25 September 2012

Midwest Edition
Calendar
October 3-5
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Payers Focus On Individual Market

HAP, UnitedHealth Launch, Relaunch Products
In anticipation of the changes that will be brought to healthcare delivery in 2014 by the Affordable Care Act, insurers are doing what they can now to create products for, a sector of the market that has previously been somewhat overlooked small businesses and individuals. The individual mandate has made this market one that insurers can hardly afford to ignore. The Congressional Budget Ofce estimates that, by 2022, there will be an estimated 22 million new people covered under the insurance exchanges and three million fewer on employer plans than there are now. I think everyone has this same focus right now, said Lori Rund, vice president of product development and market intelligence for Health Alliance Plan, a Detroit-based insurer. We are preparing for 2014 and the exchange market and are looking to be more competitive. We found out who is there, what their needs are how we align products and messaging and tools to be more attractive to that market. Rund said HAP has performed segmentation, created focus groups and undertaken one-on-one interviews to understand how consumers in the individual and small business markets look at insurance and what is important to them. On the individual side, HAP recently relaunched one of its formerly-retired products and are now seeing the highest sales ever for the plan. The Personal Alliance product line is a bridge plan lasting one to three months for people who are between jobs, coming out of college or in retirement and waiting to qualify for Medicare. Its a low-cost plan that Rund said ts a need they saw in the marketplace. HAP also has 10 different plan designs on their individual side. Rund said the market in Michigan is unique because there are so many former employees from the automotive industry which had very rich benets. This group is on the individual and small employer side and insurers are understanding how to meet their needs. For small businesses, they have found they have to provide really competitive pricing while balancing benet design and cost sharing. One way they have done this is to focus more on consumer-driven solutions. They are offering high-deductible health plans with HSAs, something she said isnt traditional for this heavily based HMO market. UnitedHealthcare, the Minneapolis-area insurer that provides coverage throughout the Midwest, is also seeing changes in its small business market.

November 15-16

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December 4-5

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Continued on Next Page

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Top Placement... Bottomless Potential

NEWS
Individual Plans (Continued from Page One)
Will Holman, spokesperson for UnitedHealth, said the plan has seen increased interest in their incentive-based wellness programs for small employers. Its program for this group provides telephone wellness coaching, gym reimbursement and at-home screening kits that provides numbers on cholesterol, triglycerides and glucose levels. These benets are available in 24 states including Wisconsin, Illinois, Iowa and Indiana. UnitedHealth also offers a new MultiChoice small business product that combines multiple benet design options under one plan. (Businesses) sometimes offer as many as a dozen different plan options based on their workforce and their budget, rather than the traditional one-size-ts-all approach, he said. Holman said this is unique for a lot of markets because it allows small businesses to

Page 2

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In Brief
Michigan Health Plans, Business Community Weighs In On Blues Conversion Proposal
Two major players in Michigans healthcare scene weighed in on the proposal of Gov. Rick Snyder to convert Blue Cross Blue Shield of Michigan into a mutual benefit corporation. Representatives for the Michigan Association of Health Plans and the Michigan Business and Professional Association offered divergent opinions on the proposed conversion. The MAHP expressed concern that such a conversion could give the Michigan Blues potential for becoming an unregulated monopoly monopoly, as it already has 70% of the states health insurance market. We hope that the proposed reform of BCBSM will take place under the shared objective of Michigan striving to become the MOST competitive marketplace in the nation which means by definition, no company be permitted to have a monopoly position in any of the commercial markets of the state," said MAHP Executive Director Rick Murdock during testimony last week in front of the Senate Health Policy Committee. Murdock said MAHP wants changes to Snyders proposal, including safeguards for the states uninsured and underinsured population. The Michigan Blues are currently an insurer of last resort and must take on all applicants. It also wanted to ensure the state is properly compensated should the Blues

craft a customized set of options for their employees. Traditionally, small businesses are only able to offer employees a couple of benet plans, he said. Employers can choose the package, set contribution levels and have employees choose what works best for them. It is available in 24 states including Wisconsin, Illinois, Iowa, Indiana, Michigan and Ohio. Rund said UnitedHealth is uncertain how things will shake out in 2014 and what their part will be in the state exchanges there are still a lot of things unknown. But they are doing product development in preparation for the individual and SHOP markets. We are running through different scenarios and we are anticipating a denite increase in our business, Rund said. The small business side will take longer, but on the individual side, we are anticipating an increase in business. TAMMY WORTH

