!!!"#$$!%&!'(&)*+!,!'*-./0)*+!'1%2/+3/456!

778
There are 225,000 souls on the payroll at
Lowes, the North Carolina-based home
improvement chain. When their hearts break
down 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. It
considered out-of-country surgery, domestic
travel surgery networks, and a single center of
excellence. It went with the last
option.
A little more than a year ago,
Lowes agreed to send its
employees who need heart
surgery to the Cleveland Clinic,
the No. 1 cardiac care medical
center in the U.S. Currently,
about 20% of its employees
who need a cardiac procedure
are doing so at the Clinic.
Lowes came to us and said,
would you build a program
around a certain kind of patient,
if they travel to you? They were
looking for additional tools to
reduce their healthcare costs,
said Michael McMillan,
executive director for market and
network services at the Clinic.
The program waives deductibles
and co-payments for all patients approved for
heart surgery. Employees also get a travel
stipend and lodging expenses for the patient
and a companion, as well as concierge
services to make the arrangements.
According to healthcare quality expert
Arnold Milstein, M.D., Lowes simultaneously
assured employee access to the nations best
surgical care and challenged all U.S. hospitals
to accelerate their pursuit of surgical
excellence.
Capturing the self-
insured Lowes was also a
big victory for the Clinic.
The Fortune 500 retailer
had $48.8 billion in
revenues and $2.01 billion
in prots last year. It
spends $750 million a year
on healthcare.
The success of the
cardiac program has
spurred Lowes and the
Clinic to expand their
partnership to orthopedics,
with a focus on spinal
surgery.
The Cleveland Clinic was
chosen, according to
McMillan, because of its
reputation 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-Mail
info@payersandproviders.com with
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 Lowes
20% of Retailers Heart Surgeries Performed in Ohio
Continued on Next Page
Michael McMillan
Cleveland Clinic
!!!"#$$!%&!'(&)*+!,!'*-./0)*+!'1%2/+3/456!778
Payers & Providers Page 2
Top Placement...
Bottomless Potential
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In Brief
Ohio To Create
Insurance Exchange
Despite Opposition
Ohio will create a health insurance
exchange despite its political leaders
distaste for the Affordable Care Act,
Gov. John Kasich said last week.
Under the reform law, each state is
required to create an online
marketplace, or exchange, where
consumers may compare health plans
and choose the one that suits them
best after the insurance coverage
provisions of the law go into effect in
2014.
The law authorizes the federal
government to create exchanges in
those states that dont create their own.
Republican leaders in some states have
denounced the law and refused to
have anything to do with implement-
ing its provisions. Presumably the
Department of Health and Human
Services would develop exchanges to
serve those states populations.
Kasich, a Republican, is not a fan of
the reform law but has directed
executive departments to prepare to
administer it. Ohio has received
federal money to build the exchange
and will soon apply for a second
round of funding.
California Group Buys
9 Nursing Homes in
Iowa and Nebraska
The Ensign Group Inc. has acquired
nine nursing homes in Iowa and
Nebraska from Careage Management,
LLC, based in Sioux City, Iowa.
The owners of Careage entertained
a variety of offers, and chose Ensign
because of its resident-centered care
and loving, dignied, home-like
environment, said Dan Myers, Careage
president and chief executive ofcer.
Continued on Page 3
NEWS
Cleveland Clinic (Continued from Page One)
its willingness to not only stand behind its
outcomes but to make them public.
By coincidence, the Cleveland Clinic had
been looking at widening its national prole
to attract more out-of-state patients. Half of its
cardiac surgical cases were already coming
from outside Ohio. It had well-established
procedures for handling traveling patients.
Now Lowes and the Clinic have some
results to talk about. As of July 12, the Clinic
has completed 37 procedures for Lowes
employees, from 23 states. Six patients are
awaiting clinical assessment or service,
McMillan said at a talk organized by the
Midwest Business Group on Health last week
in Chicago.
