October 2012

National Edition
In this Issue
1. News
A Survey on Private Health Insurance Exchanges

Private Health Insurance Exchanges A Survey on Marketplace Impact

Private health insurance exchanges continue to emerge and develop in the marketplace, usually arranged with defined contribution approaches in regards to employer funding. The private exchanges impact may depend upon the effect the pending election will have on public exchanges. During the week of October 15th, MCOL, Medimetrix and Payers & Providers jointly sponsored an online survey to ask industry stakeholders their perspectives on the future of private health insurance exchanges and defined contribution plans. This survey was conducted by MCOL and focused on private health insurance exchanges issues and trends. Survey participants typically have a more active interest in issues pertaining to private health insurance exchanges. We asked participants to respond to four items: 1. Please indicate your perspective. (Provider/Purchaser/Other) 2. What will be the impact of private health insurance exchanges over the next four years? 3. Which will have the greater ultimate impact in the marketplace: Private Exchanges, Public Exchanges or neither? 4. How prevalent will employer sponsored Health Insurance Defined Contributions become by the end of this decade? Heres what we found: A large majority of respondents believe that private health insurance exchanges will have some impact over the next four years, with 29.37% saying there will be a moderate impact and 56.29% saying there will be a significant impact. 8.39% said there will be minimal impact while 5.94% had no idea. When broken down by respondent category, providers and purchasers had no significant differences in their results falling within 3 percentage points for each option. What will be the impact of private health insurance exchanges over the next four years?

3. Vitals
Consumers Utilization of Pharmacists as a Resource for Health Consultation, Awareness, Treatment, and Control of Hypertension Among Adults, Percentage of Professionals and Managers by Industry with Employer Based Health Coverage, New Customers from PPACA

4. California
Dignity Health Facing Challenges, Childrens Hospital Receives HHS Medal Briefs - CPCA Launches Patient Home Initiative, Sierra Vista Builds $1.8M Helicopter Facility

5. Midwest
IHA Targets Readmisson Penalties Briefs - United Physicians, Beaumont Physicians Organization Plan To Merge, Study Has Mixed Data On Statin Use, Costs

6. WebinarsWhite Papers
Recent and Upcoming Events The Many Stories of One Litigious Physician Healthcare and Campaign Finance in California

7. Marketplace
Employment Advertising Opportunities Paid Subscriptions

8. Order Form
Payers & Providers Order Form

Responses Significant Moderate Minimal

Provider 57.4% 28.4% 8.8% 5.4% 100.0%

Purchaser 59.5% 28.6% 7.1% 4.8% 100.0%

Other 48.2% 33.3% 9.3% 9.3% 100.0%

Overall 56.3% 29.4% 8.4% 5.9% 100.0%

continued on page 2

Volume 2, Issue 10 October, 2012

www.payersandproviders.com

No Idea Total

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MARKETPLACE/EMPLOYMENT NEWS

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Private Insurance Exchanges continued

Those categorizing their organizations as other did vary from the other two respondent categories. Other respondents were less likely (at 48.15%) than providers and purchasers (57.43% and 59.52% respectively) to say that there would be a significant impact over the next four years. Other respondents were more likely (at 33.33%) than providers and purchasers (28.38% and 28.57% respectively) to say that there would be a moderate impact over the next four years. What will be the impact of private health insurance exchanges over the next four years?

Which will have the greater ultimate impact in the marketplace?

While 40.91% of respondents thought that more than 50% of covered employees would have defined contributions, 36.01% thought 25-49% would and 15.38% though 10-25% would. The results did trend toward greater prevalence with 76.92% of respondents saying that over 25% of covered employees would have defined contributions. How prevalent will employer sponsored Health Insurance Defined Contributions become by the end of this decade?
Responses (%of covered employees) More than 50% Somewhere between 25-49% Provider Purchaser 36.5% 39.2% 17.6% 5.4% 1.4% 100.0% 46.4% 36.9% 8.3% 3.6% 4.8% Other Overall 44.4% 25.9% 20.4% 7.4% 1.9% 40.9% 36.0% 15.4% 5.2% 2.5%

