620 S. Cleveland Ave.
Westerville
OH
43081
6005 Som Center Rd.
Willoughby
OH
44094

 

The power of two – Aetna and the Cleveland Clinic – offering care that’s simple, engaging and affordable for Northeast Ohio employers

The Aetna Whole Health – Cleveland Clinic plan is a multi-faceted collaboration with a co-branded insurance plan and the strength of the world-renowned Cleveland Clinic.

This unique plan offers Northeast Ohio employers and their employees:

  • Improved clinical outcomes
  • A more engaging experience, and a
  • Stronger bottom line
 

Anthem Commission Statement Update

Exciting news!

Anthem BCBS is now going to be moving from monthly to weekly commission statements. Whether you get your Commission Statement from Producer Toolbox or by mail, you’ll see a simpler, easier to understand format. Some of the highlights include easier navigation, improved member tracking and more clearly defined data.

For more information from Anthem, click here

 

If you have any follow up questions or concerns, reach out to CSM commissions department

Anthem’s Review on Insulin Coverage

Do you have questions about Insulin? Anthem BCBS is here to help!

Email communication from Anthem OH Medicare team from: 2/22/21

 

There are many questions regarding insulin coverage so we’d like to take a moment to highlight Insulin specific benefits on our MAPD Plans.  We have solutions to help your members manage their Insulin costs.  In many cases, these options can be even lower than the $35 Insulin Copay program.  Take a moment to review the tips below to help members make the most out of the opportunity to $ave!

Lispro, Humulin, Humalog and Levemir FlexTouch PEN are in our MAPD Tier 3 Category.  Using Mail Order, the member will receive a 90 Day Supply for 2 Months copay!  That equates to a total cost of $84; or, $28 per month!

Be certain, when doing a drug search in the OnLine Store (https://shop.anthem.com/medicare ), search “Humalog” or “Insulin Lispro”.  Make sure to indicate Mail Order for the 90 day supply pricing. Please note: you must enter “Insulin Lispro”.  Also, make sure you are running a full comparison of all drugs the individual is taking.  There can be a significant difference in pricing.

On our MAPD plans, Lancets are covered at a $0 copay.  Lifescan One Touch and Roche Accu-Check Diabetic Test Strips and Monitors are covered at a $0 copayFreestyle Libre Glucose Monitor is also covered at a $0 copay.

Our plans also provide Unlimited Routine Foot Care with a $0 copay.  Competitor plans often limit the number of visits per year and include a copay.

In addition to our Insulin benefits, there are many other benefits to consider when comparing plans:

  • MOOP
  • PERS
  • OTC benefit that carries over quarter to quarter
  • $3000 hear aid benefit
  • Essential Extras option that improve quality of life

We hope that this brief overview has helped answer some questions you have around Insulin and Diabetic Supplies.

 

 

If you have additional questions, don’t hesitate to reach out to your CSM Representative. 

Anthem Ohio Network News: Oak Street Health

Medicare Advantage Network now includes Oak Street Health in Akron, Ohio

 

Anthem has expanded their network, providing more choices for your clients, by adding quality providers. Oak Street Health in Akron, OH, is now part of the Anthem Medicare Advantage (HMO/DSNP/PPO) network.

This expanded network demonstrates Anthem’s ongoing commitment to improving people’s health –and ensuring your success by giving them what they want in a health plan.

 

If you have any questions regarding this network expansion or if you need contracting with Anthem, please reach out to your Cornerstone Senior Marketing representative

Humana AOR Process Update- PLEASE READ!

Attention Humana Agents: 

Humana DOES accept agent of record changes by MEMBER ONLY!  While the handwritten letters are NO longer accepted, a simple phone call to Humana Member services is!   

