8/6/2019 Payers & Providers Midwest Edition -- Issue of July 26, 2011

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There are 225,000 souls on the payroll atLowes, the North Carolina-based homeimprovement chain. When their hearts breakdown and need putting back together, Lowes

wants them to get the best care available.Lowes wanted to design a travel surgery

benet for high-risk, high-cost employees. Itconsidered out-of-country surgery, domestictravel surgery networks, and a single center ofexcellence. It went with the lastoption.

A little more than a year ago,Lowes agreed to send itsemployees who need heartsurgery to the Cleveland Clinic,the No. 1 cardiac care medicalcenter in the U.S. Currently,about 20% of its employees

who need a cardiac procedureare doing so at the Clinic.

Lowes came to us and said,would you build a programaround a certain kind of patient,if they travel to you? They werelooking for additional tools toreduce their healthcare costs,said Michael McMillan,executive director for market andnetwork services at the Clinic. The program waives deductiblesand co-payments for all patients approved forheart surgery. Employees also get a travel

stipend and lodging expenses for the patientand a companion, as well as conciergeservices to make the arrangements.According to healthcare quality expert

Arnold Milstein, M.D., Lowes simultaneouslyassured employee access to the nations bestsurgical care and challenged all U.S. hospitalsto accelerate their pursuit of surgicalexcellence.

Capturing the self-insured Lowes was also abig victory for the Clinic.The Fortune 500 retailerhad $48.8 billion inrevenues and $2.01 billionin prots last year. Itspends $750 million a yearon healthcare.

The success of thecardiac program hasspurred Lowes and theClinic to expand theirpartnership to orthopedics,with a focus on spinalsurgery.

The Cleveland Clinic waschosen, according toMcMillan, because of itsreputation in cardiac care and

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September 14-16

August 23-25

Calendar

26 July 2011

October 5

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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.

www.lakesidecommunityhealthcare.com

Midwest Edition

Cleveland Clinic Scores with Lowes20% of Retailers Heart Surgeries Performed in Ohio

Continued on Next Page

Michael McMillanCleveland Clinic

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Payers & Providers Page 2

Top Placement...Bottomless Potential

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In Brief

Ohio To CreateInsurance ExchangeDespite Opposition

Ohio will create a health insurance

exchange despite its political leadersdistaste for the Affordable Care Act,Gov. John Kasich said last week.Under the reform law, each state isrequired to create an onlinemarketplace, or exchange, whereconsumers may compare health plansand choose the one that suits thembest after the insurance coverageprovisions of the law go into effect in2014.

The law authorizes the federalgovernment to create exchanges inthose states that dont create their own.Republican leaders in some states havedenounced the law and refused tohave anything to do with implement-

ing its provisions. Presumably theDepartment of Health and HumanServices would develop exchanges toserve those states populations.

Kasich, a Republican, is not a fan ofthe reform law but has directedexecutive departments to prepare toadminister it. Ohio has receivedfederal money to build the exchangeand will soon apply for a secondround of funding.

California Group Buys9 Nursing Homes in

Iowa and NebraskaThe Ensign Group Inc. has acquirednine nursing homes in Iowa andNebraska from Careage Management,LLC, based in Sioux City, Iowa.

The owners of Careage entertaineda variety of offers, and chose Ensignbecause of its resident-centered careand loving, dignied, home-likeenvironment, said Dan Myers, Careagepresident and chief executive ofcer.

Continued on Page 3

NEWS

Cleveland Clinic (Continued from Page One)

its willingness to not only stand behind itsoutcomes but to make them public.

By coincidence, the Cleveland Clinic had

been looking at widening its national proleto attract more out-of-state patients. Half of its

cardiac surgical cases were already comingfrom outside Ohio. It had well-establishedprocedures for handling traveling patients.

Now Lowes and the Clinic have someresults to talk about. As of July 12, the Clinichas completed 37 procedures for Lowesemployees, from 23 states. Six patients areawaiting clinical assessment or service,McMillan said at a talk organized by theMidwest Business Group on Health last weekin Chicago.

In patient surveys conducted by Mercer, all

of the Lowes patients gave the Clinic thehighest rating for medical care, and all of themwould recommend it to someone else. Theaverage lapsed time from surgery to return towork was 5.5 weeks, compared to 6 to 12weeks for the national averages.

And, critically, the economics are working.We are exceeding our expectations on anoverall cost basis, McMillan said. We aremaking money. The nancial expectations ofboth organizations have been met. It wasnteasy.

When employers have been unsuccessfulin trying to have health plans identify high

quality, low cost centers of excellence forvarious types of conditions, said Larry Boress,president of the Midwest Business Group onHealth, Lowe's has set an exacmple of howan employer can work with a major healthsystem to focus on saving money, and alsoproviding high quality care, and supportingthe needs of their work force.

Lowes wanted to develop a strategy todrive value and impact costs. If its establishedwisdom that 20% of the population drives80% of the costs, Lowes recognized that 5%of its population drives 50% of its costs,mostly in high acuity and catastrophic care,

involving cardiovascular surgery, spinesurgery, orthopedics, and cancer care.

