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With Sumtotal, Pearson Government Solutions Supports U.s. Department of Health and Human Services

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With Sumtotal, Pearson Government Solutions Supports U.s. Department of Health and Human Services

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Home Page > Business > Corporate > With Sumtotal, Pearson Government Solutions Supports U.s. Department of Health and Human Services

With Sumtotal, Pearson Government Solutions Supports U.s. Department of Health and Human Services

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Posted: Sep 19, 2006 |Comments: 0
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SumTotal® Systems, Inc. (Nasdaq: SUMT), the largest provider of talent, learning and business performance technologies and services, said today that Arlington, Va.-based Pearson Government Solutions has deployed SumTotal Enterprise Suite 7.1 software to manage training for 3,000 customer service representatives (CSRs) who staff the 1-800-MEDICARE Helpline. Pearson Government Solutions manages the nationwide telephone line on behalf of the Department of Health and Human Services’ Centers for Medicare and Medicaid Services (CMS) to help beneficiaries with their questions about Medicare and their Medicare health plans.

Specifically, Pearson uses SumTotal Enterprise Suite 7.1 to deliver online training to CSRs who field calls on topics such as Medicare’s prescription drug coverage plan. SumTotal’s software will also assess how well the CSRs have mastered instruction on a particular topic, as CSRs must meet a high level of proficiency on a weekly basis across a number of subject areas. With SumTotal’s talent-management software, Pearson can assess each CSR’s performance.

“Measuring our representatives’ performance is critical to success, but we also want to capture institutional knowledge and disseminate that quickly to our customer service representatives,” said Mike Bowers, senior vice president and general manager of Pearson Government Solutions’ Health division. “SumTotal’s TotalCollaboration product gives us an easy way to capture knowledge from our company experts, and transfer this knowledge for future reference.”

TotalCollaboration enables Pearson’s CSRs to get answers from company experts via threaded discussions and instant messaging. According to Bowers, the system from SumTotal will boost the 1-800-MEDICARE Helpline staff’s productivity and knowledge.

“Pearson has a reputation for delivering superior service to federal government agencies,” said Don Fowler, chief executive of SumTotal. “We’re pleased that they have chosen to work with SumTotal’s Government Solutions group to serve not only the U.S. Department of Health and Human Services, but also the American public.”

For more information about SumTotal’s products and services, visit www.sumtotalsystems.com.

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Home Page > Finance > Insurance > CIGNA Government Services Federal Medicare Contracts Awarded Prestigious Quality Management Certification

CIGNA Government Services Federal Medicare Contracts Awarded Prestigious Quality Management Certification

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Posted: Dec 13, 2009 |Comments: 0
| Views: 200 |

CIGNA Government Services today announced it has again achieved the prestigious International Organization for Standardization (ISO) 9001:2008 certification, an internationally accepted quality management system. Certification includes all CGS Part B and Durable Medical Equipment Medicare Administrative Contractor (DME MAC) Program Management functions under contract with The Centers for Medicare and Medicaid Services (CMS).

ISO 9001:2008 certification requires organizations to develop and adhere to stringent quality management standards and to have controls and mechanisms in place to comply with all regulatory requirements. The ISO 9001:2008 certification also requires processes that enhance customer satisfaction and ensure continual improvements. Companies are required to pass an exhaustive audit of all quality management processes prior to receiving certification.

“This award recognizes CIGNA’s dedication to continuous quality improvement. Achieving this level of certification underscores the commitment we’ve made to our customers to continually raise the bar on performance,” said Jean Rush, president of CIGNA Government Services. “We take very seriously our responsibility as a Medicare contractor and the positive impact we can have on the lives of millions of Medicare beneficiaries, providers of durable medical equipment and health care professionals. I am proud of our employees’ continued commitment to quality and performance excellence demonstrated by this certification.”

CIGNA Government Services has provided services to Medicare since 1991. In June 2007, CIGNA was awarded the largest of four DME MAC contracts to provide claims processing, customer service and administrative services to over 55,000 durable medical equipment, prosthetics, and orthotics suppliers in 15 states, including: Alabama, Arkansas, Colorado, Florida, Georgia, Louisiana, Mississippi, New Mexico, North Carolina, Oklahoma, South Carolina, Tennessee, Texas, Virginia, and West Virginia as well as the territories of Puerto Rico and the U.S. Virgin Islands. CIGNA also holds federal Medicare Part B contracts for North Carolina and Idaho.

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Home Page > Finance > Insurance > HQP enters into agreement with Aetna to provide nurse care management services

HQP enters into agreement with Aetna to provide nurse care management services

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Posted: Jan 08, 2010 |Comments: 0
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Health Quality Partners (HQP) has entered into a three-year agreement with Aetna to provide nurse care management services to Aetna Medicare Advantage Plan members with certain chronic health conditions who receive their care at participating practices in Bucks, Montgomery, Lehigh and Northampton counties in Pennsylvania. The HQP Care Management Program is designed to help Medicare beneficiaries improve their health and quality of life and live more independently.

