Payers & Providers Midwest Edition – Issue of June 12, 2012

7/31/2019 Payers & Providers Midwest Edition Issue of June 12, 2012

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Calendar

12 June 2012

June 26-27

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Payers & Providers Page 2

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In Brief

UnitedHealth IssuesDividend, Revives

Stock Buyback

With its stock price up about 40%over the last 10 months,Minneapolis-area health insurancegiant UnitedHealth Group hasboosted its dividend and revived itsstock repurchasing program.

UnitedHealth will pay adivided of slightly more than 21cents a share on June 22 to allshareholders of record after June15. Thats up from the 16 cent-per-share quarterly divided it initiatedin mid-2011. The payout willrepresent about $210 million.

UnitedHealth also renewed itsstock purchasing program with

plans to buy back 110 millionshares over time, representingabout 10% of the stock outstanding.A previous repurchasing programinitiated in May 2011 led to thebuy back of about 77 millionshares.

The program has helped powerUnitedHealths stock from about$42 a share last August to itscurrent $58 a share in trading onthe New York Stock Exchange.

The boards actions aregrounded in the solid growth weare experiencing across ourenterprise, said Chief FinancialOfficer David S. Wichmann,

reflecting the diversity of thehealth benefits and health serviceswe bring to market, thecomplementary way our businesseswork together and the value ourclinical management, informationand technology contribute to healthconsumers and the healthcaresystem.

Continued on Page 3

NEWS

Ohio Medicaid (Continued from Page One)

Continiued on Next Page

MEET OUR READERS!

Need to promote a conference? Or your brand? PayersProvider!se-mail list for all editions is available for yourmarketing needs. Reach out to more than 12,000healthcare professionals who read our publications. Caour advertising director Claire Thayer at (503) 226-985e-mail her at [email protected].

Telehealth Taking Off In MidwestApplications Particularly Popular In Rural Regions

Molina Healthcare is pleased to be able tocontinue its partnership with the state ofOhio to provide quality health care to Ohios

Medicaid beneciaries statewide, saidMolina Chief Executive Ofcer J. MarioMolina, M.D., president and chief executiveofcer of Molina Healthcare, Inc. Wecommend ODJFS for its decision, and welook forward to continuing our strongpartnerships with the state, our providers, andcommunity-based organizations to providehigh-quality health care services for some ofOhios most vulnerable citizens.

Buckeye Community CEO Steven Whiteexpressed a similar sentiment.

We have long been committed to

carrying out our mission of deliveringinnovative healthcare solutions that result healthy outcomes for Ohio's Medicaidrecipients, and we are pleased to continueour partnership with the state of Ohio, hesaid.

All of the plans must pass a readinessassessment administered by the ODJFSprior to the new contracts commencing onJan. 1.

The traditional focus for telehealth has been tobring the services of doctors,specialists and pharmacists torural communities wherethere is a dearth of providers.

But as technologyadvances, so do its uses.Telehealth has expanded froma kind of appointment-based,

doctor-to-patient service intoa wide range of care usingvarious kinds of technologyand devices.

One organization on theedge of telemedicine servicesis Avera Health, a system of300 hospitals, clinics, long-term care facilities and otherorganizations based in SouthDakota. A growing segment of thegroups business is its eCare program, whichprovides specialty telehealth services to ICUs,

emergency rooms, pharmacies, long-term caand other facilities.

Deanna Larson, vicepresident of quality and eCaservices for Avera, stated thathe systems goal has alwaysbeen to move beyond puttina piece of technology in arural area and hoping

someone will know how touse it. Larson said they workas much with the humanstaff as they do with thetechnology.We make sure we are settinourselves up with individuaable to operate thetechnology, understand it anuse in meaningful way, she

said.Avera works with 60 emergenc

departments, 33 intensive care units, 40

Ryan Spaulding


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Page 3Payers & Providers

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NEWS

In Brief

Coventrys Illinois PactIs Renewed

The state of Illinois has renewed apact with Champaign-based

Coventry Health Care toadminister its health plans andoffer benefits.

Coventry will offer an openaccess plan to enrollees through2016. It will offer an HMO productfor enrollment between July 1 andSeptember 28.

Were grateful for anotheropportunity to assist stateemployees and their families withhigh quality, affordablehealthcare, said Mike Wolff,Coventry Health Cares executivedirector in Illinois.

Formerly known asPersonalCare Insurance, Coventry

has offered benefits to stateemployees since 1984.

