1. 2017 Outlook
With Lawmakers Poised to Shred the ACA,
Health Plans Step Into Ambiguous Future
2017 begins with far, far more questions than answers. One thing, however, is
certain. More than six years after its enactment, the future of the Affordable Care Act
(ACA) is bleak, with the Republican-led Congress already beginning the task of dis-
mantling it.
For the year ahead, however, industry observers contacted by HPW did express
some optimism. Payment models inspired by the ACA might continue to evolve, and
insurance carriers could wind up with more freedom to experiment with plan designs
if they are no longer required to include all 10 essential health benefits. And the elimina-
tion of the individual mandate could prompt a resurgence of short-term and limited-
benefit policies.
Arguably, the biggest question for the year ahead is the future of the public insur-
ance exchanges. This spring, insurance companies will need to submit proposed rates
for the products they intend to sell on public exchanges for 2018. Amid the uncertainty
of a new president and Congress, carriers are pushing for more time to decide whether
to stay.
As Obama Administration Hands the Keys to
Trump, What Will Happen at CMS and HHS?
For HHS and CMS, the potential for substantial changes in the opening days of a
new year has probably never been greater. Medicaid, Medicare and the public insurance
exchanges all are expected to undergo major modifications under the new president
and Congress. Over the past six months, the Obama administration has released a raft
of regulations aimed at strengthening the Affordable Care Act (ACA).
But industry observers contacted by HPW don’t expect radical changes or a mass
exodus at HHS and CMS after Donald Trump is sworn in as the 45th president of the
United States.
“This doesn’t feel like the last couple of transitions. The outgoing administration
has stayed busy finalizing significant regs since the election, and the incoming admin-
istration will arrive expecting to deliver on promises to substantially change Medicaid
and the ACA programs, and possibly Medicare too,” says Michael Adelberg, a former
senior official in CMS’s Center for Consumer Information and Insurance Oversight
(CCIIO), now at FaegreBD Consulting in Washington, D.C.
Republican leaders in the House and Senate — who returned to work Jan. 3 — say
a repeal of the Affordable Care Act (ACA) is at the very top of their agenda. On his first
day back, Senate Budget Committee Chair Mike Enzi (R-Wyo.) got the process rolling
by introducing a budget resolution that includes reconciliation instructions enabling
Congress to repeal the ACA with a simple majority, according to his website.
continued on p. 7
Volume 27, Number 1 January 9, 2017
Published by AIS Health, Washington, DC
An independent publication not affiliated with insurers, vendors, consultants or associations
3 From the Editor: Fasten
Your Seatbelts for 2017
4 Top HPW Headlines From
2016
4 Despite Stable Rates,
Employers Will Push
Insurers for Savings
5 Post-Recession Stock
Prices: What a Difference
Eight Years Makes
8 Health Plan Briefs
Contents
continued
Strategic Business, Financial and Regulatory News of the Health Insurance Industry
Managing Editor
Steve Davis
sdavis@aishealth.com
Executive Editor
Jill Brown
Don’t miss the valuable
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com — searchable archives,
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3. January 9, 2017 Health Plan Week 3
ACA will have at the state and local levels, as well as
from a business perspective. She says they should insist
that an ACA replacement be created before the ACA is re-
pealed. Without that, insurers will be left with too much
uncertainty and premiums will skyrocket. Moreover,
“providers will be left holding the bag” when newly
uninsured patients begin to show up for treatment.
(3) Provider-sponsored health plans will shrink:
After a growth surge last year, provider-sponsored
health plans might be running out of steam. Last month,
Denver-based Catholic Health Initiatives — one of the
nation’s largest health systems — pulled back on its
insurance business after posting a $109.6 million loss
in June (HPW 12/16/16, p. 8). In late September, Indi-
ana University Health Plans said it wouldn’t offer an
individual product through HealthCare.gov. “Provider
organizations are beginning to recognize just how dif-
ficult the insurance industry really is, how complicated it
is and how completely different the rules are compared
to what they’re accustomed to,” says Nash. Last spring,
there were more than 270 provider-sponsored health
plans participating in government and commercial mar-
kets, according to AIS Health’s annual survey of health
plans. Nash forecasts a further and significant decrease
in provider-sponsored plans for 2017. The insurance
business and the provider business are completely differ-
ent business skill sets. “I think they underestimated the
complexity of risk. Most provider-sponsored health plans
don’t employ a single actuary,” he quips.
