7/31/2019 Payers & Providers Midwest Edition Issue of June 26, 2012

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7/31/2019 Payers & Providers Midwest Edition Issue of June 26, 2012

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In Brief

HHS Says Reform HasHelped Millions Of

Younger AmericansRetain Healthcare

Coverage

New data released by the U.S.Department of Health and HumanServices concluded that 3.1 millionyoung adults have been able to gainand sustain healthcare coverage as aresult of the passage of the AffordableCare Act.

One of the tenets of the reformlaw is permitting children to stay ontheir parents insurance policy untilthey reach the age of 26.

This policy doesnt just giveyoung adults and their families peaceof mind, it also gives them freedom,said HHS Secretary Kathleen Sebelius.It means that as they begin theircareers, they will be free to makechoices based on what they want todo, not on where they can get healthinsurance.

Altogether, about 75% of youngadults have healthcare insurance, aproportion that has risen since thepassage of ACA in 2010. As of late2011, 2.5 million young adults wereable to retain their coverage, anumber that has continued to rise.

HealthPlus Says It WillPreserve Some ACA

Reforms If Law Is StruckDown

Flint, Mich.-based HealthPlushealth plan said it would continuea number of reforms contained in

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NEWS

Twin Cities (Continued from Page One)

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organizations on ways to solve the problemsas well.

They offered opinions on why things are

the way they are, what is being done andwhat needs to be done to reverse it, saidJulie Eastling, the foundations programcommunications consultant. The conclusionis that disparities arent natural; they arebased on policy decisions made overdecades.

The organization focuses its efforts infour different areas: social connectedness,early childhood development, affordablehousing and the built environment. Onesolution they have found is that children withasthma cost the system about $3,000 to$5,000 annually in visits to emergency

rooms. Putting a ventilation system into thechildrens homes would be a one-time cost of$5,000 and would mitigate attacks foreveryone in the house, Eastling noted.

We are looking at how to keep peoplehealthy before they get to the doctor, shesaid.

One interesting statistic the organizationfound has led to a new, innovative effort. A2010 national survey found that 44% ofpeople living in households below the federalpoverty limit use libraries for their computersand Internet access. The Internet is alsowhere many seniors go to get their health

information.This spurred the organization to create

its Public Libraries for Health program. The

are providing grants of up to $50,000 forlibraries that have programs to improve thehealth of citizens in low-incomecommunities.

Already, some libraries offer serviceslike tness and grief classes and the group looking at creative ways to create socialconnectedness and address factors likeincome, unemployment, community safetyand family support.We want them to look at the conditions inthe community and see who can play a pain helping their community, Eastling said.

Eastling said there are many things

beyond a persons control that impact his oher health like toxic conditions, noise, strefrom unemployment and prejudicialtreatment. These can all greatly impactsomeones health outcomes. And the onlyway to create change is to deal with theroots of the problems.Long-term improvement will only comeabout if we create the social and economicsolutions that impact the root problems inthese issues, Eastling said. We arecommitted to working on the long haul toimprove the conditions in the Twin Citiesand across Minnesota.

-- TAMMY WORTH

Univ. Of Michigan System HealthyPosts Better-Than-Expected Numbers For Fiscal 201

Although it has recently poured tens ofmillions of dollars into infrastructure tomeet soaring patient caseloads, theUniversity of Michigan Hospitals & HealthCenter reported a healthy bottom line for

scal 2012.

The Ann Arbor-based system projecnear break-even on revenue of $2.2billion, with a predicted operating loss about $11 million. However, much of t

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7/31/2019 Payers & Providers Midwest Edition Issue of June 26, 2012

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NEWS

In Brief

the Affordable Care Act even if theU.S. Supreme Court should strikedown the law as unconstitutional.

Among the reforms it willpreserve are no lifetime limits oncoverage, paid preventative careand coverage for dependentchildren until they reach the age of

26. HealthPlus joins the ranks ofMinnesota-based UnitedHealthand other major insurers that saythey will maintain similarprotections if the Affordable Act isstruck down by the Supreme Court.

HealthPlus has alwaysworked on behalf of its membersand groups to provide access toquality care and services atcompetitive prices, said ChiefExecutive Officer Bruce Hill.Regarding healthcare reformprotections, HealthPlus has had tomake very few changes to plansand policies in order to comply.

That's because our goal is, and hasalways been, finding ways topromote health and wellness to ourmembers and the communities weserve.

The high courts ruling on theACA is expected on June 28.

Reusable SharpContainers Reduces

Greenhouse Emissions

A new study suggests that employingreusable containers for medicalsharps can reduce greenhousegases.

The study, which focused onChicagos Northwestern MemorialHospitals deployment of the reusablecontainers concluded that theyreduced the facilitys greenhouse gasemissions for sharps disposal by 84%.Additionally, the hospital use ofreusable containers kept 31 tons ofplastic and ve tons of cardboard frombeing placed into a landll.

The studys ndings werepublished in the Waste Management& Research journal.

UM System (Continued from Page One)

is tied to expenditures for capital projects,including the opening of the new C.S.Mott Childrens Hospital and Van

Voigtlander Womens Hospital; asignicant emergency room expansion;and a healthcare IT overhaul.

Taking out the capital projects,operating prots would have been around$66 million, ofcials said. As it was, theoperating loss was originally projected ataround $24 million.

Meanwhile, patient growth grewswiftly during the year, with inpatient andobservation care cases up 4.5% andoutpatient visits up 4.5%.

