8/2/2019 Payers & Providers California Edition Issue of April 12, 2012

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Calendar

12 April 2012

E-Mailinfo@payersandproviders.comwith

the details of your event, or call(877) 248-2360, ext. 3. It will be

published in the Calendar section,space permitting.

California Edition

The California Department of Health CareServices has begun the rst phase of ademonstration project intended to improve thecare of those simultaneously enrolled in

Medicare and Medicaid.Los Angeles, Orange, San Diego and SanMateo Counties will be the rst of 10 countiesto shift the enrollees into managed care healthplans. They care for about 535,000 enrollees,or about half of the states total.

California is home to more than 1.1million such people, known as dual-eligibleenrollees. Most tend to be frailer than thoseindividuals enrolled in just one of theprograms, and their care is far more expensive they account for about a quarter of all Medi-Cal spending, even though they represent onlyabout 15% of enrollees.

According to research released last weekby the Kaiser Family Foundation, dualeligibles are more likely than their singleprogram enrollees to be in fair or poor health.In 2008, Medicare spending on dual eligibleswas 1.8 times higher than on other programenrollees ($14,169 versus $7,933), and 8%had annual expenditures topping $40,000.Nevertheless, in many instances the care dualeligibles receive is often uncoordinated,exacerbating their poor health.

Currently, most dual eligible beneciariesaccess services through a complex system ofdisconnected programs that often leads tobeneciary confusion, delayed care, poor care

coordination, inappropriate utilization andunnecessary costs, issues we are addressingwith this proposal, said DHCS Director TobyDouglas. The goal is to design a seamlesssystem that helps dual eligible beneciariesget the health care services they need andimprove health outcomes in a more scallyefcient manner.

The transition for the dual eligiblepopulation is similar to that for Californiasaged, blind and disabled enrollees, who weremoved into managed care programs last year.In Los Angeles County, which is home toabout a third of the states dual eligibles, L.A.

Care Health Plan and Woodland Hills-basedHealth Net will provide coordinated care tothe population, with some servicessubcontracted to Long Beach-based MolinaHealthcare.

We can improve continuity of care andservices, and maximize the ability of dualeligibles to remain in their homes and in theircommunity, said Howard Kahn, L.A. Cares

April 30-May 1

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Dual-Eligible Project Is LaunchedBenefit Rollout Begins in Three of 10 Calif. Counties

WEBINAR Thursday, April 26, 2012 10 A.M. PD

CLAIMS PROCESSING: A COLLABORATIVE EFFORT

Please join Kenny Deng, senior director of provider relations, Blue Shield of California, GeorgeMack, vice president of provider relations, Hospital Association of Southern California, and DaMartinez, director of patient financial services, Mission Hospital Medical Center, to discuss a

joint hospital/health plan initiative to streamline claims processing and improve provider bottomlines.

http://www.healthwebsummit.com/pp042612.htm

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April 20-22

April 27-29

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8/2/2019 Payers & Providers California Edition Issue of April 12, 2012

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Payers & Providers Page 2

Top Placement...Bottomless Potential

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In Brief

Fitch Gives KaiserClean Bill Of Health

Fitch Ratings has given a strong billof health for Oakland-based Kaiser

Permanente, and assigned an A+rating to its hospitals, insuranceoperation and other subsidiaries.

In addition to the rating, whichis the agencys third highest, Fitchalso assigned a stable outlook toKaisers long-term operations.

Fitch views the Kaiserorganization's earnings prole assolid characterized by a largerevenue base and reasonable marginsthat generates large amounts of (pre-tax earnings), the agency said in astatement. It noted that Kaiser hasaveraged pre-tax and net income of$942 million and $572 millionbetween 2007 and 2011, and is

modestly leveraged at 38% of debt tocapital.

Fitch did note that Kaisers largeconcentration of business inCalifornia and its capital-intensivebusiness model were its primaryweaknesses.

Altogether, Kaiser has about 9million enrollees nationwide, butnearly 80% reside in California. It hasother operations in Colorado,Georgia, Ohio, Washington, Oregon,Hawaii, Virginia, Maryland and theDistrict of Columbia.

Advocacy GroupLaunches Spanish-Language Website

Californians for Patient Care, aSacramento-based advocacy groupfor consumers, has launched aSpanish-language version of itswebsite.

The site, which is accessible atwww.calpatientcare.org, provides

Continued on Page 3

NEWS

chief executive ofcer. This can be achievedby providing appropriate services and

supports in lieu of institutional care. In doingso, we can increase the availability and accessto home-and community-based alternatives.