Wisconsin PsychiatricHospital Chain Names

New CEO

Wisconsin-based Rogers BehavioralHealth has named Patrick Hammer asits new chief executive ofcer. He willreplace David L. Mouthrop, who willretire on Aug. 31. Hammer is chiefexecutive ofcer of WellstoneRegional Medical Center inJeffersonville, Indiana. He will assume

the new position in early July.Rogers screened 500 potentialcandidates for the position. Wenarrowed the search down to three ofthe most qualied, said RogersChairman W. Carl Templer. "Webelieve that Pat will be an asset toRogers and will build upon the legacythat Dave began. No doubt he willadd some ofhis own vision and talents to theorganization.

Rogers operates ve psychiatricfacilities in the Milwaukee andMilwaukee regions, including RogersMemorial Hospital.

Minn. Blues Redefine Medical ExecsSenior Roles Focus on Specific Business Functions

Blue Cross Blue Shield of Minnesota hasrestructured the traditional role of the chiefmedical ofcer, instead replacing the job withtwo executive medical director positions thatfollow specic lines ofbusiness.

Paul Karazija,M.D., has beennamed executivemedical director forthe health planscommercial andgovernment programs.Lawrence Lee, M.D.has been named

executive medical director for providerrelations and quality.Ofcials with the Eagan-based Minnesota

Blues said the restructuring was intended tocreate greater collaboration among thevarious constituencies within the health plan.The positions are considered senior executiveroles and the highest medical leadershippositions with the organization.

Our customers look to Blue Cross tomanage the total health of their employeesand family members with new approachesthat advance the quality of clinical care and

improve people's health, said Garrett Blac

the plans senior vice president of healthmanagement. Providers look to us as atrusted partner for achieving our shared goa

of managing health carcosts, improving clinicoutcomes, and optimizthe patient experience.The appointmentsdirectly support all ofthese objectives. We loto their leadership,innovative thinking, anenergy in helping adva

the health of the people a

communities we serve.Karazija has been with the MinnesotaBlues since May 2011 as senior medicaldirector of key accounts. He was previouslchief medical ofcer at Wellmark Blue CroBlue Shield of Iowa and South Dakota. He held a variety of executive medical positionsince the mid-1990s.

Lee joined the health plan last Februarmedical director of provider analytics andclinical performance. He was previously ahealth plan medical director at Minneapolibased HealthPartners.

Telehealth (Continued from Page One)

prior to a hospital discharge, is where theis heading.

Ryan Spaulding, director of the CentTelemedicine and Telehealth at the Univof Kansas Medical Center, agreed.A lot of the care is being pushed down tdevices so it may be something a patientwears to monitor heart rate or hydrationlevels, he said. It will be done through phones or tablets or wearable devices. Itnotion of 24-7 health care that is differenfrom the standard one.

This technology is not being used wnow, but is available in closed systems liVeterans Administration, Spaulding saidsaid the VA has about 70,000 patients ushome monitoring for chronic conditions diabetes, heart disease and COPD. This iof a movement from individually focusedto population-based healthcare, he said. TAMMY WORTH

pharmacists and a handful of otherorganizations like prisons and long-term carefacilities.

Averas networks span through Minnesota,Iowa, Nebraska, Montana, North Dakota andWyoming.

The systemscommand central is staffed24 hours a day and they go well beyond thatface on the other end of a camera. Theirproviders are able to do anything from listento a patient with a stethoscope to guide adoctor through intubation with a camera thatgoes in the patients throat. They have a systemthat tracks patients in the ICU to watch forsubtle health changes and alert doctors theremay be a problem.But Larson said telehealth is quickly movingeven beyond this kind of contact to ensurepatients have access to providers outside ofthe care setting. Home management,providing support and education to people


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Payers & Providers Page

On Monday morning at 8:30, the pianist wasplaying Chopin etudes in the beautiful butdeserted four-story lobby of the new hospitalwhere my father was being cared for.

I bet my dad would have traded thismusic and this lobby for breakfast on Saturdayand a check-in by the nurse more than onceper shift for the past two days, I mused.This contrast makes me cranky,especially in light of the newRWJF/Harvardpoll reportingthat two-thirds of sick peoplein the U.S. are concernedabout the quality of their

health care and 87% areconcerned about its cost.

Every day, we read or hearin the news about the poorquality of U.S. health care, thehigh number of dangerousmedical errors, staff shortages,avoidable tests and treatments,the incompleteimplementation and adoptionof EHRs, tepid patientsatisfaction ratings and theabsolutely unsustainable price ofcare.

The majority of us who havebeen sick enough to be hospitalized in thepast year have experienced and areconcerned about all of these. What are weto make, then, of these expensive newedices? How do we make sense of thebuckets of money spent on an ad campaignfeaturing a hospitals new proton therapycenter?

