28 April 2011
California Edition
Calendar
May 4-7
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May 11-13
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June 3-5
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E-Mail
info@payersandproviders.com with
the details of your event, or call
(877) 248-2360, ext. 3. It will be
published in the Calendar section,
space permitting.
Aetna Seeks A Smaller Rate Hike
Regulatory Pressures May be Forcing Moderations
Aetna, Inc. has backed off a proposal
submitted to the California Department of
Insurance earlier this year to raise rates on its
individual policyholders an average of 17.9%,
and instead will raise rates just 12.2%.
Aetna twice agreed to reduce the rate
hike after a review by Insurance
Commissioner Dave Jones, having led a
request for a 15.6% increase last month but
since reducing it further. The new rates go into
effect for about 43,000 policyholders on July
1.
“Aetna policyholders will benet from
Aetna’s decision to lower their proposed July
1st rate increase,” Jones said in a statement
issued late Wednesday night. He added that
the change will save Aetna’s enrollees about
$6.8 million in premiums over the next year.
Last year, Aetna sought and received
permission to raise rates an average of 19% on
its approximately 65,000 individual
policyholders in California, although some
saw their premiums go up as much as 30%.
In a ling with the DOI last month, Aetna
claimed its medical costs increased 14.9% in
2010. It projected an increase of 12.5% for
2011.
An Aetna spokesperson would only
conrm that it was working with DOI on its
rate application and declined further
immediate comment.
“I’m not ready to declare victory until I
take a look at the new ling, but I will say the
www.lakesidecommunityhealthcare.com
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insurers are aware of both the federal health
reform law, and a bill in the Legislature that
would provide more scrutiny and require their
applications be much more rigorous in terms
of what they’re putting forward for rate
increases,” said Anthony Wright, executive
director of Health Access, a Sacramento-based
advocacy organization.
Aetna’s rate ling was made public at
virtually the same time the Assembly Health
Committee approved AB 52 Tuesday. That bill
would allow state regulators to reject rate
hikes considered excessive, and permit civil
litigation by consumers to potentially block
rate increases. The federal Patient Protection
and Affordable Care Act also requires insurers
to publicly announce rate increases in
advance of their imposition.
Currently, no regulatory body in
California has the right to reject health
insurance premium increases outright, but
insurers are clearly under increased pressure
to keep their rates in line. Jones publicly
announced his support for AB 52 in two
statements issued by his ofce on Wednesday.
Blue Shield of California last month
backed off on a series of rate hikes that would
have increased some premiums for individual
policyholders by as much as 87%. The
Department of Managed Health Care recently
sent a letter to the San Francisco-based health
Continued on Next Page
 Payers & Providers
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In Brief
Orange County
Supervisors Vote
Against Cal-Optima
Product Expansion
The Orange County Board of
Supervisors took the first step
toward prohibiting its quasi-public
Medi-Cal managed care health
plan from enrolling commercial
members.
The board voted unanimously
earlier this week to amend Cal-
Optima’s charter to prohibit it from
entering into commercial ventures.
A second vote in May is scheduled
to finalize the change.
The move was prompted by
concerns in Orange County’s
business and political communities
that Cal-Optima would compete
on California’s health insurance
exchange when it began selling
coverage in 2014.
The exchanges are part of the
Patient Protection and Affordable
Care Act, which has little popular
support in the mostly conservative
county. Several Medi-Cal managed
care plans statewide have
announced their intent to compete
on the exchanges.
Moreover, business leaders
were unhappy with the notion that
Cal-Optima could take
membership away from
commercial health plans.
Molina Issues 3-for-2
Stock Split
Long Beach-based Medicaid
managed care insurer Molina
Healthcare will issue a three-for-
two split of its stock.
Each Molina shareholder will
receive a dividend of one share of
stock for every two shares they
Continued on Page 3
NEWS
Rate Hikes (Continued from Page One)
plan asking to justify the imposition of a
37.5% average premium increase that went
into effect on Jan. 1. It sent a similar letter to
Anthem Blue Cross asking why it intends to
raise rates on May 1 for products regulated by
the agency more than similar products under
the DOI’s jurisdiction.
“Our action...helps to further rein in
the ‘wild west’ of rate increases for consumers
in the individual health coverage market,"
said DMHC spokesperson Lynne Randolph.
Judy Dugan, research director for
Consumer Watchdog, a Santa Monica-based
advocacy group, said plans such as Aetna
were not only greater public scrutiny, but may
also have overestimated the cost of providing
care to their members. “If their medical cost
trends came in low enough, they would have
to refund premiums to policyholders, which
they don’t want to do,” she said.
