6 January 2011
California Edition
Calendar
January 12-15
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January 18-19
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January 20
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Hospitalizations Down in California
OSHPD Data Shows Gains, But Some Groups Lag
The rate at which Californians were
hospitalized improved considerably over the
past decade, but they face an ever-growing
threat from diabetes, while African-Americans
remain at much higher risk for medical
conditions such as hypertension and urinary
tract infections.
That was the gist of two related reports
issued late last month by the Ofce of
Statewide Health Planning and Development
(OSHPD). The data, which focused on
preventable hospitalizations statewide and
racial disparities in healthcare that sometimes
lead to hospitalization, portray a healthcare
environment that is mostly improving by the
year, but still contains serious issues that some
providers are struggling to control.
The overall hospitalization rate in
California declined 6.8% between 1999 and
2008, to 10,533 hospitalizations per 100,000
population from 11,298 hospitalizations per
100,000.
Among 15 health conditions studied by
OSHPD as hotspots for potentially avoidable
hospitalizations, 10 showed declines.
Hospitalizations for chest pain were down
more than 60%, while hospitalizations for
pediatric asthma was down nearly 40%.
OSHPD ofcials give some credit to the
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improvement of outpatient care over the past
decade.
However, there are three chronic
conditions that are leading to more
preventable hospitalizations. Hypertension-
related preventable hospitalizations were up
more than 36%. Hospitalizations related to
diabetes were up 8% due to long-term
complications and 5.7% due to short-term
complications.
Finally, hospitalizations due to urinary
tract infections – a relatively minor condition
typically treated with antibiotics but can lead
to kidney damage if left untreated – were up
9.6%.
“The UTI hospitalizations were striking,”
said OSPHD Director David M Carlisle, M.D.
“I wish we had a bonade cause.” Carlisle
noted that the condition in men could be a
sign of prostate cancer. The data did not break
out incidents of infection between men and
women, who suffer the condition far more
frequently and usually from more benign
causes.
Instead, OSHPD ofcials were focused
more on publishing the data rather than
seeking correlations. Michael Kassis, an
Continued on Next Page
 Payers & Providers
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In Brief
Sutter Rolls Out
Medical Records
iPhone Application
Sacramento-based Sutter Health
has introduced a smart phone
application that allows patients to
access their own medical records
and better communicate with their
doctors.
The application, which is
available for the iPhone, may be
used by patients of the Palo Alto
Medical Foundation, the Sutter East
Bay Medical Foundation, the Sutter
Pacific Medical Foundation, the
Sutter Gould Medical Foundation
and the Sutter Medical Foundation.
Called MyChart, the app
allows users to send messages to
their physicians, check lab tests and
results, view appointments and
receive health reminders.
“Through the MyChart app,
we're giving patients the tools they
need right at their fingertips,” said
Albert Chan, M.D., a physician
with the Palo Alto Medical
Foundation.
HHS Announces
Bonuses for Medicaid
Enrollment For Kids
The U.S. Department of Health and
Human Services has awarded $206
million in bonuses to 15 states for
their work in enrolling additional
children into the Medicaid
program.
“Their actions reflect President
Obama’s serious commitment to
assuring that our country’s children
get the healthcare they need,” said
HHS Secretary Kathleen Sebelius.
“These performance bonuses
demonstrate our support for the
effective strategies these states have
undertaken.”
Continued on Page 3
NEWS
OSHPD (Continued from Page One)
OSHPD research analyst who authored the
preventable hospitalization report, suggested
that rising obesity rates may have caused the
spike in hypertension hospitalizations.
“We’re concerned it’s taken such a jump,
but we can’t conclusively say why,” he said.
Hypertension also made its presence
known in the healthcare disparities report.
African-Americans in California were
hospitalized at a rate of 147.5 per 100,000 in
2007, up about 40% from 104.7 in 1999.
However, that rate dwarfs that among whites,
at 27.6 per 100,000 in 2007, and is also far
higher than Latinos, Asians or Native
Americans.
Indeed, Africans-Americans were the
most hospitalized minority group in
California, with 130 hospitalizations per
1,000 people, compared to 110 among
whites, 86 among Latinos and 67 among
Asians.
Carlisle did not comment specically on
the reasons behind such ndings, but did
note that rising rates in some categories may
be connected to a lack of outpatient care or
no proper coordination of such care.
New Commissioner Moves Swiftly
Jones Immediately Announces MLR Regulations
Dave Jones wasted little time after being
sworn in as commissioner of the California
Department of Insurance on Monday. The
former assemblyman immediately issued an
emergency rule that would require insurers
statewide to meet mandatory medical loss
ratios of 80% for individual health plans and
85% for group rates.