A majority of respondents think that public exchanges will have a greater ultimate impact in the marketplace than private exchanges with 59.65% responding this way. 34.74% of respondents think that private exchanges will have the greater ultimate impact while 5.61% think neither will. Which will have the greater ultimate impact in the marketplace?
Responses Private Exchanges Public Exchanges Neither Total Provider Purchaser 27.9% 66.7% 5.4% 100.0% 45.2% 50.0% 4.8% 100.0% Other 37.0% 55.6% 7.4% 100.0% Overall 34.7% 59.7% 5.6% 100.0%

Somewhere between 10-24% Somewhere between 2-9% Less than 2% Total

100.0% 100.0% 100.0%

When broken down by respondent category, purchasers were the most likely to see a trend of greater prevalence of defined contributions with 83.33% thinking over 25% of covered workers would be affected by the end of the decade. Respondents in the other category were the least likely (though still likely) to predict greater prevalence with 70.37% thinking over 25% or respondents would be affected. Providers fell in the middle with 75.68% answering this way. How prevalent will employer-sponsored Health Insurance Defined Contributions become by the end of this decade?

Respondents categorizing themselves as providers were the most likely to say that public exchanges would have the greater impact, 66.67% answered this way while only 27.89% said private exchanges would have the greater impact. Purchasers were the least likely to say that public exchanges would have the greater impact with 50% responding this way and 45.24% saying that private exchanges would have the greater impact. Respondents from the other category fell in the middle with 55.56% saying that public exchanges would have the greater impact and 37.04% saying private exchanges would. Unlike the previous questions, the results as to how prevalent employer-sponsored health insurance defined contributions will become by the end of this decade, did not have a majority of respondents choosing one option.

2012, by Payers & Providers Publishing LLC and MCOL. All rights reserved

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MARKETPLACE/EMPLOYMENT VITALS
LISTS from

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Consumers Utilization of Pharmacists as a Resource for Health Consultation

Adults who have discussed a medication maintenance regimen with a pharmacist: Adults who have discussed any new medication with a pharmacist: Adults who trust a pharmacist most to help guide and inform healthcare decisions: Adults who agree pharmacists are equally qualified to answer questions about Rx medications as doctors: Adults who have regular conversations about their health with a pharmacist: Adults who report that they often rely on a pharmacist for medical advice: Adults who have received a blood pressure screening in a pharmacy: Adults who have received an in-pharmacy flu shot:

Percentage of Professionals and Managers by Industry with Employer Based Health Coverage

15% 49% 18% 76% 25% 39% 27% 22%

1. Agriculture - 80.4% 2. Construction - 45.4% 3. Finance - 85.8% 4. Health and Social Services - 83.4% 5. Information/Communications/Education - 85.7% 6. Mining/Manufacturing - 89.5% 7. Professions - 77.4% 8. Public Administration - 90.7% 9. Services - 62.1% 10. Utilities and Transportation - 87.5% 11. Wholesale and Retail Trade - 74.0%
Source: Kaiser Family Foundation, The Uninsured: A Primer http://www.kff.org/uninsured/7451.cfm

Source: RxAlly, http://rxally.com/rxally-news.html

Check out more healthsprocket lists at: www.healthsprocket.com

Awareness, Treatment, & Control of Hypertension Among Adults with Hypertension United States, 20072010
2007-2008 Awareness Treatment Control 2009-2010

New Customers from PPACA

MCOLBlog: Health Reforms New Customer Journey 30 million 24 million new customers PPACA expected to bring access to entering a new exchange new Medicaid enrollees

80.6% 71.6% 48.4%

81.9% 76.4% 53.3%

Source: NCHS Data Brief, Number 107, October 2012, National Center for Health Statistics, http://www.cdc.gov/nchs/data/databriefs/db107.htm

16 million

Source: Health Reforms New Customer Journey, MCOL Blog, October 9, 2012, http://www.mcolblog.com/kcblog/2012/10/9/health-reforms-newcustomer-journey.html

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MARKETPLACE/EMPLOYMENT CALIFORNIA

