24 April 2012

Midwest Edition
Calendar
April 25
!8!<81=$=6=0!>3#!?0/%=7@/#0!<A"#340A08=! BC@$08@0!3>!<A"#340A08=D10A$8/#E!F3#! @%$8$@$/81!/85!0G0@6=$401!100H$89!/8! $8=#356@=$38!=3!$A"#340A08=!1@$08@0E!IJ! K/##$3==(!;7$@/93E!L*(MNOE ;%$@H!?0#0!>3#!K3#0!<8>3#A/=$38

Cost-Cutting Measures In Missouri

Foundation Makes Recommendations For Future
The Missouri Foundation for Health is a nonpartisan organization that develops and funds health programs in St. Louis and Eastern Missouri. For the past couple of years, the group has been out in the eld, educating individuals about the impacts of the Affordable Care Act. Although he expects the ACA to lessen some future cost increases, Ryan Barker, director of health policy for the foundation, believes overall healthcare costs are expected to increase in the coming years. Healthcare costs are about 18% of the economy and our next big conversation is how we really will impact costs in Missouri, he said. With the state being in its budget crises for a handful of years and merely eliminating line items to save money, Barker said it was time for his organization to offer some alternative solutions. They usually are just pushing those costs elsewhere they always show up somewhere, he said. We need to address healthcare costs in a real way by coordinating care and getting rid of waste in the system and ultimately providing better coverage for Missourians. The foundation partnered with the Lewin Group to create the report, Bending the Health Care Cost Curve in Missouri, Options for Saving Money and Improving Care. Lewin brought a dozen options to the table and the Missouri Foundation for Health narrowed it to six that they thought would be the most helpful, and feasible, in Missouri. The solutions are: Implementing mandatory managed care for dual eligibles Adopting bundled payment methods Increasing shared decision making and palliative care Creating a robust state insurance exchange Implementing a medical home model for chronic disease management; and Broadening the scope of primary care. Barker noted the recommendations focus on better coordinating care. Consumers often go to a primary care provider and they do lab work and tests and then they are sent to a specialist and they do the same tests and then to a hospital and they do the same thing, he said. We are not trying to limit care, but really coordinate it in ways that provide better quality. The managed care option would mandate that individuals eligible for both Medicare and
Continued on Next Page

April 27-28
K?!!.7-1$@$/8!:0/50#17$"!!@/50ABR36!!#0!S3=!I61=!/!T3@=3#!!8-!K3#0U .7-1$@$/8!/1!:0/50#(!<8>%608@0# /85!;3AA68$@/=3#ED K$@7$9/8!?31"$=/%!!113@$/=$38 K$@7$9/8!C=/=0!V8$40#1$=-(!:/81$89E ;%$@H!?0#0!>3#!K3#0!<8>3#A/=$38

June 11-13
P7$3!?31"$=/%!!113@$/=$38 MN=7!!886/%!K00=$89E ?$%=38!;3%6A,61!/=!Q/1=38! ;3%6A,61(!P7$3E ;%$@H!?0#0!>3#!K3#0!<8>3#A/=$38

WEBINAR
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.

Thursday, April 26, 2012

Noon, CDT

CLAIMS PROCESSING: A COLLABORATIVE EFFORT

Please join Kenny Deng, senior director of provider relations, Blue Shield of California, George Mack, vice president of provider relations, Hospital Association of Southern California, and Dan Martinez, director of patient financial services, Mission Hospital Medical Center, to discuss a joint hospital/health plan initiative to streamline claims processing and improve provider bottom lines.

http://www.healthwebsummit.com/pp042612.htm

!"#$%!&'(!&)*&!+!&)*&!,-!./-0#1!2!.#34$50#1!.6,%$17$89(!::;

Payers & Providers

Top Placement... Bottomless Potential

NEWS
Missouri Foundation (Continued from Page One)
Medicaid enroll in an integrated managed care organization. This would require a partnership between the Centers for Medicare and Medicaid Services and Missouri, which would split the savings 50/50. If the state required this, it would save $4.8 billion over 10 years. If it assigned individuals to a managed care organization but allowed them to opt out, the foundation estimates savings would be $2.7 billion. Adopting bundled payments for inpatient care, physician services while a patient is hospitalized, home health care and post-acute care would save $1.9 billion spread across all payers over a decade.

