Payers & Providers Midwest Edition – Issue of August 28, 2012

7/31/2019 Payers & Providers Midwest Edition Issue of August 28, 2012

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In Brief

Case Western LinksInsomnia To MoreAggressive Breast

Cancers

Researchers at Case WesternUniversity and its affiliated hospitalin Cleveland have linked lack ofsleep to more aggressive tumors inbreast cancer victims.

The research team examinedmore than 400 post-menopausalbreast cancer victims and queriedabout their sleep habits. Thosewomen who had reported less thansix hours of sleep a night onaverage were more likely to havetumors with a genetic makeup morelikely to make them recur.

This is the first study tosuggest that women who routinelysleep fewer hours may develop

more aggressive breast cancerscompared with women who sleeplonger hours, said CherylThompson, a Case Western ReserveUniversity School of Medicine andthey studys lead author. We founda strong correlation between fewerhours of sleep per night and worserecurrence scoresthis suggeststhat lack of sufficient sleep maycause more aggressive tumors, butmore research will need to be doneto verify this finding andunderstand the causes of thisassociation.

The findings of the study werepublished in the most recent issue

of the journalBreast Cancer

Research and Treatment.

Minn. Blues, InnovalonRenew Pact

Blue Cross Blue Shield ofMinnesota has renewed its contract

Continued on Page 3

NEWS

REIT (Continued from Page One)

communities, the scope and sheer number ofproperties gives it some real panache. Thenadd the Sunrise brand to it and think there is

a lot of potential.Yedinak said the industry seems to be

splitting into communities whose residentsare with money or without. Real estateowners are beginning to place a hugepremium on communities where individualscan pay for their own care and housing.

This acquisition powerfully advancesour strategic vision: Own the highest quality,private pay seniors housing communities instrong, growing, afuent markets and alignwith experienced, dynamic managementteams, said George Chapman, Health CareREIT's chairman and CEO in a press release.

Sunrise has been a leader in thetransformation of seniors housing. Thistransaction positions us to build on ourcollaborative, relationship based investmentphilosophy and benet from the ongoingtransformation of the sector. There are fewopportunities to acquire assets of this qualityin a transaction of this scale.

Yedinak said Sunrise was ripe forpurchasing because of its choices during thereal estate bubble. The organization took on alot of debt and leverage to build some of itsnewer communities. They ran into nancialproblems when credit markets went

downhill. The company, he said, has beenin restructuring mode for a few years,selling off assets and repositioning itself.

This transaction is part of the ultimaterestructuring, he said.

One of the benets of the transactionfor REIT is its interest in Sunrises ventures.According to a statement issued by REIT, theorganization expects to own an average of28% interest in 105 of Sunrises jointventure communities when the acquisitionis complete. Thirty-seven will have purchaseoptions in 2013, 13 have them in 2014.

They have a pipeline where they canplan debt and equity offerings as well asproperty acquisitions, Yedinak said. Theyhave a roadmap laid out for the next couple

of years based on knowing when theoptions come into play.

According to the companys statement,the acquisition makes REIT one of thelargest owners of seniors housing in theworld with more than 58,000 units in theUnited States, Canada and the UnitedKingdom.

Sunrise is expected to operate thecommunities, but the terms are not beingdisclosed because of condentialityagreements and continued negations. Thedeal is expected to be completed in the rsthalf of 2013. TAMMY WORTH

Firms More Bullish On CoverageTowers Watson Survey Says More Will Keep Plans

A new survey by the benets consulting rmTowers Watson reveals signicantly morecompanies are likely to retain employerhealthcare benets after the primarycomponents of the Affordable Care Act aredeployed in 2014.

According to the survey of 440 midsizeand large employers (500+ workers), 88%say they intend to offer health insurance totheir workers for the foreseeable future.That compares to just 71% in last yearssurvey.

The New York-based Towers Watsonnoted that the renewed commitment toemployer-based healthcare benets comeseven though costs are expected to increase5.3% per employee in 2013, reaching anaverage of $11,507.

