Table of Experts Health Care

24 MINNEAPOLIS/ST. PAUL BUSINESS JOURNAL

.

HEALTHCAREHEALTHCARE

SPONSORED BY

NOVEMBER 13, 2015 25

Allison O’Toole has been MNsure’s interim CEO since May. Previously, she served as deputy director for external affairs and was MNsure’s staff liaison to the board of directors. She was responsible for the implementation of the second phase of MNsure’s multimillion dollar marketing campaign. Prior to MNsure, O’Toole was a director at Himle Rapp, state director for U.S. Sen. Amy Klobuchar, chief deputy county attorney for Carver County and assistant county attorney for Hennepin County. O’Toole has a bachelor’s degree in government from Franklin & Marshall College in Lancaster, Penn. She earned her Juris Doctor from William Mitchell College of Law in St. Paul.

Allison O’Toole • MNsure

Jesse Berg is an attorney at Minneapolis-based Gray Plant Mooty. He counsels health care providers on federal and state anti-kickback laws, the Stark physician self-referral law, Medicare and Medicaid reimbursement, enrollment and participation issues, HIPAA, and state privacy and confidentiality matters, as well as federal and state antitrust issues. Prior to Gray Plant Mooty, he served as assistant attorney general in the health care and antitrust division of the Minnesota Attorney General’s Office.

Jesse Berg • Gray Plant Mooty

Steven Rush is director of UnitedHealth Group Inc.’s Health Literacy Innovations Program, an enterprise-wide program to help consumers understand and use health and wellness communications. Prior to this, he was director of physician engagement at UnitedHealthcare Health Services. He is a licensed psychologist. His interest in health communication has been a natural part of his work in psychology and intensified about 14 years ago when he was the practice and patient safety manager for the American Academy of Neurology, and was one of the first group of trainers trained by the American Medical Association.

Steve Rush • UnitedHealth Group Inc.

Todd Hanson has been director of client services and senior benefits consultant at CBIZ Benefits & Insurance for over five years. His past experience includes the health and productivity leader role at Buck Consulting, where he provided benefits consulting, as well as delivery of various human resources services. He also has worked as a benefits practice leader for Marsh/Mercer and regional group manager for MetLife and ING Reliastar. Hanson has experience with privately held companies, public companies, health care industry clients, governmental entities and multi-employer plans.

Todd Hanson • CBIZ Inc.

Becca Miller is a senior director for Capella Education Co. She is responsible for driving Capella’s strategy for employer partnership development. Since joining Capella in 2001, she has held progressive leadership roles in enrollment, advising and operations. As the director of enrollment and advising for the College of Professional Studies, she led a team of enrollment, advising and operations leaders to deliver high-quality, highly differentiated programs for learners. Her previous experience includes recruiting and advising positions with Hibbing Community College and Sopheon. Miller holds a master’s in education from Capella University and Bachelor of Science in communications from University of Minnesota–Duluth.

Becca Miller • Capella Education Co.

John Soshnik is a partner at Lindquist & Vennum, representing health care clients on a broad range of transactional and regulatory matters. His clients include hospitals, physician groups, health systems, health care professionals and licensed entities, managed care organizations, third-party administrators, wellness service providers, disease management companies, medical device companies, and technology companies. He has experience in all aspects of HIPAA privacy issues (and their state law counterparts), including breach response, contract negotiation, and policies and procedures.

John Soshnik • Lindquist & Vennum

MODERATOR

PANELISTS


BY ELIZABETH MILLARD Contributing writer

The Minneapolis/St. Paul Busi-ness Journal held a panel dis-cussion recently, featuring five expert panelists to explore top-ics about the issues surrounding

health care. Panelists included Todd Han-son, director of client services at CBIZ Ben-efits & Insurance Services; Jesse Berg, an attorney specializing in health care law at Gray Plant Mooty; John Soshnik, a part-ner in the health law group at Lindquist & Vennum; Becca Miller, director of employ-er solutions at Capella Education Co.; and Steven Rush, director of health literacy innovations at UnitedHealth Group Inc. Allison O’Toole, interim CEO at MNsure, served as moderator.

