8/6/2019 Payers & Providers California Edition Issue of July 21, 2011

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Building on its recent shift toward improvinghealth on the community level, the CaliforniaEndowment has become the primary mover ina $200 million program intended to improve

access to capital to supermarket chains toencourage them to open locations in woefullyunderserved areas..

The pledge from the endowment will beused to establish theCalifornia FreshWorksFund. Although theprogram will worknationwide, muchattention will also be paidto California, home tomany urban areasdemographers call fooddeserts, where many

communities are served by little more thanliquor or convenience stores.

"Health happens in our neighborhoods.Families can't eat healthier food if they can'tbuy it where they live, said Robert K. Ross,M.D., chief executive ofcer of the CaliforniaEndowment. Endowment ofcials also notedthat the project will also help add constructionand service jobs in California, where theunemployment rate has been hovering above12%.

A 2007 report by the Urban andEnvironmental Policy Institute at OccidentalCollege concluded that three of the most

densely populated neighborhoods in LosAngeles Pico-Union, Westlake/MacArthurPark and South L.A. had a total of 15supermarkets serving 15,000 people. Although

more markets have since opened in thoseareas the areas remain acutely underserved.

Overall, about 1.7 million Californianslive in areas where they are one mile or

further away from asupermarket. They are 20%more likely to be obesethan those who live closerto markets, leading toexpensive healthconditions such as diabetesand heart disease.

The collaborationincludes 18 different

entities, including banks, supermarket chainsand healthcare providers. The sheer numberof banks and other investors involved provesthat this is not only the right thing to do toimprove the health of our communities, butits nancially attractive, Ross said.

One leading local collaborator is theSouthern California division ofKaiserPermanente, which is pledging $1 milliontoward the FreshWorks Fund. The money willbe used to help add new food retail space, orexpand existing spaces. Kaiser has been

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8/6/2019 Payers & Providers California Edition Issue of July 21, 2011

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Payers & Providers Page 2

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In Brief

Anthem, Blue ShieldReach Deal WithDMHC On Autism

Treatments

Anthem Blue Cross of California andBlue Shield of California have cometo terms with the Department ofManaged Health Care to providespecic treatments to its enrolleeswho suffer from autism.

The deal with Anthem,announced on Tuesday, will cover upto 4,000 children who suffer fromautism. Anthem has agreed to pay fora therapeutic treatment known asapplied behavioral analysis. Thetreatment, which focuses on behaviormodications, is intended to helpautistic kids better adapt to their

environment.Although studies have been

made about the efcacy of ABA,insurers such as Anthem and BlueShield had resisted covering thetreatment, claiming it wasexperimental or not medical innature, or have not included licensedtherapists within its providernetworks.

In the settlements, Anthem andBlue Shield still insisted that ABA canbe provided by unlicensed personnel,but agreed to cover treatmentsanyway. Neither plan admitted anywrongdoing.

Rather than just dealing a

onetime blow to health plans throughan enforcement action, this is anotherpositive step towards mending thebroken system for California familiesdealing with this issue, said EdwardHeidig, the DMHCs interim director.Blue Shields settlement with theDMHC, announced last week, cameat nearly the same time that theDepartment of Insurance orderedBlue Shield to cease and desist inrefusing to cover ABA.

Continued on Page 3

NEWS

Groceries (Continued from Page One)

sponsoring farmers markets in underservedareas such as Watts in South Los Angeles.

"The availability of healthy foods where

we live does inuence what we choose to eat,which can affect the prevalence of obesity,

diabetes, and other weight-related illnesses,"said Amy Porter, M.D., a Kaiser pediatricianwho practices in Baldwin Park and leads aweight management initiative for children inSouthern California. Catholic Healthcare West, Bank ofAmerica, U.S. Bank and Morgan Stanley havealso pledged funding.

For the moment, specic details aboutCalifornia-centric projects remain sketchy.

Major retailers such as Wal-Mart and

Walgreens have agreed to use funding fromthe program to help expand.

Walgreens, which is a drug store chainbased in the Midwest, said it would carryproduce and other non-processed foodproducts at 1,000 of its locations.

However, many other retailers that havesigned up to the FreshWorks initiative plan tobuild new locations in other states.

