Payers & Providers Midwest Edition – Issue of February 15, 2011

8/7/2019 Payers & Providers Midwest Edition Issue of February 15, 2011

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As Midwestern employers have become morefamiliar with the health reform law passedalmost a year ago, they have grown morepessimistic on how it will affect their health

care costs, according to a recent survey.As a result, a startling number of employers

--22% across the whole survey -- are nowconsidering dropping healthinsurance coverage foremployees entirely. Amongemployers with 50 to 500workers, 30% are either likelyor very likely to terminatecoverage and let workers buyindividual insurance on the newexchanges.

We didnt think it would bethat high, said Larry Boress,

president and CEO of theMidwest Business Group onHealth, based in Chicago,which commissioned thesurvey. It was 10% to 12%when the law rst came out, headded.

The survey, taken in the rsttwo weeks of December, shortly afterthe Congressional midterm election,sought to identify how large employersunderstanding of the Patient Protection andAccountable Care Act had altered since anearlier survey in April 2010. In the monthssince then, employers have been able to domore modeling and forecasting of the lawsimpact on their costs.

Today, the majority expects their costswould go up even higher than if healthcarereform had never even passed, Boress said inan interview with Payers & Providers.

The survey included responses from 437U.S. employers. Three-quarters of theemployers had more than 50 workers, and26% had more than 2,000.

Other key ndings:* Strong support for quality and payment

reform measures in the law.* Employers focus on wellness will continue

to expand.Theres a real belief that if you can keep

people healthy, you can keep costs down,Boress said.

Employers are responding in different waysto the laws provisions, thesurvey revealed. Forty-threepercent of employers havealready increased deductibles oremployee premiums, or havecut back benets in 2011 inanticipation of the costincreases imposed by the newlaw. But they are not makingmajor alterations in retiree

coverage. We thought the lawwould undermine retireecoverage. Not the case, Boresssaid.

Respondents liked the lawsemphasis on value-basedbenet design, with 62%favoring its retention and 19%

hoping for repeal. They also like theidea of paying providers based onquality and performance instead of

individual units of care, with 55% in favor and21% for repeal. The medical home conceptfound 50% in favor and 26% wishing for

repeal.A relatively small percentage ofrespondents, ranging from 20% to 35%,depending on the size of the enterprise, thinkthe laws cost and quality provisions willreduce health care costs in the long term.

Those employers who intend to drophealth insurance coverage will not necessarilyincrease wages or base salaries to help thembuy insurance on the new exchanges, which

February 15

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In Brief

Former Minn. GovernorPredicts Failure of

Obama Reform Law

Tim Pawlenty, who just finished twoterms as a Republican governor ofMinnesota, predicted that thehealth reform law passed almost ayear ago will suffer a financialcollapse in about 15 years.

The healthcare debate isreally a proxy for the largerpolitical debate overall, said theRepublican hopeful in the 2012presidential contest. He spoke inearly February at the City Club ofChicago during a book signing tourof the Midwest. The reform act wasbased on a bunch of flawedassumptions and cooked numbers,he said.

The country will have to faceits entitlement problems head-on ifit wants to salvage the economy, hesaid.

Most Local MarketsDominated by 1 or 2

Payers, AMA Says

A new survey by the AmericanMedical Association found that99% of health insurance markets inthe U.S. are highly concentrated,based on the definition used by theU.S. Justice Department. In 48% ofmetropolitan statistical areas, one

insurer had more than 50% marketshare, the AMA found.

The survey was the 2010 editionofCompetition in Health Insurance:

A Comprehensive Study of U.S.Markets.

The market power of healthinsurers places physicians andpatients at a significantdisadvanage, said Cecil B. Wilson,M.D., president of the Chicago-based physicians association.

Continued on Page 3

NEWS

Employers are Skeptical on Reform (Continued from Page 1)

was one of the expectations of the Obamaadministration. Twenty percent said theyprobably would boost pay, but 36% said

they probably wouldnt.That nding contradicts a widely held

belief among economists and consultantsthat the costs of health benets are inreality being diverted from wages, and thatif benets costs could be reined in, wageswould rise.

Employers showed a deep skepticismabout the laws ultimate purpose. Askedwhether they thought the laws intent wasto dismantle the employer-based insurancesystem and move the population into asingle payer system, 60% said yes, andonly 20% said no. Smaller employers weremore likely to agree with the statementthan large employers.

