26 June 2012

Midwest Edition
Calendar
June 26-27
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In Twin Cities, Improvement, Gaps

Life Expectancy Up For All, But Disparities Persist
There is some good news for Minnesotans. According to a recent study from the Blue Cross and Blue Shield of Minnesota Foundation, Twin Cities residents, on average, live longer than people in other parts of the country. The average life expectancy in the Minneapolis-St. Paul region is 81 years, compared to the U.S. average of 76.5 years. The life expectancy for the region grew by 1.5 years between 2000 and 2007, which is in line with the overall increase nationwide. The bad news is that there is a dramatic disparity within the area people living in the lowest-income areas of the Twin Cities are dying seven years earlier than those in highincome areas. Experts have been talking for years about the signicance of health disparities, or how ones environment can impact a persons health. The information in the study wasnt terribly shocking, but the extent of the disparity was a surprise. It was somewhat expected that there is still a consistent and strong relationship between income, education, place and health, said Melanie Ferris, the reports author. What we were most surprised about was the difference in mortality rates for different racial and ethnic groups. The report found that mortality rates improved among all groups save U.S.-born African Americans, which were about three times higher than the regional average. And race appears to have a dramatic impact on mortality life expectancy for Asians was about 83 years, while it hovered at 61.5 for Native Americans. The study analyzed the most recent health data available, organized by U.S. Census, and was a follow-up to a 2010 report by the foundation. The goal was to provide data to back up what they already knew that poorer health outcomes are often directly related to things like race, poverty, education levels and environment. And the Twin Cities have been hard by the Great Recession, which began in December 2007. The median household income dropped to $62,000 in 2010, compared to nearly $70,000 in 2000. The number of residents living under the Federal Poverty Level (about $22,000 for a family of four) increased from 7% of the population in 2000 to 11 percent in 2010, a bump of nearly 60%. But the job of the foundation isnt just to offer numbers. The organization invited, and received, comments from community
Continued on Next Page

July 10
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September 9-11

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WEBINAR

Wednesday, June 27, 2012

3 P.M. CDT

HOSPITAL VALUE-BASED PURCHASING: A ROADMAP

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.

Please join Robert A. Minkin, senior vice president, The Camden Group and Guy D!Andrea, president, Discern Consulting, to discuss the critical components of Medicare!s upcoming valuebased purchasing program for hospitals.

http://www.healthwebsummit.com/pp062712.htm
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NEWS
Twin Cities (Continued from Page One)
organizations on ways to solve the problems as well. They offered opinions on why things are the way they are, what is being done and what needs to be done to reverse it, said Julie Eastling, the foundations program communications consultant. The conclusion is that disparities arent natural; they are based on policy decisions made over decades. The organization focuses its efforts in four different areas: social connectedness, early childhood development, affordable housing and the built environment. One solution they have found is that children with asthma cost the system about $3,000 to $5,000 annually in visits to emergency rooms. Putting a ventilation system into the childrens homes would be a one-time cost of $5,000 and would mitigate attacks for everyone in the house, Eastling noted. We are looking at how to keep people healthy before they get to the doctor, she said. One interesting statistic the organization found has led to a new, innovative effort. A 2010 national survey found that 44% of people living in households below the federal poverty limit use libraries for their computers and Internet access. The Internet is also where many seniors go to get their health

Page 2

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In Brief
HHS Says Reform Has Helped Millions Of Younger Americans Retain Healthcare Coverage
New data released by the U.S. Department of Health and Human Services concluded that 3.1 million young adults have been able to gain and sustain healthcare coverage as a result of the passage of the Affordable Care Act. One of the tenets of the reform law is permitting children to stay on their parents insurance policy until they reach the age of 26. This policy doesnt just give young adults and their families peace of mind, it also gives them freedom, said HHS Secretary Kathleen Sebelius. It means that as they begin their careers, they will be free to make choices based on what they want to do, not on where they can get health insurance. Altogether, about 75% of young adults have healthcare insurance, a proportion that has risen since the passage of ACA in 2010. As of late 2011, 2.5 million young adults were able to retain their coverage, a number that has continued to rise.

information. This spurred the organization to create its Public Libraries for Health program. They are providing grants of up to $50,000 for libraries that have programs to improve the health of citizens in low-income communities. Already, some libraries offer services like tness and grief classes and the group is looking at creative ways to create social connectedness and address factors like income, unemployment, community safety and family support. We want them to look at the conditions in the community and see who can play a part in helping their community, Eastling said. Eastling said there are many things beyond a persons control that impact his or her health like toxic conditions, noise, stress from unemployment and prejudicial treatment. These can all greatly impact someones health outcomes. And the only way to create change is to deal with the roots of the problems. Long-term improvement will only come about if we create the social and economic solutions that impact the root problems in these issues, Eastling said. We are committed to working on the long haul to improve the conditions in the Twin Cities and across Minnesota. -- TAMMY WORTH