Ohio Firms Win Workplace Awards

Cited For Psychologically Healthy Cultures
Two of the ve organizations awarded this years national, Psychologically Healthy Workplace Awards are Ohio-based companies. The awards are given to employers that have a comprehensive set of policies that foster employee well-being. The companies are chosen from those honored by state afliates of the American Psychological Association. This years Midwestern honorees are Noble-Davis Consulting, Inc., in Solon, and Certied Angus Beef, LLC in Wooster. Both companies provide a comprehensive array of benets to their employees along with some atypical ones. Both employers say this combination works to promote employee satisfaction and retention. Noble-Davis Noble-Davis provides benets to its employees that include: healthy snacks like fruit and vegetables on-site; weekly in-house yoga; neck massages on Valentines Day; quarterly contests that earn employees events such as bowling parties, trips to a casino or to Cleveland Indian games.

Continued on Next Page

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Longer ALOS!*

NEWS
Ohio Mental Health (Continued from Page One)
What we want to do is treat employees like we would want to be treated and treat them like grownups, said Jan Davis, the companys president. She said the rm doesnt think about improving mental health specically, but is just following company culture. Though Nobe-Davis provides a lot of basic benets, one unusual one they offer is an open vacation policy. Davis said managers do not track when people come and go some come in at 10 a.m. and stay later, others come in early and leave early. Our philosophy is, as long as the work gets done and our clients are happy, we are happy, she said. If the work gets done and if you feel like you can take vacation, its good. Employees dont need preapproval, they just put their time away on the calendar. And they can take whatever they want, as long as its not during seasonal busy times. Davis said it doesnt work for everyone. The rm had to put upper limits on the amount of time people could take because a few took advantage of the situation. And it does take a self-motivated person, so they have to keep that in mind when they hire new people. We phased out counting the vacation time a long time ago, she said. We were trying to meet the needs of different people, simplify things for us and make people responsible. Its all just understood. Certied Angus Beef Certied Angus Beef has only about 100 employees. Pam Cottrell, the companys human resources director, said they act as much like a large family as they do a small business. The culture of our company is very family-oriented, very family-focused, she said. We really feel that this is where we

Page 3

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In Brief
ever convert to a for-profit plan, as well as the elimination of most favored nation clauses that often pitted providers against one another. By contrast, the MBPA welcomed Snyders proposal, which in addition to the conversion would require the Blues to donate $1.5 billion over 18 years into a fund that would encourage healthier lifestyles and presumably cut healthcare costs. This type of action has been needed for a long time and we feel it will benefit Michigan's business community, said Jennifer Kluge, President and CEO of both the MBPA and the Michigan Food and Beverage Association. It streamlines regulations, which will reduce costs for employers and help to create jobs. Michigan businesses look forward to working with Gov. Snyder and policymakers in our effort to modernize Michigan's outdated health insurance market and level the playing field so everyone plays by the same rules."

Health Care REIT Raises $1.7 Billion In Stock Offering

Toledo-based Health Care REIT raised $1.7 billion in a common stock offering. The company sold 29 million shares of common stock at the price of $56 a share. It will use the proceeds to retire debt and invest in new property, particularly in senior housing. Health Care REIT recently agreed to terms to acquire Sunrise Joint Venture Partners in an $845 million deal. Sunrise operates 300 senior living centers nationwide. The stock offering was underwritten by BofA Merrill Lynch, J.P. Morgan, Morgan Stanley, and Deutsche Bank Securities.