UCLA Settles Data Breach ChargesAgrees to Extensive Corrective Action Plan

UCLA Health System has agreed to pay$865,500 in nes in order to settle breaches ofcondential medical records that occurredbetween 2005 and 2008.

An investigation was launched by the U.S.Department of Health and Human ServicesOfce of Civil Rights in June 2009 after twounidentied celebrities who were patients atUCLA submitted complaints that their medicalrecords were accessed by employees who hadno need to access them.

The issue of patient data breaches at UCLAhas been going on since the middle of lastdecade, leading to the discipline of dozens ofemployees and physicians. In 2007, formeremployee Lawanda Jackson faced criminalcharges after selling the medical records ofBritney Spears and Farrah Fawcett to tabloidnewspapers. Jackson pled guilty to federalcharges in 2008, but died of breast cancerbefore her scheduled sentencing in March2009.

Covered entities are responsible for theactions of their employees. This is why it is vitalthat trainings and meaningful policies and

procedures, including audit trails, become partof the everyday operations of any healthcare

provider, said OCR Director GeorginaVerdugo. Employees must clearly understthat casual review for personal interest ofpatients protected health information isunacceptable and against the law.

The money will go directly to HHUCLA did not admit to any wrongdoing. Instatement, the system said over the past thyears, we have worked diligently to strengour staff training, implement enhanced datsecurity systems and increase our auditing

capabilities.Under the terms of the settlement, UCofcials agreed to a three-year correctiveaction plan that includes an independentmonitor and special training of employeeswho have access to patient medical record

"Our patients' health, privacy and welbeing are of paramount importance to us,"UCLA Health System Chief Executive OfcDavid T. Feinberg. "We appreciate theinvolvement and recommendations made OCR in this matter and will fully comply wthe plan of correction it has formulated. Wremain vigilant and proactive to ensure tha

our patients' rights continue to be protecteall times."

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8/6/2019 Payers & Providers California Edition Issue of July 21, 2011

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Page 3Payers & Providers

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NEWS

In Brief

UCLA Introduces NewSurgical Program

The UCLA Health System haslaunched a new program that willfocus on hand transplants and other

new and exceedingly delicatereconstructive procedures.

The new UCLA Section ofReconstructive Transplantation willhelp to repair disguring injuries tothe upper extremities, face andabdomen using microsurgicalprocedures that can repair extensivenerve and arterial damage. The newprogram will work closely with theexisting sold organ transplantprograms.

"Reconstructive transplantation iswhere we were with solid-organtransplantation in the mid-1980s," saidRonald W. Busuttil, M.D., executivechair of the department of surgery at

the David Geffen School of Medicine."With the experience that has beenaccrued in several centers throughoutthe world with reconstructivetransplantation, it is clear that forcertain patients, the outcomes can belife-changing and that majortransplant centers such as UCLAshould be pursuing this approach."

San Francisco HealthPlan Wins DHCS Award

San Francisco Health Plan, whichprovides Medi-Cal managed care for60,000 Bay Area residents, received

the Gold Award for excellence in carefrom the California Department ofHealth Care Services.

SFHP is the only one of thestates 21 Medi-Cal managed careplans that achieved high HEDIS scoresin 11 of the 15 categories in whichquality of care is measured.

"This award acknowledges theeffort of the San Francisco providernetwork," said SFHPs MedicalDirector, Kelly Pfeifer, M.D.. "Insteadof waiting until patients are sick, ourdoctors and clinics reach out to makesure our members are getting thepreventive care...to stay healthy.

The California Department of ManagedHealth Care has ned Blue Shield ofCalifornia $40,000 for retroactivelyterminating the coverage of a cancer patientwho had retained coverage after leaving heremployer.

The DMHC levied the ne against the SanFrancisco-based health plan for four violationsof the state Health and Safety Code and theCode of Regulations, including impropernotication of termination of coverage andretroactively terminating coverage.

According to DMHC correspondence, theenrollee had coverage through a small groupplan provided by her employer. She continuedthe coverage after leaving the job through

Californias COBRA program. Although shemade all of her premium payments on time,the employer stopped paying its premiums,resulting in the termination of her coverage.

The enrollee had already receivedauthorization for and was undergoingtreatments for cancer when Blue Shieldretroactively canceled her coverage and saidwould not pay for the care she received. TheDMHC determined that this constitutedcancellation without prior notice.

