May 2012

National Edition
In this Issue
1. News
Health Plan Contracting

The New Face Of Health Plan Contracting Contracts Surveyed On Changes

A wide-ranging menu of provider payment and contracting issues have taken center stage for stakeholders, driven by reform and marketplace forces. A continuing transition from volume-based to value-based payment structures underscores this new environment; with bundled payments and aligned incentives for management of hospital readmissions being significant issues to consider. Payers & Providers, and HealthcareWebSummit jointly sponsored a survey of healthcare professionals on health plan contracting during May. An exclusive report on the survey findings follows. Participants were asked to respond to Three items: 1. Please categorize your organization. Purchaser (Health Plan, Employer, TPA, Agent, PBM) Provider (Hospital, Physician, Pharmaceutical, Other Providers) Vendor or Other 2. What are the greatest opportunities from a contracting perspective?: 3. What are the greatest challenges from a contracting perspective? Heres what we found: For the third year in a row, a plurality of respondents thought that the emergence of value based and other applicable newer payment models was the greatest opportunity from a contracting perspective, with 29.6% of respondents answering this way. In 2011, the same percent of respondents agreed that this was the greatest opportunity which was three percentage points greater than in 2010. The next most prevalent answers to what was the greatest opportunity were advancements in analytics capabilities and increased covered population due to health reform. For both of these options, 18.5% of respondents answered this way. These responses had been the second and third most prevalent answers in 2011 as well, however, advancements in analytics capabilities was chosen by 19.4% of respondents and increased covered populations due to health reform was chosen by 13.9%. The remaining answers to what were the greatest opportunities from a contracting perspective (not including other which was chosen by 2.5% of respondents) were chosen by a similar percent of respondents, all of which were within one percentage point of 8%. When broken down by respondent category there were some variations. While those who categorized their organizations as purchaser or vendors/others followed the overall trend of designating the emergence of value based and other applicable newer payment models as the greatest opportunity from a contracting perspective, providers were split on what the greatest opportunity was between the emergence of value based payment models and increased covered population due to health reform both of which garnered 25% of respondents in that category.
continued on page 2
2012, by Payers & Providers Publishing LLC and MCOL. All rights reserved

3. Vitals
Snapshot of the Dual Eligible Portion of the Medicaid Population, Hospital Readmissions Linked to HealthcareAssociated Infections, Components of the Total Cost of Healthcare, Surgery Rates in Different Areas

4. California
CalHIPSO Says Its Ahead of Curve Prime Stent Care Under Scrutiny Briefs - El Camino Hospital Introduces Sleep Disorders Program, Molina Healthcare Makes Fortune 500 List Of Companies

5. Midwest
Midwest SNFs Fear Looming Cuts Study Links Low Co-Pays To ER Use Briefs - Accretive Health Responds to Frankens Query, Coury Named New President of Ohio Health Care Associatio

6. WebinarsWhite Papers
Recent and Upcoming Events Healthcare and Campaign Finance in California Midwest Non-Profit CEO Compensation

7. Marketplace
Employment Advertising Opportunities Paid Subscriptions

8. Order Form
Payers & Providers Order Form

Volume 2, Issue 5 May, 2012

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MARKETPLACE/EMPLOYMENT NEWS
Responses Consumer engagement Initiatives Continued market consolidation Cost pressures due to economic downturn ICD-10 transition Increased complexities of benefit design Increased mix of government vs. commercial covered populations Issues related to health reform provisions Other Total

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2012 8.6% 13.6% 21.0% 7.4% 12.3% 14.8% 17.3% 4.9% 2011 6.5% 7.4% 33.3% 0.9% 11.1% 16.7% 15.7% 8.3%

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2010 9.9% 14.1% 28.1% 6.6% 8.3% 14.9% 14.1% 4.1%

Health Plan Contracting continued

100.0% 100.0% 100.0%

Key: A) Advancements in analytics capabilities, B) Advancements in EHRs and transactions, C) Consumer engagement initiatives, D) Emergence of value based and newer payment models, E) Formation of ACOs, F) Increased covered population due to health reform, G) Potential growth in medical homes, H) Other

