8/8/2019 Payers & Providers – Issue of January 6, 2011 http://slidepdf.com/reader/full/payers-providers-issue-of-january-6-2011 1/6 ! ! ! "#$# ! %& ! '(&)*+ ! , ! '*-./0)*+ ! '1%2/+3/456 ! 778 The rate at which Californians were hospitalized improved considerably over the past decade, but they face an ever-growing threat from diabetes, while African-Americans remain at much higher risk for medical conditions such as hypertension and urinary tract infections. That was the gist of two related reports issued late last month by the Of ce of Statewide Health Planning and Development (OSHPD). The data, which focused on preventable hospitalizations statewide and racial disparities in healthcare that sometimes lead to hospitalization, portray a healthcare environment that is mostly improving by the year, but still contains serious issues that some providers are struggling to control. The overall hospitalization rate in California declined 6.8% between 1999 and 2008, to 10,533 hospitalizations per 100,000 population from 11,298 hospitalizations per 100,000. Among 15 health conditions studied by OSHPD as hotspots for potentially avoidable hospitalizations, 10 showed declines. Hospitalizations for chest pain were down more than 60%, while hospitalizations for pediatric asthma was down nearly 40%. OSHPD of cials give some credit to the improvement of outpatient care over the past decade. However, there are three chronic conditions that are leading to more preventable hospitalizations. Hypertension- related preventable hospitalizations were up more than 36%. Hospitalizations related to diabetes were up 8% due to long-term complications and 5.7% due to short-term complications. Finally, hospitalizations due to urinary tract infections – a relatively minor condition typically treated with antibiotics but can lead to kidney damage if left untreated – were up 9.6%. “The UTI hospitalizations were striking,” said OSPHD Director David M Carlisle, M.D. “I wish we had a bona de cause.” Carlisle noted that the condition in men could be a sign of prostate cancer. The data did not break out incidents of infection between men and women, who suffer the condition far more frequently and usually from more benign causes. Instead, OSHPD of cials were focused more on publishing the data rather than seeking correlations. Michael Kassis, an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anuary 12-15 January 20 Calendar 6 January 2011 January 18-19 8(2/C-*4/( ! 83(<?)* ! -C ! ?3) ! ;G)*/=(4 ! 8-22)5) ! -C ! RG)*5)4=& ! '3&+/=/(4+ ! JS?3 ! ;441(2 !8-4C)*)=)D !;3H(4)) !B-?)26 ! T-+)G/?)D ! ; ! 0/+=1++/-4 ! -C ! .(*/-1+ ! )G)*5)4=& ! G)0=/4) ! /++1)+D ! 8-+? ! UV;D 82/=N ! B)*) ! A-* ! E-*) ! O4C-*G(?/-4 E-Mail [email protected]with the details of your event, or call (877) 248-2360, ext. 3. It will be published in the Calendar section, space permitting. Continued on Next Page California Edition Hospitalizations Down in California OSHPD Data Shows Gains, But Some Groups Lag COO/CFO COMPENSATION A PAYERS & PROVIDERS EXCLUSIVE WHITE PAP COMPENSATION ON NEARLY 200 OF CALIFORNIA’s HEALTHCARE COOs & CFOs NOW AVAILABLE Report is $149. Report and Salary Data is $275. Call (877) 248-2360, ext. 2 OR CLICK HERE to Order
Transcript
8/8/2019 Payers & Providers – Issue of January 6, 2011
The rate at which Californians werehospitalized improved considerably over thepast decade, but they face an ever-growingthreat from diabetes, while African-Americans
remain at much higher risk for medicalconditions such as hypertension and urinarytract infections.
That was the gist of two related reportsissued late last month by the Of ce of Statewide Health Planning and Development(OSHPD). The data, which focused onpreventable hospitalizations statewide andracial disparities in healthcare that sometimeslead to hospitalization, portray a healthcareenvironment that is mostly improving by theyear, but still contains serious issues that someproviders are struggling to control.
The overall hospitalization rate inCalifornia declined 6.8% between 1999 and2008, to 10,533 hospitalizations per 100,000population from 11,298 hospitalizations per100,000.
Among 15 health conditions studied byOSHPD as hotspots for potentially avoidablehospitalizations, 10 showed declines.Hospitalizations for chest pain were downmore than 60%, while hospitalizations forpediatric asthma was down nearly 40%.OSHPD of cials give some credit to the
improvement of outpatient care over the pastdecade.
However, there are three chronicconditions that are leading to morepreventable hospitalizations. Hypertension-related preventable hospitalizations were upmore than 36%. Hospitalizations related todiabetes were up 8% due to long-termcomplications and 5.7% due to short-termcomplications.
Finally, hospitalizations due to urinarytract infections – a relatively minor conditiontypically treated with antibiotics but can leadto kidney damage if left untreated – were up9.6%.
“The UTI hospitalizations were striking,”said OSPHD Director David M Carlisle, M.D. “I wish we had a bona de cause.” Carlislenoted that the condition in men could be asign of prostate cancer. The data did not breakout incidents of infection between men andwomen, who suffer the condition far morefrequently and usually from more benigncauses.