The survey didnt inquire whetherrespondents support or dont support thereform law.

My feeling is, they would have preferredit never passed, Boress said. Theyre reallyconcerned about all the burdensomeadministrative costs that have been addedonto employers, and potential taxes. Thatswhere they see the costs going up.

Employers believe the system shouldhave been xed rst, and deal with quality,safety, payment methodologies, before youstart covering another 32 million people.

The survey can be obtained through theMidwest Business Group on Health, atwww.MBGH.org. The organizations 100members spend more than $3 billion onhealth benets annually and cover more than3 million lives.

0% 10% 20% 30% 40%

Employers, How will health reform affect your benefits costs?

No increase Costs increase less than 1%Costs increase 6% to 10% Costs increase more than 10%!Costs increase 2% to 5% No modeling done

Source: Midwest Business Group on Health

The percentage of Americans receiving health

coverate through their employer declined to anew low of 44.8% in November, according toa Gallup poll. In January 2008, when Gallupbegan tracking it, the rate was 50%.

About 26% of the population receiveshealthcare through government sources, thesurvey said. The percentage of people withgovernment-provided care or insurance(Medicare, Medicaid, or military and veteransbenets) rose from 22.5% in January 2008.

Nearly one in six (16.1%) said they did nothave health insurance at all. The rate of

Further Erosion in Employer InsurancePercent of Population Covered Hits New Low: 44.8%

uninsured jumped in late 2008, from 14%

15.8%, when the recession hit and masslayoffs deprived many people of healthbenets. Since then, the rate has stayedroughtly constant, in the range of 16% to16.8%.

The increase in the rate of government-provided care may derive in large part fromthe beginning of the baby boomer generatbecoming eligible for Medicare, as well asunemployment rate, which pushes peopletoward relying on Medicaid. The poll is baon a telephone sample of 27,218 adults.
http://www.mbgh.org/http://www.mbgh.org/http://www.mbgh.org/


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Page 3Payers & Providers

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NEWS

In Brief

When insurers dominate a market,people pay higher health insurancepremiums than they should, andphysicians are pressured to acceptunfair contract terms and corporatepolicies, which undermines thephysician role as patient advocate.

The AMA said the public and

regulators should seriouslyquestion proposed mergers byhealth insurers.

Ohio Nurses ProduceJust Culture Guide

The Nursing 2015 initiative in Ohiohas published a Just Culture guidelineon the Web for registered nurses.The toolkit is a collection of resourcesfor use by hospitals and nursing staffinterested in implementing a JustCulture in their working

environments.Just Culture is a set of values andnorms about how people shouldbehave and make decisions whenpeople make errors or near-misses inthe medical setting. Just Cultureencourages open reporting andparticipation in prevention activities,and acknowledges that errors areoften the result of system failures, andworks to support processimprovement.

The toolkit can be found at http://nursing2015.wordpress.com/blue-team/blue-team-documents/just-culture-tool-kit-building/The toolkit includes a description of

the Just Culture principles as set intopolicy at St. Ritas Medical Center inLima, Ohio. Videos on patient safetyare also provided. A decision treehelps nurses understand the differencebetween individual accountability andorganizational accountability.The Nursing 2015 program aims totransform the profession of nursingin Ohio. Facing a predicted 19%shortfall in nurses by 2015, theinitiative is trying to improve thenursing work environment, alter caredelivery patterns, and reinvigoratenursing education and leadership.

The total cost of employing a hospital workerin the U.S. went up 2.1% in 2010, comparedwith a 2% increase for workers in the generaleconomy, according to the Bureau of LaborStatistics Employment Cost Index.

Wages and salaries increased 1.6% in2010. The survey doesnt make a separateestimate on benet costs. Wages and salariesin hospitals usually comprise about 70% ofcompensation costs.

Over the past 10 years, hospitalcompensation costs have followed a steadilydiminishing rate of increase, starting at 6.3%in 2001. In the same period, the growth inhospital wages and salaries has fallen from5.9% in 2001 to 1.6% in 2010, the federalgovernment said.

For the economy as a whole,compensation for civilian employees rose 2%in 2010, an increase from 1.4% in 2009. Therate of increase for wages and salaries was1.6% in 2010 and 1.5% in 2009. For benecosts, the rate of increase was 2.9% in 2010up from 1.5% in 2009. The BLS said theincrease was due to retirement costs.

