Building on its recent shift toward improving
health on the community level, the California
Endowment has become the primary mover in
a $200 million program intended to improve
access to capital to supermarket chains to
encourage them to open locations in woefully
underserved areas..
The pledge from the endowment will be
used to establish the
California FreshWorks
Fund. Although the
program will work
nationwide, much
attention will also be paid
to California, home to
many urban areas
demographers call “food
deserts,” where many
communities are served by little more than
liquor or convenience stores.
"Health happens in our neighborhoods.
Families can't eat healthier food if they can't
buy it where they live,” said Robert K. Ross,
M.D., chief executive ofcer of the California
Endowment. Endowment ofcials also noted
that the project will also help add construction
and service jobs in California, where the
unemployment rate has been hovering above
A 2007 report by the Urban and
Environmental Policy Institute at Occidental
College concluded that three of the most
densely populated neighborhoods in Los
Angeles – Pico-Union, Westlake/MacArthur
Park and South L.A. – had a total of 15
supermarkets serving 15,000 people. Although
more markets have since opened in those
areas the areas remain acutely underserved.
Overall, about 1.7 million Californians
live in areas where they are one mile or
further away from a
supermarket. They are 20%
more likely to be obese
than those who live closer
to markets, leading to
expensive health
conditions such as diabetes
and heart disease.
The collaboration
includes 18 different
entities, including banks, supermarket chains
and healthcare providers. “The sheer number
of banks and other investors involved proves
that this is not only the right thing to do to
improve the health of our communities, but
it’s nancially attractive,” Ross said.
One leading local collaborator is the
Southern California division of Kaiser
Permanente, which is pledging $1 million
toward the FreshWorks Fund. The money will
be used to help add new food retail space, or
expand existing spaces. Kaiser has been
September 21-23
August 25-30
21 July 2011
September 19-21
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.
California Edition
Non-Profit To Seed Retail Grocers
Calif. Endowment Aims To Improve Nutrition Options
Continued on Next Page
Payers & Providers Page 2
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In Brief
Anthem, Blue Shield
Reach Deal With
DMHC On Autism
Anthem Blue Cross of California and
Blue Shield of California have come
to terms with the Department of
Managed Health Care to provide
specic treatments to its enrollees
who suffer from autism.
The deal with Anthem,
announced on Tuesday, will cover up
to 4,000 children who suffer from
autism. Anthem has agreed to pay for
a therapeutic treatment known as
applied behavioral analysis. The
treatment, which focuses on behavior
modications, is intended to help
autistic kids better adapt to their
Although studies have been
made about the efcacy of ABA,
insurers such as Anthem and Blue
Shield had resisted covering the
treatment, claiming it was
experimental or not medical in
nature, or have not included licensed
therapists within its provider
In the settlements, Anthem and
Blue Shield still insisted that ABA can
be provided by unlicensed personnel,
but agreed to cover treatments
anyway. Neither plan admitted any
“Rather than just dealing a
onetime blow to health plans through
an enforcement action, this is another
positive step towards mending the
broken system for California families
dealing with this issue,” said Edward
Heidig, the DMHC’s interim director.
Blue Shield’s settlement with the
DMHC, announced last week, came
at nearly the same time that the
Department of Insurance ordered
Blue Shield to cease and desist in
refusing to cover ABA.
Continued on Page 3
Groceries (Continued from Page One)
sponsoring farmers’ markets in underserved
areas such as Watts in South Los Angeles.
"The availability of healthy foods where
we live does inuence what we choose to eat,
which can affect the prevalence of obesity,
diabetes, and other weight-related illnesses,"
said Amy Porter, M.D., a Kaiser pediatrician
who practices in Baldwin Park and leads a
weight management initiative for children in
Southern California.
Catholic Healthcare West, Bank of
America, U.S. Bank and Morgan Stanley have
also pledged funding.
For the moment, specic details about
California-centric projects remain sketchy.
Major retailers such as Wal-Mart and
Walgreens have agreed to use funding from
the program to help expand.
Walgreens, which is a drug store chain
based in the Midwest, said it would carry
produce and other non-processed food
products at 1,000 of its locations.
However, many other retailers that have
signed up to the FreshWorks initiative plan to
build new locations in other states.

UCLA Settles Data Breach Charges
Agrees to Extensive Corrective Action Plan
UCLA Health System has agreed to pay
$865,500 in nes in order to settle breaches of
condential medical records that occurred
between 2005 and 2008.
An investigation was launched by the U.S.
Department of Health and Human Services’
Ofce of Civil Rights in June 2009 after two
unidentied celebrities who were patients at
UCLA submitted complaints that their medical
records were accessed by employees who had
no need to access them.