We should probably just grow up andrecognize that our nave notions of thebenecence of health care generally andhospital care specically are outdated. Healthcare is big business, and these new fabulous

facilities and all this advertising constitute thecost of doing that business.

By competing for private payers andtouting boutique services, hospitals try tostand out by offering ve-star-type amenities(overlooking, in my fathers case, that 24/7room service is a hallmark of such ratings).They aim to cement their stellar reputations inthe minds of the public; they seek to attract usto the afliated specialist physicians whomaintain a steady ow of sick people. A newphysical plant and advertising blitzes signalto us that this hospital provides excellent care.

When my dad rates his experience ofcare, the grand piano in the lobby will not bepart of his assessment. Rather, he will focus othe respect and attentiveness he was shown bhis doctors and nurses and the cleanliness ofhis room.

If he returns to the hospital with a raginginfection six days after he is pronounced well

enough to go home, it wont bebecause he longs for theChopin recital in the lobby. Itwill likely be because he andmy mom werent givensufcient guidance or support

to care for him when he wasdischarged.

And months later when hecontemplates his portion of thhospital bill, his memories ofhis stay wont be of gourmetmenu choices or the art on thewalls. He will think aboutwhether he will have to go inthis savings or take out a loanto pay for his care.

Dont get me wrong, Iwould far rather have surgery andbe cared for in a clean, modern

hospital than in a dingy old one.And there is legitimate evidence that peopledo a little better when there is light and airand art around in the hospital. But sucharrangements will never compensate for themedical errors and erosion of quality causedby nurse stafng shortages, underused EHRsand the lack of thoughtful, personalizeddischarge planning.

Being ill enough to be in the hospital is aserious business for us. It doesnt involvemuch whimsy; there is little place for Chopin.When so many of us are challenged to pay forour care, conspicuous spending shows

profound tone-deafness to the publics mosturgent concerns. Are these cathedrals tomedicine really about better health for me andmy family and neighbors?

OPINION

The True Conceit Of The CathedralPatients Dont Want Pianos They Want Quality

Jessie C. Gruman is founder and president o

the Center for Advancing Health.

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MARKETPLACE/EMPLOYMENTPayers & Providers Page 5

AVP - Accountable Care Organization

Patients and families from across the region and around the world come to Cincinnati Children s HospitalMedical Center because we are dedicated to improving child health. We serve the medical needs ofinfants, children and adolescents with family-centered care, innovative research and outstandingteaching programs.

Cincinnati Children's Hospital Medical Center ranks third in the nation among all Honor Roll hospitals inU.S.News and World Report's 2011- 2012 Best Children's Hospitals ranking. It is ranked #1 forgastroenterology and in the top 10 for all pediatric specialties - a distinction shared by only two otherpediatric hospitals in the United States. Cincinnati Children's is one of the top two recipients of pediatricresearch grants from the National Institutes of Health. It is internationally recognized for improving childhealth and transforming delivery of care through fully integrated, globally recognized research, educationand innovation.Working for the largest national pediatric healthcare system, the Assistant Vice President will lead andmanage its newly created Accountable Care Organization (ACO) with anticipated annual revenues up to$500 million. Major responsibilities include Network Delivery, Network Management, Credentialing, Data

Analysis and Reporting, People Management and Payor Contracting and Relations.Specifically responsible for provider enrollment with payors, network provider contracting and provider

relations issues, ACO credentialing program, processes related to administering payor contracts, medicalmanagement functions including care management, care coordination, utilization and diseasemanagement programs, quality improvement programs across ACO provider network, data analysis andreporting. Assist in payor contract negotiations.To be successful, our ideal candidate will possess a Bachelor s degree along with ten years experiencemanaging network management, care management, medical management, and/or care coordinationactivities in hospital-owned or physician-owned health plan, PHO, or payor environment. Master s degreein business or health administration preferred.The incumbent must possess resiliency and perseverance in both starting up new business enterprisesand in scaling up business enterprises after start-up phase. Demonstrated leadership and managementskills required along with experience in formulating credible, effective, long-range strategies to attainoverarching organizational objectives; anticipating future trends, as well as potential threats or

opportunities; and accurately predicting how strategies will play out.Network management experience in Medicaid managed care plan desirable. Experience starting up newbusiness enterprises preferred.Cincinnati Children's Hospital Medical Center offers a comprehensive employee benefits program that isequal to or better than the majority of the other health care institutions in the city. The benefits program isconstantly reviewed to identify better ways to deliver world-class benefits.Visit our career site at www.cincinnatichildrens.orgto submit your resume and application. JobID# 58097.Cincinnati Children s is an Affirmative Action/Equal Opportunity Employer.


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Payers & Providers Midwest Edition – Issue of June 12, 2012

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