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In Brief
CPCA Launches Patient Home Initiative
The California Primary Care Association has teamed with a variety of private companies and the NCQA in order to launch an initiative that will focus on the creation of patient-centered medical homes statewide. According to CPCA Chief Executive Officer Carmela Castellano-Garcia, the intent is receive NCQA designation for all 900 of its members, most of which are community clinics. The initiative builds on the team-based approach to care that health centers have used as their model for many years and leverages their existing strengths to build a sustainable standard for health home activities and services, Castellano-Garcia said. She added that a year-long pilot program moved about 150 clinics closer to NCQA designation as a patient-centered medical home. The initiative includes technical support offered to the clinics, primarily in the form of an online, cloud-based portal that can guide clinics through the NCQA application process. The portal was created by Arcadia Solutions, which is working with Azara Healthcare to assist the CPCA in the initiative.

Dignity Health Facing Challenges

Performance Plummets; Fitch Issues Downgrade
Dignity Health has experienced significant financial duress over the past year and will likely have some hard choices ahead as it moves forward with a non-hospital expansion outside of the western United States. The San Francisco-based Dignity, which earlier this year changed its name from Catholic Healthcare West, reported earlier this month dramatic drops in its fiscal 2012 financial performance. Both its operational margins and investment returns took significant hits. Dignitys net income for the fiscal year ending June 30 was $132.5 million a drop of nearly 85 percent from fiscal 2011s $950.5 million. Operating income was down significantly, to $59.1 million from $242.7 million in the prior year Overall revenues were flat, at $10.5 billion, compared to $10.3 billion in fiscal 2011. Dignity officials blamed the downturn on lower patient volumes and underpayments from MediCal and Medicare. Investment earnings took a bigger hit than operating income: They totaled just $73.4 million, down from $717.9 million in the prior year, a drop of 90%. During Dignitys fiscal year, the Dow Jones Industrial Average and NASDAQ were up about 3 percent. Dignity operates 39 hospitals in California, Arizona and Nevada, although the vast majority of them 32 are in the Golden State. In recent month it has made some significant acquisitions outside of the hospital market. Its purchase in August of HealthWorks, which operates occupational health clinics in 16 states, comes on top of recent investments in ambulatory surgical centers and imaging centers with other corporate partners. We are growing to work more closely with doctors, insurers, employers, and individuals to transform our health system and deliver higher quality, more efficient care, said Dignity Health Chief Executive Officer Lloyd Dean. However, Dignitys lackluster financial performance has drawn the attention of Fitch Ratings, which earlier this month downgraded the ratings on Dignitys $3.5 billion in debt from A+ to A. According to Fitch. Dignitys financial performance has been compressed since fiscal 2009. Overall financial metrics lag'A' category medians and are not expected to improve materially over the near term, Fitch said in a statement. It noted that Dignity also will assume more risk as part of its overall plans in growing its operations.

Sierra Vista Builds $1.8M Helicopter Facility

Sierra Vista Regional Medical Center in San Luis Obispo and its corporate parent Tenet Healthcare has spent $1.8 million to open an onsite helistop for faster transportation of critically injured patients. The helistop was constructed by Sierra Vista after it was designated the countys first-ever regional trauma center last March. Although the hospital was treating most of San Luis Obispo Countys trauma patients anyway, the lack of a designation meant trauma care patients were being transported to the nearest hospital first before being brought to Sierra Vista, delaying potential life saving care. The helistop, which was approved and licensed for use by CalTrans, allows helicopters to land at the hospital, but they must leave once patients have been offloaded. Sierra Vista did not make any projections on how many landings it would handle per month.

Childrens Hospital Receives HHS Medal

In Recognition of its Organ and Tissue Donor Programs
Childrens Hospital of Los Angeles received the Silver Medal of Honor award from the U.S. Department of Health and Human Services in recognition of its organ and tissue donor programs. The medal is awarded to any donor program that has a donor conversion rate of 75% or greater among living donors and 10% after a patients death. Organ donation is the one positive thing that can come out of tragedy the donor is giving another family and another child a second chance at life, said Nancy Blake, CHLAs director of critical care services and liaison to OneLegacy, the organ procurement agency Los Angeles area. Altogether, the HHS 22 hospitals in L.A. for their organ donation programs, and 13 received silver medals.
The Payers & Providers California Edition is published every Thursday with four pages of hard-hitting healthcare business and policy news and insights

