Payers & Providers Midwest Edition – March 1, 2011

8/7/2019 Payers & Providers Midwest Edition March 1, 2011

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If hospital readmissions are any indication ofquality of care, Illinois is trending toward thebottom of the deck. The state ranks 44th in thenation in the rate of Medicare 30-day

readmissions, and is getting worse.The Illinois Hospital Association and

Blue Cross and Blue Shield of Illinois haveteamed up to reduce the rate ofunnecessary readmissions. So far201 Illinois hospitals havepledged to raise the statesperformance from the bottomquartile in the nation to the tophalf by 2014. Blue Cross willinvest $1 million a year to supportthe initiative for the next fouryears.

Not only is it the right thing

to do for patient care, its the rightthing to do for bending the costcurve, said Maryjane A.Wurth, IHA president.

IHAs PREP program,Preventing Readmissionsthrough Effective Partnerships, intends to applyve key initiatives:

* Redesigning hospital discharge processes;* Improving care transitions;* Developing palliative care programs;* Reducing readmissions from infections; and* Standardizing metrics for measuring

reductions in readmissions.*

Charles Schutz, M.D., a medical director atBlue Cross, said the joint project was like analignment of the stars at a very opportunemoment. Preventing readmissions has beenon the radar for some time. Weve beenlooking for partners to help address this. Itsnot something you can effectively address asan insurance company doing routineutilization-management type things, he said.

The hospital association approached theBlues about three months ago, after the

Commonwealth Fund released Medicare datafor 2009, showing Illinois 30-day readmissionrate increased to 20.3% from 19.6% in 2007.Nationally, the median is 17.5% and the

average for the top ve states is 13.8%.That is not where this state should be,

based on the caliber of health care beingdelivered. Wurth observed. Our

board of trustees said, we need tostep up our leadership role, givethem additional assistance. Thenwe said to membership, We arebetter than this. We need to raisethe bar.

Hospitals will receiveassistance through fourestablished programs that haveproven successful in reducing

readmissions:* Project BOOST, sponsored by

the Society of HospitalMedicine;* The Illinois TransitionalCare Consortiums Bridge

program, which uses social workers to helppatients go from hospital to home;* Northwestern Memorial Hospitals trainingprogram on palliative care; and* AHRQs Project RED: Re-EngineeredDischarge.

Each of these has a slightly different takeon reducing readmissions. Project RED, for

example, concentrates on communicationsamong caregivers and patients, said JeffreyBrady, M.D., the patient safety researchportfolio lead at the Agency for HealthcareResearch and Quality in Washington.

RED underscores the importance of thepharmacist in the discharge process. In manyhospitalizations, the goal is to achieve theright balance of medications, Brady said.The patient doesnt always understand that.

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Payers & Providers Page 2

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In Brief

Humana Enters Dealto Create IncentiveWellness Program

Humana Inc., the fifth largest U.S.for-profit health insurer, has entereda joint venture with DiscoveryHoldings, a South African financialservices provider, to create a newjoint-venture corporate wellnessprogram.

The new entity,HumanaVitality LLC, will giveHumana customers tools andsupport mechanisms to leadhealthier lives. It will be based inChicago.

Discovery Vitality serves 1.9million people world wide anddescribes itself as the worldslargest incentive-based health-

enhancement program.Its U.S. subsidiary, The VitalityGroup, offers consumers asophisticated health-behaviorchnage model supported by anactuarially sound incentiveprogram, the companies said in astatement.

Discovery says that incentivesare essential to changing consumerbehavior. In 2010 it awarded itsmembers 500,000 flights, almost20,000 hotel stays, and 3.5 millionmovie tickets to people who metgoals for changing their lifestyles.

Discovery will hold 25% ofshares in HumanaVitality, and

Humana will gain a 25% stake inThe Vitality Group.

Michigan Blues Agreeto Roll Back Individual

Rate Increases

Blue Cross Blue Shield of Michiganreached an agreement with thestate attorney general to hold rate

Continued on Page 3

NEWS

Reducing Readmissions in Illinois (Continued from Page One)

RED aligns resources so that patientsunderstand why theyre being admitted andhow their care plan is changing.

Project BOOST, by contrast, has anemphasis on mentoring individual hospitals attheir specic level of competency andresources. Its targeted and exible, saidMark Williams, M.D., chief of the division ofhospitalist medicine at NorthwesternMemorial Hospital in Chicago. He is theprincipal investigator for Project BOOSTnationally.

We got input from every componentthats involved in the hospital dischargeprocess, he said.

Readmissions have long been recognizedas a quality problem in U.S. hospitals, but the

industry has never focused on it, for a numberof reasons. Recently a news articlehighlighted a handful of hospitals that hadsuccessfully reduced their readmissions, butthat were forced to end their programsbecause it was costing them too muchmoney.