The rule mirrors part of the federal
healthcare reform law mandating such MLRs
for insurers throughout the country. That
change will go into effect next year, although
the U.S. Department of Health and Human
Services has granted more than 200 waivers
to so-called “mini-med” health plans that
limit benets to a few thousand dollars per
year. Among individual plans, California
previously required only 70% of premium
dollars be spent on healthcare.
“Voters asked for an activist
commissioner and I am taking immediate
action on health reform,” Jones said during
his inauguration in Sacramento on Jan. 3. A
!!!"#$#!%&!'(&)*+!,!'*-./0)*+!'1%2/+3/456!778
Page 2
“It really implies you have a breakdown
to the access and quality of ambulatory care,”
he said.
Carlisle added that the rising rates of
uninsured and cost-shifting to those with
coverage may be contributing to such rises,
but could not say so denitively.
However, overall hospitalizations in many
areas declined signicantly. Among sufferers
of pediatric asthma, the rates dropped
dramatically among all races, as did for
chronic obstructive pulmonary disease,
dehydration, and pneumonia.
But hospitalization rates continued to rise
among virtually all races suffering short-term
and long-term complications from diabetes, a
chronic disease that is attacking Californians
at dramatically escalating rates.
According to statewide health data, the
rate of diagnosed diabetes case rose to 7.6%
in 2007, versus 5.5% in 1998, a spike of 38%
in less than a decade, with signs suggesting it
will continue to rise more in the future.
But Carlisle was pleased with the overall
trend. “There is a narrowing of the overall
disparities,” he said.
Democrat, Jones prevailed in the November
election, even though the insurance industry
mostly backed his Republican challenger,
Mike Villines, himself a former member of the
Assembly.
In addition to announcing the regulations,
Jones also said he would appoint a person
within his ofce to oversee healthcare policy.
Industry observers and even some
insurance ofcials say Jones’s at on MLRs.
will have little immediate effect on the way
insurance is underwritten and medical care is
paid for in California, but it set an immediate
tone and direction for his administration.
“It’s a signal that the consumer
protections in the new federal law are going to
be enforced in California,” said Anthony
Wright, executive director of Health Access, a
Sacramento-based advocacy organization.
Wright noted that most plans already
meet the MLR thresholds, but the effect of
Continued on Next Page
Payers & Providers
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In Brief
Alabama was by far the
largest recipient, getting nearly
$55 million. The other states
received sums ranging from $2.58
million to more than $23 million.
The bonuses were part of the
reauthorization of the Children’s
Health Insurance Program in 2009.
Although the bonuses represent a
sharp increase from the prior year
when only $75 million in bonuses
were awarded, California was not
among the recipients.
Halvorson Named To
NCQA Board
George C. Halvorson, chief
executive officer of Oakland-based
Kaiser Permanente, has been
appointed to the board of directors
of the National Committee of
Quality Assurance.
Halvorson was named to the
16-member board on Dec. 16. It
includes 15 independent directors
and NCQA President Margaret
O’Kane.
"I am tremendously excited by
the opportunity to work among an
established Board of healthcare
leaders all focused on the
collaborative goal to help the
nation position itself to better serve
the healthcare needs of the
nation."
In addition to the
appointment, Halvorson serves on
boards affiliated with the Institute
of Medicine, the American
Hospital Association and the
Commonwealth Fund.
AMN Appoints New
CFO
San Diego-based staffing firm AMN
Healthcare Services has named
Brian M. Scott chief financial
officer and chief accounting
officer. Scott replaces Bary G.
Bailey, who has left AMN for a
position at a private equity firm.
NEWS
MLRs (Continued from Page Two)
Jones’s move will make it clear to the handful
of stragglers.
“They will have to focus more on
providing dollars for healthcare rather than
for their administrative overhead or for
prot,” he said.
The regulations require approval by the
state Ofce of Administrative Law, and could
go into effect before the end of this month.
The Insurance Department would release
permanent regulations later this year.
Reaction from the insurance industry has
so far been muted. The Association of
SCAN Targets Hospital Readmissions
Plan Focuses on Pharmacy Management Program
Medicare Advantage insurer SCAN Health
Plan has joined forces with the Lakewood IPA
and a Massachusetts rm to cut down on the
hospitalizations of its more vulnerable
enrollees.
The plan, medical group and Dovetail
Health, a Needham, Mass. rm that focuses
on managing care for chronically ill patients,
have created Healthy Transitions, a 24-month
pilot program that keeps a sharp eye on the
medications its enrollees take. SCAN ofcials
say the program may be rolled out to SCAN’s
entire membership based on the data it
provides.
The Long Beach-based SCAN is focusing
on members with intensive healthcare needs
who take an average of 12 medications. A few
medication errors after a hospitalization can
easily lead to a readmission that could
otherwise be avoided.
“If a patient taking 12 medications and is
being discharged with even more medicine to
take, they live alone or have spotty caregiving,
this is not simple for them to manage,” said
Elizabeth Russell, SCAN’s senior vice
president of network management.