(4) Provider-sponsored health plans will grow: Mi-
chael Adelberg, a senior director at FaegreBD, predicts
these hospital owned health plans will grow in 2017.
“Despite all of the headlines about mergers and insurers
dropping markets, there will be more entities with health
insurance licenses at the end of 2017 than there are now.
That is because we will continue to see hospital systems
bridging into insurance, enabled by [accountable care
organizations] and joint ventures with out-of-area in-
surers,” he says. Adelberg is a former senior official in
CMS’s Center for Consumer Information and Insurance
Oversight (CCIIO).
(5) Lawmakers may push to privatize Medicare:
Warmuth predicts Medicare privatization and entitle-
ment reform could be the “new looming threat” to the
health insurance industry. On the campaign trail, Trump
said he wouldn’t cut Medicare. But some industry ob-
servers expect lawmakers will follow House Speaker
Paul Ryan’s (R-Wis.) playbook and push to turn Medi-
care into a premium support program.
(6) Carriers will continue to invest in value-based
care: Insurance carriers have no reason to pull back on
VBC, which has the potential to slow medical cost in-
creases and improve quality. But results are dependent
upon effective integration between carriers and provid-
ers, which must go beyond initial collaboration and
include shared risk, says Paul Lambdin, a managing
director at Deloitte Consulting LLP. “Increasingly, VBC
is understood to require shared risk, both up and down-
side.” The idea of being “in it together,” he adds, requires
health insurers to rethink the value proposition brought
to providers.
(7) Consumers will turn to the Internet for Rx shop-
ping: Consumers will increasingly turn to the Internet to
shop for everything from medical services and providers
to discounts for prescription drugs, says Libby Baney, an
attorney and principal at FaegreBD. She points to Blink-
Health, a legitimate discount service, or the more than
30,000 websites that illegally sell prescription medicines
without a prescription from unlicensed entities. Those
organizations, she warns, frequently sell falsified or un-
approved products.
(8) Population health could gain strength: Payers
have been driving the market toward population-based
care for decades, and have successfully used care coor-
dination and evidence-based practice to reduce admis-
sions, says Nash. “You could argue that payers have been
on the righteous road more than providers, and now we
have some existential questions under Trump,” he says.
Web addresses cited in this issue are live links in the PDF version, which is accessible at
HPW’s subscriber-only page at http://aishealth.com/newsletters/healthplanweek.
From the Editor:
Fasten Your Seatbelts for 2017
Dear readers: AIS Health has decided to shut-
ter HPW’s sister publication, Inside Health Insurance
Exchanges, due to the unknown future of both public
and private exchanges. Five years after launching
HEX, I’ve moved back home to Health Plan Week, the
publication I wrote during the ferocious battle over
health reform in 2009, and during the development
of legislation that ultimately became the Afford-
able Care Act in 2010. It appears that I’ll soon begin
documenting the unraveling of that very law…and
explaining the impact on health insurers, broker/
agents, benefits consultants and employers. HPW’s
annual Outlook issue includes perspectives from
more than a dozen industry observers who weigh in
on everything from the future of insurance exchang-
es and transition challenges at CMS to the ever-
evolving large-group market, and what employers
want from insurers in the year ahead. As we begin
our initial approach into the New Year, please be
sure your seat backs and tray tables are in their full
upright and locked positions, and that your seatbelts
are securely fastened. It looks like we’re about to hit
some rough air.
continued
4. 4Health Plan Week January 9, 2017
“I’m hoping the road from volume to value remains
clear, paved and accessible. But there are potholes on this
road.
(9) Carriers might outsource more technology: Aging
infrastructure, and the costs of keeping up with technol-
ogy, could push regional health plans to outsource more
functions, and that could help to free capital, says Lamb-
din. He says there is a healthy market for outsourced
solutions, which could help to shift the culture of a health
plan “to focus on what is differentiating and meaningful
to consumers and providers.” Health plan CEOs realize
that the pace of change in technology, as well as the in-
vestment and scale required to keep up with it, requires
them to “relinquish building and focus on effective
sourcing and orchestration of assets,” he says.