O’Toole: I’d like to start with some big-picture issues, and let’s begin with UnitedHealth. Steve, you’d mentioned that October is Global Health Literacy Month, so tell me what you’re seeing in that arena.

RUSH: Global health literacy month is a worldwide opportunity to bring some focus on the need to create simple, acces-sible and actionable health communica-tions. Even in the most complex health care environments, it is important to have simplicity. At UnitedHealth Group, we’re working to create some standards by which we can communicate in ways that people can understand and use. We also want to raise awareness of the bar-riers to health communications that are associated with low health literacy — and there are a lot of them. We feel people need to understand health care and insurance terms, and even some of the legal terms.

O’Toole: Are there some groups that are more challenged than others? Who needs the kind of health care information that you’re providing?

RUSH: Everyone needs simple, under-standable and actionable health commu-nications. There are some groups of peo-ple for whom this type of communication is more important: people who do not have English as a primary language and people who have low literacy skills. Also when people get sick, their illness can cre-ate a communications burden, which can be difficult to overcome. So, we need to address that. You can’t always tell which person has low health literacy, so we have to create materials designed for a broad approach.

HANSON: It’s ironic, too, that when you go to a health care provider you get some-thing called an explanation of benefits, but we’ve found that most people don’t understand that document. This docu-ment that’s supposed to describe a recent claim — what’s covered by the health plan and what isn’t covered, what’s paid by the health plan and what the person has to pay everything they need to know — is not understandable. That makes health care literacy a huge need. We work with employers, and communication is a big part of what we do for them. Employ-ees need to understand the health plans that are offered. They also need to have information to choose the right provider. This all rolls up under the health literacy umbrella.

O’Toole: How are companies using those health care benefits to attract and retain employees?

HANSON: As health plans cost more and more, voluntary plans have filled a need. Employers are almost having to pull back a little bit, because if you offer an overly generous plan, you may have to pay an excise tax in 2018. This is the Cadil-lac Tax under ACA. Employers are using voluntary plans to fill the gap to lower the premium and lower the cost. Also, in terms of attracting and retaining employ-ees, what we’re seeing is a transition from

wellness to well-being. It’s not just physi-cal wellness, such as whether you smoke, nutrition or your weight, but it’s now extending to other aspects like the role you play in your community, if you feel socially connected, do you feel a sense of spiritual well-being, are you financially solid. All of those areas affect productivity, and they are very important to employees, so a good well-being program helps in finding the right employees and helps to keep them.

SOSHNIK: We’re seeing many creative health-benefit solutions being considered and developed by companies. Some are quite promising, but the parties involved need to keep in mind the serious compli-ance issues that are involved with these products and plans. We work hard with clients to help them innovate and improve health care for their constituents while remaining compliant with the maze of health care regulations that apply in this arena.

O’Toole: Let’s talk about the integration and incentive to work together. With all the mergers and consolidations that are going on, what do you think will happen?

BERG: This year alone there have been 71 hospital consolidations, so that puts us on pace for the largest number since 1999. And it’s a great question to ask: Why is that happening. And one of the biggest reasons is the Affordable Care Act, which has initiatives that are intended to push providers towards working together. This includes things like reimbursement that rewards managing large patient popula-tions, implementing performance-based reimbursement programs, assuming risk, better sharing of data and leveraging infor-mation technology. All of these have a huge cost, all of them take management and centralized authority, so that forces providers into a place where they need to think about working together. And that’s easier to accomplish in a large, integrated

system. SOSHNIK: One of the biggest factors for

my clients is that they’re being asked to take on more risk, and that’s easier to do if you have the volume to absorb that risk. Also, for physician groups, especially for certain specialties, reimbursement may be changing as the health care model evolves. The uncertainty surrounding where reim-bursement is going, along with expecta-tion of increased risk sharing, has moti-vated some physician groups to sell their practice and integrate with hospitals and health systems.