The rest of the options for what the greatest challenges are from a contracting perspective are (excluding other) all fell within ten percentage points of each other. 8.6% of respondents chose consumer engagement Initiatives, 13.6% chose continued market consolidation, 7.4% chose ICD-10 transition, 12.3% chose increased complexities of benefit design, and 14.8% chose increased mix of government program vs. commercial covered populations as the greatest challenge. Looking at responses year over year, most answers ticked slightly up in 2012 compared with 2011 and 2010 with two exceptions; cost pressures due to economic downturn, which dropped 12.3 percentage points from 2011, and increased mix of government program vs. commercial covered populations, which dropped almost 2 percentage points from 2011. When broken down by respondent category the greatest variation was on whether cost pressures due to economic downturn was the greatest challenge. 42.9% of respondents categorizing themselves vendor/other thought that this was the greatest challenge, while only 15.9% of providers and 17.4% of purchasers thought this

The biggest variation among respondent category was on the response to whether advancements in analytics capabilities was the greatest opportunity from a contracting perspective. Overall, 18% of respondents thought that this was the greatest opportunity. Purchasers were the most likely to answer this way with 30.4% of those respondents choosing this as the greatest opportunity. Respondents categorizing themselves as vendor/other were the least likely to respond this way with only 7.1% believing it as the greatest opportunity.
Responses Advancements in analytics capabilities Advancements in EHRs & transactions Consumer engagement initiatives Emergence of value based/newer payment models Formation of ACOs Increased covered population due to health reform Potential growth in medical homes Other Total 2012 18.5% 7.4% 7.4% 29.6% 8.6% 18.5% 7.4% 2.5% 100.0% 2011 19.4% 10.2% 12.0% 29.6% 7.4% 13.9% 3.7% 3.7% 100.0% 2010 7.5% 16.7% 10.8% 26.7% 16.7% 17.5% 0.8% 3.3% 100.0%

Just as with the greatest opportunity, the respondents choice for the greatest challenge carried over a three year trend with a plurality of respondents signaling that cost pressures due to economic downturn was the greatest challenge with 21% of respondents answering this way. This was a much smaller plurality than in previous years and was only 3.7 percentage points greater than the next most common answer for what the greatest challenge was; issues related to new health reform provisions.

A) Consumer engagement Initiatives, B) Continued market consolidation, C) Cost pressures due to economic downturn, D) ICD-10 transition, E) Increased complexities of benefit design, F) Increased mix of government program vs. commercial covered populations, G) Issues related to new health reform provisions, H) Other

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

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MARKETPLACE/EMPLOYMENT VITALS
LISTS from

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Snapshot of the Dual Eligible Portion of the Medicaid Population

Total dual eligible beneficiaries Enrolled in both programs with full benefits Medicare beneficiaries with cost sharing paid by Medicaid Percent of Medicaid beneficiaries that are dual eligible Percent of Medicare beneficiaries that are dual eligible Percent of Medicaid costs that are for dual eligibles Percent of Medicare costs that are for dual eligibles The average dual eligible per capita cost Total annual expenditures for dual eligibles

9 million 7 million 2 million 15% 19% 40% 31% $39,000 $350 billion

2012 Milliman Medical Index (MMI): Components of the Total Cost of Healthcare for a Typical Family of Four Covered by a PPO

1. Physician $6,647 2. Inpatient $6,531 3. Outpatient $3,699 4. Pharmacy $3,056 5. Other $795
Notes: the family of four is insured by an employersponsored PPO plan, which includes certain out-of-pocket costs such as copays and deductibles. The plans premiums are paid jointly by the employer and by the employee via payroll deductions.
Source: Milliman Medical Index (MMI) http://publications.milliman.com/periodicals/mmi/pdfs/millimanmedical-index-2012.pdf

Source: Managing Medicaid Patients with Physical and Behavioral Health Dual Diagnoses through Advanced Analytics HealthcareWebSummit, May 1, 2012, http://www.healthwebsummit.com/medai050112.htm