Page 2

Advertise Here
(877) 248-2360, ext. 2

In Brief
Revocation Of Property Tax Exemption Could Hit Illinois Hospitals Credit
Champaign County denied a property tax exemption to one of its hospital systems in 2002 because it was not providing enough charity care to the community. Since then, the state has taken up the charge and begun reviewing hospitals statewide, and three more lost their tax-exempt status last fall. The combination of cuts from Medicare and Medicaid along with property tax increases could negatively impact the providers credit reports, according to a New York-based credit agency. Fitch Ratings said the taxexempt status of 15 hospitals is being reviewed by the Illinois Department of Revenue. The ratings agency figures a hospitals credit risk by looking at its property assessment, tax rate and credit profile. Clearly, Fitch believes the higher rated borrowers are in better position to absorb the additional expense of property taxes, while for lower rated borrowers the impact may be more profound, said a press release issued by the ratings agency.

The third option, creating the states own insurance exchange, would save $3.3 billion over the next 10 years. This could be accomplished by allowing the state to address its unique needs and having a competitive bidding model for insurers involved, instead of using a federally implemented plan. Another provision would require providers to use patient decision aids and hospitals to establish palliative care programs. These programs, according to the foundation, prompt patients in end-of-life care to decline costly and invasive treatments. Study aids also help improve patient satisfaction.

The Price Of Spurning Prescriptions

CVS Study Says Non-Adherence Costs $290B a Year
A study by CVS Caremark has concluded that non-adherence to drug treatment regimens costs $290 billion a year in the United States. The company, based in Woonsocket, RI, spends resources educating the public and healthcare providers to increase awareness of the issue of adherence and create solutions to the issue. Their newest report looks at how patients in the United States are complying with their doctors directions about taking medications. They teamed up with Harvard University and Brigham and Womens Hospitals Division of Pharmacoepidemiology and Pharmacoeconomics, which analyzed information from CVSs pharmacy claims data. The researchers looked at four common diseases that make up a large portion of pharmacy care hypertension, high cholesterol, diabetes and depression. To determine adherence rates, the study authors looked at medication possession ratios; rstll prescription rates; the use of generics, which show how many new patients are more prone to take medication that is less costly; and how many people receive their medication by mail order. Some of the best performers in the Midwest were: Colorado, which ranked above average in adherence and mail dispensing; Illinois ranked high in mail dispensing rates, but low in the use of generics; Minnesota ranked above average on most measures and excellent in generic dispensing; Missouri had good adherence including mail order and generic dispensing rates; Nebraska ranked well on rst ll persistency and among the top ten states on commercial health coverage and physicians per capita; Wisconsin had high ranking on rst ll and possession ratio as well as generic and mail dispensing.

Many Hospitals Link ACA to Revenue Drop

More than half of the health systems surveyed recently by HighRoads, a software compliance and benefits organization and Sullivan, Cotter & Associates, Inc. an HR consulting firm, are anticipating a decrease in revenue

HEALTHCARES BEST ADVERTISING VALUE

]

PAYERS & PROVIDERS reaches 5,000 hospital, health plan and nonprot executives statewide. There is no better venue for marketing your organization or conference, or recruiting new staff.

Continued on Page 3

CALL (877) 248-2360, ext. 2 OR CLICK HERE

!"#$%!&'(!&)*&!+!&)*&!,-!./-0#1!2!.#34$50#1!.6,%$17$89(!::;

Payers & Providers

Longer ALOS!*

NEWS

Page 3

Advertise Here
(877) 248-2360, ext. 2
*For our ads, not your hospital

Illinois Proposes Deep Medicaid Cuts

Gov. Quinn Wants to Cut $1.35 Billion From Program
Illinois Gov. Pat Quinn released a plan last week to prevent the collapse of the states Medicaid program. The proposal will save the system $2.7 billion and includes cuts and reductions of $1.35 billion, reduced payments to providers of $675 million, $337.5 million in a cigarette tax and the same amount in a federal funding that matches the cigarette tax. The governors proposal for scal year 2012 was created because, according to a press release from his ofce, the state will have $1.9 billion in unpaid Medicaid bills. With no changes to the system, there would be an expected $21 billion by 2017. Not everyone supports the cuts. The Illinois Hospital Association has released a statement that praised the governor for his efforts, but also called the plan too drastic and too rash to impose on the states already fragile healthcare system. There is an expected 8% rate cut, or $350 million to hospitals, according to the organization. This is on top of $150 million in cuts like reduction of detox follow-up service in hospitals and eliminating $13 million in payments to teaching hospitals that are proposed in the plan. The IHA recommends a multi-year approach to the problem. The group recommends alternatives to rate cuts that include enhancing the Hospital Assessment Program; increasing matching federal revenues for certain populations; and augmenting the current Primary Care Case Management Program.