work, this is not our life. Work-life balance is emerging everywhere else, and weve already had it here for 30 years. The organization provides its employees with benets that include a personal trainer, certied nancial planner, attorney, seamstress and physician. They come on-site once a month and provide services free-of-charge during the work day. But one of their most novel benets, and the reason they received the award, is the clinical psychologist who spends one day a month on the worksite. We didnt think it was unique, we thought we were doing something helpful for our employees, Cottrell said. We really look at it from a bigger-picture perspective. Everybody has stress from their job, family, aging parents, small children. We dont leave those challenges at the door and it can impact our ability to be engaged and present. And the therapy is popular. Marianne Bowden, whom they call Dr. B, has an ofce across the street from the company. She arrives monthly and walks through the halls, talks with people about their families and looks at their family photos before heading into the wellness room. In order to reduce the stigma of therapy, they call the program Shrink Your Stress With Dr. B. All appointments are placed on a calendar everyone can see and theres no shame in visiting with her. She is typically booked solid during her visit. We were wanting to remove the stigma of mental health and make it OK for our staff to visit with the clinical psychologist, Cottrell said. All of the wellness staff are consultants and Cottrell said the investment is a good one for the company. It has a 90% participation rate in its annual health risk assessment. TAMMY WORTH

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Payers & Providers

OPINION

Page 4

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Kansas Hospitals May Face Bleeding

ACA, Other Issues Will Impact Their Finances Long-Term
Healthcare is changing. For hospitals, the Poverty, chronic illness, unhealthy lifestyles and problem isnt necessarily the change itself; it is lack of access to care hamper hospitals ability the uncertainty. To make the best decisions for to improve the health of the communities they the communities they serve, hospitals must serve. Hospitals need to be a part of efforts to have an understanding of the environment. address the impact of these problems on the The Kansas Hospital Association has released healthcare system. However, no member of the a new report identifying some of the most provider community can independently signicant healthcare policy issues for the inuence these metrics. It will require a states hospitals. The report, entitled: Assessing coalition of healthcare providers and the Healthcare Environment for Kansas community leaders to improve population Hospitals, focuses on issues that are unknown health indicators. To assist with this, hospitals but could affect the states hospitals, including have been involved in the creation of a new the 2012 elections and the future of Medicaid Web site, www.KansasHealthMatters.org, which expansion and health insurance exchanges. It is designed to help communities learn about also addresses trends that are clearer, such as their community health needs and collaborate economic and demographic trends, for positive change. consolidation in healthcare, the impact Kansas has weathered the of technology, and performance recession better than many states. By improvement. However, many hospital margins Tom Bell remain at breakeven or below. This will In broad terms, what the research indicates is that Kansas hospitals will be present challenges to hospitals as challenged by the conuence of state and emphasis is placed on improving the health of national policy decisions, fundamental shifts in our communities and pay-for-performance the way the healthcare system operates and the initiatives. states demographic shifts and economic Kansas ranks well on many performance environment. measures in national surveys and ranks high in The 2012 election has moved the patient satisfaction, actually scoring rst in a healthcare debate to the forefront, which is recent state-by-state summary by the Hospital good. A robust debate about the direction of Consumer Assessment of Healthcare Providers the healthcare system is important for and Systems (HCAHPS) Survey, administered by designing the future healthcare delivery system the U.S. Department of Health and Human to meet the needs and desires of patients and Services. Hospitals are committed to continued families. However, the ongoing nature of the improvement. Kansans deserve great hospitals. debate complicates hospitals ability to make As turbulent and challenging as the present is for investments. Cuts to entitlements, especially hospitals, Kansas hospitals are focused on signicant federal cuts to Medicare, could delivering the best care to the communities they jeopardize hospitals and physicians limiting serve. access to care. The states pending decisions Kansas is fortunate to have 127 community about Medicaid expansion also will have a hospitals serving communities both large and substantial impact, at a time when hospitals small. And like Kansans, Kansas hospitals are have already surrendered signicant Medicare resilient. That strength will be important as state revenue through the Affordable Care Act with and federal healthcare policymakers reshape the the expectation of expanded coverage. environment for providers and patients. The difcult nancial climate, in Kansas and across the nation, has led to integration in Tom Bell is the president and CEO of the healthcare. More hospitals are aligning Kansas Hospital Association in Topeka, Kan. through partnership, mergers and acquisitions. The Kansas Hospital Association is a not-forThe number of physicians who are seeking profit association that includes 211 member hospital employment is increasing. Although facilities. these trends can bring additional assets for patient health, the sharing of technology and streamlining patient transitions are signicant Op-ed submissions of up to 600 words are and costly investments. welcomed. Please e-mail proposals to Population health remains a challenge. editor@payersandproviders.com

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