5 November 2009

5 November 2009

California Edition

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November 17-20

Downward Enrollment For Health Net 1,000 Jobs Cut; Rebound Predicted In Mid-2010 A healthy quarterly earnings report for enrollment in its small group/individual Health Net belied a significant drop in market is down 23.5% since the end of commercial enrollment in California over 2007, from 477,000 to 365,000. the past two years, a trend company Systemwide enrollment in the third officials quarter of 2008 attribute to was down 3.5% Health Net’s California Commercial Enrollment, 2007-2009 the economy compared to and do not the year-ago September March September December 2009 2009 2008 2007 expect to quarter, and abate until at down 3.3% least since the end of mid-2010. 2007. 1,253,000 1,315,000 1,390,000 1,468,000 However, the Health Woodland Net Senior Source: Health Net Earnings Reports Hills-based Adviser David insurer sees Olson attributes great promise in products with a much of the losses in the large group narrower scope of providers. market to layoffs. In some instances among Partly due to the economic situation, the smaller groups, some firms have been the company has cut 1,000 jobs – about changing or dropping plans to try and save 10% of its total workforce – in the past money. year to reduce costs. “The rate of decline is slowing, but Health Net’s commercial enrollment you can’t necessarily know where the in California has dropped 9.5% between bottom is,” Olson says. “It is likely at least the third quarter of 2009 and 2008, to two or three quarters off.” 1.25 million. Since the end of 2007, its Although Health Net operates in seven overall commercial enrollment in other states, California represents about California has dropped 215,000, or about 70% of its overall book of business. Its 14%. commercial plans comprise about oneThe decline was more pronounded third of its total business. among Health Net’s small group and By contrast, Health Net’s Medicare individual market, which was down more Advantage enrollment has been on the than 15% in the third quarter of 2009 rise, up about 4% between the third versus the third quarter of 2008. Overall Continued On Next Page

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In Brief GOP Rolls Out Healthcare Reform Proposals Republican Congressional lawmakers introduced a bill that would reform healthcare on the GOP’s own terms. The 232-page piece of legislation is a fraction of the size of the Democratic-backed proposals being oated in the House and Senate. The bill, HR 3962, would relax federal restrictions on insurers to sell healthcare coverage across state lines; promote the creation of association health plans; and offer $50 billion in incentive payments to states to either cut insurance payments or reduce the number of uninsured. The bill would also cap noneconomic damage awards in medical malpractice suits to $250,000. In its preamble, the bill promises to reform healthcare “without raising taxes, cutting Medicare benets for seniors, adding to the national decit, intervening in the doctor-patient relationship or instituting a government takeover of health care.” The bill was blasted by Democratic lawmakers, who maintain majorities in both houses of Congress. Rep. Christopher Murphy, DConn., says the bill would do nothing to help bring medical coverage to the uninsured. “The message is: ‘Sorry, you’re out of luck,” Murphy says.

San Diego County Reforms In-Home Support Program

NEWS

Page 2

Medical Tourism (Continued From Page 1) quarter of 2009 and the third quarter of 2008. The losses in the small group market might have been even steeper had it not been for Health Net’s focus on marketing its Silver health plan option, a product that narrows the provider network by including only the most cost-effective providers and geographically convenient providers. “Small groups are by definition geographically concentrated, and what you are excluding are high-cost institutional providers in a broader geographical area,” Olson says. By example, a small group in the Inland

Empire might not have access to tertiary hospitals in the Los Angeles area. The result is a premium that is up to 20% lower compared to products with broader networks, according to Olson. The silver option has experienced a 35% growth in the past year. It’s proven so popular that Health Net will roll it out to its Medicare Advantage plans in four Southern California counties at the start of 2010. Health Net did beat analysts’ expectations by posting quarterly net income of $69.6 million, excluding one-time charges, on revenue of just under $4 billion. Net income for the third quarter of 2008 was $37.8 million on revenue of $3.8 billion.