O’Toole: How does this all impact the consumer?

RUSH: Health care and health insur-ance is extremely confusing to patients. They aren’t prepared to be able to accept that burden. We live in a chronic care environment. There are a lot of people with heart problems and back problems and diabetes and other chronic condi-tions. All of those are very costly. Ninety-five percent of the care necessary to man-age those problems is within the power of the patient, but they don’t know how. So, one thing that providers may need is to change their communication to better engage patients. Some providers say that takes a lot of time and money, and that’s true, but only at the beginning. And it’s a compensated approach.

SOSHNIK: I think some of the inno-vations are trying to accomplish that. The ACO product, for example, provides incentives to primary care providers to successfully address chronic conditions and manage their patients’ overall health.

O’Toole: Let’s hear a little bit about mobile health tools. What challenges and opportunities are we seeing because of those?

BERG: There are a lot of exciting oppor-tunities in that area. I think of mobile health as running the gamut, from Fit-

NANCY KUEHN

From left: Allison O’Toole, MNsure; John Soshnik, Lindquist & Vennum; Becca Miller, Capella Education; Steve Rush, UnitedHealth Group; Jesse Berg, Gray Plant Mooty; Todd Hanson, CBIZ


bit to tools that providers can use to treat patients remotely. This is terrific for patient care because it provides a way to bring care to rural or underserved populations. Providers can make clinical and educa-tional information available to patients, communicate with them and generally make them feel more involved and invest-ed in their own care. So, there are a lot of really positive things coming out of this trend. There are some challenges, and the scope of these challenges will involve how complex this technology is. On one end of the spectrum are tools that pro-vide educational information to patients, but don’t facilitate direct communication between patients and providers or don’t allow providers to reach into the cloud and pull out health information. On the other end of the spectrum are tools that permit patients to connect directly with their pro-viders and to receive care over the Inter-net. But when you get into technologies where patients and providers are exchang-ing clinical information, that’s great but it creates potential licensure issues if the patient and provider are located in differ-ent states. If medical information is stored in the cloud, another question is whether the technology vendor is meeting HIPAA requirements.

HANSON: I’d add that one of the ben-efits we’ve seen is a transition of nurse lines to telehealth and Web-based deliv-ery of health. Even with problems you’ve mentioned, we’ve seen a big growth in this

area. That’s a low-cost, high-value option. BERG: One other thing to add is reim-

bursement rules are really behind the times when it comes to telehealth. Medi-care only started reimbursing providers for telemedicine services in 1999. And there’s still a very limited list of things that will be covered. It seems like the folks writing these regulations are really behind the times in terms of what providers are doing, and unfortunately, a lot of reim-bursement policy in the country is driv-en by decisions that Medicare makes. So, hopefully that will change in the future.

RUSH: I think the concept of mobile health does open up a new area, called e-health literacy, that requires more of the consumer. Not only do they have to know about technology and computers, but also science literacy and health litera-cy. Also we need to think about the thou-sands apps. We have to look at how they’re being used.

O’Toole: Let’s shift gears a little bit and focus on workforce development and helping health care employers find solutions, such as finding nurses.

MILLER: I think many of the emerging topics in health care that we are discussing relate to what we do at Capella. In terms of topics like telehealth and transition-ing to community- and population-based health, we work closely with employer partners to identify where gaps in knowl-edge and skills exist in their workforce.

We then develop or revise our curricula in accordance with these. We use a com-petency-based education model to teach and assess relevant competencies that are professionally aligned.

O’Toole: Are there certain benchmarks that are impacting the education space?

MILLER: Yes, based on substantial research evidence, the National Acade-my of Medicine (formerly known as the Institute of Medicine) is recommending that 80 percent of nurses have their BSN degree by 2020. Currently, the percentage is about 50 percent. That’s a very aggres-sive goal, but we’re seeing some health care organizations get close to that. The seminal piece of research upon which the recommendations were based suggested a 10 percent increase in the proportion of BSN nurses on a hospital staff is associ-ated with a 4 percent decrease in deaths. Since that study, further research has sug-gested decreases in certain negative conse-quences of hospitalization and treatments with increasing percentages of BSN-edu-cated nurses. In addition, studies point to a positive correlation in higher nursing edu-cation and patient satisfaction.