Dugan, whose organization has
CDPH Fines Nursing Facility $100,000
Citation Stems From 2010 Strangulation of Patient
The California Department of Public Health
has issued the most severe citation under state
law and levied a $100,000 administrative
penalty against a Bay Area skilled nursing
facility where a patient was allegedly
murdered by a staff member last year.
The penalty was issued against the San
Francisco Nursing Center – formerly known
as the Convalescent Center Mission Street –
for violating state regulations prohibiting the
abuse of patients. It stemmed from a bizarre
and gruesome incident that took place on the
premises on March 22, 2010.
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Page 2
endorsed AB 52 and won a voter initiative
victory governing automobile insurance rate
increases back in the late 1980s, added that
criticism from regulators and the public only
has a limited effect.
“Jawboning only works for a little while.
They’re not going to keep rates lower forever
because they’re getting a ‘tut, tut’ from the
government,” she said.
And despite what appears to be a
potential future of more moderate premium
increases, Wright remained concerned that
Aetna’s hike would still put nancial pressure
on its policyholders.
“I’m not sure most consumers would
cheer a double-digit hike (in lieu of) a 30%
increase,” said Wright, who sits on the Payers
& Providers editorial board. “We’re still going
to take a closer look at those lings, and we
still have work to do.”
According to the CDPH and published
reports, an employee walked into a patient
room and caught 33-year-old nursing assistant
Maximo Hong Fajardo, Jr. allegedly pinching
the nostrils of 87-year-old patient Barbara
McIver while covering her face with a pillow.
Fajardo ed the facility and proceeded to
carjack and crash two vehicles and attempted
to carjack a third vehicle when bystanders
apprehended him.
Continued on Next Page
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In Brief
own. The distribution will be
made on May 20 for shareholders
of record on May 9. Trading based
on the split will commence on
May 23. The issuance is expected
to increase Molina’s float by
about 15 million shares, to just
under 46 million.
“We are pleased to expand
the opportunity for additional
investors to participate in our
success and to provide existing
shareholders with a stock
dividend to reward them for their
continuing confidence in our
company,” said Molina Chief
Executive Officer J. Mario Molina,
M.D.
Molina trades on the New
York Stock Exchange under the
symbol of “MOH.” Shares were
down slightly Wednesday, the day
the split was announced, but the
stock is trading near its 52-week
high of $42 per share.
Blue Shield Claims
Initiative On Green
Front
Blue Shield of California has
claimed it has reduced the
amount of paper it uses in
communications by 45% over the
past two years, preventing the
discharge of more than 3,500 tons
of greenhouse gases, 26 million
gallons of wastewater and 1,100
tons of solid waste.
The San Francisco-based
non-profit health plan disclosed
the data as part of its report on
social responsibility initiatives.
"We're committed to
reporting tangible numbers that
demonstrate the impact of our
social responsibility work
wherever possible," said Nancy
Shaw, corporate social
responsibility manager for Blue
Shield of California. "By
measuring our efforts, we're able
to track our progress on initiatives
that benefit the environment, the
community, and our members.”
NEWS
CDPH (Continued from Page One)
McIver was non-responsive, and it was later
determined she died of asphyxiation.
Fajardo, who had been licensed as a nursing
assistant since 1999 and had no criminal
record, has since been charged with McIver’s
murder. He is expected to go on trial later
this year.
In its report, the CDPH noted that
Fajardo had been hired and assigned to care
for seven patients, even though he had no
prior experience caring for elderly or frail
patients. He was given no formal orientation
or informed of his specic duties and
obligations to the patients. The alleged attack
Plans Say Bills Are Too Burdensome
Claims Pending Legislation Could Cost $709M
The primary lobbying group for the state’s
health maintenance organizations says bills
pending in the Legislature mandating
additional healthcare coverage would impose
more than $709 million in additional
premiums on Californians – a claim the state
agency in charge of analyzing such legislation
called inaccurate.
The California Association of Health
Plans declared that 12 pending bills that
mandate expanding coverage for benets such
as autism, breast cancer screenings, mental
health services and acupuncture could add as
much as $790.1 million to premiums if
passed. The group used analyses compiled by
the California Health Benets Review
Program, which briefs the Legislature on
healthcare bills.
CAHP spokesperson Nicole Kasabian
Evans said the impact on premiums was much
higher than in past years. During the previous
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Page 3
on McIver – who suffered from dementia –
occurred on Fajardo’s rst day on the job after
a two-week training period. No formal
evaluation of Fajardo took place during his
training period. The nursing director refused to
check on Fajardo the day of the alleged
murder, even though a colleague repeatedly
informed her he appeared disoriented.