Hospitals still created 50,100 jobs in2010, which was almost twice as many jobsthey created in 2009. The overall healthcaresector created 265,800 jobs in 2010.

The BLS looked at 63,000 occupationaldata points chosen from 12,900 private sectemployers, and 11.500 data points taken fro1,800 bureaus in state and local governmen

Illinois is offering new options for state residentswith pre-existing conditions. The state will nowmake available a $1,000 deductible plan topeople who have been uninsured for six monthsor longer. Previously, the only option was a$2,000 deductible plan.

The Illinois Pre-Existing Condition InsurancePlan, known as IPXP, will charge slightly morein monthly premiums for the new option. A 45-year-old Chicago resident who is a non-smokerwould pay $323 a month, compared with $280a month for the higher-deductible plan.

IPXP was launched last August and hassigned up more than 1,000 people so far. It ispart of the federal push to enroll more people in

high-risk pools. Nationally, those poolsregistered about 8,000 new enrollees by Nov1, which is seen as a disappointment to thoswho lobbied for the plans. Congressappropriated $5 billion to fund the high-riskpools as part of the Affordable Care Act. Michael McRaith, the states insurancedepartment chief, said Illinois relativelyaffordable premiums gave the IPXP plan thehighest or second-highest enrollment in thecountry.

The state wants to unveil a plan with a$5,000 deductible in the summer.

Illinois Expands State Insurance PlanHigher Premiums for Pre-existing Conditions Option

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Hospital Labor Costs Continue to Rise2.1% Increase Exceeds Rate For Overall Economy


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Payers & Providers Page

As anticipated, an effort to repeal health reformwas defeated in the U.S. Senate in earlyFebruary, largely along party lines. Even if therepeal effort had passed both chambers,President Obama was expected to veto the billonce it arrived on his desk. In the face of effortsto derail the nearly year-old law, advocatesmust continue to educate the public andpolicymakers about its benets.

One in ve Americans underthe age of 65 has a pre-existingcondition, according to a reportpublished last year. Thats one

out of every

ve of yourneighbors who might be deniedhealth insurance because of amental illness, cancer, or otherchronic disease. In our currenthealth care system, one inseven applications for healthcoverage from the largestinsurers is denied for a pre-existing condition, with pregnancyone of the reasons given for denial.

For these Americans deniedaffordable coverage, the day-to-day uncertaintyof how they will receive and afford treatment

without coverage and how they will get theirprescriptions lled, is stressful. The nancialand emotional security of entire families isaffected.

Health reform will put an end to thisscenario, as insurance companies will nolonger be able to deny coverage for pre-existingconditions. Ending these unfair denials willhelp give peace of mind to hundreds ofthousands of hard-working Americans. This isjust one example of how health reform canhelp us, our co-workers and our neighbors.

In Kansas, the health reform law is alreadyimproving the lives of ordinary people. More

than 30,000 Kansas seniors received rebatechecks to help them purchase medicationsonce they reached the cut-off point at whichtheir Medicare drug plans no longer paybenets. As of January 1, seniors on Medicarecan now receive preventative health benetswithout co-pays or deductibles. Being able tohave wellness checks, mammograms and otherpreventative measures gives comfort to seniorsand their families and helps avoid costlytreatment for preventable illnesses that cannow be detected early.

Despite the benets of health reform,

many critics have stooped to baseless attacks oppose the law. Some critics call health reformjob-killer, although there is no evidence tosupport their claim. The nonpartisanCongressional Budget Ofce says that healthreform is unlikely to raise insurance premiumsmost businesses, and repealing it could increathe countrys decit by $230 billion over the n

10 years.Challenges to the Affordable

Care Act have also been builtaround the disputed constitutionof the laws individual mandate.

Thirteen cases brought beforedistrict courts have been dismissoutright. But two judges havedeclared the mandateunconstitutional, including a discourt judge in Florida who threwout the law in its entirety.

As differing opinions mount,likely that the nal verdict on th

law will rest with the U.S. SupremeCourt. But the inevitability of thatcourts hearing the case has not dete

some states from pursuing constitutional amenments to exempt their citizens from the indivi

mandate. In 2010, the Missouri House of Re-presentatives passed an early resolution againthe mandate. The vote came just days before tACA passed Congress. Conservative leaders inKansas House introduced a constitutionalamendment that failed in 2010 but wasreintroduced this year. A key health committethe Kansas House passed the proposedconstitutional amendment two weeks ago.It is clear that efforts to stop health reform wilend with last weeks vote by the U.S. Senate. ongoing challenges to the law only rekindle thcommitment of advocates to press forward ineducating consumers and our elected ofcials

about the merits of health reform. We will notstop. We want families throughout the Midwekeep the consumer protections they have waiso long for and so richly deserve.