CNA/CHW Pact Targets Pandemics Both Sides Will Collaborate on H1N1 Preparedness Catholic Healthcare West and the California Nurses Association have come to terms on a new four-year labor contract that will also affect how the hospital chain’s management and its workers address future pandemic outbreaks. The two sides agreed to form a joint task force that would address training, communications and monitor equipment availability in the case of the declaration of any pandemic, such as the H1N1 swine flu virus. Officials with CNA, which had used H1N1 preparedness as an issue in bargaining with CHW, called the formation of the committee unprecedented. “It’s really significant step forward in establishing, uniform, consistent systemwide policies regarding how to address a pandemic outbreak,” says CNA spokesman Chuck Idelson. “The nurses and hospital staff will do everything they

can to examine the availability of equipment, how well things are proceeding with implementing national, state and local guidelines, and making sure all hospitals have in place the best training to confront epidemics.” It was unclear who would specifically would sit on the task force, which would be comprised of six CNA members and six CHW employees, or who the panel would report to. The new four-year pact covers 12,000 CNA members at 28 CHW facilities in California and four others in Nevada. The post-contract rhetoric was absolutely glowing compared to the charges the union, known for its brash tactics,had made against CHW. Among them: its facilities had not been adequately prepared to treat H1N1 patients, and were putting both patients and employees at risk in the epidemic. The CNA had scheduled a one-day strike at various facilities in Continued On Next Page

The San Diego Board of Supervisors voted unanimously earlier this week to reform its troubled In-Home Supportive Services Program. Although state funding is supposed to cover most of the cost, the county must currently fund a $43 million shortfall. Critics say

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In Brief fraud and lax oversight of the program has ballooned enrollment to 25,000, when perhaps 5,000 residents meet the criteria, some critics contend. Under the new reforms, inhome workers who participate in the program will undergo background checks, fingerprinting and reviews of their timecards. The program is intended to provide medical care to elderly and frail patients in their homes, rather than in hospitals or skilled nursing facilities.

Report: Budget Cuts Lead To Lax Nursing Home Oversight A new report by the California Senate Office of Oversight and Outcomes concludes that the ombudsmen who report nursing homes abuses are being unduly shackled by regulatory hurdles and budget cuts. One of the biggest obstacles is the state’s often contradctory interpretation of federal law that requires consent from all witnesses – including that of alleged abusers – before ombbudsmen can report abuse cases to law enforcement authorities. California is the only state with such a regulation, although it is being revisited in the wake of the Senate report. "The last thing we should do is handcuff those who we entrust to watch over the care and safety of our elderly loved ones with conflicting and illconceived...regulations," says Senate President Pro Tem Darrell Steinberg, D-Sacramento. The report also noted budget cuts to the program for the 2009 fiscal totaled 50% compared to prior years. Funding for the 2010 fiscal year will go up, but will remain 27% below 2007 levels.

NEWS

Page 3

NCQA (Continued From Page 2) California on Oct. 30, but backed off the action. To date, the H1N1 epidemic has claimed about 200 lives in California, including a nurse who was represented by CNA, according to union officials. “Since the pandemic was declared last spring, we have been taking measures to ensure the health and

safety of our patients, employees and communities. We are pleased to have the CNA's full collaboration in furthering our efforts,” says Robert Wiebe, M.D., a CHW senior vice president and chief medical officer. The CNA continues contract negotiations with the Daughters of Charity Healthcare System and the St. Joseph Healthcare

Kaiser Gains On Osteoporosis Care

Study Shows New Ways to Prevent Bone Fractures Kaiser Permanente’s Southern California division has been able to ratchet up preventative care for its enrollees with osteoporosis, dramatically reducing the number of hip fractures they suffer. Kaiser claims a 38% reduction in hip fractures through the use of its Healthy Bones program, which allows physicians to comb through electronic medical records to identify enrollees at risk for bone fractures. That subset includes any patient over the age of 50 who has suffered a fracture, women over the age of 65 and men over the age of 70. “Men are not routinely screened for osteoporosis, but we do it,” says Richard M. Dell, M.D., a Kaiser orthopedic surgeon who who launched the initial prevention program in 2002. “Most men do not think they’re at risk, but that is not the case.” About 10 million Americans suffer from osteoporosis, 80% of them women. Another 34 million over the age of 55 suffer from low bone density, a precursor to the disease. Kaiser enrollees who are identied as being at-risk are encouraged to get bone density scans through telephone calls, e-mails and even postcards. The compliance rate is about 70%, Dell says. According to data from the National Committee on Quality Assurance, only about 20% of those at-risk for osteoporosis undergo routine bone density

screenings. Overall, bone density screenings among Kaiser patients in Southern California increased 263% between 2002 and 2007, to 78,262 annually, up from 21,557. Enrollees suffering from low bone density were treated on the spot, prescribed generic oral bisphosphonates, and supplements of vitamin D and calcium. The number of enrollees receiving such treatments increased to 84,155 in 2007, compared to 33,208 in 2002. Some enrollees at high risk for falling also received counseling to try and reduce their risk. As a result, about 970 hip fractures among Kaiser Southern California enrollees were avoided in 2007, according to the study. It was published in this month’s issue of the Journal of Bone & Joint Surgery, a peer-reviewed publication. The cost-savings is considerable for Kaiser. Dell estimates that each fractured hip in a senior costs about $40,000 in additional medical costs over the next two years. A quarter of patients over the age of 65 who suffer a hip fracture die within a year of the injury. The Healthy Bones program has now been instituted throughout the Kaiser system, Dell says. He has also been invited to the United Kingdom to implement a program based on Healthy Bones.