O’Toole: Tell us about how you’re educating and reaching employers to get their workforces to the level they want.

MILLER: One of the trends we are see-ing is with the amount of mergers and acquisitions. Many organizations are

Economic Forecast Publication Date: 1/29/16

Wealth Managers Publication Date: 2/12/16

M&A Publication Date: 2/19/16

Senior Living Publication Date: 3/4/16

International Business Publication Date: 3/25/16

Government Policies Publication Date: 4/15/16

Private Equity Publication Date: 4/22/16

SBA Publication Date: 5/6/16

Workforce Publication Date: 5/27/16

Design/Build Publication Date: 6/10/16

IP/Patent Publication Date: 8/12/16

Transportation Publication Date: 8/19/16

Residency Tax Publication Date: 9/2/16

Startups Publication Date: 9/9/16

Family-owned Business Publication Date: 9/23/16

Manufacturing Publication Date: 10/21/16

Health Care Insurers Publication Date: 10/28/16

Education Publication Date: 11/4/16

Nonprofits Publication Date: 12/16/16

Franchising Publication Date: 12/23/16

For information on future Table of Experts, please contact Kathy Robideau at 612-288-2134 or [email protected].

2016

* Your health care businessis due for a legal checkup. Our lawyers are in.

Learn more by visiting lindquist.com.

©2015 United HealthCare Services, Inc. Insurance coverage provided by or through UnitedHealthcare Insurance Company or its affiliates. Administrative services provided by United HealthCare Services, Inc. or their affiliates. Health Plan coverage provided by or through a UnitedHealthcare company. UHCMN759128-000

Saluting the Minneapolis/St. Paul Business Journal Table of Experts on Healthcare participants for striving to improve the health care system. Thank you for your commitment and the impactful difference you make.

Better health care begins here.


gpmlaw.com | Minneapolis | St. Cloud | Fargo, ND | Washington, DC

You’re on a mission to help people. We’re impassioned to help you.

Your work matters—to your patients and to your communities. Legal complications should be the last thing you need to worry about. Let us know how we can put our passion to work for you.

For Your Company’s GrowthProviding Expertise

CBIZ Benefits &Insurances Services

Deb Busch • [email protected] • 612.436.4624 www.cbiz.com

© C

opyr

ight

201

5. C

BIZ,

Inc.

NYS

E Li

sted

: CBZ

. All

right

s re

serv

ed.

BENEFITS CONSULTING & ADMINISTRATION

HEALTH CARE REFORM

WELLBEING CONSULTING

INSURANCE & RISKMANAGEMENT SERVICES

RETIREMENT SERVICES

looking for programs that can bring their workforce together. We have been respon-sive to this in the development of two competency-based RN-to-BSN program options. Our standard credit-based pro-gram is a 10-week session with required learning activities facilitated by a facul-ty member and set time lines for assign-ments and other course requirements. We also have our revolutionary FlexPath option, which is not tied to credit or con-tact hours and allows learners to move through competency assessments at their own pace. Learners can use any resourc-es they want in preparing to demonstrate competencies, including prior profession-al experience. Therefore, learners do not have to spend time on what they already know; they can demonstrate competency in an area and move on. Proportionately, more time is spent on topics with which they aren’t familiar. It just makes sense. It is a very learner-centric and empowered approach to higher education. However, it is not right for everyone for numerous reasons, including relative lack of profes-sional experience.

O’Toole: Do you think others are doing enough to support this aggressive goal? Is there any collaboration?

MILLER: I think there’s always room for more collaboration between employers and educational institutions. It’s impor-tant to understand what an employer

needs and to develop curricula that aligns to industry standards. We have to work for them and with them in creating the best solution. There needs to be even more col-laboration and validation that the curricu-lum is meeting tomorrow’s needs.