In patient surveys conducted by Mercer, all
of the Lowes patients gave the Clinic the
highest rating for medical care, and all of them
would recommend it to someone else. The
average lapsed time from surgery to return to
work was 5.5 weeks, compared to 6 to 12
weeks for the national averages.
And, critically, the economics are working.
We are exceeding our expectations on an
overall cost basis, McMillan said. We are
making money. The nancial expectations of
both organizations have been met. It wasnt
easy.
When employers have been unsuccessful
in trying to have health plans identify high
quality, low cost centers of excellence for
various types of conditions, said Larry Boress,
president of the Midwest Business Group on
Health, Lowe's has set an exacmple of how
an employer can work with a major health
system to focus on saving money, and also
providing high quality care, and supporting
the needs of their work force.
Lowes wanted to develop a strategy to
drive value and impact costs. If its established
wisdom that 20% of the population drives
80% 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, spine
surgery, orthopedics, and cancer care.
However, corporate medical tourism --
even if it is domestic -- is more talked about
than done, said Michael Millenson, author of
Demanding Medical Excellence. Its not a
new idea, Millenson said. You have to get
people to do it.
Today, circumstances may have changed
enough to make it worthwhile for both
employer and employee.
If you take a world-famous reputational
center, like the Cleveland Clinic, maybe
people will go, Millenson said.
He added that hospitals and physicians
may be more business savvy and aggressive
than 25 years ago. They are making deals for
discounted fees that they wouldnt have
engaged in before.
And nally, we are beginning to see the
effects of consumer-driven healthcare. The
deductible of $500 in the 1980s might not
have been enough to move the market. Now,
if the deductible is $5,000, and the employer
smoothes the way to a top-quality outcome,
the carrot is much larger. The higher
deductible in the health plan gives the
employer more leverage.
For a national company like Lowes that
operates in almost every healthcare market,
the local variations in quality of care and cost
of care can be galling and inexplicable.
The work of John Wennberg, M.D., and
the Dartmouth Atlas have demonstrated that
those variations are attributable to no
particular reason except differences and
preferences in medical practice.
Lowes has set up a turnkey program
with a simplied bundled payment, a built-out
support system for the patient and traveling
companion, and full administrative support for
the employer and employee.
This is a disruptive message to local
hospitals, McMillan said. It means that
healthcare is no longer local, and that quality
trumps convenience and price.
Managing the relationship with the
hometown physician is critical, McMillan
observed.
You have to make sure that people
understand this is an appropriate location for
care, as opposed to what might have been
recommended at home, he said. In this
model, the employee says to the physician,
Im going to the Cleveland Clinic. How do
you manage that patient-physician
relationship and coordinate the post-surgical
followup?
It means patients must receive clear follow-
up instructions to take home, and hometown
cardiologists have to be assured of easy
communications with the Clinics doctors.
Any number of health systems will try
to use this as a model, Boress said. The
challenge for them is how do you combine all
of the services and provide the level of support
needed within the price, and still generate
enough revenue to make it worthwhile.
!!!"#$$!%&!'(&)*+!,!'*-./0)*+!'1%2/+3/456!778
Page 3
Payers & Providers
Longer ALOS!*
Advertise Here
(877) 248-2360, ext. 2
*For our ads, not your hospital
NEWS
In Brief
We expect the former Careage
facilities to pave the way for
additional disciplined growth in
Nebraska, Iowa, and the Midwest,
said Christopher Christensen, Ensigns
president and CEO, in a statement. He
said the nine facilities have a high rate
of private-pay patients and are less
dependent on Medicaid
reimbursements.
The facilities all together had an
occupancy rate of 74%. The
transaction was made with cash.
Ensign, based in Mission Viejo, Calif.,
owns 96 nursing homes, three hospice
companies, and three home health
businesses in eight Western states,
plus now Iowa and Nebraska.
Christensen said Ensign is looking
to acquire both well-performing and
struggling long-term care operations
across the United States.
Feds Turn Down Illinois
Revisions to Medicaid
Eligibility Regulations
Republican legislators in Illinois were
angered last week when the federal
government rejected an effort by the
state to tighten eligibility standards for
Medicaid.
