Payers & Providers California Edition – Issue of January 12, 2012

8/3/2019 Payers & Providers California Edition Issue of January 12, 2012

1/6

!"#$"%&!'(!)*+)!,!)*++!-&!."&/%0!1!.%2345/%0!.$-64074#8(!99:

Calendar

12 January 2012

[email protected]

the details of your event, or call(877) 248-2360, ext. 3. It will be

published in the Calendar section,s ace ermittin .

California Edition

Hospital-Acquired Infections DetailedLong-Term Care Facilities Report Some Higher Rates

Long-term acute care hospitals in Californiareported signicantly higher rates of someinfections acquired during patient stays thantheir general acute care counterparts,according to data they reported to the

Department of Public Health.The data covered surgical site infections,

central line bloodstream infections,Methicillin-resistant Staphylococcus aureus(MRSA), vancomycin-resistant Enterococcus(VRE ) infections and incidents ofClostridiumdifcile, a form of diarrhea transmitted bybacterial exchanges in the hospital setting.

Hospitals have been reporting the data forthe past two years, following passage of a lawin 2008 making such reporting mandatory.

These reports provide the most detailedpicture yet of healthcare-associated infectionsin California's hospitals, said CDPH Directtor

Ron Chapman, M.D. The information inthese reports is intended to increaseawareness and lead to appropriate changesthat will decrease the number of theseinfections.

Among long-term facilities, the MRSA/VRE infection rate was 1.1 cases per 10,000patient days, compared to a statewide averageof 0.6. The rate among major teachinghospitals was 1.0, and 0.5 for communityfacilities.

For C. difcile, the rate was 18.8 cases per10,000 patient days, compared to 9.4 per

10,000 patient days among general acute carehospitals. For both sets of infections, data wasstudied for the period of April 1, 2010 toMarch 31, 2011.

Altogether, 49% of hospitals did not have

a single MRSA infection during the reportingperiod, and 50% did not report a single VREinfection.

The executive summary on C. difciletransmission suggested why the infection ratesmay be higher at the long-term facilities:patient stays at those hospitals are at least 25days about ve times longer than theaverage stay at an acute care facility. As aresult, there is far more opportunity for apatient to be exposed to infection-causingbacteria.

The surgical site infection data studiedincidents of infection for colon surgery,

coronary artery bypass graft, hip replacementand knee replacement procedures. Data wasstudied for surgeries performed between April1 and June 30 of last year.

The CDPH did not include specic ratesbecause surgeries were not performed at allfacilities. No hospital reported more than foursurgical site infections per procedure,although in those instances, the rate was farhigher than the predicted average.

January 12-14

:"64;2%#4"!:7"?/%8/#@&!.7&04@4"#0!A'=7!"##$"6!>?/%8/#@&!B/54@4#/!4#!C20/?4=/!

@2#;/%/#@/D!E7F"#//!G2=/6(!C20/?4=/!H"=42#"6!."%ID!E!540@$0042#!2;!=%/#50!"#5!=%/"=?/#=0!";;/@=4#8!>J!@"%/D!KAL'MKLN*D!

:64@I!G/%/!;2%!B2%/!O#;2%?"=42#

January 23-24

./%02#"64P/5!B/54@4#/!Q2%65!:2#;/%/#@/!)*+)D!:2?


2/6

!"#$"%&!'(!)*+)!,!)*++!-&!."&/%0!1!.%2345/%0!.$-64074#8(!99:

Payers & Providers Page 2

Top Placement...Bottomless Potential

Advertise Here

(877) 248-2360, ext. 2

In Brief

Health Net SellsMedicare Pharma

Subsidiary

Woodland Hills-based insurer HealthNet has agreed to sell its standalone

Medicare prescription drug plansubsidiary to an afliate ofCVSCaremark for $160 million.

Health Net has 400,000Medicare enrollees in 40 states andthe District of Columbia in the plan,which has $490 million in annualrevenue. The plan has worked closelywith CVS for the past ve years.Health Net will continue to offerprescription drug coverage through itsMedicare Advantage plan.

We believe this proposedtransaction is in the best interests ofour Medicare PDP members and ourstockholders, said Health Net ChiefExecutive Ofcer Jay Gellert. Our

Medicare PDP members...will now beafliated with one of the nationslargest Medicare PDP sponsors.

Health Net expects to net $140million from the sale after taxes andcosts. Gellert said the money wouldbe used to benet Health Netstockholders, but did not providespecics.

The deal is subject to regulatoryscrutiny, including approval from theCenters for Medicare and MedicaidServices, but is expected to close inthe second half of this year.

IEHP Expands Health

Navigator Service

Inland Empire Health Plan willexpand its Health Navigator programto the High Desert region of SanBernardino County later this month.