In Brief
as a result of the Affordable Care Act. Almost 200 hospitals and health systems were queried between November 2011 and January 2012 for the survey. The findings showed that 55% of hospitals expect to see revenue drop due to the ACA, 12% expect an increase and 28% dont know what its impact will be. A shift in the way care is provided is also expected. Fortytwo percent of respondents plan to become an accountable care organization and another 18% plan to structure their employee health plan like an ACO.

AHA Announces Volunteer Awards

Hospitals Cited For Quality of Specific Programs
The American Hospital Association has announced its Hospital Awards for Volunteer Excellence program winners. The program, in its 29th year, honors volunteer organizations and their impact on patients, hospitals and their communities. This years winners are: for the Community Service Program, Food Pantry (Castle Point & Montrose), at the VA Hudson Valley Health Care System in Montrose, N.Y. The Fundraising Program, Pay It Forward Fund, at North Memorial Hospital in Minneapolis. The In-Service Hospital Volunteer Program winner is Cherished Portraits, at the University of Iowa Hospitals & Clinics, University of Iowa Childrens Hospital in Iowa City. And the Community Outreach and/or Collaboration Program went to Charla de Lupus (Lupus Chat), at the Hospital for Special Surgery in New York City. AHAs Award of Honor this year went to the Ronald McDonald House Charities in Oak Brook, Ill. and Schwartz Center for Compassionate Healthcare in Boston. These awards go to organizations that provide contributions to the health and wellbeing of individuals in their communities through policy or social leadership. The AHA Board of Trustees Award, given to people or groups who have made special contributions to the work of the AHA, go this year to Larry Gage, retired president of the National Association of Public Hospitals and Health Systems and Larry McAndrews, retired president and CEO of the National Association of Childrens Hospitals and Related Institutions.

Community Health Centers Ranked

Data on six quality measures diabetes control, timely prenatal care, hypertension control, low birth weight, childhood immunization and cervical cancer screenings provided by community health centers was released recently by the U.S. Health Resources and Services Administration. The nations 1,200 centers began reporting data on these measures in 2008 in a push to bring transparency and improve quality where they are weak. Some of the ndings include: organizations in the Midwest, New England and California tend to perform better than those in the South. Almost 75% performed at least below 10% of the national average in screening female patients for cervical cancer. Nearly 73% performed well below average in helping diabetic patients keep blood sugar levels stabilized. And about one-quarter were below average in child immunizations. The rankings of all of the centers can be found online at http:// www.kaiserhealthnews.org/Stories/ 2012/April/18/community-healthcenter-chart.aspx?loc=interstitialskip/.

!"#$%!&'(!&)*&!+!&)*&!,-!./-0#1!2!.#34$50#1!.6,%$17$89(!::;

Payers & Providers

OPINION

Page 4

<3%6=0!&(!>1160!*?
./-0#1!2!.#34$50#1!$1! "6,%$1705!040#-!@6015/-!,-! ./-0#1!2!.#34$50#1!.6,%$17$89(! ::;A!!8!/886/%!$85$4$56/%! 16,1B#$"C$38!$1!DEE!/!-0/#! FD*'E!$8!,6%G!6"!C3!*)! 16,1B#$,0#1HA!>C!$1!50%$40#05!,-! 0I=/$%!/1!/!.JK!/CC/B7=08C(! 3#!/1!/8!0%0BC#38$B!80L1%0CC0#A
!%%!/540#C$1$89(!16,1B#$,0#!/85! 05$C3#$/%!$8M6$#$01N
FOPPH!&'OI&QR) $8S3T"/-0#1/85"#34$50#1AB3=