State ofcials have ambitious plans forthe program. They expect the move tomanaged care will not only improveoutcomes, but save as much as $678 millionin 2013, year and another $1 billion in 2014.

California Insurance Commissioner DaveJones is prohibited from exing his musclesover proposed rates hikes, but he at least isclearing his throat.

Jones called Aetnas planned rate hikes forsmall employers unreasonable last week. Itis the rst time he did so under SB 1163,legislation signed into law last year that mostlycodies the Patient Protection and AffordableCare Act in California, but also requiresinsurers to submit their rate hikes to regulators

for review. However, Jones has no actualauthority to block rate hikes.Aetnas rate hike, which went into effect

on April 1, raised premiums for its smallemployer groups by an annual average of 8%.However, some groups will see increases ashigh as 21.4%, with those enrollees in PPOplans seeing increases of more than 30% overthe next two years.

The California Department of Insurancesaid Aetna had made projections about rises inmedical costs that were not supported byAetna's actual claims experience. The

department also noted that Aetna made anearly 28% prot selling health insurance inCalifornia last year and is increasing rates iexcess of the U.S. Bureau of Labor's medicacost ination index.

Although Jones was able to exert pressuon Anthem Blue Cross to scale back aproposed rate hike for nearly 600,000enrollees in California last month, Aetna didnot yield. Aetna takes our commitment to osmall business customers seriously, and we

making every effort to maintain an affordabarray of products that provide access to quahealthcare services, the insurer said in astatement.

Jones again called for passage of AB 52bill that would give his ofce power toregulate premium increases but has stalled the Legislature. He also backs a proposedNovember ballot initiative that would give hthe same authority.

That initiative, launched by the SantaMonica-based advocacy group ConsumerWatchdog, is gathering the 800,000 signatuto qualify for placement.

California is one of 15 states currentlyinvolved with demonstration projects to

improve care and cut costs for its dual-eligibenrollees.Pending approval by the Legislature, the

DHCS is soon expected to roll out theprogram in Alameda, Contra Costa, RiversideSacramento, San Bernardino and Santa Claracounties, which will affect another 220,000lives.

Dual Eligibles (Continued from Page One)

Aetna, Jones Spar Over Rate Hikes

Payer Balks on Proposed Small Market Increase

FOLLOW THE MONEY]

CALIFORNIAS HEALTHCARE INDUSTRY ANDPOLTICAL FINANCE

CALL (877) 248-2360, ext. 2 to orderOR CLICK HERE

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8/2/2019 Payers & Providers California Edition Issue of April 12, 2012

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Page 3Payers & Providers

Longer ALOS!*

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In Brief

county-by-county lists of services foruninsured and underinsuredindividuals. Ofcials said a Spanish-language site was crucial given thestates demographics.

Nearly 60% of Californiasuninsured are Latino and we arepleased to offer the Latino community

a trusted resource with a variety ofinformation about how to navigateour complicated healthcare system,said Carmella Gutierrez, Californiansfor Patient Cares executive director.

Ourwebsite offers culturallyand linguistically appropriateinformation about connecting toaffordable healthcare options andmany other issues of importance tothe Latino community.

Nearly 30% of those expected togain insurance coverage if theAffordable Care Act is implementedare Latino, according to data recentlyreleased by the White House.

John Muir Names FirstChief Medical Officer

John Muir Health has named IrvingM. Pike, M.D. as its rst chief medicalofcer. In the role, Pike will be anadvisor to the two-hospital Muirsexecutive leadership and medicalstaff.

A gastroenterologist by training,Pike has practiced in Virginia since theearly 1980s. Hes spent the past dozenyears as an executive with SentaraHealth, primarily as vice president ofmedical affairs.

Dr. Pike brings a breadth ofclinical and leadership experience, aswell as proven collaboration skills to

John Muir Health, said John Muirchief executive ofcer Cal Knight. Aswe work together to navigate achallenging health care environment, Iknow he will be a passionate voiceand advocate for our physicians,patients and John Muir Health.

Based in Walnut Creek, JohnMuir Health operates two hospitals inthe East Bay.

Technology Fund, which provided $1 million

About 100 sites statewide began using thenetwork in late 2011 to allow patients to beexamined and consult with physiciansremotely. CTN ofcials eventually expect tohave 850 provider sites online.