The service helps IEHPsMedicaid managed care enrollees tobetter use their coverage, avoidingunnecessary emergency room visitsand hospitalizations. Enrollees get ahome visit from staff to educate them

Continued on Page 3

NEWS

A new report by the consulting rm TowersWatson predicts that the labor demand athospitals in California and elsewhere willchange dramatically in the coming years dueto the implementation of the Affordable CareAct.

More than three-quarters of the 100hospital and hospital systems surveyed agreethat they will have to recruit executives with afar more diverse range of experience.Physician management skills will beparticularly coveted.

Organizations that arent alreadypreparing for this change by deningthe necessary leadership competencies andrefreshing their succession-planningprocesses could nd themselves with alimited pipeline of talent with the rightcombination of skills to drive transformation,the report said.

While most of those surveyed say there isno shortage of executive talent, the reportconcludes that respondents may not beconcerned enough about recruiting to anexpanded skillset.

The study also suggested that hospitalsand health systems are not fully prepared toexpand primary care and outpatient services

considered big keys to a functionalaccountable care organization. Projectednances are not expected to leave muchmargin to implement such dramatic change93% of respondents say they expectreimbursements will be cut in the comingyears.

At the same time, 70% of the respondeforecast labor shortages in specic professioover the next several years, particularlyphysicians and nurses.

Towers Watsons own research suggeststhat many providers are being lulled into afalse sense of security due to the recent glut

nursing school graduates.A perfect storm of forces is hitting thehospital industry all at once...hospital have rethink and rene core business and operatprocesses while continuing to deliver qualitcare to the communities they serve, saidHeidi Toppel, a Towers Watson seniorconsultant. Many executives recognize thetransformation required to meet the vision omultidisciplinary accountable care willultimately help improve health outcomes anreduce costs. However, the path from thecurrent to the enhanced state wont be asmooth one in the short term.

Reform Will Shift Hospital StaffingReport Says Management Skills Must Change

Ruling (Continued from Page One)

Meanwhile, more than 93% ofCalifornias hospitals reported that they hadprotocols in their intensive care units in

place to insert central lines in a mannerdesigned to reduce related infections. Aprotocol designed by Johns HopkinsUniversity researchers virtually eliminatescentral line infections if followed precisely.

The rates of adherence were slightly lower atpediatric and neonatal ICUs.

Such infections kill about 28,000 hospital

patients each year and cost more than $2billion annually to treat.

CDPH ofcials indicated that morereports regarding hospital-acquired infectiondata would be released in July.

HEALTHCARES BEST ADVERTISING VALU]

PAYERS & PROVIDERS reaches 5,000 hospital, health plan and noprot executives statewide. There is no better venue for marketin

your organization or conference, or recruiting new staff.

CALL (877) 248-2360, ext. 2OR CLICK HERE
http://payersandproviders.com/advertise.phphttp://payersandproviders.com/advertise.php


3/6

!"#$"%&!'(!)*+)!,!)*++!-&!."&/%0!1!.%2345/%0!.$-64074#8(!99:

Page 3Payers & Providers

Longer ALOS!*

Advertise Here

(877) 248-2360, ext. 2

*For our ads, not your hospital

NEWS

In Brief

about the differences between ERs andurgent care, provide informationabout dental providers, and helpschedule primary care visits andimmunizations.

Since its rollout last year in SanBernardino and Riverside, theprogram helped cut avoidable ER

visits by about 40%.The program serves as a linkbetween members, providers and thehealth plan, which ultimately leads tobetter coordination and care, saidIEHP Chief Executive Ofcer BradleyGilbert, M.D. It is funded through agrant from First 5 San Bernardino.

The rollout will begin inVictorville, then move to Hesperia andother communities in the region.

El Camino Hospital ToExpand Its Board

The board of directors at El Camino

Hospital in Mountain View hasundertaken a rare feat in healthcaregovernance an expansion of its size.

The 399-bed hospital about 20miles southeast of San Francisco willexpand its board from six to ninedirectors by June. It is seekingcandidates with expertise in nance,quality measures and healthcarepolicy.

El Camino is also seeking up to15 more individuals for appointmentsto six committees that advise thehospitals board.

As the complexity of thehealthcare environment continues toevolve, it is important that we prepare

our organization," said El CaminoChairman John Zoglin. The hospitaland the community stand to gain fromthe additional expertise placed on ourboard and committees.

In recent years, many hospitalshave sought to shrink their board size,trying to move from bodies with up to50 trustees with a philanthropic focusto a leaner governance more focusedon business and healthcare policy.Typically, a 15-member board is nowconsidered ideal by most healthcaregovernance experts.

UCLA Expands Teen Health InitiativeHealth Net Partnership Focuses on Social Media

Sutter Health has placed $400 million into itspension plan to keep it fully funded part of a$1 billion effort by the Sacramento-basedhospital operator in recent years to preserve the

benet for its retired employees."At a time when companies are downsizingor eliminating employee pensions, Sutter Healthhas made funding our pension a top priority,"said Sutter Chief Executive Ofcer Patrick Fry."Employees deserve to know that when theyretire, the money they worked so hard for willbe there for them."