  • The Agent of Record Protection Pledge protects the original AOR when Humana Telesales agents change plans for members.
  • As of December 13th, 2018; Humana MarketPoint no longer accepts the following AOR change requests:
    • AOR change requests received from a member (e.g. handwritten letter or email
    • AOR change requests received from an agent (other than through the Delegated Commission Assignment Form, which should not be used for individual AOR update)
      AOR changes are not processed by Agent Support or our MarketPoint offices. However, Members have the option to contact Member Services to change their Agent of Record. Member Services is the only avenue at this time to request an AOR change.

View Humana’s updated Agent of Record Protection Pledge document below for more details:

 

HUMANA’S 2021 AOR PROTECTIO PLAN PLEDGE DOCUMENT

 

If you have any questions on Humana’s AOR process please reach out to your Cornerstone Service Rep.

Aetna Mail Delays – IMPORTANT UPDATE

Mail delays due to winter storms

Due to winter storm conditions across the country, policy and ID card delivery may be delayed by the USPS. Both policy pages and ID cards can be viewed at any time by signing into the member side of aetnaseniorproducts.com.

The Aetna office is currently closed due to the weather, and not able to receive, process or send any mail from their office at this time. Many Aetna vendors have also been dealing with mail delays, power outages, and diminished staff due to local weather conditions.

Aetna anticipates they will begin processing mail again on Monday, February 22.

Here’s how Aetna is supporting you and your clients:

  • No policies will lapse due to winter storms delaying mail delivery.
  • Teams are working remotely and continuing to process new business and claims as normal.
  • Customer service teams are available through both Live Chat on the website and by phone.

If you have any questions, just contact the Agent Services team by using the Live Chat feature at aetnaseniorproducts.com or by calling 866-272-6630, or reach out to your Cornerstone Senior Marketing Service Representative:  614-763-2255 or by email:  service@cornerstoneseniormarketing.com

New – Devoted Health Star Sellers Program

Attention Northern Ohio Agents!

Introducing our new Devoted Health Star Sellers Program (SSP).This program is designed to celebrate your wins – big and small and helps us reward you for all your hard work.

• There are four tiers in the program: Bronze, Silver, Gold and Platinum. The tier in which you qualify for is based on the total number of CMS approved application accrued each plan year
• As you submit more applications, you will qualify for higher tier levels which means more training, programs and Broker Bucks towards sales and marketing materials to help you sell
• Total app count is based on effective dates from 1/1 through 12/1 of each year. Program resets every plan year. This means eligible applications written for 1/1/21 are counted for this year’s program!
• This Star Sellers Program replaces prior broker loyalty programs offered by Devoted Health and is subjected to change at any time with or without notice.

 

READ FULL PROGRAM DETAILS

 

Request contracting today and add Devoted Health to your carrier portfolio!

Call me: Colleen Baird | 567-205-2551 – NORTHWEST OH
Email: colleen.baird@cornerstoneseniormarketing.com

Call me: Jaime Lebrón | 216-503-4509 – NORTHEAST OH
Email: jaime.lebrón@cornerstoneseniormarketing.com

 

DCP: Important Portal Registration Delay

Dental Care Plus Group Broker Update from 2/8/21:

WellCare Introduces Summa Health to Ohio Market

WellCare Broker Announcement from 2/9/21:

As the market continues to expand, we want to ensure we are providing you with the necessary resources to continue to be successful in the field – and best serve our members.

WellCare is excited to announce the addition of Summa Health to the Ohio market. As of Jan. 1, 2021, this partnership came with the addition of more than 600 providers – ranging in 12 different license types.

With Summa Health now in network, we are able to provide more resources and options when it comes to accessing affordable healthcare. We hope you keep WellCare and Allwell plans on the top of your list when presenting to potential members.

 

If you have any questions please reach out to your CSM rep.

Anthem Revisions to 2021 Medicare Supplement Commission Schedules

Revisions have been made to Anthem’s 2021 Medicare Supplement base schedules adding the language:

“Replacement policies will be paid at the renewal rate in alignment with state DOI guidelines”.

See below for specific state schedules

OHIO

KENTUCKY

INDIANA 

 

If yo have any questions please reach out to your Cornerstone rep.