HANSON: I think that’s a very good point, and it brings up another point, which is employee engagement. The more you can offer education and improvement of job skills, the more you engage your employees.

RUSH: I’ve talked with many col-leagues about health literacy and nursing, and nursing has at its core curriculum for many years this concept of patient educa-tion and counseling. One of the things that happens when people go out and practice, they lose that initial training. One of my colleagues, who was a nurse for 35 years, has retired and is creating curriculum to re-engage nurses in health literacy. So, my thought is the ongoing stress on health lit-eracy is really important, and it does take a community approach.

SOSHNIK: One interesting develop-ment occurring now is the broadening of the scope of practice for nurses. As nurses are allowed and expected to pro-vide more independent medical care, it is important that their roles in patient edu-cation and counseling are not devalued or de-emphasized.

BERG: From the provider point of view, some of the laws around accountable care

organizations are aimed at getting the patients invested and involved in care. Meanwhile there’s an obscure law called the civil monetary penalty statute that says the providers can’t improperly induce patients to come and get care from the pro-vider, and the idea is that the doctor can’t be handing out gift cards to get patients to come in. So, providers are in a tough spot because they want to get patients to come in and they want them invested in their own care, but they have to be careful that what they do doesn’t cross the line into improper inducement.

SOSHNIK: Similarly, the current push towards reimbursement based on quality metrics could be seen as in conflict with fraud and abuse laws. For example, under health reform, providers can be rewarded for contributing to lower hospital readmis-sion rates. In the past, incentives related to hospital readmission rates were consid-ered an indicator of potential fraud issues.

RUSH: From a provider standpoint, it’s interesting that hospitals are getting pun-ished for having higher readmission rates, and those tie into the fact that people don’t understand their discharge instructions. If you think about those instructions in meaningful-use terms, you have to think about the extent to which patients can use them. Some of those documents are eight pages long. I don’t read eight pages.

O’Toole: At MNsure, I’m dealing with

such a small part of this whole industry, so it’s fun to hear about this broader work. But the ACA really turned the consumer engagement on its head and is requiring consumers to be so much more involved and to behave in a different way then they have been. We’re seeing such a need for the literacy piece.

RUSH: You bring up engagement, and how difficult it is, and the research would indicate that people with low health lit-eracy typically don’t have the confidence to ask questions, and typically don’t feel they have control over their health care, or that they have the right to ask questions. Our health care in the past has said, “We’re the professionals. We’re going to tell you what to do.” And now that’s turning the paradigm for providers and patients, and that’s difficult.

O’Toole: Let’s shift to talking about another major topic around health care, and that’s fraud and abuse. What kinds of issues and challenges are you seeing there?

BERG: We always hear, “How can we cut back on health care costs?” and one of the big things that always comes up is waste, fraud and abuse, and how there’s so much in the system. Providers are frus-trated by that because the rules are com-plicated and most providers really do their best job to comply with all these laws. Health care is the second most-regulated


industry in the U.S., behind nuclear pow-er. You’ve got doctors and nurses trying to sort through complicated rules, and meanwhile, the enforcement environment is terrifying. Last year, the Department of Justice recovered $2.3 billion just from health care fraud. And that’s five years in a row where they’ve recovered over $2 bil-lion just from health care fraud. So, while fraud and abuse is out there, most provid-ers are doing their best. Everyone in this industry is finding that it’s taking more time and effort than ever before to try to sort through all these regulations, and honestly, that takes energy and resourc-es that could have been spent on things like health literacy or really engaging the patients.

SOSHNIK: There are so many potential compliance pitfalls out there now, and anyone in the health care field needs to remain vigilant. Serious compliance issues can arise from seemingly reasonable and innocent activity.

O’Toole: Thinking about compliance, security and privacy, and all the information coming in from so many different directions, how are you advising your clients or consumers to navigate this?