The cash infusion comes on top of a $120million injection by Sutter in 2010 and $500million in 2008.

The move comes at a time when many othernon-prot healthcare entities are scrambling tokeep their pension plans fully funded.

According to Standard & Poors, thetypical non-prot healthcare pension plan only 68% of required funds on hand to paypension liabilities, down from 90% in 200

Ofcials said that pension assets fellprimarily due to the 2008 nancial crisis thbattered the stock market. Although priceshave since rebounded, the discount rate pension accounting pegged to returns on hgrade, xed income debt have fallen. Evesmall decline in such rates can dramaticallworsen forecasts for covering pensionliabilities.

The funded status hasnt improved, sStandard & Poors Director Elizabeth SweeEven as assets have bounced back, liabilithave (gone up). She added though thatpension-to-asset liabilities are beginning to

stabilize.

Health Net and the UCLA School of Public

Health are expanding a social media programto help adolescents better understand theirhealthcare options.

The initiative, known as teen2extreme orT2X, was created to test whether the use ofsocial networking could increase teenunderstanding of healthcare delivery andbetter engaged them in making healthcaredecisions. The National Institutes for Healthprovided a $1.1 million grant to launch theinitiative.

Although the results of the test phasehave yet to be fully evaluated, access to thewebsite was recently expanded to all U.S.

teenagers with a computer and an Internetconnection.

The website, www.t2x.me, includes

services such online chats with healthcareexperts, a nurse advice line to teens who havcoverage through Health Net, and a service treceive healthcare-related texts through ausers cell phone.

T2X was recently cited by the NationalCommittee for Quality Assurance as a bestpractice in patient engagement.

If this intervention is indeed successful allowing teens to become more engaged intheir healthcare and health decisions, wecould validate the use of social networkingsites for the rest of our population, saidNancy Wongvipat Kalev, Health Nets directo

of health education and cultural and linguistiservices.

Sutter Health Bolsters Pension Plan$400 Million Contribution Helps Maintain Full Fundin

FOLLOW THE MONEYHealthcare and Political Finance in California

White Paper $149White Paper & Contributions Data $199

CLICK HERE
https://www.managedcarestore.com/pandp/p&pwhitepapers.htmhttps://www.managedcarestore.com/pandp/p&pwhitepapers.htm


4/6

!"#$"%&!'(!)*+)!,!)*++!-&!."&/%0!1!.%2345/%0!.$-64074#8(!99:

Payers & Providers PageOPINION

Brokers, Exchange Need Each OtheGood Execution Means Both Will Prosper Post-Reform

Jason Andrew is the owner/operator of St

Meadow Benefits and Insurance Associat

Redwood City. Email:[email protected]

;26$00$/!)."&/%0!1!.%2345/%0!40!

?$-6407/5!/3/%&!@7$%05"&!-&!."&/%0!1!.%2345/%0!.$-64074#8(!99:A!B#!"##$"6!4#54345$"6!0$-0C%4?D42#!40!EFF!"!&/"%!GE+=F!4#!-$6H!$?!D2!+*!

0$-0C%4-/%0IA!>D!40!5/643/%/5!-&!/JT!&2$!52!#2D!%/C/43/!&2$%!400$/!2T!."&/%0!1!.%2345/%0!-&!+!.AVA!2#!

@7$%05"&(!?6/"0/!C"66!GPQQI)=PJ)RS*AOp-ed submissions of up to 600 words ar

welcomed. Please e-mail proposals to

[email protected]

California is implementing provisions of theAffordable Care Act that could signicantlyhelp small businesses, but none more so thanthe California Health Benet Exchange. Ifimplemented correctly, the exchange could beinstrumental in lowering insurance costs whileincreasing choice for small employers andtheir employees.

Californias exchange board, the rst inthe country, is focused on creating the SmallBusiness Health Options exchange, otherwiseknown as the SHOP exchange. This will be anonline marketplace where small employerscan pool their buying power to drive down

health insurance costs.When the SHOP opens in 2014, the

healthcare marketplace will lookdifferent and brokers are uncertainas to what their exact role in theexchange will be. Some are evenconcerned it may put them out ofbusiness. As a long-time broker inthe state, I know that if our brokercommunity works with theexchange and vice versa theexchange and small businessescan all benet.

The new law leaves it up tothe exchange to determine theroles brokers play. At a Nov. 16panel discussion hosted by SmallBusiness Majority, we discussedmolding a productive relationshipbetween brokers and theexchange. New Yorks HealthPass andConnecticuts Health Connections areexamples of this type of partnership workingextremely well. Both have formal roles forbrokers, and both partnerships have led tosuccessful exchanges.

