Health insurer Aetna Inc. said that it has terminated two Medicare Advantage plans, affecting about 200 individual plan members in Connecticut, the Hartford Courant reports. One plan, an HMO, had 75 members and had fallen below the minimum of at least 100 members required by the federal government. The other, a private, fee-for-service plan, is being phased out by Aetna in all but five states. The termination of the plan is the result of the federal government's mandating that all fee-for-service plans become network-based by 2011, said Aetna representatives.

Three new international studies detailing how patients became gravely ill with swine flu reinforce concerns that U.S. intensive-care units could be severely stressed as the second wave of the disease builds through the fall and winter. The studies of patients in Canada, Mexico, Australia, and New Zealand were reported a week after the vaccine against the H1N1 flu began being distributed in the U.S. The Centers for Disease Control and Prevention says the disease has become widespread in 37 states.

Enacting national healthcare reform legislation to extend coverage to the uninsured could prove to be a boon to one federal program: Medicare. By providing care to uninsured adults prior to age 65, more individuals could see improved healthcare—resulting in reduced Medicare spending in the long term, according to researchers of a new study published in the Annals of Internal Medicine.

Earlier studies have shown that Medicare spending may be higher for previously uninsured adults with cardiovascular disease and diabetes if poor or delayed care leads to complications before the age of 65 years. In addition, uninsured adults also may delay various costly elective procedures such as joint replacements for severe arthritis until they become eligible for Medicare, according to the researchers from Harvard Medical School.

The researchers used data from the nationally representative Health and Retirement Study, which beginning in 1992 interviewed older adults every two years about sources of health insurance. Looking at claims data from 1996 to 2005, they reviewed spending and hospitalization rates for adults with cardiovascular disease, diabetes, and arthritis, and also assessed annual total Medicare spending after age 65.

When the 2,951 continuously insured adults were compared with 1,616 adults who were continuously or intermittently uninsured before age 65, a noticeable difference was noted in annual costs.

Mean adjusted annual Medicare spending over the study period—from 1996 to 2005—appeared to be "significantly higher" for previously uninsured adults than for previously insured adults: $5,796 for those previously uninsured versus $4,773 for the previously insured, they said. Multiplied over years for millions of Medicare beneficiaries, these savings could be significant.

Much of the difference in the annual rates were related largely to increased inpatient and home health agency spending—concentrated among the 67% of adults who had cardiovascular diseases or diabetes. Those adults who were previously uninsured had more hospital stays and outpatient institutional visits than previously insured adults—but not more physician office visits.

Among those adults with cardiovascular diseases or diabetes, previously uninsured adults were more likely to be hospitalized for complications such as myocardial infarction, heart failure, or even stroke. And for those with arthritis, those who were uninsured before enrolling in Medicare were more likely to be hospitalized for joint replacement than those with prior coverage.

Thus, extending insurance to uninsured adults may result in improved health for many older working age adults—and even increased life expectancy. Plus, subsequent reductions in Medicare spending after age 65 could partially offset increased spending from expanded coverage before age 65.

The researchers, putting their findings into dollars, calculated that providing coverage to adults ages 51 to 64 would increase healthcare spending by $197 billion annually. However, this increased coverage would decrease later Medicare spending (for adults ages 65 to 74) by about $98 billion—essentially offsetting nearly half of the original costs.

These benefits suggest that health insurance coverage for uninsured adults—especially over the age 50—would be a more "valuable investment for the United States than previously thought," the researchers said.

The 2010 Towers Perrin annual Health Care Cost Survey of the nation's 300 largest businesses projects that the average per-employee healthcare cost in the coming year will increase by 7%, pushing that expense across the $10,000 threshold for the first time.

There weren't any hospitals in this group, but that doesn't mean we shouldn't pay attention to the findings. The healthcare sector—a notorious laggard in many worthy trends—is better protected from the risings costs of providing employee healthcare benefits than is the rest of the economy. That sometimes leads those within the healthcare sector to ignore the efforts of other industries grappling with healthcare costs.

Actually, other sectors of the economy might be leading the healthcare sector when it comes to creative healthcare costs containment measures. For example, the Towers Perrin survey found that large employers have aggressively embraced wellness programs as more and more data demonstrate their positive impact in the reduction of sick days and chronic disease, and improved productivity and morale.

"It's pretty clear that the trend is to try to build a culture of health," says Mark Olson, chief actuary for Towers Perrin Healthcare Consulting. "And as employers, especially HR executives, have crafted their plan, we see successful companies map out a strategy on what they want to do and how they want to achieve it and then begin to measure how well they're meeting those goals and tweaking things to achieve it."

The Fortune 1000 companies in the survey provide healthcare coverage to 5.2 million employees and dependents, who spend $29.4 billion on healthcare every year. Analyzing the 2010 data by coverage level, the average reported cost of medical coverage is $5,124 annually ($427 per month) for active employee-only coverage, $10,500 annually ($875 per month) for employee-plus-one-dependent coverage and $15,084 annually ($1,257 per month) for family coverage. With numbers like that, you can understand why curtailing healthcare expenditures has become a top priority for most business sectors.

With healthcare costs rising precipitously, employers are changing the measures by which they determine whether or not their healthcare program is a success. The focus of high-performing companies, for example, is expected to emphasize employee health status and risk, gaps in care through ongoing review of medical claims and employee perceptions of well-being in the workplace.

"It's not just the measurements, though. It's how you get employees engaged in their own well being and responsible for their care," Olson says. "The incentives then go along with trying to have employees buy into this and view their health as being an asset not just for now, but a longer-term asset that they can invest in by doing certain things and possibly changing behaviors."

High-performing employers that are most aggressively addressing rising healthcare costs plan to expand the use of employee health risk assessments, wellness programs, on-site biometric screening, promotion of healthy foods, and access to retail clinics.

People are uncomfortable with the idea that employers are taking a more and more aggressive role in the health of employees. How far will this go? When does the incentive turn to punishment for employees who can't meet their personal health metrics? There is an inherent friction between the rights of the individual and the legitimate concerns of the company as it tried to contain out-of-control healthcare costs.

"It is a really good point that employers have to be extremely careful with how far they go with this," Olson says. "Most employers are fairly cautious about what they do and how they structure it and they are careful that it is more inclusive than exclusive. If you got into a program and for some reason you didn't reach some goals, they encourage you to try and try again. It's about trying to change behavior and it's not easy to change behavior. To try to get people to motivated to keep trying to do the right thing."

Within five years, Olson says he expects to see more aggressive biometric screenings for data on body mass, blood pressure, blood sugar, and measures for behaviors like exercise, as electronic medical records facilitate patient connectivity, all of which will bring the privacy debate to the fore. "It's a fine line. It goes back to how intrusive are employers going to be," he says. It's clear that wellness programs are not a fad. In fact, these programs will be around as long as this nation's workforce gets older, fatter, and sicker. They will become more sophisticated and more effective with each year.

It's hard to deny that the wellness movement is motivated primarily by money. So what! In this case, the profit motive of the employer is aligned with the well-being of the employee. A successful wellness program means everybody wins. Privacy concerns are legitimate, but they can be overcome. Wellness programs are an encouraging trend born of necessity.