CTN Chief Executive Ofcer Eric Brownsaid the latest grant would help increasetechnical and programmatic support at itsclinical sites. Less than 20 percent of ourlocations have onsite information technologyexpertise. Thefunding also enables CTN toprovide much needed IT support to our sites enable them to better utilize the technologyCTN makes possible, he said.

Insurance giant UnitedHealthcare has

contributed $700,000 to the CaliforniaTelehealth Network to expand training intelemedicine and spread its use to moreunderserved rural clinics and hospitals.

To date, UnitedHealthcare has donated$1.3 million to CTN, which provides abroadband link that connects providersthroughout the state. It provided $600,000 in2010 as startup funding, although much of theprojects seed money has come from theFederal Communications Commissions ruralhealthcare pilot program, which provided $9million, and the California Emerging

NEWS

Cal/OSHA Fines Coalinga Hospital$200,000 in Total Penalties Given To Five Facilities

United Ups Its Telemedicine AnteHas Now Given $1.3 Million to Telehealth Networ

Cal-OSHA has

ned Coalinga State Hospitalabout $20,000 for violations pertaining toworkplace safety.

Regulators say the hospital, whichfocuses on the treatment of sex offenders,did not provide adequate protection toemployees from being assaulted and has afaulty system for notifying workers ofpotential issues. Cal/OSHA issued twoseparate citations in late March allegingserious violations that could lead toserious physical harm or death of notaddressed.

Altogether, Cal/OSHA has ned ve

state mental hospitals a total of $200,000over the past year for workplace issuessimilar to those of Coalingas. Amongfacilities receiving a citation was Napa StateHospital, where a technician was murdered

by a patient in 2010. That citation is currentlyunder appeal by the California Department ofMental Health, which operates all of the citedfacilities. It is also appealing a citation given tothe Metropolitan State Hospital in Norwalk.

It is unknown if the DMH plans to appealthe Coalinga citation. The current appealshave drawn criticism from the CaliforniaAssociation of Psychiatric Technicians a tradeassociation and labor union that representsabout 7,000 employees statewide.

Weve been trying to get these problemsaddressed for years, but Coalinga and DMHadministrators have ignored us, said Juan

Nolasco, who works at the Coalinga facilityas a psychiatric technician. And now, eventhough theyve been cited by Cal/OSHA, theproblems are still happening. We cant tolerateanother assault or injury.

HEALTHCARES BEST ADVERTISING VALU]

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8/2/2019 Payers & Providers California Edition Issue of April 12, 2012

4/7

!"#$%!&'(!')&'!*!')&'!+,!-.,/#0!1!-#23$4/#0!-5+%$06$78(!99:

Payers & Providers PageOPINION

Doctors Grumble More Than RumbleThey Want to Leave Practices, But More Often Stay P

Aaron Carroll, M.D., is associate professor

pediatrics and associate director of Child

Health Services Research at Indiana Unive

School of Medicine. This op-ed was adop

from a post from the Incidental Economist

blog.

;2%5005/!&?-.,/#0!1!-#23$4/#0!$0!

"5+%$06/4!/3/#,!@65#04.,!+,!-.,/#0!1!-#23$4/#0!-5+%$06$78(!

99:A!!7!.775.%!$74$3$45.%!05+0B#$"C$27!$0!DEE!.!,/.#!FD&=E!$7!+5%G!5"!C2!&)!

05+0B#$+/#0HA!>C!$0!4/%$3/#/4!+,!/I150) wanot. And, surprising me not at all, the use oinformation technology had no impact onwhether a younger physician might thinkabout leaving the practice of medicine.

Older physicians were more likely tothink about retiring. They arealso more likely to think aboleaving the practice of medicif they have high numbers ofuninsured, Medicare orMedicaid patients. Those insolo- or two-doc practices wmore likely to think aboutleaving than those in largerpractices.

Heres the irony. For all tanecdotal stories of docsplanning to quit because ofoutrage over the ACA, a numof provisions contained with

may make primary care docs, especiyounger ones, less likely to jump shiThe ACA will reduce the number ofuninsured, high numbers of which w

associated with younger docs thinkinabout leaving. The formation of ACOs shoualso lead to fewer solo or small practices,which was associated with older docs thinabout leaving. Docs also like to see morepatients, and no one thinks the ACA is gointo lead to fewer patients in the health caresystem.