However, corporate medical tourism --even if it is domestic -- is more talked aboutthan done, said Michael Millenson, author ofDemanding Medical Excellence. Its not anew idea, Millenson said. You have to getpeople to do it.

Today, circumstances may have changedenough to make it worthwhile for bothemployer and employee.

If you take a world-famous reputational

center, like the Cleveland Clinic, maybepeople will go, Millenson said.

He added that hospitals and physicia

may be more business savvy and aggressivthan 25 years ago. They are making deals fdiscounted fees that they wouldnt haveengaged in before.

And nally, we are beginning to see theeffects of consumer-driven healthcare. Thedeductible of $500 in the 1980s might nothave been enough to move the market. Noif the deductible is $5,000, and the emplosmoothes the way to a top-quality outcomthe carrot is much larger. The higherdeductible in the health plan gives theemployer more leverage.

For a national company like Lowes t

operates in almost every healthcare markethe local variations in quality of care and cof care can be galling and inexplicable.

The work ofJohn Wennberg, M.D., anthe Dartmouth Atlas have demonstrated ththose variations are attributable to noparticular reason except differences andpreferences in medical practice.

Lowes has set up a turnkey programwith a simplied bundled payment, a builtsupport system for the patient and travelingcompanion, and full administrative supporthe employer and employee.

This is a disruptive message to local

hospitals, McMillan said. It means thathealthcare is no longer local, and that quatrumps convenience and price.

Managing the relationship with thehometown physician is critical, McMillanobserved.

You have to make sure that peopleunderstand this is an appropriate location care, as opposed to what might have beenrecommended at home, he said. In thismodel, the employee says to the physicianIm going to the Cleveland Clinic. How dyou manage that patient-physicianrelationship and coordinate the post-surgic

followup?It means patients must receive clear fol

up instructions to take home, and hometowcardiologists have to be assured of easycommunications with the Clinics doctors.

Any number of health systems will to use this as a model, Boress said. Thechallenge for them is how do you combineof the services and provide the level of supneeded within the price, and still generateenough revenue to make it worthwhile.

8/6/2019 Payers & Providers Midwest Edition -- Issue of July 26, 2011

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Page 3Payers & Providers

Longer ALOS!*

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*For our ads, not your hospital

NEWS

In Brief

We expect the former Careagefacilities to pave the way foradditional disciplined growth inNebraska, Iowa, and the Midwest,said Christopher Christensen, Ensignspresident and CEO, in a statement. Hesaid the nine facilities have a high rateof private-pay patients and are less

dependent on Medicaidreimbursements.

The facilities all together had anoccupancy rate of 74%. Thetransaction was made with cash.Ensign, based in Mission Viejo, Calif.,owns 96 nursing homes, three hospicecompanies, and three home healthbusinesses in eight Western states,plus now Iowa and Nebraska.

Christensen said Ensign is lookingto acquire both well-performing andstruggling long-term care operationsacross the United States.

Feds Turn Down Illinois

Revisions to MedicaidEligibility Regulations

Republican legislators in Illinois wereangered last week when the federalgovernment rejected an effort by thestate to tighten eligibility standards forMedicaid.

The state has long wanted to havestronger proof of residency andincome eligibility for Medicaidbeneciaries, who until now havemerely had to write down their homeaddress and show one paycheck stub.A new law mandated showing amonth of paycheck stubs to

demonstrate income.The federal government turnedthumbs down on the Illinois changesbecause the Affordable Care Actprohibits states from ratcheting downMedicaid eligibility requirements afterPresident Obama signed the act onMarch 23, 2010.

Frankly, this is what enragespeople, Senate Minority LeaderChristine Radogno told the ChicagoTribune. If all we want to do is ndout if people are actually eligible forthe services, and the federalgovernment is telling us we cant dothat, thats absolutely ridiculous.

Two Midwestern states made it into the Top 10in the CDCs survey of state obesity rates lastweek: Michigan and Missouri. In Michigan30.9% of adults were deemed obese, and in

Missouri, 30.5% were.The statistics were released as part of the

public health agencys effort to document theoverweight epidemic. In 2010, the Centers forDisease Control and Prevention reported, nostate had a prevalence of obesity less than20%. Twelve states had a prevalence of 30%or more. Michigan is the only state in thatcategory outside the South.

Obesity was dened as a body mass indexof more than 30.

Wisconsin, often thought of as a bastion ofcheese eaters, scored relatively well at 30th

most obese. Minnesota was the onlyMidwestern state to do better, at 37th.

The Midwestern states, in descending ordfrom fattest to thinnest:

8. Michigan 30.9%10. Missouri 30.5%14. Indiana 29.6%15. Kansas 29.4%16. Ohio 29.2%18. Iowa 28.4%19. Illinois 28.2%30. Wisconsin 26.3%37. Minnesota 24.8%

Mississippians were most obese, at 34% ofadults, and Coloradans were the least, at 21

The Centers for Medicare and Medicaid

Services will assume responsibility forreviewing health insurance premium increasesin 10 states, among them Missouri and Iowa.