In January, an Insure the UninsuredProject workgroup offered recommendationsfor implementing the exchange and used thesuccesses of other exchange models toconrm that come 2014, brokers will be in aunique position to educate others,particularly small businesses, on theExchanges benets and operations.

Past marketplaces like the HealthInsurance Plan of California (HIPC), whichlater became PacAdvantage and shut its doorsin 2006 minimized the role of brokers.HIPC's policies discouraged brokerparticipation, and while the state later

reversed this and had more broker friendlpolicies, it was too little, too late.Whats more, it would have been lessexpensive to pay broker commissions thansell directly to employers. Why? Becausesmall-business owners trust their brokers aturn to them when making decisions abouhealth insurance.

A report released last month by PacicCommunity Ventures showed 75% of smabusiness owners with fewer than 20employees use brokers when making covechoices. And 88% of those employers say brokers opinion carries signicant weight

when they make important decisions.Entrepreneurs are busy people focused

growing their businesses. Theres junot enough time in the day for thebecome experts on health insurancIf the examples of past exchanges any indication, small businessesparticipating in the SHOP willcontinue to rely on their brokers fotheir invaluable expertise andassistance. Peter Lee, the executivedirector of the exchange, recentlymade encouraging comments in aIBA West newsletter about forming

partnership with brokers: Werecognize the important role brocan play and look forward toworking with the brokercommunity. This is good news, amy hope is that we will continue

see ongoing engagement with the brokeragcommunity and others to make the exchansuccessful.The Affordable Care Act is changing the waour country approaches healthcare, and thneed for brokers has never been greater.Innovative brokers who adapt to the newmarket will nd new business opportunitiehelping ensure that employers understand SHOP exchange once it is up and runningMore importantly, we will help ensurebusiness owners use it.

By

Jason Andrew


5/6

!"#$"%&!'(!)*+)!,!)*++!-&!."&/%0!1!.%2345/%0!.$-64074#8(!99:

MARKETPLACE/EMPLOYMENTPayers & Providers 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. 2Or e-mail: [email protected]

Or visit: www.payersandproviders.com

*New England Journal of Medicine, 2004.

CLAIMS ENCOUNTERS ANALYSTLarge MSO in the SFV has an immediate opening for a ClaimsEncounters Analyst. This is a challenging and results orientedposition with oversight of all Claim encounters submissionsto the contracted health plans. Processes will include meetingturnaround times, meeting adequacy requirements by the plans,ensuring claims data accuracy, provider training on encountersubmissions and feedback reporting.

This person will be the primary liaison with the health plansand clearinghouses. This person must also be knowledgeable ofEDI 5010 transaction requirements. Must have a minimum of2 years experience in claims processing and management and/or EDI analysis, understanding of claims payment arrangements,procedures, coding, and regulatory and health plan requirementswith emphasis on Medi-Cal. Strong working knowledge of MS

Office 2007, EZ-CAP, Crystal Reports XI and/or SQL ServerReports preferred. Strong communication skills are a must.Competitive Salary and Benefits.

For immediate consideration, please e-mail resume [email protected],

or fax to 818-702-9128.

MANAGER, PROVIDER CONTRACTS

Molina Healthcare is a publicly traded Fortune 1000 company withover 5,000 employees and revenues of $3.6 billion.

RESPONSIBILITIES: Manage, train and assist the ContractManagers and Contract Specialist(s). Oversee development of provider contracting strategies and establishing a sufficient networof Participating Providers to serve the health care needs of Molinamembership. Advise in preparation and negotiations of provider contracts and oversee negotiation of contracts. Oversee the maintenancof all Provider Contract Templates. Adheres to the company and/or departmental confidentiality standards, HIPAA compliance programs, fraud and abuse prevention/detection policies and programs.

QUALIFICATIONS: BA or equivalent education and experiencerequired. Masters preferred. Minimum 5 years in managed care witcontract negotiations experience (all provider types - physician, hos

pital and ancillary providers). Minimum 3 years of supervisory experience (hospital and ancillary provider contracting). Demonstrateknowledge of reimbursement methodologies and managed careprocesses; specific knowledge of managed care lines of businessincluding Medicaid, Managed Medicaid, Medicare and CommerciaHMO products. Contract management system/software experience.

Please forward resumes to:[email protected]


6/6

Payers & Providers MARKETPLACE/EMPLOYMENT Page 6

SEEKING A NEW POSITION?

CAN HELP.

We publish advertisements for those seekingnew career

opportunities for just $1.25 a word.

If you prefer discretion, well handle allresponses to your ad.

Call (877) 248-2360, ext. 2, or [email protected].

Payers & Providers California Edition – Issue of January 12, 2012

Documents

Transcript of Payers & Providers California Edition – Issue of January 12, 2012