Its entirely possible that the ACA mighlead to fewer primary care physicians leavmedicine, not more. We will have to see. Bthe next time you read an op-ed by an docoutraged by the ACA, threatening to quit, itworth remembering that he or she might n

be representative of all of them.

ByAaron

Carroll, M.D.

Op-ed submissions of up to 600 words ar

welcomed. Please e-mail proposals to

editor@payersandproviders.com

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8/2/2019 Payers & Providers California Edition Issue of April 12, 2012

5/7

!"#$%!&'(!')&'!*!')&'!+,!-.,/#0!1!-#23$4/#0!-5+%$06$78(!99:

MARKETPLACE/EMPLOYMENTPayers & Providers Page 5

SENIOR HEALTHCARE ANALYST

JOB SUMMARY: This position will support the HCC andEncounter Team in Health Care Informatics by collecting and ana-lyzing healthcare related data by performing data management,quality improvement studies and by conducting statistical analysisand generating reports for the organizations decision makers.

ESSENTIAL JOB RESULTS: Support operational needs byperforming complex analyses on a wide range of organizational

data - investigate and uncover root causes, identify trends, etc.and propose solutions. Achieve results by effectively leverag-ing expertise in healthcare/managed care data including, butnot limited to, membership, provider, claims, authorizations,pharmacy, and financial information. Commitment to customerservice achieved through timely, accurate, and supportabledeliverables. Support customer needs for what-if scenarioanalysis by developing analytical tools/models. Ensures under-standing of customer needs by proactively clarifying scope andrequirements and keeps customers apprised of project statusthrough effective communication. Achieves high-quality deliv-erables by assuring accuracy and thoroughness in executingprojects. Manages multiple (department) projects by effec-tively prioritizing work and communicating workload issues to

management. Develops and maintains up-to-date knowledgeof the Data Warehouse and other organizational data sources.Maintains professional and technical knowledge by attendingeducational workshops; reviewing professional publications;establishing personal networks; participating in professionalsocieties. Contributes to team effort by accomplishing relatedresults as needed.

QUALIFICATIONS: Bachelors Degree, or equivalent experiencerequired. 4+ years of proven analysis experience highly pre-ferred, or 2+ years of proven analysis experience in a Healthcare/Managed Care environment highly preferred. Ability to effec-tively interact with, and present findings to customers at all levelsof the organization including operational managers, medical direc-tors and executives required. Proficiency with MS SQL (queries)

highly preferred. Clinical code knowledge related to claims/utili-zation highly preferred. Experience with managed care contractterms/analysis a plus. Experience in a Medicare Advantage envi-ronment a plus. Experience with MS BI products a plus. Expertskills in MS Office productivity software, especially MS Excel.Excellent technical, interpersonal, written and oral communica-tion skills required. Superior analytical skills required.

FT position, M-F 8 AM to 5 PM, with extended work hours andpossible travel, as needed. Apply to www.scanhealthplan.com

Job Opportunities Req. #11-540

MARKET EXPANSION PROFESSIONAL

JOB SUMMARY: Plan, design, and complete processes tachieve business objectives for network and membershigrowth via market expansion. Manage and perform a broarange of tasks using resources effectively and efficiently tmeet identified timeframes for planned product and servicexpansions. This includes coordination of efforts and collaboration with external entities to meet all regulatory requirementand to ensure market expansion filings are fully compliant anapproved.

ESSENTIAL JOB RESULTS: Coordinate and execute completasks related to network and membership growth via markeexpansion, in order to ensure the successful completion oongoing cycles of work. Utilize detailed work lists to managthe timely completion of tasks for each phase of a particula

market expansion process and provide necessary updates tmanagement, escalating risks as appropriate. Develop anmaintain positive relationships with internal departments anexternal entities, creating partnerships to achieve programobjectives. Effectively communicate and assign deliverableand timelines. Monitor and manage the assigned tasks tachieve timely completion. Monitor quality of tasks performed, develop and recommend process improvements foimplementation. Assure a quality market expansion procesoutcome by making sure that each finished task meets threquired level of quality. As needed, troubleshoot issues anprovide innovative solutions, focused on continuous qualitimprovement. Maintain professional and technical knowledgby attending educational workshops; reviewing professionapublications; establishing personal networks; participating i

professional societies. Contribute to team effort by accomplishing related results as needed.