The state has long wanted to have
stronger proof of residency and
income eligibility for Medicaid
beneciaries, who until now have
merely had to write down their home
address and show one paycheck stub.
A new law mandated showing a
month of paycheck stubs to
demonstrate income.
The federal government turned
thumbs down on the Illinois changes
because the Affordable Care Act
prohibits states from ratcheting down
Medicaid eligibility requirements after
President Obama signed the act on
March 23, 2010.
Frankly, this is what enrages
people, Senate Minority Leader
Christine Radogno told the Chicago
Tribune. If all we want to do is nd
out if people are actually eligible for
the services, and the federal
government is telling us we cant do
that, thats absolutely ridiculous.
Two Midwestern states made it into the Top 10
in the CDCs survey of state obesity rates last
week: Michigan and Missouri. In Michigan
30.9% 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 the
overweight epidemic. In 2010, the Centers for
Disease Control and Prevention reported, no
state had a prevalence of obesity less than
20%. Twelve states had a prevalence of 30%
or more. Michigan is the only state in that
category outside the South.
Obesity was dened as a body mass index
of more than 30.
Wisconsin, often thought of as a bastion of
cheese eaters, scored relatively well at 30
th

most obese. Minnesota was the only
Midwestern state to do better, at 37
th
.
The Midwestern states, in descending order
from 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% of
adults, and Coloradans were the least, at 21%.

The Centers for Medicare and Medicaid
Services will assume responsibility for
reviewing health insurance premium increases
in 10 states, among them Missouri and Iowa.
Under the Affordable Care Act, states are
required to review signicant rate increases and
disclose them to the public. The ACA makes
$250 million in federal funds available to help
states undertake this project. CMS said Rhode
Island, California, North Dakota and
Connecticut have already used their authority
to roll back exorbitant increases.
Several states, such as Idaho and Montana,
have declined to participate because they
oppose the law. Other states dont have the
necessary regulatory framework or enabling
legislation. CMS has authority to exercise the
rate review function in states that dont have a
mechanism. CMS will handle rate reviews for
small group and individual policies in
Missouri, and for small group policies in Iowa.
Tom Alger, spokesman for the Iowa
Division of Insurance, said his ofce didnt
agree with the CMS assessment of Iowas
capabilities. We have rate review equal to or
more stringent than other states which were
found to have effective rate review. We have
written to them to request that they reconsider
that, he said. We have given them additional
information to support our case.
In Missouri, state law does not require
health insurers to submit rates, which was the
basis for the determination by HHS, said John
M. Huff, director of insurance.
CMS to Handle Insurance Reviews
Missouri, Iowa Are Found Lacking in Capability
HEALTHCARES BEST ADVERTISING VALUE
]
PAYERS & PROVIDERS reaches 5,000 hospital, health plan and non-
prot executives statewide. There is no better venue for marketing
your organization or conference, or recruiting new staff.
CALL (877) 248-2360, ext. 2
Michigan, Missouri Lead in Fatness
CDC Report Shows Major Gains in U.S. Girth
!!!"#$$!%&!'(&)*+!,!'*-./0)*+!'1%2/+3/456!778
Payers & Providers Page 4
How many times have you lled in the family
history questionnaire on paper only to have it
led away, never to be seen again? And even if
seen, does your healthcare provider know how
to assess risk and refer you to a genetics
professional?
The Centers for Disease Control and
Prevention recently released its goals for
Healthy People 2020. For the rst time, the
goals include genetics-enabled healthcare: to
identify as many individuals as
possible who are at genetic risk
for breast and colon cancers and
get them to proper genetic care.
The potential improvement in
cancer prevention and early
detection would have major
implications for the overall
public health.
The public perception of
personalized medicine is
askew: the term is often viewed
as a common treatment option
for rare genetic disorders. The
truth is that our recent
understanding of genetic and
genomic information grants
physicians a new authority to offer a
higher form of individualized care
to their patients.