Negotiating The Maze Of Networks

Looking For Signs to Partner Up Regionally or Nationally
Health plans around the country have slowly with their physicians to demonstrate value but steadily been reintroducing tiered and through their own cost and quality data. narrow networks to their product offerings as For those provider organizations considering they search for ways to differentiate themselves partnering with providers, there are three key and offer employers lower-cost products critical success factors. without signicantly reducing benet levels. First, understand your current value Tiered networks allow beneciaries to proposition. If you have not invested in the data choose from different levels or tiers of systems, decision tools, or analytical expertise to providers based on a cost/quality value fully understand how your cost and quality data equation. Participants can lower their cost compare to others, consider outsourcing these sharing by choosing tier one providers who capabilities. In addition, many health plans would offer the best value according to the health like to offer alternatives to other provider/payer plan. products and are willing to partner with, and even Narrow networks are networks that offer a fund, efforts by competing providers to develop limited choice of providers. In many cases, only competing narrow or tier one networks. those facilities and providers afliated with a Second, develop critical mass. If your particular hospital, medical group, or health organization and its physician partners cannot system. Health plans have been aggressively cover a substantial portion of your service area introducing narrow network plans alone, it is time to partner. Even if By across the country. you are not ready to move toward Teresa Koeing, M.D. further consolidation discussions In some cases, such as PepsiCo with Johns Hopkins and and Jay Warden with crosstown competitors, Lowes with the Cleveland Clinic, developing an alternative network employers are contracting directly with to a major aggressor in your market can show nationally known health systems for high-cost your physicians that partnership with you is not a and complex procedures and services. dead end. As these arrangements become more Third, cover all bases from a service-line commonplace, providers need to understand perspective. Some large and sophisticated health the driving forces behind such arrangements systems have recognized that they may not be and better prepare themselves for success able to compete with local academic systems or where such plans are being offered. nationally known organizations in certain There are three primary driving forces for the specialties such as high-end cancer or proliferation of successful tiered or narrow cardiovascular care, so they have developed networks in any given market. national relationships with the likes of M.D. First, in addition to publicly available Anderson, The Cleveland Clinic, or Duke Health government data, most large payers have a to brand their programs and give employers substantial amount of cost and quality data that considering a narrow network the condence that can be used to index the value provided by the local health system can deliver nationally individual providers. It is increasingly difcult known specialists and programs. for providers to dispute whether they are being Now is the time to begin discussions with excluded or placed in a lower tier unfairly. payer partners, if you have not already started. It Secondly, in most large markets, there has is likely that your competitors are already moving been enough consolidation of facilities and in that direction, and you will be surprised how physicians that managing tiered networks is not ready and willing payers in your market are to as onerous. Single organizations are able to consider alternatives and discuss these network offer enough geographic and comprehensive approaches if you can clearly demonstrate your services coverage to be considered for a narrow value proposition. or exclusive network. Lastly, many larger, proactive and Teresa Koenig, M.D. and Jay Warden are senior sophisticated provider organizations have not vice presidents with The Camden Group. only developed the geographic and service offering diversity to be considered for a narrow Op-ed submissions of up to 600 words are network, but they have successfully worked
welcomed. Please e-mail proposals to editor@payersandproviders.com

U/$%$89!/55#011N
O*O!VA!W3%%-L335!X/-(!Y6$C0!Z Z6#,/8G(!;!!E*?)?

X0,1$C0
LLLA"/-0#1/85"#34$50#1AB3=

K/B0,33G
LLLAS/B0,33GAB3=["/-0#1"#34$50#1

@L$CC0#
LLLACL$CC0#AB3=["/-0#1"#34$50#1

\5$C3#$/%!Z3/#5
X$%%$/=!UA!JL-0# W0/%C7B/#0!YC#/C09$1C ]/81/1!;$C-(!U3A ^/-!X/#508 Y08$3#!<$B0!.#01$508C @70!;/=508!_#36" `311!!A!Y%3CC08(!UAJA ]%0$8!Y%3CC08!2!K#08B7 ;7$B/93 U$B7/0%!:A!U$%%08138 .#01$508C W0/%C7!a6/%$C-!!54$13#1!::; W$97%/85!./#G(!>%%A

"6,%$170#T"/-0#1/85"#34$50#1AB3=

`38!Y7$8G=/8

.6,%$170# \5$C3#

C/==-AL3#C7T1,B9%3,/%A80C >S!-36!53!83C!#0B0$40!-36#!$1160!3S! ./-0#1!2!.#34$50#1!,-!*!.AUA!38! @6015/-(!"%0/10!B/%%!FOPPH&'OI&QR)A

@/==-!X3#C7

!"#$%!&'(!&)*&!+!&)*&!,-!./-0#1!2!.#34$50#1!.6,%$17$89(!::;

Payers & Providers

MARKETPLACE/EMPLOYMENT

Page 5

It costs up to $27,000 to fill a healthcare job*

will do it for a lot less.

Employment listings begin at just $1.65 a word Call (877) 248-2360, ext. 2 Or e-mail: advertise@payersandproviders.com Or visit: www.payersandproviders.com
*New England Journal of Medicine, 2004.

SEEKING A NEW POSITION?

CAN HELP.
We publish advertisements for those seeking new career opportunities for just $1.25 a word. If you prefer discretion, well handle all responses to your ad. Call (877) 248-2360, ext. 2, or e-mail advertise@payersandproviders.com.

!"#$%!&'(!&)*&!+!&)*&!,-!./-0#1!2!.#34$50#1!.6,%$17$89(!::;