Payers & Providers Midwest Edition – Issue of June 21, 2011

8/6/2019 Payers & Providers Midwest Edition Issue of June 21, 2011

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Sandy Praeger, an independent-thinkingRepublican, is insurance commissioner ofKansas. She gave Payers & Providers a wide-ranging interview in early June.

In last weeks issue, we published her viewson the Patient Protection and Affordable CareAct and the challenges for state ofcials whohave to implement it.

This week, in Part 2 of a conversation witheditorDuncan Moore, Praeger talksabout the response of insurers andconsumers in Kansas to the law,Paul Ryans Medicare reformproposal, and why access to health-care is a right instead of a privilege.

What is the biggest problem facinginsurers in Kansas right now?

The biggest issue is thecontinuing increase in overallhealthcare costs, which have to bepassed on. Some of them are facingsome premium issues with the newprovisions. They have to get rid oflifetime limits, rst-dollar coverage,and kids going back on parentscoverage up to the age of 26. That last oneisnt a big deal, unless theres a reason a childcant get coverage because of a preexistingcondition.

That is combined with high unemployment.A lot of people without jobs let their coverage

lapse. People who need coverage buy it, so

theres some adverse selection in theindividual market right now, more thannormal.

What are the major insurers in Kansas, andtheir approximate market share? Blue Cross Blue Shield of Kansas operatesin 103 of our 105 counties. The other twocounties in the Kansas City area are served by

Blue Cross Blue Shield of KansasCity, plus 14 counties inMissouri.

Blue Cross of Kansas has lessthan 50% market share. The nextlargest by market share isCoventry. It started in Kansas asPreferred Health Systems, orPHS, owned by a Catholic health

system in Wichita. They mergedwith Coventry a little over a yearago. A long time ago, Coventrybought the old HealthNetsystem, which was based around

St. Lukes Hospital in Kansas Cityand its physician groups. UnitedHealthcare is fairly

signicant. To a lesser extent, Cigna and Aetnaand Humana.

How will the health reform act change thebusiness model of insurers?

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Oct. 13-14

September 14-16

Calendar

21 June 2011

June 23-24

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[email protected]

the details of your event, or call(877) 248-2360, ext. 3. It will be

published in the Calendar section,space permitting.

www.lakesidecommunityhealthcare.com

Midwest Edition

Healthcares a Right, Not a PrivilegeKansas Republican Takes Iconoclastic Stance

Continued on Next Page

Sandy Praeger
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In Brief

U.S. DoJ Files Briefin Planned Parenthood

of Indiana Case

The U.S. Department of Justiceweighed in last week against Indianas

recent law denying Medicaidpayments to Planned Parenthoodclinics.

In a briefled on behalf of thereproductive health services provider,the Department of Justice argued thatU.S. District Judge Tanya Walton Prattshould give an injunction because thestate law contravenes federal lawregarding patient preferences forMedicaid.

Planned Parenthood, whichoperates 28 clinics in Indiana, ofwhich four perform abortions, wassingled out in a law signed in earlyMay by Gov. Mitch Daniels. Theorganization typically receives about

$1.3 million a year in state money.Federal authorities have taken a

dim view of the states policy. DonBerwick, M.D., chief of the Centers forMedicare and Medicaid Services,warned state ofcials that they couldface penalties for not complying withthe Social Security Act, which allowspatients covered by Medicaid to selectany qualied provider that acceptsMedicaid payments.

The judge is expected to rule in the

case by July 1.

Physicians are Reluctant

to Treat Children onMedicaid, Study Finds

Specialist physicians are discriminatingagainst children insured throughMedicaid, by denying them appoint-ments or making them wait longer tosee them, according to a new study.

Researchers posed as parents ofchildren needing specialty care fromallergists, dermatologists, psychiatrists,

Continued on Page 3

NEWS

Sandy Praeger (Continued from Page One)

They will have a lot more customers. Themedical loss ratio limit will force them tobecome more efcient. Its going to ensure

that, of the premium money policyholders payin, 80% or 85% is going to go to bothhealthcare expenditures and qualityimprovement activities. Thats a good thing.

What kinds of market behaviors or responsesare you seeing in this state in the lead-up tofull implementation of the ACA? Theyre cutting back on agentcommissions. The agent community is lookingat that. Theyre in a wait-and-see mode.

The companies are trying to build as muchreserve as they can right now. When you takeaway medical underwriting, they have to take

all comers. There will be a risk managementcomponent of the new law, rules yet to bedetermined. Theyre just nervous. They alsodont know what the rules are going to be.

In the long run, if everybody has access toprivate insurance, and companies are com-peting on a level playing eld, it will be bene-cial to them. Theyre not opposed to this.

Well, if they support it, theyve been mightyquiet about it.

If they were opposed, we would be hearingit. They feel they dodged a bullet. It couldhave been a national exchange. That would

have bene

ted the large national companies.They saw that would potentially lead us moredown the road to a single payer, where therewouldnt be much need for them.