Blue Shield did not immediately responto comment.

The ne is among the largest of the 181administrative actions levied against the heaplan by the DMHC since 2001.

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DMHC Fines Blue Shield $40,000Retroactively Canceled Plan For Cancer Patient

Chu Named To AHA ChairmanshipPrestigious Post Given to Kaisers So. Calif. Chief

The head ofKaiser Permanentes Southern

California division has beennamed the chairman designatefor the nations leading hospitallobby. Benjamin K. Chu, M.D.,group president of KaiserSouthern California, was electedto the position by the AmericanHospital Association board ofdirectors earlier this week. Hewill begin serving a one-yearterm in 2013.

Chu will be the secondSouthern California hospital executive tochair the AHA in less than four years.Thomas M. Priselac, chief executive ofcerof the Cedars-Sinai Health System in Los

Angeles, served as AHA chairman in 2009.

"It is my privilege to serve inthis role as hospitals fromacross the countrydiscuss how we can best carefor our patients in thischanging healthcarelandscape," said Chu, whooversees 14 hospitals forKaiser. "Healthcare is at acrossroads and hospitals willplay an important role inimproving the health of allAmericans."

The 59-year-old Chu has

served in senior roles with Kaiser since 2005.He previously served as president of the NewYork City Health and Hospitals Corp.

Benjamin K. Chu. M.D.

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8/6/2019 Payers & Providers California Edition Issue of July 21, 2011

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Payers & Providers Page

!A key part of the Patient Protection andAffordable Care Act is the mandate that everystate establishes ahealth insurance exchangeby January 1, 2014, or default to a federalfallback program.!While exchanges have notyet received the headlines that haveaccompanied other aspects of reform, theirpotential impact is causing many to speculatethat these exchanges may end up the measureby which health reform is judged for years tocome. Healthinsurance exchanges create anonline one-stop shopping mall

where consumers can viewcompeting health insurance plansside by side and comparebenets, costs, provider networksand other features.!! Along withchoosing from multiple insurancecarriers, individuals will be ableto select from four benet levels-- bronze, silver, gold andplatinum --- each having adifferent set of benets and adifferent price point.! In this wayconsumers can pick a plan thatbest meets their needs and

budget. The CongressionalBudget Ofce estimates eightmillion people will use the exchanges in 2014,with participation tripling by 2018.

Clearly, exchanges make good sense formany individuals and small businesses lookingfor the best healthcare options available tothem.! In addition to providing greater choicefor those purchasing through an exchange,many individuals who previously went withoutcoverage will be able to obtain healthinsurance through a state exchange thanks topremium assistance subsidies. ! Thesesubsidies will be available to individuals

earning between 133% and 400% of thefederal poverty level. At the same time, smallbusinesses that purchase coverage throughstate-based exchanges may be eligible, underthe Small Business Health Option Program foran annual tax credit.

Will employers participate? While nobodyknows for sure, a survey by the not-for-protPacic Community Ventures released in Marchrevealed that 555 of Californias small businessowners would participate in an exchange onceprovided basic information on how they work.

This is signicant as today there are 47 millionAmericans working at 5.9 million smallbusinesses.!These workers are almost three timas likely to be uninsured as those who work folarge businesses.

For Californias hospitals, exchanges creanew population of insured patients, thus lessethe number of uninsured coming to theemergency department and/or being admittedthe hospital itself. Some of these will be newpatients which will lead to expanded

opportunities for marketplacegrowth (for physicians and

hospitals) while others will bethose who previously were inneed of charity care and addto a hospitals proportion of badebt. Either way, more payingpatients are good for a hospitabottom line.

How a state-run exchaultimately impacts the localmarketplace remains to be seebut it is important to note thatnations most successful privahealth exchange,CaliforniaChoice, is located r

here in California, serving mothan 150,000 members and10,000 employers. This speaks to the marketsacceptance and satisfaction with the insurancexchange concept as many hospitals andphysicians across the state already see patientwho are part of an exchange.! This is destinedincrease as all plans in an exchange must offeset of essential benets that will includehospital, emergency, and other care. Ashospital leaders prepare for the age of ACOs,enhanced public scrutiny and increased nanpressures, now is a good time to take a close at something designed to actually improve the

bottom line and contribute to market sharegrowth.! Health insurance exchanges make seNow lets all pull together to make them work

OPINION

Keeping Tabs On The ExchangesTheir Development Will Shape Perceptions of Refor

By Ron Goldstein

Ron Goldstein is chief executive officer of

CHOICE AdmInistrators, which manages an

administers health insurance exchanges.