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In Brief
United Physicians, Beaumont Physicians Organization Plan To Merge
Two Michigan-based medical groups have announced their intention to merge. The fusion of United Physicians Inc., the Wolverine States largest medical group and the Beaumont Physician Organization, the affiliated medical group of Beaumont Health System, is expected to be completed by the end of the year. The merged group will operate as United Physicians, Inc. The combined organization will help with development of a clinical integration program where Beaumont and its private practice and employed physicians work together to control costs and improve the quality of health care services in the population that it serves, said Ananias Diokno, M.D., Beaumonts chief medical officer.

IHA Targets Readmisson Penalties

Wants Member Hospitals to Avoid Costly Dings
The Illinois Hospital Association recently increased its focus on helping hospitals reduce readmission rates in anticipation of penalties to be handed down by the Centers for Medicare & Medicaid Services. On Oct. 1, CMS began implementation of a penalty program passed in the Affordable Care Act. The program focused on hospitals that have high rates of readmission for heart attacks, heart failure and pneumonia, based on national benchmarks. The penalties are based on Medicare readmissions for these three conditions between July 2008 and June 2011. Hospitals with above-average readmissions will now have their Medicare reimbursements reduced by up to 1% per claim. This equals approximately $280 million during the first year about 0.3% of what Medicare pays overall to hospitals. More than 2,200 hospitals (about twothirds of U.S. hospitals) will be penalized this year. According to an analysis by Kaiser Health News, 278 hospitals will lose the maximum amount of 1%. The penalties will increase to 2% in October 2013 and 3% in October 2014. Illinois is one of the states that will be hardest hit by the penalties with 128 paying an average of 0.45%. It ranks at the top, just behind New York, Pennsylvania, Florida, Ohio, Texas and California. To help reduce the number of readmissions, the Illinois Hospital Associations Institute for Innovations in Care and Quality is providing learning collaboratives, education, best practices, tools and data resources for its 200 member hospitals. The institute will offer an interactive tool for hospitals to evaluate readmission rates. These are unprecedented times in health care and our ambitions have to be bold, said IHA President and CEO Maryjane A. Wurth. Hospitals are facing tremendous challenges in a rapidly changing environment. The Institute is helping hospitals develop and implement solutions to bridge to the new, transformed healthcare system that focuses on better care, better health, and lower costs. The Institute also helps members adopt evidence-based practices to reduce readmissions through the Illinois Partnership for Patients Hospital Engagement Network (HEN) and IHAs collaboration with Blue Cross Blue Shield of Illinois, Preventing Readmissions through Effective Partnerships (PREP). HENs goal is to reduce 30-day readmission rates by 20% before the end of 2013. Most hospitals agree that penalties for excessive readmission rates are fair, but groups like the American Hospital Association and the American Association of Medical Colleges contend CMS should consider factors like a hospitals demographics that might factor into its rates. Issues like lack of primary care providers, high numbers of Medicaid patients and unaffordable medication are often out of the scope of hospitals reach. The national average for hospital readmissions within 30 days of discharge is 19.9% for heart attacks, 24.8% for heart failure and 18.4% for pneumonia. Studies have estimated that unplanned readmissions cost Medicare about $17.4 billion annually. TAMMY WORTH

Study Has Mixed Data On Statin Use, Costs

A new study conducted by St. Paul, Minn.-based pharmacy benefits manager Prime Therapeutics in conjunction with Blue Cross and Blue Shield of Minnesota concluded that the regular use of statins improved patient health but raised their overall costs. According to the study of nearly 46,000 Minnesota Blues enrollees, those who were adherent to their statins regimen were 2.6% less likely to visit the emergency room. As a result, their overall medical costs were $767 lower. However, the pharmaceutical costs of those who took their medications as prescribed were 45% higher a difference of $1,606. Although prior studies of statin adherence had concluded they lower medical costs overall, the population differences in this study including a relatively young population may have played a role, according to researchers.