(10) Consumers will have greater access to virtual
providers: Baney predicts telehealth will play an in-
creased role in public and private plans and in direct-to-
consumer care “driven by the need to address access to
care and cost issues at a time of uncertainty for plans and
patients,” she says. Over the past year, several states have
broken through barriers that limited how carriers used
telehealth. Last March, Indiana Gov. and Vice President-
elect Mike Pence signed a telehealth bill that gave pro-
viders authority to write prescriptions for non-controlled
substances through telehealth visits. The law, which went
into effect July 1, also eliminated a rule that requires tele-
health patients to undergo a physical examination before
a prescription can be written. Last month, the Wiscon-
sin Medical Examining Board approved new rules that
would, among other things, allow a valid physician-
patient relationship to be established through an online
visit, The National Law Review reported Dec. 21. The rules
require approval from state lawmakers and Republican
Gov. Scott Walker.
Contact Day at rosemarie@dayhealthstrategies.com,
Baney at libby.baney@faegrebd.com, Potter at wendell@
wendellpotter.com, Nash at david.nash@jefferson.edu,
Greene at sgreene_us@yahoo.com, Adelberg at michael.
adelberg@faegrebd.com, Lambdin at plambdin@deloitte.
com and Warmuth at jay.warmuth@faegrebd.com. G
2017 Outlook
Despite Stable Rates, Employers
Will Push Insurers for Savings
Health insurance rates in the group market have
remained relatively stable over the past several years.
However, little has been done to impact the cost of medi-
cal care, and employers in 2017 will push health insurers
for more savings.
As the economy has grown more robust, employ-
ers are looking to grow their business and want to rein
in employee benefit costs, says Cary Badger, a former
Regence Group executive who is now a principal at Chi-
cago-based consulting firm HealthScape Advisors LLC.
Employers will increasingly look to carriers to control
costs through tighter integration with providers, which
could mean more bundled payments for episodes of care,
for example. “It’s not a fee-for-service environment any-
more. Employers want to see some creativity on the part
of carriers. Employers don’t want to get out of insurance
or move to defined contribution….They want robust
benefits that they feel are sustainable.”
The Affordable Care Act (ACA) made several im-
portant changes to the individual market, which have
the potential to take root in the group market, says Mark
Hall, a professor of law and public health at Wake For-
est University. Those developments include private
exchanges and narrower networks. And chaos in the
individual market could negatively impact group-market
rates if an ACA appeal prompts an increase in uncom-
pensated care. Cuts to the Medicaid program also could
affect group rates, says Chantel Sheaks, an employee
benefits attorney and director at PwC.
Although it’s difficult to predict whether group rates
will stay steady, large employers are starting to look to
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should click the blue “Login” button at www.AISHealth.com, then follow the “Forgot your password?” link to receive further instructions.
Top 10 HPW Headlines From 2016
Here’s a list of the top 10 issues from HPW’s
front pages in 2016:
u HRA Provision in Cures Act Could Be a Shot in
the Arm for Ailing Individual Market (Dec. 19)
u Anthem-Cigna Trial Starts as Wall Street Remains
Dubious Amid Tough Questioning (Nov. 29)
u Trump Reigns: Health Insurers Face a New World
as ACA Is an Endangered Species (Nov. 14)
u Insurers Are Blamed for Not Meeting ACA Rules,
Delaying Opioid Addiction Coverage (Oct. 3)
u MACRA Poses Questions for Health Plans As
Providers Gauge Networks, Payments (Aug. 1)
u Boeing Takes Direct-to-Employee ACO Model to
SoCal, Will Offer to 15,000 Staff (June 27)
u Dire Warnings on Possible Spread of Zika Virus
Put Some Plans in the Crosshairs (May 30)
u UnitedHealth Exits Two ACA Markets for ’17; In-
dustry Ponders Big Picture for Exchanges (April 18)
u Anthem Ratchets Up Pressure, Files $15B Suit vs.
Express Scripts in Contract Dispute (March 28)
u Health Insurers May Have New Options for HIV
Drug Strategies as Generics Loom (March 21)
6. 6Health Plan Week January 9, 2017
u Deeper employee engagement: A growing number of
employers encourage their workers to take a more active
role in their health care. That trend is expected to increase
in 2017. Employers traditionally have leveraged plan
design to drive utilization behavior in an effort to reduce
medical expenses. But employers are expecting, and
even demanding, more behavior changes as they seek
a deeper impact on cost, says Valerie Bogdan-Powers,
chief business development and client relations officer at
Horan Securities, Inc., a Cincinnati-based benefits consul-
tancy and United Benefit Advisors (UBA) partner firm.
u Adoption of narrow networks: While moving to a
narrow provider network can reduce coverage costs, it’s
generally a one-time cost savings that doesn’t improve
medical trend significantly, says Badger. “It’s a bit of an
artificial tactic, and workers generally don’t like them,”
he says. But Wojcik contends there has been increased
interest in tighter, high-performance networks if carriers
can ensure patients receive high-quality, cost-efficient
care. Over the past 20 years, people have seen wide vari-
ation in quality, he says. “I don’t think it’s a one-time fix.