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OPINION

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Healthcare Needs A Healing Process Beyond Reform, The Public’s Trust Must be Regained !The biggest issue facing healthcare today isn’t • Candidly acknowledge the inherent the reform being debated in Washington.! It relationship between cost and quality isn’t cost, access or quality.! It isn’t shrinking margins, workforce shortages, malpractice • Demystify healthcare by adopting plain speak and openness in how we conduct insurance or any of the other much business ballyhooed topics which populate the evening news.! It is something much more fundamental to any relationship. • Speak more about ethics and what we stand for !!!!!!It is a loss of trust. !!!!!!Over the past quarter century, Americans have lost trust in the healthcare system just as • Produce and celebrate the heroes among us we have lost trust in so many of the other institutions and amenities in which we •Develop and follow a code of ethics; and historically believed (think education and government for starters).! Until trust is restored, • Strive to return to a time of public purpose over private gain. nothing we as healthcare leaders !!!!! do or say will matter. !Restoring public trust won’t be !!!!!!It is not surprising that people easy.! That’s why Michael have stopped trusting us.! Why Josephson of the Josephson should they believe in a system Institute of Ethics in Los Angeles that they feel no longer believes called trust the “most complex in them?! Costs have skyrocketed, and most fragile of all of the ethical quality is elusive to measure, 47 By Ross K. principles contained in the idea of million are uninsured, medical Goldberg character.”! Those in our industry errors are front page news!and "big unable to understand this basic business" has kidnapped something reality no longer deserve equal once believed to be personal and time. sacred.! There is no need to get bogged down !!!!!!Think about the people you trust most in in a useless debate over the validity of these your life.! Chances are that traits such as accusations.! Instead, we are better off honesty, integrity, promise keeping and acknowledging that as an industry concerned loyalty are fundamental to how they conduct with saving lives, it’s time we focused on how their lives and how they interact with others.! to save our own hides before the real revolt How many of us can candidly say that our takes place.! industry or that our own institutions, every !!!!!!As far back as 2002 the Harvard day and in every way, follows those same University School of Public Health sponsored behaviors in everything we do?! Until we a symposium examining the erosion of trust in practice them as instinctively as sh swim, our nation's healthcare system and in 2006 we’ll continue to be met by a skeptical the American Hospital Association issued a public who wonders what happened to an paper entitled “Trust Counts Now.”! Those two industry they once cherished and wants so groups, and others equally committed to this badly to cherish again.! chilling issue, challenge all organizations to adopt ethical principles, pursue transparency in everything they do and make trust a Ross Goldberg is chairman of the board of trustees at Los Robles Hospital and Medical fundamental precept of corporate governance. Center in Thousand Oaks, and president of !!!!!!If healthcare is to regain the public’s longKevin/Ross Public Relations in Westlake Village, lost trust, we can add to that list at least eight other core imperatives.! We must: Op-ed submissions of up to 550 words are • Put the wants and needs of the patient or welcomed. Please e-mail proposals to member rst [email protected], or call (877) • Admit that medicine is an imperfect science 248-2360, ext. 3.

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Payers & Providers

EMPLOYMENT/MARKETPLACE

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HEALTH! EDUCATOR - Under the general supervision of the Health Education Manager, this position is responsible for the completion of health education aspects of L.A. Care's disease management program(s). !Primary functions include the design, implementation and evaluation of member and provider focused interventions on various chronic disease management topics, including diabetes and asthma. ! Related responsibilities include the assessment and delivery of patient education and self care principles, identification and development of culturally sensitive and linguistically appropriate health education materials and resources, and participation in disease management team meetings.! For complete job description, qualifications/requirements, and additional opportunities, visit our website: www.lacare.org! For consideration, email resume with salary history/ requirement to [email protected], referencing “Payers & Providers Ad”

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 Ron Shinkman at (877) 248-2360, ext. 2, e-mail him at: [email protected] Or visit: www.payersandproviders.com We Accept All Major Credit Cards

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