SOSHNIK: It gets back to the basics and just having solid compliance in place. Whether it’s a provider, vendor, a health plan, having a robust, but basic compli-ance program that covers the basic bread-and-butter health care issues is important. You also need to cultivate a culture of com-pliance in the company, where that’s not the last hurdle, but it’s part of the build-ing process. Keep it in mind at the design

phase, not just as a way to clear legal.BERG: I would just add to that, the

Office for Civil Rights, which is the agen-cy that enforces HIPAA. They put out some great guidance and have done a nice job of putting out audit tools that you can use to evaluate your internal policies and procedures. One of the things every cov-ered entity has to have is a robust security assessment and evaluation. They have to think about what they’re doing to secure electronic communications, maintain backups of health records and take steps to address any vulnerabilities identified in the course of the security assessment. Pro-viders and plans need to be able to show their homework. It’s like math class when you were in school, where it’s less impor-tant to get the right answer, and more important that you can show the steps you took to get to that answer. Regulators want providers and plans to show what they have done to try and achieve compli-ance. The other thing is that privacy is the one thing that everyone in health care can relate to. Everybody has been to the doc-tor and everybody has had some worry or experience about identity theft. So, it’s a huge area of focus, and I think we’ll see more investigations in this area.

O’Toole: I think that comes back to literacy, and what’s happening with companies and individuals when it comes to protections. What are you seeing?

HANSON: From the employee benefits consulting perspective, compliance has become a bigger part of what we deliver. Now with the Affordable Care Act, prep-ping for the Cadillac Tax along with HIPAA

concerns, compliance has become a large part of the services delivered to employers.

RUSH: In terms of a consumer’s per-spective, there’s certainly a concern about sharing health information. We tell peo-ple that we’re collecting this data, but it will be confidential. UnitedHealth Group has an aggressive compliance program so we can help patients and providers bet-ter engage. We continue to work on that.

MILLER: It comes back to our respon-sibility of keeping curriculum up-to-date on evolving fields like informatics and data analytics. There is so much data. The health care workforce not only has to understand how to use it, but also how to protect it.

O’Toole: What are you most excited about? What’s coming down the pike that you look forward to seeing?

HANSON: Some of the benefits trends that we’re working with are exciting. We talked about telehealth and Web-based health, or virtual health delivery as a grow-ing segment. We’re working with employ-ers on defined contributions, which is now gaining traction. Another trend is concierge approaches, then there’s on-site clinics. That used to be just for large employers, but now it’s coming down to medium size. The transition from employ-ee wellness to well-being is important. So, there are half a dozen things that are com-ing and it should be very interesting.

RUSH: I think we’re in a perfect storm. We have an aging population, and as they age, they have difficulty processing new information and there’s a ton of new info related to health care coming down the pike. We also have our newest generation,

and they’re better educated, but they also have the widest gaps in terms of health care knowledge. We also have more people who are new to the United States and don’t understand our health care system, which is becoming more complex. Then you have innovation coming in. All of this will be a challenge, but also an opportunity.

SOSHNIK: I am looking forward to see-ing how many of the current innovations being rolled out in the Medicare program will be integrated into the commercial market. I look forward to seeing how some of these innovations will actually improve health care and the overall health of our population. Overall, I am optimistic about the direction health care is moving.

MILLER: One of the things I’m most excited about is increased collaboration between employers and educational insti-tutions. Health care and higher education have many similarities in terms of needs for transformation. Increased access and affordability is key to reform in both areas and finding new ways to meet the chang-ing needs of the health care profession. It’s an exciting time to think about what the next models will look like.

BERG: I’d say that what I’m most excit-ed about is a sub-agency called the Cen-ter for Medicare and Medicaid Innovation, which came out of the Affordable Care Act. The idea is to really incentivize individuals and organizations to come up with new and innovative models of care delivery and give them financial incentives to try and makes these new innovations a real-ity. Overall, I just think we’re finally see-ing the silos that have been in health care begin to break down, and that is a very welcome change.

PHOTOS BY NANCY KUEHN

From left: Todd Hanson, CBIZ; Allison O’Toole, MNsure; Jesse Berg, Gray Plant Mooty; John Soshnik, Lindquist & Vennum