Employers could reap the benefits of it each year if they
use quality as a criterion for those networks.” Bogdan-
Powers says some employers are embracing narrow
networks and/or going to a single provider system in
order to further cost improvements.
u Providers opting out of networks: Sheaks says she’s
seen an uptick in providers opting out of networks,
which creates potential problems for insurers and
employers. When a worker seeks care from an out-of-
network provider, neither the carrier nor the employer
can do anything to control costs. And enrollees typically
don’t understand that they could be balance billed — un-
less state law prohibits it in insured arrangements — or
the claim may not be paid at all, she says.
u More litigation: Sheaks says 2017 will bring more
litigation for insurance carriers. She notes that 2016 was
record-setting in the number of proposed health care
class actions — from mental health parity to COBRA
Get instant health plan news! Follow HPW at:
www.twitter.com/AISHealth • www.facebook.com/AISHealth • www.linkedin.com/company/atlantic-information-services
notices to lactation. “I see this continuing into 2017, and
insurers and plan sponsors need to be on the defensive.”
u Cadillac tax 2.0: Late last year, Congress delayed
implementation of the Cadillac tax, or excise tax on
high-value health plans, from 2018 to 2020. But employ-
ers could face a different type of cost under the new
administration. Tom Price, M.D. (R-Ga.), Trump’s pick
to head HHS, has proposed capping the tax deductibil-
ity of health coverage at $8,000 per worker ($20,000 for
families). If that happens, consumers could see higher
out-of-pocket costs if employers boost copayments and
deductibles to keep premiums below the cap, says Bryce
Williams. “The effect will be similar to the Cadillac tax,”
he says, “with health care inflation taken on solely by the
employees.” Sheaks agrees and notes that while many
employers support repeal of the Cadillac tax, the replace-
ment would be a tax on workers.
u Private exchanges: Despite the enormous buzz around
private insurance exchanges a few years ago, many em-
ployers are dubious the model can reduce coverage costs.
While Badger suggests employers are willing to experi-
ment, he says they want a model where carriers compete
more aggressively on more than premiums, such as
the performance of provider relationships. Alternative
solutions, such as benefits administration and human
resource information systems (HRIS), offer employees a
similar buying experience without requiring a defined
contribution model, adds Rooney. Vicki Ferentz, vice
president at Acadia Benefits, Inc., a UBA partner firm
in Portland, Maine, says employers in her area haven’t
shown much interest in private exchanges. Many em-
ployers are afraid to make a change, she says.
u Enhanced wellness programs: Rooney says success-
ful wellness programs have proven to be effective in
mitigating rate hikes. Groups that implement a sustain-
able wellness program as part of their corporate culture
experience a higher return on investment in the form of a
healthier employee population and lower claims experi-
ence, he says.
u Narrower prescription coverage: Everyone wants
their drug covered and their condition to have access to
the newest and best drugs, but that comes with a hefty
and growing price tag, says Ferentz. Many insurance
companies have created narrower formularies, to help
control costs in their community rated pools — and for
the claims experience on their large experience-rated
groups/customers. These new formularies come with
higher copays, higher coinsurance and dropped coverage
for certain drugs, she says. Employers then have to de-
termine the type of benefits they can afford, as well as the
impact on employee relations and retention issues.
u Better shopping through technology: Employers are in-
vesting in tools that allow employees to research cost and
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Cross and Blue Shield Association or any of the independent
Blue Cross and Blue Shield companies.
7. January 9, 2017 Health Plan Week 7
asked to do, and continue to serve the American people
as best they can.”
A mass exodus at HHS and CMS could impact the
Trump administration’s ability to carry out its promises,
says Peter Nakahata, a former senior advisor on exchang-
es at CCIIO. Some career employees will stick around
because they are invested in federal service, while some
senior CMS and HHS officials might be enticed to leave
by offers in the private sector. “My guess is that there will
be some early attrition, but not an immediate flood.”