“We respect and value Aetna’s strong commitment to innovation and collaboration and look forward to working together to help improve the health of their Medicare Advantage plan members.”

Since 2002, HQP has participated in the Medicare Coordinated Care Demonstration, a national demonstration project sponsored by the Centers for Medicare and Medicaid Services (CMS). HQP’s care management model has proven successful in reducing hospitalizations and health care costs, and in improving health outcomes for Medicare beneficiaries at higher risk.

This unique model of community-based nurse care management incorporates well-established, evidence-based interventions designed to help reduce cardiovascular and geriatric risks for Medicare beneficiaries with chronic health conditions. Essential to the model’s effective implementation are the long-term relationships between the nurse care managers, patients and their families, primary care providers, other health care professionals and community resources.

“Aetna is very excited to offer access to this highly regarded program to our Medicare Advantage plan members in this area,” said Eric Cormier, general manager of Aetna Medicare in Pennsylvania. “Health Quality Partners has been a leader in providing outstanding, cost-effective care management programs to seniors in our region, and they share Aetna’s commitment to continually improving the quality of care received by our members to help them live healthier lives.”

“Every day, millions of older adults with chronic illnesses suffer needlessly and wind up using costly health care services for health problems that may have been prevented. Programs like HQP’s community-based nurse care management program can help improve quality of care and potentially reduce health care costs, according to the latest research,” said Dr. Ken Coburn, president and CEO of Health Quality Partners. “We respect and value Aetna’s strong commitment to innovation and collaboration and look forward to working together to help improve the health of their Medicare Advantage plan members.”

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Latest Centers For Medicare And Medicaid Services Auctions

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Healthcare Services: Why is our role as consumer being denied?

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Healthcare Services: Why is our role as consumer being denied?

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Home Page > Finance > Insurance > Healthcare Services: Why is our role as consumer being denied?

Healthcare Services: Why is our role as consumer being denied?

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Posted: May 20, 2009 |Comments: 0

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Healthcare Services: Why is our role as consumer being denied?

By: Rene Luis

About the Author

Rene Luis is the Founder of VitalOne Health and has worked in the Health Care and Health Insurance Industry for over 15 years. In 1991 he passed is certified public accounting examination in San Antonio, Texas.

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Article Source: http://www.articlesbase.com/ – Healthcare Services: Why is our role as consumer being denied?

The fact is we need to either ask the office manager, the plan administrator, the network provider, or the doctor how much it is for a particular health service. The reason is that prices for healthcare services are not easily accessible. They are difficult to compute, assess and manage. For this reason, we as consumers do not feel empowered to make good decisions with respect to our healthcare. The cards are stacked against us.

In recent times, it has come to light that many hospitals and providers charge special lower rates for services rendered to policy-holders of large insurance companies. Whereas, uninsured patients are charged the highest rates for the same services rendered. In addition, it is practically impossible to track and manage these costs. This is unfair and unjust.

Healthcare is not a transparent industry that caters to consumers. Most other industries that service consumers are focused on market conditions that drive their businesses. This means that promoting their prices is important. Imagine going to a gas station and not knowing how much they were charging for unleaded gasoline! Imagine attending a spa and just not knowing the cost of the services, but also later receiving the final bill that would be impossible to understand and that it would include items and services that you did not feel you received! There are not many businesses that could survive with this strategy.

As consumers, we are very disconnected from the healthcare services and costs that we receive. This is not a good model that entices good consumerism. Due to the fact that we are removed from the process of acting like a consumer, it is then easier to understand why we are not as focused on the costs. Yet, we complain and scream at our rising health insurance premiums. The truth is that it is not entirely our fault. We want to be better consumers, but the system doesn’t work to assist us. It is common practice to keep prices confusing to consumers and not to promote them.

All of us understand that healthcare is complex and includes many, many different goods and services, but it is definitely not as difficult as it is represented. American consumers are smart, intelligent, and able to make decisions with respect to their healthcare while also assessing a provider’s economic value for their goods and services. It is paramount that consumers are brought back into the healthcare model; they will drive up competition and quality service.

Like most of every other industry in the United States, pricing is an important gauge for goods and services. It is not acceptable that the healthcare industry does not provide its prices for goods and services to the users of those goods and services on a more formal and easier basis. As our healthcare industry matures, this will be a reform change that will come to the front of issues being raised.

As more and more health insurance plan designs incorporate consumer risk through high-deductible and health savings accounts, consumers will demand more transparency from their providers. It is only fair; it is only the right thing to do. There is no need to keep prices and costs behind locked doors where only a select group has readable access.

One may ask why government run businesses do not work, and they only need to look at our Medicare and Medicaid programs. In these cases, the consumer again has been removed from the equation therefore there are no checks and balances to guide the ship.

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