Univ. Of Michigan System Healthy

Posts Better-Than-Expected Numbers For Fiscal 2012
Although it has recently poured tens of millions of dollars into infrastructure to meet soaring patient caseloads, the University of Michigan Hospitals & Health Center reported a healthy bottom line for scal 2012. The Ann Arbor-based system projects near break-even on revenue of $2.2 billion, with a predicted operating loss of about $11 million. However, much of that
Continued on Next Page

HealthPlus Says It Will Preserve Some ACA Reforms If Law Is Struck Down
Flint, Mich.-based HealthPlus health plan said it would continue a number of reforms contained in

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Continued on Page 3

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Longer ALOS!*

NEWS
UM System (Continued from Page One)
is tied to expenditures for capital projects, including the opening of the new C.S. Mott Childrens Hospital and Van Voigtlander Womens Hospital; a signicant emergency room expansion; and a healthcare IT overhaul. Taking out the capital projects, operating prots would have been around $66 million, ofcials said. As it was, the operating loss was originally projected at around $24 million. Meanwhile, patient growth grew swiftly during the year, with inpatient and observation care cases up 4.5% and outpatient visits up 4.5%. "To see this kind of patient growth, and to beat our own expectations despite the Michigan economy, major investments and great change, is a testament to our entire team," said UMHHC Chief Executive Ofcer Doug Strong. Every one of our staff and faculty have pulled together to ensure that we serve patients

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In Brief
the Affordable Care Act even if the U.S. Supreme Court should strike down the law as unconstitutional. Among the reforms it will preserve are no lifetime limits on coverage, paid preventative care and coverage for dependent children until they reach the age of 26. HealthPlus joins the ranks of Minnesota-based UnitedHealth and other major insurers that say they will maintain similar protections if the Affordable Act is struck down by the Supreme Court. HealthPlus has always worked on behalf of its members and groups to provide access to quality care and services at competitive prices, said Chief Executive Officer Bruce Hill. Regarding healthcare reform protections, HealthPlus has had to make very few changes to plans and policies in order to comply. That's because our goal is, and has always been, finding ways to promote health and wellness to our members and the communities we serve. The high courts ruling on the ACA is expected on June 28.

well, and nd every opportunity to improve operations in ways large and small. Strong and other system ofcials attributed the better-than-projected numbers to the use of lean thinking an automotive industry concept that includes examination of every process within the hospital to determine how it may be made more efcient. Additionally, the system completed more than a dozen projects focused on increasing energy efciency during the scal year. Those projects are saving more than $500,000 a year in energy costs. In this environment, with revenue and expense challenges, a chief reason for our success is this willingness to look at everything we do and ask, 'Can we do it better?' to improve quality, access, safety and our patients' experience, said system Chief Operating Ofcer Tony Denton.

Scrutiny Of Accretive Ramping Up

Lawmakers Request Documentation of its Practices
Accretive Health, under increasing scrutiny from lawmakers due to its collection practices at a group of Minnesota hospitals, has not immediately responded to requests for documents from members of Congress. According to a June 21 letter to Accretive Chief Executive Ofcer Mary Tolan from Reps. Henry Waxman, D-Calif. and Diana DeGette, D-Colo., the Chicago-based rm did not provide documentation on the companys policies and practices in regards to collection work it did on behalf of Minneapolis-based Fairview Health Services. Both lawmakers serve on the House Committee on Energy and Commerce. The Minnesota Attorney Generals ofce led suit against Accretive during the spring, alleging the rm had inserted its own employees into Fairviews hospitals and engaged in aggressive collection practices that interfered with healthcare delivery. Accretive ofcials have mostly denied the charges, saying that it would successfully rebut them. Fairview has since canceled its contract with Accretive, and the rm has also lost business from other hospital clients. The company, which was on track to reporting revenues of $1 billion this year, has seen its stock price srop from about $28 a share in late February to about $11 today. Waxman and DeGette are seeking information pertaining to what Accretive termed pre-collections, an attempt to obtain payments from patients prior to receiving services. Accretive claimed such practices are not subject to debt collection laws. They are also seeking an explanation as to why an Accretive employee had access to the protected health information of Fairview patients without their express consent. They have also requested copies of all company policies and procedures, documentation of complaints from patients and medical professionals and documentation as to how Accretive estimates the prices for medical procedures in advance. They also want proof Accretive follows industry standards.

Reusable Sharp Containers Reduces Greenhouse Emissions

A new study suggests that employing reusable containers for medical sharps can reduce greenhouse gases. The study, which focused on Chicagos Northwestern Memorial Hospitals deployment of the reusable containers concluded that they reduced the facilitys greenhouse gas emissions for sharps disposal by 84%. Additionally, the hospital use of reusable containers kept 31 tons of plastic and ve tons of cardboard from being placed into a landll. The studys ndings were published in the Waste Management & Research journal.