The Payers & Providers Midwest Edition is published every Tuesday, with four pages of hard-hitting healthcare business and policy news and insights

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MARKETPLACE/EMPLOYMENT WEBINARS WHITE PAPERS

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Recent and Upcoming Webinar Events

CD-ROMs with full audio recordings and presentation slides from all recent HealthcareWebSummit events cosponsored by Payers & Providers are available, and attendee registrations are accepted for all upcoming events. To order a CD-ROM or register to attend any of the following recent or upcoming events, call 209.577.4888 or go to www.healthwebsummit.com Medi-Cal Expansion 2014 and Beyond to be held October 25, 2012 at 10 AM Pacific with Elizabeth Benson Forer, Executive Director of the Venice Family Clinic and Lucien Wulsin, founder and executive director of Insured the Uninsured The California Healthcare Exchange: A Progress Report August 15, 2012 with David Panush, Director of Government Relations, California Health Benefits Exchange, Anthony Wright, Executive Director, Health Access and Jon Gabel, Senior Fellow, NORC at the University of Chicago Hospital Value Based Purchasing: A Roadmap June 27, 2012 with Robert A. Minkin, Senior Vice President, The Camden Group, Guy DAndrea, President, Discern, LLC, Jason Lee, Senior Manager, ECG Management Consultants Patient Finance: Issues and Pathways June 13, 2012 with Mitch Patridge, Chief Executive Officer, CSI Financial Services, Ron Shinkman, Publisher, Payers & Providers, and Rick Tsupros, President, Match Point Solutions Hospital Districts: Mapping the Future May 24, 2012 with Michael A. Dowell, Partner, Hinshaw & Culbertson LLP, Walter Kopp, President, Medical Management Services, Inc. and Cleo E. Burtley, Manager, The Camden Group Claims Processing: A Collaborative Effort April 26, 2012 with Kenny Deng, Senior Director of Provider Services and Operations, Blue Shield of California, George H. Mack, Vice President, Payer/Provider Relations, and Vice President, Member Relations, Hospital Association of Southern California, and Dan Martinez, Director of Patient Financial Services, Mission Hospital Reducing Readmissions: Collateral Effects April 11, 2012 with Daniel C. Cusator, M.D., Vice President The Camden Group and Maria Lopes, M.D., Chief Medical Officer, AMC Health Managing an Increasing Trend of Elective Preterm Deliveries February 24, 2012 with Larry Boress, President & CEO at Midwest Business Group on Health, Harold Miller, Executive Director, Center for Healthcare, Quality and Payment Reform, and Peter Weeks, M.D., Chairman, Department of Obstetrics & Gynecology at Edward Hospital Charity Care & Community Benefits: The New Paradigm February 16, 2012 with Ronald Sorensen, Director of Community Partnerships at Providence Health and Services

On May 30, 2012 Payers & Providers released a special white paper, The Many Stories of One Litigious Physician. It is about a prominent surgeons decision to sue the patients she treated at hospital emergency rooms. Many had suffered serious injuries. She sued even if these patients and their families had insurance. She sued even after regulators ordered her to stop. This white paper raises significant questions regarding the payment levels specialist physicians receive to be on call, the role hospitals play in supervising their medical staffs, and the consumer protections available to patients. The Many Stories of One Litigious Physician is available in pdf format for $149. This white paper is the product of months of reporting. It might be the single most significant piece of journalism Payers & Providers has published. To order, call 209.577.4888 or go to www.healthexecstore.com

The Payers & Providers white paper, Follow The Money: Healthcare and Campaign Finance in California, discusses and analyzes the influence of the sectors money on politics and policy. It traces the biggest healthcare industry contributors to candidates and political action committees, how much theyre giving, and where that money is going. Follow the Money is available for $149. In addition to this concise and in-depth investigation, two databases in an easyto-read Excel spreadsheet format are also available for purchase for $129, or with the white paper for $199. They include: All healthcare-related organizations and the itemized contributions they made to candidates and PACs for the 2009-2010 campaign season. Details on more than 90 organizations and big individual contributors are included. A database of the largest donations made by individual employees of Californias hospitals, insurance plans and other healthcare organizations. Details on more than 200 entities are included. Both databases are available in an easy-to-read Excel spreadsheet format.