The issue of patient data breaches at UCLA
has been going on since the middle of last
decade, leading to the discipline of dozens of
employees and physicians. In 2007, former
employee Lawanda Jackson faced criminal
charges after selling the medical records of
Britney Spears and Farrah Fawcett to tabloid
newspapers. Jackson pled guilty to federal
charges in 2008, but died of breast cancer
before her scheduled sentencing in March
“Covered entities are responsible for the
actions of their employees. This is why it is vital
that trainings and meaningful policies and
procedures, including audit trails, become part
of the everyday operations of any healthcare
provider,” said OCR Director Georgina
Verdugo. “Employees must clearly understand
that casual review for personal interest of
patients’ protected health information is
unacceptable and against the law.”
The money will go directly to HHS.
UCLA did not admit to any wrongdoing. In a
statement, the system said “over the past three
years, we have worked diligently to strengthen
our staff training, implement enhanced data
security systems and increase our auditing
Under the terms of the settlement, UCLA
ofcials agreed to a three-year corrective
action plan that includes an independent
monitor and special training of employees
who have access to patient medical records.
"Our patients' health, privacy and well-
being are of paramount importance to us,"
UCLA Health System Chief Executive Ofcer
David T. Feinberg. "We appreciate the
involvement and recommendations made by
OCR in this matter and will fully comply with
the plan of correction it has formulated. We
remain vigilant and proactive to ensure that
our patients' rights continue to be protected at
all times."
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Page 3
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In Brief

UCLA Introduces New
Surgical Program
The UCLA Health System has
launched a new program that will
focus on hand transplants and other
new and exceedingly delicate
reconstructive procedures.
The new UCLA Section of
Reconstructive Transplantation will
help to repair disguring injuries to
the upper extremities, face and
abdomen using microsurgical
procedures that can repair extensive
nerve and arterial damage. The new
program will work closely with the
existing sold organ transplant
"Reconstructive transplantation is
where we were with solid-organ
transplantation in the mid-1980s," said
Ronald W. Busuttil, M.D., executive
chair of the department of surgery at
the David Geffen School of Medicine.
"With the experience that has been
accrued in several centers throughout
the world with reconstructive
transplantation, it is clear that for
certain patients, the outcomes can be
life-changing and that major
transplant centers such as UCLA
should be pursuing this approach."
San Francisco Health
Plan Wins DHCS Award
San Francisco Health Plan, which
provides Medi-Cal managed care for
60,000 Bay Area residents, received
the Gold Award for excellence in care
from the California Department of
Health Care Services.
SFHP is the only one of the
state’s 21 Medi-Cal managed care
plans that achieved high HEDIS scores
in 11 of the 15 categories in which
quality of care is measured.
"This award acknowledges the
effort of the San Francisco provider
network," said SFHP’s Medical
Director, Kelly Pfeifer, M.D.. "Instead
of waiting until patients are sick, our
doctors and clinics reach out to make
sure our members are getting the
preventive care...to stay healthy.”
The California Department of Managed
Health Care has ned Blue Shield of
California $40,000 for retroactively
terminating the coverage of a cancer patient
who had retained coverage after leaving her
The DMHC levied the ne against the San
Francisco-based health plan for four violations
of the state Health and Safety Code and the
Code of Regulations, including improper
notication of termination of coverage and
retroactively terminating coverage.
According to DMHC correspondence, the
enrollee had coverage through a small group
plan provided by her employer. She continued
the coverage after leaving the job through
California’s COBRA program. Although she
made all of her premium payments on time,
the employer stopped paying its premiums,
resulting in the termination of her coverage.
The enrollee had already received
authorization for and was undergoing
treatments for cancer when Blue Shield
retroactively canceled her coverage and said it
would not pay for the care she received. The
DMHC determined that this constituted
cancellation without prior notice.
Blue Shield did not immediately respond
to comment.
The ne is among the largest of the 181
administrative actions levied against the health
plan by the DMHC since 2001.
PAYERS & PROVIDERS reaches 5,000 hospital, health plan and non-
prot executives statewide. There is no better venue for marketing
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CALL (877) 248-2360, ext. 2
DMHC Fines Blue Shield $40,000
Retroactively Canceled Plan For Cancer Patient
Chu Named To AHA Chairmanship
Prestigious Post Given to Kaiser’s So. Calif. Chief
The head of Kaiser Permanente’s Southern
California division has been
named the chairman designate
for the nation’s leading hospital
Benjamin K. Chu, M.D.,
group president of Kaiser
Southern California, was elected
to the position by the American
Hospital Association board of
directors earlier this week. He
will begin serving a one-year
term in 2013.