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

Hospital Readmissions Associated Infections

Linked

to

Healthcare-

Surgery Rates in Different Areas

MCOLBlog: A Practical Roadmap for the Perilous Journey from a Culture of Entitlement to a Culture of Accountability, By Nate Kaufman, May 4, 2012 Wilson HSA (North Carolina) Rate of mastectomy vs. lumpectomy * .4 per 1000 McAllen, TX The rate of Coronary Artery Bypass Surgery *(for Medicare beneficiaries)
Data source: Dartmouth

According to a new study published in the June 2012 issue of Infection Control and Hospital Epidemiology, that tracked patients with positive cultures for one of three major healthcare-associated infections: methicillin-resistant Staphylococcus aureus (MRSA), vancomycin-resistant enterococci (VRE), or Clostridium difficile (C. difficile) after more than 48 hours following hospital admission. These patients were 40% more likely to readmitted to the hospital within a year and 60% more likely to be readmitted within 30 days than patients with negative or no clinical cultures.
Source: Society for Healthcare Epidemiology of America http://www.shea-online.org/View/ArticleId/152/Expensive-hospitalreadmissions-linked-to-healthcare-associated-infections.aspx

Goldsboro HSA (North Carolina) 2.7 per 1000 Pueblo, CO 1.9 per 1000

8.9 per 1000

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MARKETPLACE/EMPLOYMENT CALIFORNIA

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In Brief
El Camino Hospital Introduces Sleep Disorders Program
El Camino Hospital in Los Gatos has launched a sleep disorders program, hoping to capitalize on a growing market. According to federal data, about 18 million Americans suffer from sleep apnea. The condition is often linked to obesity, and is also often connected to sexual dysfunction issues in men. Many of my patients come to me with a long list of health problems that none of their doctors has been able to link together heart disease, obesity, depression, fatigue. So I ask, Hows your sleep? said Edward Karpman, M.D., an El Camino urologist. (I) find out they havent had a really good nights sleep in years. I think trying to figure out the sleep angle is just as important as everything else.

CalHIPSO Says Its Ahead of Curve

Provider Interest In EHRs Tops Original Projections

The California Health Information Partnership and Services Organization has moved more than 7,700 providers toward the adoption of electronic health records far ahead of the agencys initial projections. CalHIPSO began operations in 2010 with $33.2 million in federal grants. It originally predicted it would recruit just under 6,200 providers to receive initial subsidies for technical assistance and eventually work with regional health connectors to install EHR systems. Such installations are expected to move the providers smaller practices, clinics and rural hospitals toward stage one of meaningful use requirements, at which point they would begin receiving incentive payments from the federal government. We're well on our way to helping thousands of providers in California transition their practices from paper-based medical records to electronic systemsimproving both the efficiency and quality of primary care," said CalHIPSO Executive Director Speranza Avram. However, some challenges remain. To date, only 210 of those providers currently qualify as meeting stage one of the meaningful use requirements. And only 813 rural providers have signed on to the program. Adoption of EHRs by rural providers is considered key for improving often sparse healthcare services in those regions. The barrier is not so much connectivity as it is financing, Avram said. She added that CalHIPSO would soon announce agreements with lower-cost EHR vendors to better expedite adoption.

Molina Healthcare Makes Fortune 500 List Of Companies

Molina Healthcare, the Long Beach based Medicaid managed care plan, was named to the latest edition of Fortune magazines 500 list of largest U.S. companies. I am pleased with our management team and our employees, who have worked hard to help shape and grow our company. I would also like to thank our state agency partners for working with us to serve the Medicaid beneficiaries in their communities, said Molina Chief Executive Officer J. Mario Molina, M.D. Molina debuted at number 500 on the Fortune list. Its revenue was $4.6 billion in 2011, and it expects to inch toward $5 billion in 2012. Less than a decade ago, Molinas revenue was about $500 million a year. However, the company has expanded rapidly in markets outside of California. It focuses primarily on states looking to reduce their Medicaid costs. Molina was founded in the late 1970s. It originally operated out of a single clinic in Long Beach. It currently has 1.8 million Medicaid managed care enrollees in 10 states.