Under the Affordable Care Act, states arerequired to review signicant rate increases anddisclose them to the public. The ACA makes$250 million in federal funds available to helpstates undertake this project. CMS said RhodeIsland, California, North Dakota andConnecticut have already used their authorityto roll back exorbitant increases.

Several states, such as Idaho and Montana,have declined to participate because theyoppose the law. Other states dont have the

necessary regulatory framework or enablinglegislation. CMS has authority to exercise the

rate review function in states that dont have

mechanism. CMS will handle rate reviews fosmall group and individual policies inMissouri, and for small group policies in Iow Tom Alger, spokesman for the IowaDivision of Insurance, said his ofce didntagree with the CMS assessment of Iowascapabilities. We have rate review equal to omore stringent than other states which werefound to have effective rate review. We havewritten to them to request that they reconsidthat, he said. We have given them additioninformation to support our case.

In Missouri, state law does not requirehealth insurers to submit rates, which was th

basis for the determination by HHS, said JoM. Huff, director of insurance.

CMS to Handle Insurance ReviewsMissouri, Iowa Are Found Lacking in Capability

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Michigan, Missouri Lead in FatnessCDC Report Shows Major Gains in U.S. Girth

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Payers & Providers Page

How many times have you lled in the familyhistory questionnaire on paper only to have itled away, never to be seen again? And even ifseen, does your healthcare provider know howto assess risk and refer you to a geneticsprofessional?

The Centers for Disease Control andPrevention recently released its goals forHealthy People 2020. For the rst time, thegoals include genetics-enabled healthcare: toidentify as many individuals aspossible who are at genetic riskfor breast and colon cancers andget them to proper genetic care.

The potential improvement incancer prevention and earlydetection would have majorimplications for the overallpublic health.

The public perception ofpersonalized medicine isaskew: the term is often viewedas a common treatment optionfor rare genetic disorders. Thetruth is that our recentunderstanding of genetic andgenomic information grantsphysicians a new authority to offer a

higher form of individualized careto their patients.

Personalized healthcare, in and of itself, ishardly new: ABO blood typing is a superbexample of widespread genetics-basedpersonalized healthcare dating back to WorldWar II. It continues to have universalapplicability, and will for centuries.

Consider a more recent example: Commonassociations for breast cancer account foralmost 3% of all breast cancers, whereas a raremutation (BRCA1-2) alone accounts for 10% ofall breast cancers. There are currently at leasteight other breast cancer predisposing genes

that help knowledgeable healthcare providersmake the correct diagnosis and that informpatients of risks of other cancers.

From a practical point of view, we all wantto use genetic and genomic information tobenet the patient. Despite all good intent, howsuccessful have we been?

Researcher Douglas Levy surveyed 35,000healthy individuals by taking family histories ofcancer diagnoses. By family history alone, 350people appeared to be at risk for hereditarybreast and ovarian cancer syndrome. Yet only

35 discussed their concern about family histowith their healthcare providers, and only four these people reached appropriate testing. Evemore alarming, it is unknown how many receappropriate pre- and post-test genetic counse(considered the standard of care).

Only 1% of those who require such genetiinformed personalized clinical management aeven identied and referred to geneticsprofessionals.

As Harvard Professor Michael Poauthor ofRedening Health Care,said, American healthcare in the 2century is practiced on a 19th-cen

organizational structure that hasreceived a thousand Band-Aids toeven limp along. Healthcareproviders are swamped by a thousregulations, which bring along pilpaperwork.

Family health histories are the total of an individuals genetic legand his or her environmentalexposures. Trained geneticsprofessionals can look at anindividuals personal and familyhistories and narrow down which

particular gene(s) may predispose th

for specic disease(s).By testing the most likely gene in

setting of genetic counseling, providemay give patients a highly accurate gene-enabdiagnosis. The particular gene involved willdictate what else the individual is at risk for. Athat, increased screening or tailored, preemptstrikes can be planned. Importantly, once theyknow where the gene alteration is, other famimembers can ask to be screened only for thatparticular alteration, resulting in a 100% accugene-enabled diagnosis.

If we can take advantage of healthinformation technologies, then we must some

ensure that every single individual who sees hher healthcare provider, whether primary carespecialist, has an accurate family health historThat history can be risk-assessed without drainmore time from our healthcare providers.Both physicians and patients must be more

proactive in educating themselves about genetesting and its wealth of benets.

OPINION

The Real Promise of GeneticsSelective Testing Offers Major Gains Against Cance

By Charis Eng,

M.D.

Charis Eng, M.D., is chair and founding

director of the Genomic Medicine Institute

the Cleveland Clinic.

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8/6/2019 Payers & Providers Midwest Edition -- Issue of July 26, 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

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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!

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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 Midwest Edition -- Issue of July 26, 2011

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Payers & Providers MARKETPLACE/EMPLOYMENT Page

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