Chu will be the second
Southern California hospital executive to
chair the AHA in less than four years.
Thomas M. Priselac, chief executive ofcer
of the Cedars-Sinai Health System in Los
Angeles, served as AHA chairman in 2009.
"It is my privilege to serve in
this role as hospitals from
across the country
discuss how we can best care
for our patients in this
changing healthcare
landscape," said Chu, who
oversees 14 hospitals for
Kaiser. "Healthcare is at a
crossroads and hospitals will
play an important role in
improving the health of all
The 59-year-old Chu has
served in senior roles with Kaiser since 2005.
He previously served as president of the New
York City Health and Hospitals Corp.
Benjamin K. Chu. M.D.
Payers & Providers Page 4
!A key part of the Patient Protection and
Affordable Care Act is the mandate that every
state establishes a health insurance exchange
by January 1, 2014, or default to a federal
fallback program.!While “exchanges” have not
yet received the headlines that have
accompanied other aspects of reform, their
potential impact is causing many to speculate
that these exchanges may end up the measure
by which health reform is judged for years to
come. Health
insurance exchanges create an
online one-stop shopping mall
where consumers can view
competing health insurance plans
side by side and compare
benets, costs, provider networks
and other features.!! Along with
choosing from multiple insurance
carriers, individuals will be able
to select from four benet levels
-- bronze, silver, gold and
platinum --- each having a
different set of benets and a
different price point.! In this way
consumers can pick a plan that
best meets their needs and
budget. The Congressional
Budget Ofce estimates eight
million people will use the exchanges in 2014,
with participation tripling by 2018.
Clearly, exchanges make good sense for
many individuals and small businesses looking
for the best healthcare options available to
them.! In addition to providing greater choice
for those purchasing through an exchange,
many individuals who previously went without
coverage will be able to obtain health
insurance through a state exchange thanks to
“premium assistance subsidies.” ! These
subsidies will be available to individuals
earning between 133% and 400% of the
federal poverty level. At the same time, small
businesses that purchase coverage through
state-based exchanges may be eligible, under
the Small Business Health Option Program for
an annual tax credit.
Will employers participate? While nobody
knows for sure, a survey by the not-for-prot
Pacic Community Ventures released in March
revealed that 555 of California’s small business
owners would participate in an exchange once
provided basic information on how they work.
This is signicant as today there are 47 million
Americans working at 5.9 million small
businesses.!These workers are almost three times
as likely to be uninsured as those who work for
large businesses.
For California’s hospitals, exchanges create a
new population of insured patients, thus lessening
the number of uninsured coming to the
emergency department and/or being admitted to
the hospital itself. Some of these will be new
patients which will lead to expanded
opportunities for marketplace
growth (for physicians and
hospitals) while others will be
those who previously were in
need of “charity care” and added
to a hospital’s proportion of bad
debt. Either way, more paying
patients are good for a hospital’s
bottom line.
How a state-run exchange
ultimately impacts the local
marketplace remains to be seen,
but it is important to note that the
nation’s most successful private
health exchange,
CaliforniaChoice, is located right
here in California, serving more
than 150,000 members and
10,000 employers. This speaks to the market’s
acceptance and satisfaction with the insurance
exchange concept as many hospitals and
physicians across the state already see patients
who are part of an exchange.! This is destined to
increase as all plans in an exchange must offer a
set of “essential benets” that will include
hospital, emergency, and other care. As
hospital leaders prepare for the age of ACOs,
enhanced public scrutiny and increased nancial
pressures, now is a good time to take a close look
at something designed to actually improve their
bottom line and contribute to market share
growth.! Health insurance exchanges make sense.
Now let’s all pull together to make them work.
Keeping Tabs On The Exchanges
Their Development Will Shape Perceptions of Reform
By Ron Goldstein
Ron Goldstein is chief executive officer of
CHOICE AdmInistrators, which manages and
administers health insurance exchanges.
Op-ed submissions of up to 600 words are
welcomed. Please e-mail proposals to
Payers & Providers Page 5
Responsibilities include managing consulting engagements and teams; interfacing with clients at
senior management and board levels; and some business development.! The company’s 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
www.TheCamdenGroup.com !
Payers & Providers Page 6
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, benets and
relocation assistance are offered. Interested candidates or condential recommendations should be sent to
the Witt/Kieffer consultants, Stephen J. Kratz and Shirley Cox Harty at CareDelivery_BCBSA@wittkieffer.com.
Payers & Providers
Page 7
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.

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oníy uííov lor crucìuí momonts to ìntoruct vìth thoso thought íoudors. \ìth koundtubío lntoructìvo, you'íí cut through tho
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Page 8 Payers & Providers
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