Personalized healthcare, in and of itself, is
hardly new: ABO blood typing is a superb
example of widespread genetics-based
personalized healthcare dating back to World
War II. It continues to have universal
applicability, and will for centuries.
Consider a more recent example: Common
associations for breast cancer account for
almost 3% of all breast cancers, whereas a rare
mutation (BRCA1-2) alone accounts for 10% of
all breast cancers. There are currently at least
eight other breast cancer predisposing genes
that help knowledgeable healthcare providers
make the correct diagnosis and that inform
patients of risks of other cancers.
From a practical point of view, we all want
to use genetic and genomic information to
benet the patient. Despite all good intent, how
successful have we been?
Researcher Douglas Levy surveyed 35,000
healthy individuals by taking family histories of
cancer diagnoses. By family history alone, 350
people appeared to be at risk for hereditary
breast and ovarian cancer syndrome. Yet only
35 discussed their concern about family history
with their healthcare providers, and only four of
these people reached appropriate testing. Even
more alarming, it is unknown how many received
appropriate pre- and post-test genetic counseling
(considered the standard of care).
Only 1% of those who require such genetics-
informed personalized clinical management are
even identied and referred to genetics
professionals.
As Harvard Professor Michael Porter,
author of Redening Health Care, has
said, American healthcare in the 21
st

century is practiced on a 19
th
-century
organizational structure that has
received a thousand Band-Aids to
even limp along. Healthcare
providers are swamped by a thousand
regulations, which bring along piles of
paperwork.
Family health histories are the sum
total of an individuals genetic legacy
and his or her environmental
exposures. Trained genetics
professionals can look at an
individuals personal and family
histories and narrow down which
particular gene(s) may predispose them
for specic disease(s).
By testing the most likely gene in the
setting of genetic counseling, providers
may give patients a highly accurate gene-enabled
diagnosis. The particular gene involved will
dictate what else the individual is at risk for. After
that, increased screening or tailored, preemptive
strikes can be planned. Importantly, once they
know where the gene alteration is, other family
members can ask to be screened only for that
particular alteration, resulting in a 100% accurate
gene-enabled diagnosis.
If we can take advantage of health
information technologies, then we must somehow
ensure that every single individual who sees his or
her healthcare provider, whether primary care or
specialist, has an accurate family health history.
That history can be risk-assessed without draining
more time from our healthcare providers.
Both physicians and patients must be more
proactive in educating themselves about genetic
testing and its wealth of benets.
OPINION
The Real Promise of Genetics
Selective Testing Offers Major Gains Against Cancer
By Charis Eng,
M.D.
Charis Eng, M.D., is chair and founding
director of the Genomic Medicine Institute of
the Cleveland Clinic.
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!!!"#$$!%&!'(&)*+!,!'*-./0)*+!'1%2/+3/456!778
MARKETPLACE/EMPLOYMENT
Payers & Providers Page 5
MANAGER, FINANCE AND TRANSACTION ADVISORY SERVICES
Responsibilities include managing consulting engagements and teams; interfacing with clients at
senior management and board levels; and some business development.! The companys client
base consists of healthcare systems and hospitals, physician groups, insurance/managed care
organizations and other healthcare service/product/technology companies.! The successful
candidate will have excellent analytical and communication skills with proven ability to interact
with C-level executives and boards.! Consulting experience with a national rm is also preferred.!
Requirements: Masters Degree, 4 years of healthcare industry experience, hospital/medical group
nance, managed care operations, and/or experience with a national healthcare consulting or
national advisory rm.! Experience with managed care contracting, predictive modeling, and
clinical integration is highly desirable.
The rm provides a broad range of advisory services involving nancial acumen including:
strategic planning, nancial planning and modeling, managed care, ACO development, bundled
payments and clinical integration strategies, feasibility studies, M & A transactions, valuations,
fairness opinions, nancial advisory services, debt capacity analysis, private equity and venture
capital transaction services.