Report Suggests Desert Valley Pushed Procedure

Ontario-based hospital operator Prime Healthcare Services has drawn scrutiny for cardiac stent procedures performed at 83- bed Desert Valley Hospital in Victorville. According to the investigative journalism website California Watch, Desert Valley performed four times as many heart stent implants as the typical hospital in California with a limited heart care license. Desert Valley was fully licensed by state regulators last March. The California Department of Public Health said in a statement that the hospital passed two inspections prior to its granting of full licensure. Under a limited license, Desert Valley was only able to perform stent procedures during emergencies. California Watch uncovered four incidents of stents being inserted in nonemergency situations that led to patient death or injury. Two patients died, and one injured patient was in need of a heart transplant. State health inspectors have cited Desert Valley four times for cardiac care lapses since 2007, including a 2008 incident involving the death of a relatively healthy 72-year-old patient. Regulators uncovered at least 18 incidents where stents were implanted at the hospital outside of the purview for a facility with a limited license. However, data analyzed by California Watch also reported that patient deaths at the hospital for stents are within the statewide average mortality rates. A Prime spokesman said stent procedures can be unpredictable.

Prime Stent Care Under Scrutiny

The Payers & Providers California Edition is published every Thursday with six pages of hard-hitting healthcare business and policy news and insights

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

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MARKETPLACE/EMPLOYMENT MIDWEST

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In Brief
Accretive Health Responds to Frankens Query
Accretive Health, the Chicago based hospital collections firm that is being sued by the Minnesota Attorney General, defended its practices in response to a query from Sen. Al Franken, D-Minn. The suit filed by Lori Swanson earlier this month was the result of Accretives alleged practices at hospitals owned by Fairview Health Services in Minneapolis. In its 28-page response to Frankens questions, Accretive flatly denied that its employees suggested to patients they may not receive treatment if they couldnt pay for it or pay a past debt. Accretive also claimed that most walkoff patients those who left Fairview emergency rooms without receiving treatment because they may have been pressured to pay actually received treatment. Only one-tenth of 1% of patients have complained about its collections practices, Accretive said.

Midwest SNFs Fear Looming Cuts

Debt Ceiling Deal May Spell January Reductions

Ohios skilled nursing facilities could lose up to $37.3 million in federal funding if a budget stalemate is not resolved, according to a new report from Avalere Health. The funding cuts would come primarily from the Medicare program, which funding for patients if they are transferred from an acute care facility. They would be part of the 2011 Budget Control Act, the compromise legislation Congress crafted to end last summers debt ceiling crisis. It calls for automatic cuts beginning in early 2013 if amendments are not made. The SNF cuts come on top of another $30.5 million in Medicare cuts for Ohio, also scheduled for early next year. Nationwide, payments to nursing homes could be slashed by as much as $782.3 million. Ohio was one of two Midwest states to cut Medicare reimbursement rates to nursing facilities in 2012, along with Indiana. Minnesota, Illinois and Nebraska instituted rate freezes, according to data from the Alliance for Nursing Home Care, a trade group. The Alliance estimates that one out five nursing homes relies on Medicare reimbursements to subsidize their Medicaid patients. "Ohio seniors, caregivers and facilities have been battered by a series of highly destabilizing federal and state funding cuts, and this latest threat comes at a time when facilities are caring for rising numbers of patients, requiring higher levels of care, and with a workforce under severe duress," said Alliance President Alan G. Rosenbloom. "What seniors really deserve is a more rational, cost-effective Medicare postacute payment system, not more irrational Medicare and Medicaid cuts that jeopardize Ohio seniors' ongoing access to quality care, and which undermine facility operations. Ohio Health Care Association Executive Director Peter Van Runkle called for Congressional intervention. It is wrong for Ohio seniors to be placed in jeopardy due to budgetary dysfunction in Washington," Van Runkle said.