They were losing the revenue fromreadmissions, Williams said. That has been

the nancial driver facilitating ignoring thisproblem.

Some community hospitals have

readmission rates of 25% to 30%, he added.If you dropped to 10% those hospitals wouldgo bankrupt. The country cant afford this anylonger, and the changes in federal law willforce everybody to pay more attention,Williams said.

Schutz said the initiative is in large partdriven by provisions in the Accountable CareAct that levy penalties on hospitals that dontcontrol their readmissions rate. That ismotivating hospitals all over the country to geon the ball, he said.

Those nancial penalties would besignicant for Illinois hospitals, Wurth said.

Based on an IHA analysis of the new law,Illinois hospitals would forfeit $680 millionover 10 years if the state stayed in the bottomquartile, compared to what they would save ifthey moved into the top quartile. It hasntcreated the need to change, but its providingacceleration and emphasis she said.

21 Charged in Detroit Fraud CasesMedicare Bilked of $23 Million, Investigators Say

Federal prosecutors in Detroit charged 21individuals with Medicare fraud on Feb. 17 aspart of a nationwide takedown of illicithealth care providers. The defendants includeowners and operators of companies,physicians, physical and occupationaltherapists, ofce employees, and patientrecruiters, according to the Ofce of the U.S.Attorney for the Eastern District of Michigan.

We want health care providers to knowthat we are paying attention to billing records,and that abuses will be aggressivelyprosecuted, said U.S. Attorney Barbara L.McQuade. The cases include:

* U.S. v Hernandez et al. Ten 10 people,including a physician, six clinic owners ormanagers, two employees and one patientrecruiter were charged with submitting falseclaims for nerve conduction studies in Livonia,Mich.* U.S. v. Mahmud et al. Five people wereaccused of submitting false claims for physicaland occupational therapy at a location inDearborn, Mich.* U.S. v Javidan et al. Three people, including

two physical therapists, were charged withsending in false claims for home healthservices and physical therapy.

Erroll Sherman, 63, a podiatrist in Oak ParkMich., was charged with submitting $700,000in false claims.

Surya Nallani, 43, a physician in Troy, Michwas charged with billing $8.5 million forexcessive home visits.

Joann McGhee, 45, of Southeld, Mich., wacharged with participating in a $6.1 millionscheme to submit false claims for psychotherapservices. She was also charged in Tennesseewith billing $1.1 million for services notdelivered.

Other defendants include: Tariq Mahmud,53, of Canton, Mich.; Fatima Hassan, 43, ofDearborn; Victor Jayasundera, 57, of SoutheldCarol Gant, 65, of Berkley, Mich.; VanessaDowell, 49, of Oak Park; Karina Hernandez, 26of Doral, Fla.; Marieva Briceno, 45, of Doral;Dora Binimelis, 57, of Miami; JonathanAgbebiyi, 61, of Rochester Hills, Mich.;Santiago Villa-Restrepo, 33, of Doral; Juan Villa28, of Doral; Isaac Carr, 28, of Belleville, MichDiana Brown, 50, of Farmington Hills, Mich.;Jasmine Oliver, 32, of Oak Park; Henry Briceno57, of Miami; Mehran Javidan, 48, of WestBloomeld; Vishnu Pradeep Meda, 30, of Troy;and Ram Naresh Rajalupati, 31, of Canton.


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Page 3Payers & Providers

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NEWS

In Brief

increases on individual policies tobetween 7% and 9.3%.

The insurer had originallysought increases of 7.8% to 15%for about 195,000 policyholdersyounger than 65.

Blue Cross said it is takinglosses on these products. Under

the agreement, the not-for-profitcompany will raise rates for 62,000policyholders by 7%, and the other133,000 individual policyholderswill see an increase of 9.3%. Thenew rates may become effective assoon as May 1.

Medtronic Trims Jobsas Sales Decline

Medtronic, the Minnesota basedmedical device maker, said lastweek it will reduce its work forceby 4% to 5%, or roughly 1,500 to

2,000 positions. IThe company employs 8,000in Minnesota. It wasnt clear howmany of the layoffs would be inthat state.

Medtronic, the largest medicaldevice company, with 24,200 U.S.workers and 41,000 globally, isbased outside Minneapolis.Its cardiac rhythm diseasemanagement division is losingmarket share in key segments, andsaw its sales sales decline 2% to$1.22 billion in the most recentquarter.

A recent article in the Journalof the American Medical

Association said that about 22%of patients who receivedimplantable cardiac defibrillatorsprobably didnt need them.

The market for cardiac rhythmmanagement devices andpacemakers is slowing in the U.S.,analysts say, although it is growingin emerging markets.