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Page 3
California Life and Health Insurance
Companies, the state’s major lobby for carriers
that provide individual health coverage, has
denied comment, saying they have not yet had
a chance to review them. Jones released the
draft version of the regulations to insurers on
Tuesday.
The California Association of Health
Plans did not respond to a request for
comment. Blue Cross of California, one of the
state’s largest seller of individual health plans,
declined comment, as did Woodland Hills-
based Health Net.
Hospital readmissions are the bane of
seniors: about 20% are sent back to the
hospital within 30 days of an initial discharge,
according to Medicare data.
Russell said that the rehospitalization rate
among SCAN members is lower than the
nationwide average, but that the plan is
looking for ways to continue to improve the
care it provides.
Under Healthy Transitions, SCAN
enrollees discharged from the hospital or
nursing facilities are met at their homes by
pharmacists employed by Dovetail with
training in geriatric medications. They work on
creating manageable medication regimens
and will see if the patient may be taking
expired meds, which can also lead to
problems.
The seniors are cycled out of the program
within 30 days. SCAN is enrolling about 10
seniors every month, according to Russell.
Not enough data has yet been generated
to provide specics, but Russell noted that
anecdotal evidence points to several
rehospitalizations that have been avoided
since SCAN began the pilot last summer.
Payers & Providers
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OPINION
2011’s Top Ten Healthcare Trends
Keep an Eye on Capital Needs, Adverse Selection
For those who liked 2010, 2011 looks a
little more promising. Job loss trends seem
to have slowed, with modest economic
growth expected in 2011. Much of what
will likely occur in 2011 is a continuation
of an improving 2010. The pressures on
providers to reduce costs and improve
quality will continue to increase. Expect
continued consolidation of hospitals and
medical groups/independent practice
associations. Physicians will also
continue to seek employment
through hospitals or in large
medical groups.
Lastly, given all the interest in
accountable care organizations,
bundled payments, and patient-
centered medical homes, many
organizations will question their
ability to organize in time, align
providers, manage costs, and
improve quality while maintaining By Steven improved outcomes and lower costs,
choice of provider and open access.
The devil remains in the details.
Here are five of 10 trends I Valentine and designing and implementing
believe will take shape during 2011.
The remainder I will discuss in next week’s
issue:
• Insurance membership takes a hit
from slow recovery. The economy will
remain sluggish given high unemployment
and significant underemployment. Few
unemployed take advantage of COBRA,
and those who are employed will pay a
larger portion of their health plan
premium. Consequently, they will likely
choose high deductible, low premium
PPO plans which will result in adverse
selection to HMOs. Kaiser Permanente
will continue to gain market share.
• No easing on payment pressure.
Payments from health plans will keep
pace with inflation and operating cost
increases while Medi-Cal and Medicare
payments will not.
• Patients postponing care hurts
providers, too. Volumes at hospitals,
ambulatory centers, and physician offices
will remain soft at 2010 levels as patients
postpone visits due to health plan benefit
design, increased cost sharing, and high
unemployment.
• Cost is king. Cost management will
!!!"#$#!%&!'(&)*+!,!'*-./0)*+!'1%2/+3/456!778
Page 4
again be a focus for all hospitals in
response to downward revenue pressure,
soft volume, and a deteriorating payer mix
with increased bad debt. Organized labor,
staffing ratios, and numerous regulations
will make cost reduction difficult.
• Capital remains elusive. As in 2010,
most non-profit hospitals will find it
difficult to access capital. Lenders are
requiring an increase in days cash-
on-hand, higher coverage ratio,
stronger EBITDA, and smaller
borrowings. Credit rating agencies
want to see: 1) physician alignment
strategy, 2) clinical integration and
cost reduction action, 3) IT plan,
and 4) plans to capture more market
share.
Physician organizations will make
or break new care models. To
demonstrate better value through
hospitals and medical groups will
T.
focus on delivering accountable care,
bundled payments, patient-centered
medical homes, and/or clinical integration.
In California, the large medical groups (e.g.,
Healthcare Partners, Monarch, Hill
Physicians, Regal, etc.) all function as ACOs
or close to one. Reducing variation in
physician care will be central to any
successful strategy.
An effective bundled payment strategy is
dependent on specialists who must address
clinical resource consumption and supply
cost and use, as well as standardization of
care protocols in conjunction with
hospitalists and intensivists. Frequency of
procedures will become the responsibility of
both primary care and specialists. Similarly,
healthcare reform places the primary care
physician at the center of the medical home
and accountable care models.
Steven T. Valentine is president of The
Camden Group. He is a member of the Payers
& Providers editorial board.
Op-ed submissions of up to 600 words are
welcomed. Please e-mail proposals to
editor@payersandproviders.com,
Payers & Providers MARKETPLACE/EMPLOYMENT Page 5

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