A spokesperson for the Trump transition team de-
clined to respond to HPW’s questions about the exchang-
es, HealthCare.gov or the future of the agencies and their
employees under the new administration.
Will Carriers Abandon Ship?
During a late-December conference call with report-
ers, HHS Sec. Burwell said HealthCare.gov had received
more than 30,000 questions about whether Obamacare
was ending and if they should still sign up for coverage.
Christopher Condeluci, principal of CC Law & Pol-
icy in Washington, D.C., expects that the premium sub-
sidies and the ACA exchanges will continue for at least
two years. He suggests carriers might have an incentive
to stick around. Republican lawmakers will work to
improve the regulatory environment for carriers because
they fear being blamed if the marketplaces collapse, even
though the current unbalanced risk pool is largely due to
Democratic policies, he says.
“Republicans don’t want carriers to pull out and, in
fact, would like to bring back carriers that left,” he says.
“Republicans believe status quo isn’t healthy for the carri-
ers and it certainly won’t encourage carriers to re-enter.”
Improvements could include more robust and meaning-
ful enforcement of the special enrollment periods (SEPs),
which might require pre-verification of eligibility. They
also might require that premiums be paid within 30 days,
rather than 90, to ensure coverage. Condeluci worked for
the Senate Finance Committee during the drafting of the
ACA.
Scully agrees that exchanges will operate as usual
for the next two years, or more. While carriers have lost
billions on the exchanges, they now have a better under-
standing of the enrollees and their costs.
If insurers believe they can make money on the ex-
changes, they’ll continue to participate. Scully expects
the incoming leadership will work to convince carriers to
hang in at least another year.
Contact Condeluci at chris@cclawandpolicy.com,
Scully at thomas.scully@alston.com, Nakahata at pete@
ptn-consulting.com, Jost at jostt@wlu.edu and Adelberg
at michael.adelberg@faegrebd.com. G
Business as Usual at HHS, CMS?
continued from p. 1
Given the volume of new regs, the incoming admin-
istration will need to sift through them and determine
whether to keep or reverse them, says Thomas Scully,
who headed CMS under President George W. Bush.
“I don’t think there will be any radical change [at
HHS or CMS]. But there will be almost nothing new
coming out.” He says it could take several months before
the Senate confirms an HHS secretary and a CMS admin-
istrator. Until then, the agencies will likely be operated
by a skeleton transition team as government appointees
pack up. But many career staffers will remain.
“Career people at the agency are incredibly loyal.
They might not always agree with the philosophy of the
administration, but they are supportive,” he adds. Scully
is now a general partner with Welsh, Carson, Anderson
& Stowe, a private equity firm in New York. HHS has
more than 77,000 employees, and CMS employs more
than 6,000.
Politico reported Dec. 21 that independent research-
ers were downloading key health care data and docu-
ments before Jan. 20 for fear they could be expunged.
It’s presumed that the exchange open-enrollment
period will move along, concluding Jan. 31 as scheduled.
HealthCare.gov and the call center will be available and
staff will continue to work on data-matching issues, says
Timothy Jost, Ph.D., emeritus professor, Washington and
Lee University School of Law.
“There are people who have spent the past six years
working hard to implement a very complicated statute
under very difficult circumstances. Many of them have
been around for quite a while and have lived through
several administrations that had different views,” he
says. “Those people will continue to do what they’re
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should click the blue “Login” button at www.AISHealth.com, then follow the “Forgot your password?” link to receive further instructions.
quality of services prior to receiving them, says Bogdan-
Powers. Technology is advancing in this area to allow a
better shopping experience in an industry that has had
very little. An example of this is the ability to research
MRI costs across multiple providers within a ZIP code
prior to making an appointment. Employers are setting
maximum prices on certain procedures to encourage bet-
ter engagement, she adds.
Contact Badger at cbadger@healthscape.com,
Wojcik at wojcik@businessgrouphealth.org, Sheaks at
chantelsheaks@gmail.com, Joe Moran for Rooney at joe.
moran@selectebs.com, Bogdan-Powers at valerieb@hor-
anassoc.com, Hall at mhall@wakehealth.edu, Rob Wyse
for Williams at rob@capital-content.com and Ferentz at
vferentz@acadiabenefits.com. G
8. 8Health Plan Week January 9, 2017
Call BJ Taylor at 202-775-9008, ext. 3067 for rates on bulk subscriptions or site licenses, electronic
delivery to multiple readers, and customized feeds of selective news and data…daily, weekly or whenever you need it.