Instead, OSHPD of cials were focusedmore on publishing the data rather thanseeking correlations. Michael Kassis, an
Sacramento-based Sutter Health has introduced a smart phoneapplication that allows patients toaccess their own medical recordsand better communicate with theirdoctors.
The application, which isavailable for the iPhone , may beused by patients of the Palo AltoMedical Foundation , the Sutter EastBay Medical Foundation , the SutterPacific Medical Foundation , theSutter Gould Medical Foundation and the Sutter Medical Foundation .
Called MyChart, the appallows users to send messages totheir physicians, check lab tests andresults, view appointments andreceive health reminders.
“Through the MyChart app,we're giving patients the tools theyneed right at their fingertips,” saidAlbert Chan, M.D ., a physicianwith the Palo Alto MedicalFoundatio n.
HHS AnnouncesBonuses for Medicaid
Enrollment For Kids
The U.S. Department of Health andHuman Services has awarded $206million in bonuses to 15 states fortheir work in enrolling additionalchildren into the Medicaidprogram.
“Their actions reflect PresidentObama’s serious commitment toassuring that our cou ntry’s childrenget the healthcare they need,” saidHHS Secretary Kathleen Sebelius .“These performance bonusesdemonstrate our support for theeffective strategies these states haveundertaken.”
Continued on Page 3
NEWS
OSHPD (Continued from Page One)
OSHPD research analyst who authored thepreventable hospitalization report, suggestedthat rising obesity rates may have caused the
spike in hypertension hospitalizations.“We’re concerned it’s taken such a jump,but we can’t conclusively say why,” he said.
Hypertension also made its presenceknown in the healthcare disparities report.African-Americans in California werehospitalized at a rate of 147.5 per 100,000 in2007, up about 40% from 104.7 in 1999.However, that rate dwarfs that among whites,at 27.6 per 100,000 in 2007, and is also farhigher than Latinos, Asians or NativeAmericans.
Indeed, Africans-Americans were themost hospitalized minority group in
California, with 130 hospitalizations per1,000 people, compared to 110 amongwhites, 86 among Latinos and 67 amongAsians.
Carlisle did not comment speci cally onthe reasons behind such ndings, but didnote that rising rates in some categories maybe connected to a lack of outpatient care orno proper coordination of such care.
“It really implies you have a breakdownto the access and quality of ambulatory care,”he said.
Carlisle added that the rising rates of uninsured and cost-shifting to those withcoverage may be contributing to such rises,but could not say so de nitively.
However, overall hospitalizations in manyareas declined signi cantly. Among sufferersof pediatric asthma, the rates droppeddramatically among all races, as did forchronic obstructive pulmonary disease,dehydration, and pneumonia.
But hospitalization rates continued to riseamong virtually all races suffering short-termand long-term complications from diabetes, achronic disease that is attacking Californians
at dramatically escalating rates.According to statewide health data, therate of diagnosed diabetes case rose to 7.6%in 2007, versus 5.5% in 1998, a spike of 38%in less than a decade, with signs suggesting itwill continue to rise more in the future.
But Carlisle was pleased with the overalltrend. “There is a narrowing of the overalldisparities,” he said.
New Commissioner Moves SwiftlyJones Immediately Announces MLR Regulations
Dave Jones wasted little time after beingsworn in as commissioner of the CaliforniaDepartment of Insurance on Monday. Theformer assemblyman immediately issued anemergency rule that would require insurersstatewide to meet mandatory medical lossratios of 80% for individual health plans and85% for group rates.
The rule mirrors part of the federalhealthcare reform law mandating such MLRsfor insurers throughout the country. That
change will go into effect next year, althoughthe U.S. Department of Health and HumanServices has granted more than 200 waiversto so-called “mini-med” health plans thatlimit bene ts to a few thousand dollars peryear. Among individual plans, Californiapreviously required only 70% of premiumdollars be spent on healthcare.
“Voters asked for an activistcommissioner and I am taking immediateaction on health reform,” Jones said duringhis inauguration in Sacramento on Jan. 3. A
Democrat, Jones prevailed in the Novemberelection, even though the insurance industrymostly backed his Republican challenger,Mike Villines, himself a former member of theAssembly.
In addition to announcing the regulations, Jones also said he would appoint a personwithin his of ce to oversee healthcare policy.
Industry observers and even someinsurance of cials say Jones’s at on MLRs.will have little immediate effect on the way
insurance is underwritten and medical care ispaid for in California, but it set an immediatetone and direction for his administration.
“It’s a signal that the consumerprotections in the new federal law are going tobe enforced in California,” said AnthonyWright , executive director of Health Access , aSacramento-based advocacy organization.
Wright noted that most plans alreadymeet the MLR thresholds, but the effect of
Continued on Next Page
8/8/2019 Payers & Providers – Issue of January 6, 2011
Alabama was by far thelargest recipient, getting nearly$55 million. The other statesreceived sums ranging from $2.58million to more than $23 million.The bonuses were part of thereauthorization of the Children’sHealth Insurance Program in 2009.Although the bonuses represent asharp increase from the prior yearwhen only $75 million in bonuseswere awarded, California was notamong the recipients.