Coury Named New President of Ohio Health Care Association

The chief operating officer of Generations HealthCare Management in Berea, Ohio has been named president of the Ohio Health Care Association. In addition to his executive position, Michael Coury has served for nine years on the board of the Ohio Board of Examiners of Nursing Home Administrators. The association represents about 700 long-term care and skilled nursing facility operators, which is home to about 1.7 million Ohioans. "My commitment to you over the next year is to continue our effort to stop the erosion of resources which make a difference to those 1.7 million lives," Coury said during his inaugural speech. "My request of you is to continue to provide the quality, efficient, and innovative services we are known for."

Study Links Low Co-Pays To ER Use

Consumers May Be Becoming More Cost Conscious

The relatively low out-of-pocket cost to visit a hospital emergency room may be driving overutilization of that resource compared to primary care, according to a new study. Based on research conducted by the Boston-based HighRoads and the Corporate Executive Board, the average co-payment for an emergency room visit is $76. The study correlates that to two of the 10 most common conditions for ER visits: Toothaches and sprains. The study also found that there is a minimal out-of-pocket differential between urgent care and primary care ($32 versus $17), which may also be driving more urgent care visits because they keep longer hours than the offices of primary care physicians. The interesting data on co-pays show employees are basically acting as price sensitive consumers and going for what they perceive as the best value and convenience for the price, said CEB Senior Director Ania Krasniewska. However, it also sounds a warning that some visits to ER and urgent care facilities should, in fact, be handled at the more costeffective primary care level. Not only does this affect cost to the employee in the end, but in large quantities, this significantly affects the cost to the organization. The study also found that health plans charge relatively mild co-payments for cancer treatment visits and for primary care for dependent children.

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

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

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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 Hospital Districts: Mapping the Future to be held May 24, 2012 at 10 AM Pacific 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 Hospital C-Suite Compensation: How Much is Too Much? January 20th, 2012 with Claudia Wyatt-Johnson, CoFounder, Partners in Performance, Ron Shinkman, Publisher, Payers & Providers Editor, Fierce HealthFinance and Mike Rosenbaum, Partner and Vice Chair of Employee Benefits and Executive Compensation Practice Group, Drinker Biddle & Reath LLP California's Healthcare Environment: A forecast for 2012 December 15th, 2011 with Steven T. Valentine, President, The Camden Group, Henry R. Loubet, Chief Strategy Officer, Keenan and Jim Lott, Executive Vice President, Hospital Association of Southern California Midwest Healthcare Environment: A Preview for 2012 December 9th, 2011 with Michael L. Millenson, President, Health Quality Advisors LLC, Jay Warden, Senior Vice President, The Camden Group and William M. Dwyer, Founder and President, Dwyer HC Strategies

A new 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

Payers & Providers popular non-profit hospital CEO salary survey is now available the Midwest edition. This voluminous survey will examine the compensation of more than 700 hospital CEOs in 10 states throughout the Midwest. The salary survey is available in two distinct components: The salary survey white paper analyzes the compensation data from the 30,000-foot view. Authored by Payers & Providers Midwest edition editor Duncan Moore, it includes interviews with hospital officials and compensation experts and includes key compensation statistics. This white paper is $149. The raw salary compensation data itself is available in an Excel spreadsheet format. It includes base salary, additional compensation and other key indicators. The data is taken from the 990 tax returns each hospital submits to the Internal Revenue Service. This data may be purchased on its own for $249, purchased in combination with the white paper for $349, or by state for $99 apiece.

The hospital CEO compensation survey is Payers & Providers single most popular product. Its useful for quickly gauging what your colleagues earn and whether your own compensation is in line. To order, call 209.577.4888 or go to www.healthexecstore.com

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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 AVP - Accountable Care Organization-Cincinnati, OH Finance Director, Mental Health MCO-Charlotte, NC VP of Medical Operations - New York Vice President/Chief Operating Officer at HealthPlus of Michigan

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.

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 5
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

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