Phil Nalbone, an analyst withWedbush Securities, said thatMedtronic is starving for growth.Hospitals, physicians, and payershave been taking a more criticallook at pricing and overuse ofmedical devices.

Blue Cross and Blue Shield of Illinois last week

agreed to pay $25 million to settle allegationsthat it denied coverage to sick children underpolicies that it should have honored.

The civil settlement, among Blue Cross BlueShield, the state of Illinois, and the federalgovernment, arises from complaints of parentsof medically fragile children who aredependent on technological devices to stayalive and healthy. They said that Blue Cross hadwrongly terminated insurance coverage forprivate-duty, skilled nursing care, so that itcould shift the patients to a Medicaid programdesigned to provide home care for children atrisk of being institutionalized.

In a statement, the Blues said that the

settlement resolves a longstanding disputeconcerning certain claims involving private-duty nursing benets. We disagree with theallegations and deny any inappropriate conductat any time.

Under the agreement, Blue Cross BlueShield will pay $14.25 million to the state and$9.5 million to the federal government. Thecompany will pay a further $1.25 million to thestate for allegations under the consumer fraudlaw.

Blue Cross did not admit liability andagreed to the settlement to avoid the delay,uncertainty, and expense of protractedlitigation, according to a statement issued bythe ofce ofPatrick Fitzgerald, U.S. attorney forNorthern Illinois. The period covered by thesettlement is 2000 to 2010.

The Illinois Blues are the largest insurer inIllinois. Their parent company, Health CareServices Corp., also based in Chicago, is thelargest mutually owned Blues organization inthe country. It also controls Blues plans inTexas, Oklahoma, and New Mexico.

The investigation was started by the ofce

Lisa Madigan, the state attorney general, whoalleged that children whose care should havebeen covered by the insurance company undeexisting policies were instead shifted to theHome and Community Based ServicesMedicaid program, run by the Illinois Divisioof Specialized Care for Children. Parents whoasked for a claims review after being deniedcoverage were fraudulently told that theirchildren werent covered for private-dutynursing, the government said.

Linda Wawzenski, deputy chief of the cividivision in the U.S. attorneys ofce in Chicagsaid that patients were already receiving thenursing care. Then Blue Cross told them, No

this is no longer covered, this benet will nolonger be provided to you. Blue Cross denpatient claims based on internal undisclosedguidelines that were more restrictive than thelanguage provided to beneciaries in planpolicy materials, the government said.

Blue Cross, in its statement, said that incooperation with the state attorney general, ithad expanded the explanation of benets toexplicitly describe the nursing benets under plans.

Wawzenski said it was an unusual case foher ofce, which usually prosecutes Medicareand Medicaid fraud by providers.

We settled it before we actually had to

a complaint, she said. The U.S. attorneys of

is obligated to notify a defendant any time itthinks there might be a serious case developinNinety-nine percent of the time, people areinterested in having a conversation with us, ssaid. In this instance, Blue Cross was willing tdiscuss a settlement with the governmentagencies before a civil case was led.

Illinois Blues Pay $25M to State, FedsCivil Settlement Covers Medicaid Allegations

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Payers & Providers Page

Maybe the uninsured could learn somethingfrom Egyptians and the Arab streets. At atime when the health reform granting mostof the uninsured access to medical care isbeing threatened, protests by the uninsuredthemselves are nowhere to be seen.

In 2009, a staggering 51 millionAmericans had no healthinsurance. The Urban Instituteestimates that 400 of them dieeach week due to lack ofaccess to care. However,

instead of pouring into thestreets to protest, the uninsuredleave the loudest push-back to(well-insured) politicalpartisans.

One in six Americans isnow uninsured. Where arethey? Their faces and voicesand names are missed. At ahearing led by Sen. TomCoburn, an OklahomaRepublican, a sobbing,middle-aged woman

confessed she couldnt afford care for herbrain-injured husband. Coburn, a physician,glibly responded that the idea thatgovernment is the solution to ourproblemsis very inaccurate. The partisanRepublican crowd applauded.

An estimated 690,000 Oklahomans haveno health insurance. Why were so few inthe room? Why did hundreds of them notjam into Coburns ofce the next day? Whydo they not continue to tell their stories?

Like the ruling elite in Egypt or Bahrain,who genuinely dont comprehend the

problems of the average family, Republicansare more likely than Democrats to believethat the uninsured really dont have anytrouble nding care.