"To see this kind of patient growth,

and to beat our own expectations despitethe Michigan economy, major investmentsand great change, is a testament to ourentire team," said UMHHC ChiefExecutive Ofcer Doug Strong. Every oneof our staff and faculty have pulledtogether to ensure that we serve patients

well, and nd every opportunity toimprove operations in ways large andsmall.

Strong and other system ofcialsattributed the better-than-projectednumbers to the use of lean thinking automotive industry concept that includexamination of every process within thehospital to determine how it may be mamore efcient. Additionally, the systemcompleted more than a dozen projectsfocused on increasing energy efciencyduring the scal year. Those projects aresaving more than $500,000 a year inenergy costs.

In this environment, with revenue a

expense challenges, a chief reason for osuccess is this willingness to look ateverything we do and ask, 'Can we do itbetter?' to improve quality, access, safetyand our patients' experience, said systeChief Operating Ofcer Tony Denton.

Fairview has since canceled its contracwith Accretive, and the rm has also lostbusiness from other hospital clients. Thecompany, which was on track to reportingrevenues of $1 billion this year, has seen itstock price srop from about $28 a share inlate February to about $11 today.

Waxman and DeGette are seekinginformation pertaining to what Accretivetermed pre-collections, an attempt to obpayments from patients prior to receiving

services. Accretive claimed such practices not subject to debt collection laws. They aalso seeking an explanation as to why anAccretive employee had access to theprotected health information of Fairviewpatients without their express consent.

They have also requested copies of allcompany policies and procedures,documentation of complaints from patientand medical professionals anddocumentation as to how Accretive estimathe prices for medical procedures in advanThey also want proof Accretive followsindustry standards.

Accretive Health, under increasing scrutinyfrom lawmakers due to its collection practicesat a group of Minnesota hospitals, has notimmediately responded to requests fordocuments from members of Congress.

According to a June 21 letter to AccretiveChief Executive Ofcer Mary Tolan from Reps.Henry Waxman, D-Calif. and Diana DeGette,D-Colo., the Chicago-based rm did notprovide documentation on the companyspolicies and practices in regards to collection

work it did on behalf of Minneapolis-basedFairview Health Services. Both lawmakersserve on the House Committee on Energy andCommerce.

The Minnesota Attorney Generals ofceled suit against Accretive during the spring,alleging the rm had inserted its ownemployees into Fairviews hospitals andengaged in aggressive collection practices thatinterfered with healthcare delivery.

Accretive ofcials have mostly denied thecharges, saying that it would successfullyrebut them.

Scrutiny Of Accretive Ramping UpLawmakers Request Documentation of its Practic

7/31/2019 Payers & Providers Midwest Edition Issue of June 26, 2012

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Payers & Providers Page

No matter the outcome of the Affordable CareAct, the long-term picture for payers remainsuncertain. Even if all the ACA provisions areenforced by the Supreme Court, there are stillmany issues to sort out. Ifsome of the provisions arestruck down, then otherissues will be encountered.

There is one thing forsure, however, amidst allthis uncertainty: thoughwe cant know exactlywhat changes we will face,none of them are going to

ease the pressure on costreduction and improvedperformance.

In an unpredictablebusiness environment,Blue Cross Blue ShieldMontana decided to giveitself a physical and makeprocess improvements tocontrol what we couldcontrol. Over the past twoyears, we have reduced costs in anumber of critical operational areas atthe same time that we made it easier

and faster for customers to do businesswith us.

One of the biggest challenges at BCBSMTwas the increasing complexity of customerservice. Our internal process improvementteam collaborated with our customer servicearea implementing six sigma principles. As aresult of these efforts, BCBSMT reached eachcustomer service process improvement goalthat we set:

The average speed of answering thephone is now 10 seconds or less.Abandon call rates are down to less than 1%.A 50% improvement in the number of calls

handled by a customer service representativeeach day.

While we had success performing processimprovement with our own team, werecognized that we needed to establish morerigor around our improvement efforts andincrease our scope to include more areas inour company. We partnered with GuidonPerformance Solutions, which deployedexperienced process improvement Black Beltsor coaches who helped us involve allemployees in embracing and applying lean sixsigma improvements.

Guidon conducted an initial assessment ocompany by interviewing approximately a thiour employees to identify areas that would mbenet from process improvement. They

set up a number of kaizens (hifocused process improvement sessions that included a crosssection of employees) to focussolving the most obvious roadand waste points quickly.

One of the rst projects wasimproving the claims processiworkow in our medicalmanagement area. We physic

moved all the departments to asingle location to create real tiface-to-face collaboration.Previously, the teams were divinto separate areas, whichhampered their ability to makedecisions on treatment andreimbursement. We also trainemployees on multiple systemsoftware and programs so that

could recognize efciencyimprovements between the different divisTaking a more collaborative approach anapplying data methods has:

Reduced the claims processing backlog

Reduced the appeals backlog

Resulted in double digit improvement inproductivity and responsiveness.

Other departments followed suit and realizedsimilar improvements.

These are exactly the kinds of gains that ahealthcare insurers must achieve given regulademands and the likely increase in insurancechoices for consumers. Continuing market ch

provides a clarion call to act pre-emptively toimprove cost, quality, and responsiveness as wmobilize employees to raise their improvemenconsciousness and customer centricity.

OPINION

The Pressure On Payers Is RelentlessCosts Must Be Kept Down While Efficiencies Rise

Michael Frank is the chief executive officer

Blue Cross Blue Shield Montana.

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