The CDPH issues three classes of
citations, with AA being the most severe. The
$100,000 ne is also the highest permitted
under law. The facility could lose its license if
it receives another AA citation within two
years.
legislative session, the potential impact on
premiums was $280 million, and $400 million
in the session prior to that, according to CAHP
data.
However, CHBRP took issue with the way
CAHP performed its calculations. “We don't
agree with CAHP's methods of adding up all
the dollars of the marginal impact of each of
the bills since if all the bills were to pass into
law there would be overlap,” said director
Susan Philip. For example, Philip noted that
two pharmacy benet bills currently pending
would likely be consolidated into a single bill
at a future date.
Most bills would impact premiums no
more than one-tenth of 1%, according to
Philip. But SB 155, a bill that would require
more maternity service coverage by preferred
provider organizations, could impact
premiums by as much as 3.5%. However, that
bill was not included in the CAHP analysis
because it does not represent PPOs.
]
Payers & Providers
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OPINION
Small Practices Avoid EHR Installation
Changes Must Be Made to Encourage Adoption
With the federal government’s electronic health all the trafc to exit and take back roads.
record (EHR) incentive program hitting high-
gear, early signs are that it is a success.
The program for providers ling for the
payments through the Medicaid system began
on Jan. 6 in about a dozen states and has
already distributed $37 million in payments.
The Medicare system incentive program will
begin nationwide on April 18. !
These payments will be awarded to physicians
and hospitals that have demonstrated
“meaningful use” of EHRs through
either Medicaid or Medicare.
The government’s goal is to
have virtually 100% of the nation’s
physicians and hospitals using and
exchanging EHRs for patient data.!
However, we are seeing some
trends that indicate a substantial
number of physicians, primarily in
small medical groups, will be left
out. !
A survey conducted in early
2010 by SK&A found that only
28% of solo practitioners had By Brad Melis
adopted EHRs, while 71% of
physicians in large medical
groups (26+ doctors) had done so. A more
recent survey, conducted after the meaningful
use program was launched by the National
Center for Health Statistics (NCHS), found that
while 41% of ofce-based physicians are
planning to achieve meaningful use and qualify installed in a physician’s ofce.
for the incentives, 14% said they were not
planning on qualifying or applying for
payments.!
Who are these reluctant physicians who
remain dependent upon paper records? Studies
show them to be solo practitioners or
physicians in smaller, independent medical
groups that are not closely afliated with a
hospital. They tend to be older physicians who
are not comfortable with computers or the
Internet. !
We can’t afford to ignore small medical
groups. About 40% of all physicians are solo
practitioners or work in a medical group of six
or less. When the federal incentive program
ends in four years, if we have 20 or 25% of the
nation’s physicians unable to collect and
transmit EHRs, it will be considered a failure.
For example, imagine a 1,000-mile interstate
highway with a gap every 100 miles, requiring
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Page 4
Bottlenecks and trafc jams would be a way of
life, commerce could not ow smoothly and
transportation costs would be high. !
Three steps in particular will help improve
EHR adoption rates among small medical
groups:
1. EHR systems must improve their usability.
While most EHR systems have improved steadily
in terms of speed and ease of use in recent
years, some physicians still nd them difcult to
use. One area that holds signicant
potential is voice recognition. Many
older physicians are used to
dictating their notes. Advanced
EHRs now incorporate dictation
and voice commands. !
2. Health information exchanges
(HIEs) must expand. HIEs are
currently operating only in scattered
regions around the country.. It is
very difcult for physicians to
realize signicant value from
EHRs when they cannot send and
receive information from other
physicians and hospitals. !
3. EHR vendors must become
more involved with the meaningful use program.
Vendors must become more committed to
helping physician customers meet the
meaningful use standards. Too often, vendors
feel their obligation is to simply get their EHR
Second, vendors should take the time to get
involved in working with federal ofcials in
shaping Stages 2 and 3 of the meaningful use
program.
There will be no turning back the clock; the
era of EHRs has arrived. Small, independent
medical groups face a unique set of challenges
when implementing EHRs and connecting to
larger regional networks. Our national drive to
adopt EHRs and move to a new level of
efciency and accountability will not be
complete until we get these physicians
incorporated into the new world of connectivity.
Brad Melis is executive vice president of
ChartLogic in Salt Lake City.
Op-ed submissions of up to 600 words are
welcomed. Please e-mail proposals to
editor@payersandproviders.com,
Payers & Providers MARKETPLACE/EMPLOYMENT Page 5

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opportunities for just $1.25 a word.

If you prefer discretion, we’ll handle all

responses to your ad.
Call (877) 248-2360, ext. 2, or e-mail
advertise@payersandproviders.com.

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