Halvorson Named ToNCQA Board
George C. Halvorson , chief executive officer of Oakland-basedKaiser Permanente , has beenappointed to the board of directorsof the National Committee of Quality Assurance.
Halvorson was named to the16-member board on Dec. 16. Itincludes 15 independent directorsand NCQA President MargaretO’Kane.
"I am tremendously excited bythe opportunity to work among anestablished Board of healthcareleaders all focused on thecollaborative goal to help thenation position itself to better servethe healthcare needs of thenation."
In addition to theappointment, Halvorson serves onboards affiliated with the Instituteof Medicine , the AmericanHospital Association and theCommonwealth Fund .
AMN Appoints NewCFO
San Diego-based staffing firm AMNHealthcare Services has namedBrian M. Scott chief financialofficer and chief accountingofficer. Scott replaces Bary G.Bailey, who has left AMN for aposition at a private equity firm.
SCAN Targets Hospital ReadmissionsPlan Focuses on Pharmacy Management Program
Medicare Advantage insurer SCAN HealthPlan has joined forces with the Lakewood IPA and a Massachusetts rm to cut down on thehospitalizations of its more vulnerableenrollees.
The plan, medical group and DovetailHealth , a Needham, Mass. rm that focuseson managing care for chronically ill patients,have created Healthy Transitions, a 24-monthpilot program that keeps a sharp eye on themedications its enrollees take. SCAN of cialssay the program may be rolled out to SCAN’sentire membership based on the data itprovides.
The Long Beach-based SCAN is focusingon members with intensive healthcare needswho take an average of 12 medications. A fewmedication errors after a hospitalization caneasily lead to a readmission that couldotherwise be avoided.
“If a patient taking 12 medications and isbeing discharged with even more medicine totake, they live alone or have spotty caregiving,this is not simple for them to manage,” saidElizabeth Russell, SCAN’s senior vicepresident of network management.
Hospital readmissions are the bane of seniors: about 20% are sent back to thehospital within 30 days of an initial discharge,according to Medicare data.
Russell said that the rehospitalization rateamong SCAN members is lower than thenationwide average, but that the plan islooking for ways to continue to improve thecare it provides.
Under Healthy Transitions, SCAN
enrollees discharged from the hospital ornursing facilities are met at their homes bypharmacists employed by Dovetail withtraining in geriatric medications. They work oncreating manageable medication regimensand will see if the patient may be takingexpired meds, which can also lead toproblems.
The seniors are cycled out of the programwithin 30 days. SCAN is enrolling about 10seniors every month, according to Russell.
Not enough data has yet been generatedto provide speci cs, but Russell noted thatanecdotal evidence points to severalrehospitalizations that have been avoidedsince SCAN began the pilot last summer.
HEALTHCARE’S BEST ADVERTISING VALUEPAYERS & PROVIDERS reaches 5,000 hospital, health plan and non-pro t executivesstatewide. There is no better venue for marketing your organization or conference, or
recruiting new staff.
LEARN MOREHEREOR CALL (877) 248-2360, ext. 2
MLRs (Continued from Page Two)
Jones’s move will make it clear to the handfulof stragglers.
“They will have to focus more onproviding dollars for healthcare rather thanfor their administrative overhead or forpro t,” he said.
The regulations require approval by thestate Of ce of Administrative Law , and couldgo into effect before the end of this month.The Insurance Department would releasepermanent regulations later this year.
Reaction from the insurance industry hasso far been muted. The Association of
California Life and Health InsuranceCompanies , the state’s major lobby for carriersthat provide individual health coverage, hasdenied comment, saying they have not yet hada chance to review them. Jones released thedraft version of the regulations to insurers onTuesday.
The California Association of HealthPlans did not respond to a request forcomment. Blue Cross of California , one of thestate’s largest seller of individual health plans,declined comment, as did Woodland Hills-based Health Net .
MEDICARE COMPLIANCE ADVISOR - ensures that L.A. Care and its subcontracted provider network is compliant with all Centersfor Medicare & !Medicaid federal regulatory requirements. This is achieved by participating in the annual PPG and quarterly audits,working with internal and external staff to correct performance de ciencies, identifying internal areas for improvement, serving asthe compliance contact with Plan Partners for member grievance oversight, provider services oversight, and interpreting CMS/SNPProgram requirements for L.A. Care. !Additionally, this individual is a resource to internal staff on compliance matters relating toCMS/SNP standards, including, but not limited to, marketing materials, grievances and appeals, member rights issues, and claimsadjudication. ! Responsible for performing internal audits, monitoring for implementation of corrective measures, and interpretationof CMS requirements. !Working knowledge of federal and state requirements is required, as well as highly developed analytical skills
and excellent verbal and written communication skills. !
For complete job description, quali cations/requirements, visit our websit e: www.lacare.org
To apply, email resume with salary history and requirement to: [email protected] referencing “Payers & Providers Ad”