Another 77% ofrms say they considerhealthcare benets as core to their

employee value proposition over the nextseveral years. However, more than a third ofthose companies also say they will examinetheir healthcare benets within a totalrewards framework by 2013. Another 39%say they plan to do so during 2014 or 2015.

Affordable healthcare remains a toppriority for employers and a key componentin employee value propositions, said RandalAbbott, senior healthcare consulting leader aTowers Watson. However, due to theincreasing costs of medical benets and theadditional burden of compliance, businessleaders need to keep the pressure on tocontrol costs, increase workforceaccountability and engage workers to lead ahealthier lifestyle.

Towers Watson said it will release the fulresults of its survey next month, according tospokesperson Binoli Savani.


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Page 3Payers & Providers

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NEWS

In Brief

with Inovalon to improve patientoutcomes.

The Eagan-based health planand Bowie, Md.-based Inovalon,which was formerly known asMedAssurant, reached terms onwhat Inovalon called a multi-yearengagement.

As part of the deal, Inovalonwill provide the Minnesota Blueswith data-driven solutions toimprove the overall healthcareoutcomes for its commercial andMedicare Advantage enrollees.

We are highly dedicated todelivering high quality, cost-effective care to our members,said Frank Fernandez, vicepresident of government programsfor the Minnesota Blues. We lookforward to continuing our workwith Inovalon to implementinnovative programs andcomprehensive services that helpachieve these goals.

Inovalon has been providingservices to the Minnesota Bluessince 2004.

IHS Self-Study FocusesOn Wellness Program

A study by Chicago-based firmInteractive Health Solutions founda correlation between the use of awellness program and reducedhealthcare costs.

However, there is a catch: Thestudy focused exclusively on IHSwellness clients, which werecompared against a control group

that did not use a wellnessprogram. Another firm, ZoeConsulting, performed the study,using two years of medical claimsdata.

According to the data, thoseenrolled in IHS wellness programincluded an average 6.1%reduction in medical cost trendsand a 13.5% reduction amongthose enrollees with chronicconditions. Overall, 85% of thoseparticipating in wellness programsmaintained their health withoutany deterioration.

The State of Ohio has awarded contracts tove insurers to provider care to 114,000Medicare-Medicaid seniors and persons withdisabilities under a pilot program that beginsin 2013.

Connecticut-based Aetna, Inc. andCalifornia-based Molina Healthcare will bethe lead health plans, with both winningcontracts from the Ohio Department of Joband Family Services to provide care in thestates densely populated central region.UnitedHealthcare of Ohio, Dayton-basedCareSource, in conjunction with HumanaInc., and Buckeye Community Health Plan

were the other contract winners. All theplans will serve three geographical regionsapiece.

People who are dually eligible forMedicaid and Medicare are among the mostvulnerable populations, with multiplechronic conditions and complex health careneeds, said CareSource Chief ExecutiveOfcer Pamela Morris. Today, they face thedaunting challenge of navigating two

separate programs often resulting inuncoordinated and costly care.The CareSource-Humana team will serve

the northeast, east-central and northeastcentral regions, which include Akron,Cleveland and Youngstown and have 56,000eligible lives. Centene and UnitedHealth willalso be enrolling lives in the Cleveland area.

Our experience coordinating care for at-risk individuals who are eligible for bothMedicaid and Medicare in Ohio and acrossthe country will allow us to improve healthoutcomes while helping reduce costs for thestate of Ohio, said Amy Schultz Clubbs,

president ofMolina Healthcare of Ohio.Molinas contract includes the Dayton,Cincinnati and Columbus regions.

Molinas recent earnings report noted itsdeep losses providing care for similarpopulations in Texas. A Molina spokespersondeclined to comment on that issue.

Aside from Aetna, all the plans currentlyprovide managed care to Ohios generalMedicaid population.

Ohio Awards SPD HMO ContractsMolina, Aetna Considered Big Winners in Bidding

Anthem Ohio In CPC InitiativeWorking With 500 Provider Groups In Cincinnati

and Medicaid Services chose 500 primarycare medical groups in seven regions toparticipate in the pilot.