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OPINION

Page 4

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The Pressure On Payers Is Relentless

Costs Must Be Kept Down While Efficiencies Rise
No matter the outcome of the Affordable Care Guidon conducted an initial assessment of our Act, the long-term picture for payers remains company by interviewing approximately a third of uncertain. Even if all the ACA provisions are our employees to identify areas that would most enforced by the Supreme Court, there are still benet from process improvement. They then many issues to sort out. If set up a number of kaizens (highly some of the provisions are focused process improvement work struck down, then other sessions that included a cross issues will be encountered. section of employees) to focus on There is one thing for solving the most obvious roadblocks sure, however, amidst all and waste points quickly. this uncertainty: though One of the rst projects was we cant know exactly improving the claims processing what changes we will face, workow in our medical none of them are going to management area. We physically ease the pressure on cost moved all the departments to a reduction and improved single location to create real time, performance. face-to-face collaboration. In an unpredictable Previously, the teams were divided business environment, into separate areas, which Blue Cross Blue Shield hampered their ability to make Montana decided to give decisions on treatment and itself a physical and make reimbursement. We also trained process improvements to employees on multiple system control what we could software and programs so that they control. Over the past two could recognize efciency By years, we have reduced costs in a improvements between the different divisions. number of critical operational areas at Michael Taking a more collaborative approach and the same time that we made it easier Frank applying data methods has: and faster for customers to do business with us. Reduced the claims processing backlog One of the biggest challenges at BCBSMT was the increasing complexity of customer Reduced the appeals backlog service. Our internal process improvement team collaborated with our customer service Resulted in double digit improvement in productivity and responsiveness. area implementing six sigma principles. As a result of these efforts, BCBSMT reached each Other departments followed suit and realized customer service process improvement goal similar improvements. that we set: These are exactly the kinds of gains that all The average speed of answering the healthcare insurers must achieve given regulatory phone is now 10 seconds or less. demands and the likely increase in insurance Abandon call rates are down to less than 1%. choices for consumers. Continuing market changes A 50% improvement in the number of calls provides a clarion call to act pre-emptively to handled by a customer service representative improve cost, quality, and responsiveness as well as each day. While we had success performing process mobilize employees to raise their improvement consciousness and customer centricity. improvement with our own team, we recognized that we needed to establish more rigor around our improvement efforts and Michael Frank is the chief executive officer of increase our scope to include more areas in Blue Cross Blue Shield Montana. our company. We partnered with Guidon Performance Solutions, which deployed Op-ed submissions of up to 600 words are experienced process improvement Black Belts welcomed. Please e-mail proposals to or coaches who helped us involve all editor@payersandproviders.com employees in embracing and applying lean six sigma improvements.

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MARKETPLACE/EMPLOYMENT

Page 5

AVP - Accountable Care Organization

Patients and families from across the region and around the world come to Cincinnati Children s Hospital Medical Center because we are dedicated to improving child health. We serve the medical needs of infants, children and adolescents with family-centered care, innovative research and outstanding teaching programs. Cincinnati Children's Hospital Medical Center ranks third in the nation among all Honor Roll hospitals in U.S.News and World Report's 2011- 2012 Best Children's Hospitals ranking. It is ranked #1 for gastroenterology and in the top 10 for all pediatric specialties - a distinction shared by only two other pediatric hospitals in the United States. Cincinnati Children's is one of the top two recipients of pediatric research grants from the National Institutes of Health. It is internationally recognized for improving child health and transforming delivery of care through fully integrated, globally recognized research, education and innovation. Working for the largest national pediatric healthcare system, the Assistant Vice President will lead and manage its newly created Accountable Care Organization (ACO) with anticipated annual revenues up to $500 million. Major responsibilities include Network Delivery, Network Management, Credentialing, Data Analysis and Reporting, People Management and Payor Contracting and Relations. Specifically responsible for provider enrollment with payors, network provider contracting and provider relations issues, ACO credentialing program, processes related to administering payor contracts, medical management functions including care management, care coordination, utilization and disease management programs, quality improvement programs across ACO provider network, data analysis and reporting. Assist in payor contract negotiations. To be successful, our ideal candidate will possess a Bachelor s degree along with ten years experience managing network management, care management, medical management, and/or care coordination activities in hospital-owned or physician-owned health plan, PHO, or payor environment. Master s degree in business or health administration preferred. The incumbent must possess resiliency and perseverance in both starting up new business enterprises and in scaling up business enterprises after start-up phase. Demonstrated leadership and management skills required along with experience in formulating credible, effective, long-range strategies to attain overarching organizational objectives; anticipating future trends, as well as potential threats or opportunities; and accurately predicting how strategies will play out. Network management experience in Medicaid managed care plan desirable. Experience starting up new business enterprises preferred. Cincinnati Children's Hospital Medical Center offers a comprehensive employee benefits program that is equal to or better than the majority of the other health care institutions in the city. The benefits program is constantly reviewed to identify better ways to deliver world-class benefits. Visit our career site at www.cincinnatichildrens.org to submit your resume and application. Job ID# 58097. Cincinnati Children s is an Affirmative Action/Equal Opportunity Employer.

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MARKETPLACE/EMPLOYMENT

Page 6

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