They recognize that getting everybodycovered is a good business model for them.

What are you hearing from consumers? Theyre confused. They dont know what tobelieve. Some are wondering if this law is ineffect. It is, sort of. There were early benets:Kids staying on parents policies, rst-dollarcoverage. The big benets havent accrued yet.

I think consumers are still wondering what

its going to mean for them, unless they werealready beneting.

As an elected insurance commissioner, how isyour job different from that of an appointedcommissioner? How many electedcommissioners are there in the U.S.? We have 11. The advantage is that I answerto the voters, to the citizens that ourdepartment is charged to protect. Its my onlyfocus. If youre appointed, then youre part of agovernors cabinet. Most appointedcommissioners feel they cant get too far out in

front of their governor. They have to wait units a priority of the governors ofce.

How does being married to a surgeon affecyour thoughts about health care, insuranceand regulation? It gives me a lot of insights. I frequently wtell stories that I get from my husband. Myfavorite lately is talking about why fee forservice has to change. Mark, my husband, ithe rst to acknowledge the faults in the hesystem. He does not believe in physician-owned facilities. He thinks that creates all twrong incentives. You should be rewarded fpatient care, not for equipment that you owlike MRIs.

What do you think about Wisconsin Rep. P

Ryans proposal to restructure Medicare anmake it a more consumer-driven kind ofinsurance? I think it shifts the cost to our Medicarebeneciaries. Medicare is not a welfareprogram, its a retirement program, a pensioPeople contribute through Social Security tohave that benet. It really is a majorrestructuring.

I dont think its a good idea to haveMedicare recipients go out in a voucherprogram. Are they going to have guaranteedissue? Medical underwriting? I think there aa lot of questions about it.

Changes in the Medicare program need be on the table. It is running out of money. dont think privatizing it is the answer.

Do you have an opinion about the McKinsestudy showing that many employers willpossibly drop health insurance? I have not read the report. Ive haddiscussions with folks, some of whom feel ihas exaggerated, overstated the potential. Wknow companies have wanted to move awafrom dened benet to dened contributionand the exchange would facilitate that. Thewould give their employees a certain amou

and say go to the exchange.

Any last words? Whether you like the new law or not, atleast we focus on getting everybody coveredthink having access to healthcare services isimportant in our community as being able tturn on the faucet and knowing its safe todrink, as knowing that you have police andre protection. I think healthcare is absoluta right. It should not be a privilege. Thats wwe do in a civilized society. We come togetto provide those services to make sure we call share in the American dream.


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NEWS

In Brief

or orthopedists. They called eachdoctors ofce twice, once saying theyhad private insurance, and againsaying they had Medicaid. Specialistsdeclined to give appointments to 66%of the Medicaid children and 11% ofthe privately insured children. Atofces that accepted both, the

Medicaid children had to wait anaverage of 42 days, and the privatelyinsured children had to wait 20 days.

The study was performed in CookCounty, Ill., the countrys second mostpopulous county, which includesChicago. It was regarded as probablyreecting barriers to care for theMedicaid population across the U.S.

The study by lead author KarinRhodes, M.D., an emergencyphysician at the University ofPennsylvania, was published in theNew England Journal of Medicine.

The study was paid for by theIllinois Department of Healthcareand Family Services under a consent

decree from a lawsuit alleging thatpoor children in Cook County werenot receiving equal access to basicmedical care.

Catholic Health SystemRestructures in Plan

for Future Acquisitions

Catholic Health Partners of Cincinnatiis restructuring itself into twodivisions: a North Division and aCentral/Senior Health and HousingService Division. The system recentlyslimmed down from four divisions by

selling off its Northeast Region inScranton, Penn., and it expects to sellits Tennessee-based division by theend of the year.

The new structure should help thesystem to develop integrated deliverynetworks through physicianpartnerships, and focus on growthopportunities that will extend ourministry, according to CEO MichaelConnelly. We see the potential fornumerous acquisitions and mergersnow and in the future, and we areactively pursuing new growth that willenhance our mission in both the short-term and long-term.

SSM Health Care will no longer hire peoplewho smoke or chew tobacco at its seven St.Louis area hospitals, the health systemannounced last week. Applicants for work willbe asked whether they use tobacco, and thosewho answer yes will be dropped from thehiring pool.

The hospital system will also requireemployees to get u vaccinations. The twopolicies go into effect July 1.

We need to take a leadership role onthese major public health issues, said SisterMary Jean Ryan, FSM, Chair/CEO of SSMHealth Care, in a statement. Not hiringtobacco users is a rst step toward creating ahealthier work force, and mandatory uvaccinations will help protect our patients, ourcolleagues, and their families.

State law in Missouri permits SSM to takethese actions. In the other states where SSM

operates hospitals and clinics, Illinois,Oklahoma, and Wisconsin, the health systemwill press for enabling legislation.

People in St. Louis deluged the commentboard at the St. Louis Post Dispatch with coplaints about the edict, arguing that itinterfered with personal freedoms and wouldlead to the creep of employer control overprivate life.