Also must have the ability to work well with individuals at all levels of an organization, and
excellent analytical written, and oral communications skills.! Comprehensive compensation
packages offered. Los Angeles-based position.
Contact Information:
Mary Lasnier, The Camden Group
HR@TheCamdenGroup.com
www.TheCamdenGroup.com !
!!!"#$$!%&!'(&)*+!,!'*-./0)*+!'1%2/+3/456!778
MARKETPLACE/EMPLOYMENT
Payers & 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 independent
community 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 Strategic
Services 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. For
additional 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 for
providing leadership, strategic direction and actionable solutions in support of the imperative to transform
care delivery in the United States to ensure a long term sustainable/viable health care system. The Executive
Director manages ongoing market assessments, integration and synthesis of care delivery activities to
supplement Plan thinking and evolution of their alternative approaches. The Executive Director has three
direct reports and a total staff of seven.
The successful candidate must have a Masters degree. A minimum of 15 years of broad-based care delivery
experience at the executive level in a large, sophisticated integrated delivery system, health plan, or health
system 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 and
relocation assistance are offered. Interested candidates or condential recommendations should be sent to
the Witt/Kieffer consultants, Stephen J. Kratz and Shirley Cox Harty at CareDelivery_BCBSA@wittkieffer.com.
!!!"#$$!%&!'(&)*+!,!'*-./0)*+!'1%2/+3/456!778
MARKETPLACE/EMPLOYMENT
Payers & Providers Page


luyors & lrovdors und MCCL prosont koundtubo lntoructvo. lt dobuts Murch 20|| n tho luyors & lrovdors Nutonu odton.
Cur roudors uvuys vunt to knov vhut s on tho mnds ol houthcuro's c-suto oxocutvos. Conloroncos und trudo ovonts olton
ony uov lor crucu momonts to ntoruct vth thoso thought oudors. \th koundtubo lntoructvo, you' cut through tho
promnuros und mmodutoy knov vhut's on thor mnd.
Lvory koundtubo lntoructvo v louturo u C&A sosson conductod by luyors & lrovdors lubshor kon Shnkmun. Hs
docudos ol oxporonco n ournusm und tho houthcuro ndustry v promso concso und rovoung ntorvovs.
1opcs lor upcomng koundtubo lntoructvos ncudo:
!! lntogrutod Systoms vs. lrvuto lructco: 1o vhut dogroo v physcuns not uroudy n urgor modcu groups or ntogrutod
houth systoms romun n prvuto pructco durng ths docudo, und vhy. \hut uro tho udvuntugos, dsudvuntugos und
mpcutons n toduy's onvronmont:
!! Modcud luns und Dovory Systoms: Hov much s thor cout grovng us Modcud onromont s prooctod to sour us
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houth puns und systoms try to ncrouso shuro und concontruton n ths murkot:
!! Accountubo Curo Crgunzutons: Aro thoy ovorhypod: \hut typo ol houth curo systoms shoud bo pursung ACCs, und
vhut systoms shoud bo sttng on tho sdonos lor nov: Hov tod s tho ACC movomont to tho succoss or luuro ol
Modcuro ACC pots: Doos tho dolnton ol ACCs nood moro spoclcty, or s t prolorubo to huvo u bg tont ol
ncuson:
Do you vunt to proposo or purtcputo n u luturo koundtubo lntoructvo: lurtcputon s ontroy onno, vth u commtmont ol
no moro thun ono hour. Cu kon Shnkmun ut 877-248-2360, oxt. |, or o-mu hm ut odtorpuyorsundprovdors.com.
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. 2
Or e-mail: advertise@payersandproviders.com
Or visit: www.payersandproviders.com
*New England Journal of Medicine, 2004.
!!!"#$$!%&!'(&)*+!,!'*-./0)*+!'1%2/+3/456!778
Payers & Providers
MARKETPLACE/EMPLOYMENT
Page
SEEKING A NEW POSITION?
CAN HELP.
We publish advertisements for those seeking
new career
opportunities for just $1.25 a word.
If you prefer discretion, well handle all
responses to your ad.
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