Given the ramifications of the landmark U.S. Supreme Court Citizens United case, you and your organization simply cannot lack a roadmap to where the political money flows from the healthcare industry in California. To order, call 209.577.4888 or go to www.healthexecstore.com

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MARKETPLACE/EMPLOYMENT MARKETPLACE

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Employment
The following employment opportunities are listed in the Payers & Providers MCOL Employment Marketplace online at www.mcol.com/emp.htm System Vice President, Managed Care Strategy and Director of Communications - Urbana, IL Director Operations, Managed Care-Oklahoma City, OK Health Information Technology (HIT) Program Manager - Los Angeles, CA The Payers & Providers MCOL Employment Marketplace provides three solutions for employers and recruitment firms to promote employment opportunities to the MCOL and Payers & Providers audience: 1. Payers & Providers Display Ads - that prominently feature your opportunity in the California, Midwest and or National Editions of Payers & Providers. 2. Payers & Providers Marketplace Ads - economically provide readers detailed information on your opportunity in any editions of Payers & Providers. 3. Online Advertising - with a package including web site listings of your opportunity in mcol.com and PayersandProviders.com, plus inclusion of your listing in the monthly edition of MCOL's @Career enewsletter, and eligibility to post the announcement in MCOL's member LinkedIn group. All Payers & Providers Display Advertising, plus qualifying Payers & Providers Marketplace ads receive the online advertising package at no additional cost. Call 209.577.4888 or go to www.mcol.com/aboutcls.htm to request an Employment Advertising Kit, post an employment opportunity or obtain additional information.
Volume 2, Issue 10
Payors & Providers Natinal Edition is published monthly by Payers & Providers Publishing, LLC. Inquiries may be directed to: Phone: (877) 248-2360 e-mail: info@payersandproviders.com Postal: 818 N. Hollywood Way, Suite B, Burbank CA 91505 Web: www.payersandproviders.com Facebook: http://www.facebook.com/Payers-Providers Twitter: www.twitter.com/payersproviders Editorial Board Members: California Edition: Steven T. Valentine, President, The Camden Group; Ross Goldberg, Immediate Past President, Los Robles Hospital and Medical Center; Mark Finucone, Managing Director, Alvarez & Marsol; Henry Loubet, Chief Strategy Officer, Keenan; Anthony Wright, Executive Director, Health Access California Midwest Edition: William M. Dwyer, Healthcare Strategist, Jay Warden, Senior Vice President, , The Camden Group, Ross A. Slotten, M.D., Klein Slotten & French, Michael L. Millenson, President, Health Quality Advisors LLC, Publisher /Editor: Ron Shinkman publisher@payersandproviders.com

Advertising Opportunities
Payers & Providers, publishes the weekly California and Midwest Editions in electronic format and the monthly National Edition in print and electronic format, and serves as the superior source for healthcare business and policy news and insights. Available advertising solutions through these publications include: Dedicated e-blasts to applicable Payer&Providers distribution lists Sponsor messages in each cover email of any Edition Display Advertising inside each Edition Inquire about Sponsored white paper and webinar opportunities To request a 2012 Payers & Providers Media Kit or other detailed Advertising information, please call 209.577.4888.

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Payers & Providers is the premier publication covering healthcare business and policy news in California, the Midwest and Nationally. Each issue of the weekly California and Midwest Editions includes feature articles, Editorials, News Briefs and more, all dedicated to payer and provider news of direct interest to stakeholders. Paid Subscriptions are available for $99 annually for individuals or $149 in bulk for up to ten subscribers. Payer and Provider California or Midwest Edition Paid Subscriptions receive the applicable weekly Edition via email notification listing issue highlights, with links to two viewing options for each issue (direct pdf download, and online viewing). Along with the following additional benefits: Exclusive access to an online archive of past applicable Editions A copy at no additional cost of upcomingl Payers & Providers Quarterly White Papers for that Edition (typically valued at $149 per edition)* Complimentary attendance to Payers & Providers sponsored Healthcare Web Summit event each December: Healthcare Trends (a $225 value) 50% discount on registrations with other Payers & Providers co-sponsored Healthcare Web Summit events Complimentary electronic subscription to Payers and Provider National Edition (a $99 value)
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