Asked about enforcement, system spokesman Chris Sutton said: We will takeapplicants at their word. However, not beingtruthful on an application is grounds fordismissal.

As for the vaccine policy, he said, if theyrefuse to get vaccinated and they have notsubmitted a medical or religious waiver asrequired by the policy, they will have 45calendar days from the compliance date to gvaccinated or they will be dismissed.!

A cloud of skepticism began to surround a

widely publicized study by McKinsey &Company last week after the consulting rmrefused to give more details on how itconducted a survey of employers and theirresponse to the federal health reform law.

An article in the McKinsey Quarterly,published online on June 7, described aradical restructuring of employer-sponsoredhealth benets that will ensue in the wake ofthe health reform law last year. The shift awayfrom employer-provided health insurance willbe vastly greater than expected and will makesense for many companies and lower-incomeworkers alike, the article said.

McKinsey claimed that 30% of the 1,300

employers it contacted in a survey would

denitely or probably stop offering employsponsored insurance in the years after 2014,when the law goes into full effect. Amongemployers with a high awareness of what thelaw includes, the proportion will be closer to50%.

McKinseys ndings contradicted those oseveral others studies analyzing the sameproblem, and researchers and congressionalDemocrats, as well as the White House, askto see the rms raw data.

But McKinsey, following its custom,declined to release the survey methodology to explain how it arrived at its surprising

conclusions.

McKinsey Study Draws Fire in D.C.Firm Rebuffs Questions about Survey Methodology

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SSM Wont Hire Tobacco UsersMissouri Hospitals Will Ask Applicants if They Smoke
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Two weeks ago, McKinsey & Companyproduced a report suggesting that 30% ofemployers are likely to drop employee healthinsurance once the federal health reform lawgoes into effect in 2014. (See article on p. 3)

The number of employers projected to dropcoverage in the McKinsey study is consistentwith what the Midwest Business Group onHealth (MBGH) and others are predicting.However, dropping coverage, while seeminglya simple decision for many small employers,actually could result in highercosts for them over time.

Numerous studies haveshown that people with healthinsurance are healthier thanthose without coverage. Accessto preventive, acute, and chroniccare services allows people tomaintain their health.Alternatively, an employer thatdrops insurance exposes itself togreater absenteeism, loss ofproductivity, and the subsequentreduction in protability ifworkers cant perform their jobsbecause of illness.

Earlier this year, MBGHreleased the results of a nationalemployer survey on health reform. The ndingsindicated that while employers believe the lawwill increase their benet costs (through itsadministrative and tax provisions), they alsobelieve that keeping workers healthy andimplementing strategic health managementapproaches are necessary to reduce costs.

Its been suggested that in those instanceswhere employers drop coverage, they will raisethe salaries of workers so they can purchaseinsurance benets for themselves in the newlycreated Health Benet Exchanges. However, in

the MBGH survey, while 22% of all employerssaid that it is likely that they would considerdropping benets altogether, only about 20%indicated they will raise worker salaries to helppay for individual coverage.

The lack of an added boost in salaries, incombination with the small penalty forindividuals who decide not to obtain coverage,may lead many workers to hold on to theirmoney until they are in need of care. Then theywill obtain insurance, and later drop it whentheir care is completed. This will result in moreemergency room visits, increased sick days, and

extended hospitalizations, as people let theirhealth deteriorate until it cant be ignored. Foemployer, this will increase lost time andreplacement worker costs.

In response to this scenario, many employare recognizing that to keep their work forcehealthy, they still must offer health managemeprograms and resources, even if they decide nto provide insurance. Among respondents in tMBGH survey, almost 60% of all employers sthat they will expand wellness programs in lig

of the increased incentives thnew health reform law allows

For the past 20 years, wevbeen working with employerstheir health benet challengeIts become evident that to stacompetitive in the globalmarketplace, employers needget a handle on the high costhealth benets and services. to keep their health benet colow, employers dont need todrop coverage. Instead theyshould consider an extrememakeover in their own houof benets.

The foundation for this nehouse must be built onknowing the covered populations needs andmaintaining a healthy work force. As Universiof Michigan Professor Dee Eddington says, anemployer must keep the healthy people healthand keep the sick ones from getting worse. Wnow know that the 18% to 20% of people witchronic disease who are responsible for 85% 90% of health costs is not a static group, but othat turns over each year.

Employers dont offer benets because thealtruistic. They do so to retain and recruit taleas well as to maintain a healthy and productiv

work force. Health benets must be seen as ainvestment in human capital, not an expense.

Dropping coverage is a limited cost-reductionstrategy, which will not be enough to keep anemployers costs down or ensure protability.

OPINION

Dropping Coverage Isnt the AnsweIn the End, Employers Need a Healthy Work Force

By Larry Boress

Larry Boress is president and CEO of the

Midwest Business Group on Health in Chica

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Payers & Providers Midwest Edition – Issue of June 21, 2011