Under the program, the providers will paid an additional fee from CMS averagingabout $20 per member per month to improand better coordinate primary care services

Altogether, CMS has selected more tha2,100 providers who serve 313,000 Medicaenrollees in eight states. The Cincinnati/Dayton/Kentucky region is the only Midwe

area selected.

Anthem Blue Cross Blue Shield of Ohio willbegin working with 75 physician practices inthe Cincinnati and Dayton regions as part of aMedicare pilot project.

The Ohio Blues and the practices wereselected by the Centers for Medicare andMedicaid Services to participate in theComprehensive Primary Care Initiative. Theobjective is to improve the primary careMedicare Advantage enrollees receive in orderto cut down on more expensive

hospitalizations. The Centers for Medicare

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A colleague of mine in primary care medicinehas decided to leave the practice of medicine.She is very well trained, has impeccableprofessional credentials, and works in athriving practice.

Over the past several years, however, shehas noticed an unrelenting decline in thesense of fulllment she derives from her work.She feels increasingly frustrated with what shecalls the "bureaucratization" of medicine, andresents spending "more time lling out formsthan caring for patients." My colleague issuffering from what is commonly described asburnout.

A new report in theArchives of InternalMedicine indicates that rates of burnoutamong U.S. physicians signicantlyexceed those of the generalpopulation. This is a very serious issuewith effects that will ripple throughoutsociety, and it warrants widespread,earnest attention. The solution, though,does not lie in incentivizing physicians withmoney or restructuring systems to minimizestress on physicians it lies in nding earnestprofessional fulllment.

Medicine is not a job. It is not even acareer. At its heart, medicine is a calling.

According to psychologists, signs of burnoutinclude decreased enthusiasm for work,growing cynicism, and a low sense of personalaccomplishment. As the name implies,individuals suffering from burnout feel asthough a re that once burned inside them hasdwindled, and perhaps even been entirelyextinguished.

Of nearly 7,300 physicians whoparticipated in theArchives of InternalMedicine's national survey, 46% reported atleast one symptom of burnout, and the overallrate of burnout among physicians was 38%, asopposed to 28% among other U.S. workers.

The highest rates of burnout were reportedamong primary care physicians, includingfamily physicians and general internists.

Why should rates of burnout be higheramong physicians? For one thing, physicianstend to work longer hours than other workers,on average about 10 more hours per week.Moreover, striking an appropriate work-lifebalance appears to be a bigger challenge forphysicians, in part because they often tend tokeep work and personal life more separated

than other workers. The issue of physicianburnout is important.

As the U.S. population grows and ages,the number of physicians needed to care forthem increases. When burnout leadsphysicians to reduce or cease their practicealtogether, patient access to medical care isdiminished. Moreover, burned-out physiciansare likely to be less productive, make moremistakes, and generally deliver a lower qualityof care than their fully engaged colleagues.Finally, physicians are human beings too, andtheir suffering should summon no lesscompassion and concern than anyone else's.

To enhance fulllment and quality ofwork, it is necessary to focus on the work

itself. In the case of medicine, dophysicians recognize what they ndmost fullling? If they cannot see thetarget they are aiming for in thiscase, the aspects of their work thatthey nd most meaningful and take

most pride in they are unlikely to hit it. Whadoes their best work look like? Are theymaking full use of their knowledge, skills, andinnate abilities? Are they growing anddeveloping as human beings? Do they feelthat they are making a real difference in the

lives of their patients and communities?Burnout is not a disease. It is a symptom.

The key to combating physician burnout is noto reduce stress, but to promote professionalfulllment. And promoting professionalfulllment is not merely a matter of reducingcosts and error rates or increasing clinicalefciency.

If we are genuinely concerned aboutphysician burnout, we need to focus less onreducing stress and more on promoting whatis best in physicians: compassion, courage,and above all, wisdom. Only by keeping whamatters most at the forefront can we reap a fu

harvest of professional fulllment.

OPINION

Avoiding Physician Burnout Is CriticaPrimary Care Access Will Be Under Threat Otherwise

Richard Gunderman, MD, is a faculty memb

at Indiana University and a regular contribu

to The Atlantic online, where this blog was

originally published in its entirety.


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Payers & Providers Midwest Edition – Issue of August 28, 2012

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