OPINION

Health Reform is Worth DefendingAdvocates for the law must step up their efforts

Anna Lambertson is executive director of th

Kansas Health Consumer Coalition, which

advocates for affordable care.

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I14@(4!T--*)0:--*)ST>!-4!=1)+0(&6!!"> Op-ed submissions of up to 600 words arewelcomed. Please e-mail proposals to

[email protected],

By Anna

Lambertson


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MARKETPLACE/EMPLOYMENTPayers & Providers Page 5

DIRECTOR OF PHARMACY

(Urbana, IL)

Health Alliance Medical Plans seeks Pharmacy top-level individual responsible for drug formulary design and development,implementation, contract negotiation, and risk management. Quality, utilization management, customer service, and cost

containment are key performance metrics. Responsible for dealing with the wide variety of clinical, administrative, nancialand regulatory challenges involved in the management of pharmacy cost and utilization. Responsible for the supervision andmanagement of the Pharmacy Network, Pharmacy Staff, and pharmacy related contracting.

JOB REQUIREMENTS

Education, training, experience:

Education: Doctor of Pharmacy preferred.

Licensure: Current unrestricted license from the State Board of Pharmacy, State of Illinois by examination.

Experience: Five years industry experience and two years experience in managed care organization. Must include experiencein third party reimbursement, formulary and clinical programs. Government program experience (Part D and Medicaid) isdesirable. Previous experience in pharmaceutical rebates/discount contracting negotiation with pharmaceutical manufacturePrevious experience and understanding of retail pharmacy, hospital pharmacy, LTCF operation, billing, and drug purchasing.Extensive experience with word processor and spreadsheet applications. Personnel management experience.

Other Knowledge/Skills: Ability to organize, interpret and distill large volumes of data formats and accurately communicateissues to physicians, pharmacists, employers, administration, and Health Alliance staff. Ability to create and utilize cost beneanalysis (pharmacoeconomics) of therapeutic selection and available alternatives. Must be able to anticipate and take correctaction in response to changes in pharmacy regulations, prescribing patterns, new therapeutic technologies, etc. Ability tomaintain a credible professional image with physicians and drug manufacturers. Must be adept at persuasion and directconfrontation. Working knowledge of claims systems, pharmacy operations, and managed care required. Ability to positivelyaddress issues from dissatised enrollees and pharmacists.

Contact:Lesley Schacht

Professional RecruiterHuman Resource Services

Carle and Health Alliance Medical [email protected]

http://www.carlecareers.com


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Payers & Providers MARKETPLACE/EMPLOYMENT Page 6

DIRECTOR OF OPERATIONS MEDICARE

!! (Health Plan in Midwest) Perform duties as senior liaison between the Medicare business unit and Corporate department. Partner with multiple stakeholders and business unit leadership to establish operational objectives and procedures. Support due diligence and integration for business unit expansions.

Facilitate operational oversight for Medicare business units and identify opportunities for maintaining effectiveoperations.

Ensure cost effective programs are developed and maintained throughout the business unit. Identify operational efciencies and develop best practice policies and procedures. Contribute to the development of new products and markets. Utilize corporate and industry standard management tools and techniques to effectively oversee projects; negotiate

with project stakeholders to identify resources, resolve issues, and mitigate risks. Coordinate cross-functional meetings with various functional areas to meet overall stakeholder expectations and

business unit objectives. Provide functional and technical expertise across multiple business and technical areas. Coordinate cross-functional meetings with various functional areas to meet overall stakeholder expectations and

business unit objectives.

Bachelor's degree in Business Administration, Finance, Accountancy or equivalent. Six-plus years of experience in Medicaremanaged care operations with emphasis on nance and information technology preferred. Project management, administratioor operations in the Healthcare industry preferred. Masters degree preferred.

Contact:ES&P SEARCH!!!!

Sonia Varian at (818) 707-7118, [email protected]

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Payers & Providers Midwest Edition – Issue of February 15, 2011