u In some regions of the country, expensive insur-
ance premiums “are bugaboos” for coverage sold
through public insurance exchanges, but they can
be remedied by policy proposals, according to a
Jan. 4 Urban Institute report funded by the Robert
Wood Johnson Foundation. Large premium increases
were seen in many markets that had very low premi-
ums during the early years of reform. The paper also
notes that premiums tend to be higher in areas where
an insurer or provider group has a monopoly or few
competitors. Finally, the authors say that inadequate
risk adjustment, such as moving premium dollars
from insurers with low-cost enrollees to insurers
with high-cost enrollees, might also have contributed
to high premiums in some areas. The authors suggest
increased financial assistance, combined with higher
penalties for not having coverage, could make ben-
efits more affordable. The report also suggests cap-
ping the amount doctors and hospitals are paid for
their services. See the report at http://tinyurl.com/
j6olpmz.
u As of Dec. 31, 8.7 million people had signed up
for coverage through HealthCare.gov — up 1.8%
from the same date a year ago, CMS reported
Jan. 4. However, this year’s enrollment includes
Kentucky (70,542), which previously operated a
state-based exchange and wasn’t included in last
year’s count. When open-enrollment began this year,
HHS predicted between 12.8 and 14.8 million people
would select plans for 2017. About 75% of people
who have signed up for coverage were previously
covered by an exchange-based plan. Over the past
three years, enrollment in Medicaid and the Chil-
dren’s Health Insurance Program (CHIP) has in-
creased by 30%, or 17 million people, CMS reported
Dec. 30. Enrollment among the Medicaid expansion
states increased 37%, while it grew by 16.5% in non-
expansion states.
u Rochester, N.Y.-based Excellus BlueCross
BlueShield is partnering with Geneia LLC, an ana-
lytics and technology company, to deliver value-
based analytics to the health plan’s 1.5 million
members. Geneia says its Theon platform led to a
7.2% reduction in inpatient admissions, a nearly 15%
reduction in readmissions for Medicare plan custom-
ers, and an 8% reduction in emergency department
visits for employer group and Medicare plan cus-
tomers. Visit Geneia.com
u More than 20% of Medicare fee-for-service
payments now flow through alternative payment
models, which is within reach of the Obama ad-
ministration’s goal of 50% by 2018, the Journal
of the American Medical Association reported Jan. 3.
A recent change in the way Medicare pays for joint
replacements is saving millions of dollars annually
without impacting patient care, according to the
report. Under the new program, Medicare effectively
agrees to pay hospitals a bundled payment for all
care related to hip or knee replacement surgery. The
study points to a Texas hospital system that saved
Medicare $5,577 (about 21%) for each knee replace-
ment performed since the program’s inception. Rep.
Tom Price, M.D. (R-Ga.), an orthopedic surgeon and
President-elect Trump’s pick for HHS secretary, op-
poses mandated bundled payments for orthopedic
operations. Visit http://tinyurl.com/zvc647p.
u Overall Medicare expenditures in 2015 reached
$646.2 billion, or 20% of total health care spend-
ing, according to the latest annual health expen-
ditures update from CMS’s Office of the Actuary.
And at 4.5%, the rate of Medicare spending growth
was slightly slower than the 4.8% increase in 2014,
which CMS largely attributed to a smaller increase in
Medicare enrollment (2.7% in 2015 vs. 3.1% in 2014).
Meanwhile, Medicare per-enrollee spending growth
was fairly stable at 1.7% in 2015, compared with 1.6%
in 2014, as Medicare hospital and prescription drug
spending growth slowed. CMS attributed the slower
hospital spending to reductions in disproportionate
share hospital payments as well as a continued de-
cline in utilization that was partially due to decreas-
ing hospital readmissions from 2011 to 2015. View
the full data sets and a CMS fact sheet at http://
tinyurl.com/zp7vbz7.
u CVS Health will launch its Transform Diabetes
Care program in early 2017, the company said Dec.
13. The initiative will focus on improving three as-
pects of the condition — medication adherence, A1C
control and lifestyle management — to boost health
outcomes and lower both pharmacy and medical
costs. The program “emphasizes tailored support for
members with diabetes.” The PBM says its custom-
ers could experience savings of “between $3,000 to
$5,000 per year for each member who successfully
improves control of their diabetes.” Contact Chris-
tine Cramer at christine.cramer@cvshealth.com.
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