The political and legal peril in whichhealth reform nds itself is attributable tothe failure of the uninsured to visiblyadvocate on their own behalf. Those withouthealth insurance have allowed the issue tobecome a referendum on Big Government.And they have left the heavy work of

lobbying against repeal to the big insuranccompanies such as Aetna, Humana,UnitedHealth Group and WellPoint

Worse, while the Institute of Medicinecharacterizes the consequences of a lack oaccess to care as needless illness, sufferinand even death, it is Republican physicia

Congress brazenly lead theeffort to repeal care coverag

By coincidence, there arabout the same number ofelderly on Medicare as there

uninsured. Egyptiansunderstand the power of anaroused populace. Do theuninsured? In red states andblue states in 2012, there wbe congressional districts ansenatorial races up for grabsand a contest for the presidefeaturing a man who made ahistoric effort on their behaRepublicans have never forth a serious proposal toprovide access to care for a

Will they suffer any consequences?If anyone understands the power of

individuals coming together to make demaon their own behalf, it is a black man whostarted his career as a community organizeon Chicagos South Side. Yet rather than rathe uninsured, President Obama has allowRepublicans to frame the issue as a debateover the commerce clause of the Constitut

The ght to retain actual funding for theexpanded coverage in the Affordable Careis just beginning. It is a battle that Democrcan win only if Americans understand that

health and lives of their friends, neighbors relatives is at stake. For that to happen, thowhose lives are most intimately affected mrst stand up for themselves.

OPINION

Its Time to March Like An EgyptianUninsured Should Take to the Streets to Save Reform

By Michael Millenson

Michael Millenson is president of Health

Quality Advisors in Highland Park, Ill.

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Page MARKETPLACE/EMPLOYMENTPayers & Providers

DIRECTOR OF PHARMACY

(Urbana, IL)

Health Alliance Medical Plans seeks Pharmacy top-level individual responsible for drug formulary design and development,implementation, contract negotiation, and risk management. Quality, utilization management, customer service, and costcontainment are key performance metrics. Responsible for dealing with the wide variety of clinical, administrative, nancialand regulatory challenges involved in the management of pharmacy cost and utilization. Responsible for the supervision and

management of the Pharmacy Network, Pharmacy Staff, and pharmacy related contracting.

JOB REQUIREMENTS

Education, training, experience:

Education: Doctor of Pharmacy preferred.

Licensure: Current unrestricted license from the State Board of Pharmacy, State of Illinois by examination.

Experience: Five years industry experience and two years experience in managed care organization. Must include experiencein third party reimbursement, formulary and clinical programs. Government program experience (Part D and Medicaid) isdesirable. Previous experience in pharmaceutical rebates/discount contracting negotiation with pharmaceutical

manufacturers. Previous experience and understanding of retail pharmacy, hospital pharmacy, LTCF operation, billing, anddrug purchasing. Extensive experience with word processor and spreadsheet applications. Personnel management experience

Other Knowledge/Skills: Ability to organize, interpret and distill large volumes of data formats and accurately communicateissues to physicians, pharmacists, employers, administration, and Health Alliance staff. Ability to create and utilize costbenet analysis (pharmacoeconomics) of therapeutic selection and available alternatives. Must be able to anticipate and takecorrective action in response to changes in pharmacy regulations, prescribing patterns, new therapeutic technologies, etc.Ability to maintain a credible professional image with physicians and drug manufacturers. Must be adept at persuasion anddirect confrontation. Working knowledge of claims systems, pharmacy operations, and managed care required. Ability topositively address issues from dissatised enrollees and pharmacists.

Contact:Lesley Schacht

Professional RecruiterHuman Resource Services

Carle and Health Alliance Medical [email protected]

http://www.carlecareers.com


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DIRECTOR OF OPERATIONS MEDICARE

!! (Health Plan in Midwest) Perform duties as senior liaison between the Medicare business unit and Corporate department. Partner with multiple stakeholders and business unit leadership to establish operational objectives and procedures. Support due diligence and integration for business unit expansions. Facilitate operational oversight for Medicare business units and identify opportunities for maintaining effective

operations. Ensure cost effective programs are developed and maintained throughout the business unit. Identify operational efciencies and develop best practice policies and procedures. Contribute to the development of new products and markets. Utilize corporate and industry standard management tools and techniques to effectively oversee projects; negotiate

with project stakeholders to identify resources, resolve issues, and mitigate risks. Coordinate cross-functional meetings with various functional areas to meet overall stakeholder expectations and

business unit objectives. Provide functional and technical expertise across multiple business and technical areas. Coordinate cross-functional meetings with various functional areas to meet overall stakeholder expectations and

business unit objectives.

Bachelor's degree in Business Administration, Finance, Accountancy or equivalent. Six-plus years of experience in Medicaremanaged care operations with emphasis on nance and information technology preferred. Project management, administratioor operations in the Healthcare industry preferred. Masters degree preferred.

Contact:ES&P SEARCH!!!!

Sonia Varian at (818) 707-7118, [email protected]

MARKETPLACE/EMPLOYMENTPayers & Providers Page 6

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Payers & Providers Midwest Edition – March 1, 2011

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