QUALIFICATIONS: Bachelors Degree required. Preferred areof study: Business or Health Administration, Managemenor Process Engineering. Experience within HealthcareManaged Care, preferred. Demonstrated interpersonal skillwith the ability to compromise, persuade, and negotiatebe well-rounded and have excellent communications skillsSolid leadership skills, excellent written and verbal communications skills and ability to establish effective workinrelationships with many different people, ranging from managers, supervisors, and professionals, to administrative ansupport staff personnel. Analytical, detail-oriented, flexible

and decisive. Ability to coordinate several activities at oncquickly analyze and resolve specific problems, and managdeadlines. Ability to work with minimal supervision, so neeto be self-motivated and disciplined. Expert skills in MOffice productivity software and strong computer skills aressential.

FT position, M-F 8 AM to 5 PM, with extended work hours andpossible travel, as needed. Must maintain valid drivers license,

automobile insurance and reliable transportation. Apply towww.scanhealthplan.com - Job Opportunities Req. #12-612

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8/2/2019 Payers & Providers California Edition Issue of April 12, 2012

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!"#$%!&'(!')&'!*!')&'!+,!-.,/#0!1!-#23$4/#0!-5+%$06$78(!99:

Payers & Providers MARKETPLACE/EMPLOYMENT Page 6

It costs up to $27,000 to fill a healthcare job*

will do it for a lot less.

Employment listings begin at just $1.65 a word

Call (877) 248-2360, ext. 2Or e-mail: advertise@payersandproviders.com

Or visit: www.payersandproviders.com

*New England Journal of Medicine, 2004.

SEEKING A NEW POSITION?

CAN HELP.

We publish advertisements for those seekingnew career

opportunities for just $1.25 a word.

If you prefer discretion, well handle allresponses to your ad.

Call (877) 248-2360, ext. 2, or e-mailadvertise@payersandproviders.com.

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8/2/2019 Payers & Providers California Edition Issue of April 12, 2012

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Page 7Payers & Providers MARKETPLACE/EMPLOYMENT

Since 1959, Presbyterian Intercommunity Hospitalof Whittier has been committed to building a mutu-ally supportive health care team consisting ofpatient care givers, medical staff, volunteers and theboard of directors that have ensured our local popu-lation the highest quality of medical services in Los

Angeles County.

Our Home Health & Hospice departmentis currently seeking an

ASSISTANT DIRECTOR OF PATIENT SERVICES.

The Assistant Director of Patient Services is respon-sible and accountable for services provided topatients through Home Health and Hospice. Withdirection from the Director of Patient Services, theAssistant Director will assess and assist the Director

in all areas of operations, compliance, professionalstandards and IDS relationship.

Requirements include: Bachelors degree in Nursingor other health-related field. Valid CA RN license;BLS certification. At least 7 years of experience,5 of which must be in a home health agency. 3years of experience in a supervisory or administrativecapacity. Able to direct nursing, therapy and socialwork within the framework of regulations to care forpatients while understanding the rationale of rule-making in the industry. Must have an active interestin improving current level of skill and knowledge.

Beyond the benefits that come with working forthe areas leading community health care provider one that also recognizes the need to ensure patientsafety and comfort youll enjoy an extremely com-petitive compensation and benefits package. Plus,we use team concepts to encourage professionalgrowth and development.

Please apply online at www.pih.net,or recruitment@pih.net.

Providence is calling aSENIOR FINANCIAL ANALYST OF REPORTIN

BUDGETING & PRACTICE ANALYSIS

to Providence Medical Institute, Torrance, CA.

In this position you will: Develop and maintain monfinancial reporting, prepare the annual budget, and supOperations management to identify and resolve finaopportunities in physician practices. The position willcreate, manage and track results of the annual OperaBudgets. Analyze physician compensation based on methodology.

Required qualifications for this position include:10 years of experience within a large healthcare orgation. Bachelors Degree in Accounting or Finance. Stanalytical skills with and expertise in using MicroOffice Access, Excel, PowerPoint, & Outlook. KnowledgLawson Financial Software.

Preferred qualifications for this position incluPhysician Compensation Analysis experience. MedGroup experience.

Providence Health & Services Southern California is furdeveloping its physician integration strategy. Historithe largest asset has been Providence Medical Institumedical foundation that provides administrative and osupport services to affiliated medical groups. ProvidMedical Institute is expected to grow significantly innext several years, bringing with it facilities, staff and sician growth to support that objective.

PROVIDENCE IS CALLING!

For immediate consideration, qualified candidates areencouraged to apply on-line at www.ProvidenceIsCalling.

Apply Onlinehttp://bit.ly/providence06640Healthfax

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