Payers & Providers National Edition – March 2011

8/7/2019 Payers & Providers National Edition March 2011

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Page 3Payers & Providers NEWS

In Brief

mandated minimum of 3.2 hours of

nursing per patient day, and falselyadvertising that it had.

Kaiser Wins TopDiversity Award

Oakland, Calif.-based KaiserPermanente has been named thetop company on the DiversityIncsTop 50 Companies For Diversitylist.Kaiser has been on the list since2006, and was ranked fourth lastyear. It beat 535 other companiesfor the top spot.

Among its accomplishments:

25% of its regional presidents areAfrican-American; 25% are Asian-American and half are women.

"As an organization, we servea very diverse population, andfrom our board and leadership toour frontline employees, weunderstand and value diversity,said Kaiser CEO GeorgeHalvorson.Kaiser also made the D iversityInc.stop 10 for recruitment of Latinos,African-Americans and Asian-Americans. DiversityInc CEO LukeVisconti said Kaiser understandseffective healthcare delivery is tiedto having a diverse staff.

In a statement, Kaiser said itsefforts go back to operating the firstracially integrated hospital in theUnited States in the 1940s.

Michigan Blues Earn$222 Million in Net

Income in 2010

Blue Cross Blue Shield of Michiganearned $222 million in 2010 ontotal revenue of $19.2 billion, butlost money on its insurancebusiness.

The company made a profit byvirtue of strong investment incomeof $443 million, a 9% return.

The Blues lost $168 million oninsurance, including a $200million loss on Medicaresupplemental politics and $51million loss on individual policies.Group insurance lines wereprofitable. It covered 4.35 millionmembers in the state.

The insurer raised reserves to$2.76 billion from $2.56 billion in2009. In 2009 the company had aprofit of $233 million.

networks with ACOs using bundledpayments so its already in the commercialmarkets. Blue Cross in Illinois signed an

Exclusive contract with Advocate. Thecontract is for bundled payment andAdvocate is using it as a recruiting tool fordocotrs and hospitals.Susan Pantely:Bundled payments, shifting risk to providers,will make sense to health plans with thenew MLR rules that don't reward them fortaking risk. It always does away with thevolume incentive so utilization controls arenot as onerous.Moderator:Name three things an ACO will have to doin order to thrive in the long-term.

Peter Boland:Bundles don't address if the procedureshould have been done (thus a boontowards volume); quality metrics need to gobeyond the usual process measuresDoug Hastings:Be effectively clinically integrated so that itcan score well on evidence-based measures.Be flexible to accommodate evolvingpayment methodologies. Have aknowledgeable Board that understandsaccountable care.Susan Pantely:1. Timely, actionable reporting on quality

and financial issues. 2. Good integratedsystem with communication 3. Strongleadership structure.Bill DeMarco:Build trust, prove accountability, and investin customer service.Moderator:Name three things ACOs have the capabilityof screwing up.Peter Boland: Results (bundles, episodes,global risk) depend on trust which dependson transparency (data and pricing), thustransparency is key and is not somethingmost c-suiters are comfortable with yet --

thus, leading to limited collaboration atbest.Doug Hastings:1. Not engaging the consumer.2. Putting all their eggs in the MedicareACO basket and not exploring opportunitieswith other payers.3. Not creating linkages with the full rangeof necessary providers.4. A failure to match the payment model to

the level of ACO care coordination.

Susan Pantely:1. Underestimating the expense for nonmedical costs (infrastructure)

2. Setting too aggressive targets. I think financial targets could be set tooaggressively. Moving to a more efficientorganization won't happen overnight.3. Leaving the consumer out of theequation.Bill DeMarco:Keeping the status quo. Hospitals whodominate the doctors ability to effectivemanage, those who market to Medicareonly, commercial is a good candidate foACOPeter Boland:Consumer values and preferences in the

treatment process are largely ignored, tvery little patient engagement. Same forphysician engagement; not the same asbuying practices. There are a host of "soresources to bring to bear in order toattract physician support.Moderator:Describe what you believe the ACOlandscape will be 10 years from now?Doug Hastings:Just as we have seen remarkable progrein the 10 years since Crossing the QualChasm was published, in 10 more yearswe will have seen significant further

penetration of evidence-based practiceand coordinated care.Susan Pantely:I think we will see winners and losers. Ithink we will see successful organizatiothat have different structures. What worin one region or for one organization mnot work in another.Bill DeMarco:Some will remain as networks contractiwith public and private payers and somwill become CO-OPs under the newdesigantion and offer thier own productPeter Boland:

Just like "managed care," it will becomenormative and we won't call it ACOs pese.Doug Hastings:The market power issue may still beplaguing us. New forms of contracting(rather than mergers) among competingproviders to accomplish accountable cagoals through bundled and globalpayments may help create antitrust-acceptable pathways.

Roundtable (Continued from Page Two)


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Payers & Providers OPINION Page 6

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I spent most of my life in the patient side

of healthcare. At age 24, I was diagnosedwith rheumatoid arthritis. For 17 years Ilived with a back brace and my only way tomove around was on a wheelchair.Although the pain was excruciating, Imanaged to have a fulfilled life as a teacherin Florida. Later, my health problems werere-diagnosed as untreated Lyme disease.! Asa result, I did therapy witha specialist in chronicpain, who usedosteopathic manipulationof my joints andacupuncture, as well as

changed my diet.Eventually, I was freedfrom my back brace andwheelchair and wasinspired to become adoctor and specialize inosteopathy.

A few years later, Imoved to Tutwiler, a smalltown of 1,150 people inthe Mississippi delta, to re-open aclinic that had been closed for manyyears.! In addition to Tutwiler, ourclinic also handles the health needs of

the families in the surrounding fivecounties (last year we handled over8,500 visits).! For those who are notfamiliar with the area, the Mississippidelta is one of the most depressed of thecountry. Some of my patients work on localcotton plantations or farms growing corn,soybeans and rice. The majority of mypatients are unemployed and uninsured.!Even those with steady work rarely haveinsurance.! In fact, most of them cannotafford to pay for care and only about 15%qualify for Medicare or Medicaid. And thatsonly the beginning of our challenges. A

large majority of our patients have notfinished high school. This means that a largeportion of each visit is spent informing ourpatients about healthful lifestyle choices, towhich most are completely oblivious.

Having been a patient myself for so long,I have a good understanding of thechallenges of our healthcare system. Thefrustration I experienced motivated mydecision to do everything possible toimprove the quality of care we provide at

the Tutwiler Clinic. My ultimate goal for o

clinic is to educate our patients andempower them to be custodians of theirhealth (this includes proper diet, nutritionand proper medical check-ups).

One of the best ways to ameliorate ourpatients!experience at the clinic was toembrace technology. Many healthcaremedical groups in the country have been

reluctant to usetechnology, but i t mademuch sense for us. Afterreceiving approval for agrant, and with the helpdonors and a local IT

volunteer, the clinicpurchased andimplemented a SageIntergy system.The use of electronichealth records at the clihas brought so manybenefits to our practice.has resulted in improved

efficiency and substantiasavings and, when you work in a ruand depressed area, those twoelements are vital to the success ofyour work.

With EHRs, our staff can deliver mocare in less time, which means we cnow use that additional time to realfocus on our patients and provide

quality care even with limited resources. Tsystem has also helped us be more conciswith our medical charting and dictation.

At 72, I have had numerous experiencemy life, but the most rewarding has been twork I do at the clinic and in the Mississipdelta surroundings. We have overcome mchallenges and still have many with whichwe need to deal, but the people we treat athe positive impact we have in their lives

makes it all worth it. !

A Little Technology, A Big MiracleEHRs Help Even The Humblest of Patients And Provide

Op-ed submissions of up to 600 words are

welcomed. Please e-mail proposals to

[email protected], or call (877

248-2360, ext. 3.

Sister Anne Brooks is an osteopathic doctor

practicing in Mississippi.

By

Sister

Anne

Brooks,D.O.


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Payers & Providers National Edition – March 2011

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