9-21:)!;6!

8/6/2019 Payers & Providers California Edition Issue of July 21, 2011

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MARKETPLACE/EMPLOYMENTPayers & Providers Page 5

MANAGER, FINANCE AND TRANSACTION ADVISORY SERVICES

Responsibilities include managing consulting engagements and teams; interfacing with clients at

senior management and board levels; and some business development.!The companys clientbase consists of healthcare systems and hospitals, physician groups, insurance/managed care

organizations and other healthcare service/product/technology companies.! The successfulcandidate will have excellent analytical and communication skills with proven ability to interactwith C-level executives and boards.! Consulting experience with a national rm is also preferred.!Requirements: Masters Degree, 4 years of healthcare industry experience, hospital/medical groupnance, managed care operations, and/or experience with a national healthcare consulting ornational advisory rm.! Experience with managed care contracting, predictive modeling, andclinical integration is highly desirable.

Therm provides a broad range of advisory services involving

nancial acumen including:strategic planning, nancial planning and modeling, managed care, ACO development, bundled

payments and clinical integration strategies, feasibility studies, M & A transactions, valuations,fairness opinions, nancial advisory services, debt capacity analysis, private equity and venturecapital transaction services.

Also must have the ability to work well with individuals at all levels of an organization, andexcellent analytical written, and oral communications skills.! Comprehensive compensationpackages offered. Los Angeles-based position.

Contact Information:Mary Lasnier, The Camden GroupHR@TheCamdenGroup.comwww.TheCamdenGroup.com!

8/6/2019 Payers & Providers California Edition Issue of July 21, 2011

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MARKETPLACE/EMPLOYMENTPayers & Providers Page 6

EXECUTIVE DIRECTOR, CARE DELIVERY INNOVATION

The Blue Cross Blue Shield Association (BCBSA) is seeking an Executive Director, Care Delivery Innovation.Located in the heart of downtown Chicago, BCBSA is the national federation of the 39 independentcommunity based Blue Cross and Blue Shield (BCBS) companies serving 100 million people.

The Executive Director, Care Delivery Innovation is a newly created position housed within the StrategicServices Division of BCBSA. Strategic Business Services works with Member Blue Plans to develop business

solutions through strategic business relationships that strengthen the competitive position of the Blues. Foradditional information on BCBSA, please visit their website at www.bcbs.com.

Reporting directly to the Vice President, Strategic Business Services, the Executive Director, is responsible forproviding leadership, strategic direction and actionable solutions in support of the imperative to transformcare delivery in the United States to ensure a long term sustainable/viable health care system. The ExecutiveDirector manages ongoing market assessments, integration and synthesis of care delivery activities tosupplement Plan thinking and evolution of their alternative approaches. The Executive Director has threedirect reports and a total staff of seven.

The successful candidate must have a Masters degree. A minimum of 15 years of broad-based care deliveryexperience at the executive level in a large, sophisticated integrated delivery system, health plan, or healthsystem with a strong provider orientation is required. He/she must possess high standards of excellence and a

proven track record of driving innovation in a mature market. Excellent compensation, benets andrelocation assistance are offered. Interested candidates or condential recommendations should be sent tothe Witt/Kieffer consultants, Stephen J. Kratz and Shirley Cox Harty at CareDelivery_BCBSA@wittkieffer.com .

8/6/2019 Payers & Providers California Edition Issue of July 21, 2011

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T)!$)5!@#-3!3)!2&)2)'%!)&!2#&3+9+2#3%!+-!#!C535&%!4)5-,3#67%!8-3%]+*%S!"#&3+9+2#3+)-!+'!%-3+&%7$!)-7+-%I!@+3;!#!9)BB+3B%-3!)C!-)!B)&%!3;#-!)-%!;)5&:!/#77!4)-!M;+-AB#-!#3!VWWE

8/6/2019 Payers & Providers California Edition Issue of July 21, 2011

8/8

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