8/2/2019 Payers & Providers California Edition Issue of April 5, 2012

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8/2/2019 Payers & Providers California Edition Issue of April 5, 2012

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In Brief

County By CountyHealth Rankings

Released

A new study of the nations healthrankings on a county-to-county basis

shows a wide disparity of healthcareoutcomes in California.

According to the Public HealthInstitute of California, Marin, SanBenito and Santa Clara Counties hadthe highest rankings in healthoutcomes statewide. Siskiyou, DelNorte and Trinity County had thelowest rankings. Among the healthfactors that affect the outcomes,Marin, Placer and San MateoCounties had the highest rankings,while Tulare, Kern and Yuba Countieshad the lowest marks.

The study was conducted by theWisconsin Population HealthInstitute and the Robert Wood

Johnson Foundation. According tothe Public Health Institute, which ispromoting the rankings in California,residents of Trinity County are threetimes more likely to die a prematuredeath compared to residents of MarinCounty.

"By highlighting these healthdisparities across California counties,the Rankings inform a larger andcritical discussion about what can bedone to reduce them," said PHI ChiefExecutive Ofcer Mary Pittman.

Health Plans Criticized

For AvailableSubstance Abuse

Treatments

A recently released report on thequality of Californias health planswas criticized by a drug treatmentadvocacy group for a systemic failureto get appropriate care for thoseconfronting substance abuse issues.

Continued on Page 3

NEWS

CalOptima Moves To Oust PR FirmAgencys Head Tied To Inappropriate Remarks

As CalOptimas reins are handed over to aninterim chief executive ofcer, more turmoil atOrange Countys Medi-Cal managed care planhas surfaced regarding its longtime publicaffairs consultant.

A memo distributed earlier this week bydeparting CEO Richard Chambers saidCalOptima was consulting with legal counselabout terminating its contract with LagunaHills-based public affairs agency Laer PearceAssociates immediately as opposed toentering a 30-day wind-down period asrequired in its contract.

The Laer Pearce rm itself has already

notied CalOptima of its intent to servenotice, according to the April 3 memo.

The decision to part ways centers aroundalleged conduct involving the rms president,Laer Pearce.

The memo alleged that Pearce, during aphone call with a staffer for the OrangeCounty Board of Supervisors, madestatements that are not consistent withCalOptimas decision or direction. Theparticular Supervisor was not named, althoughsources say the communication involved astaff member for Supervisor Bill Campbell. ACampbell spokesperson conrmed Pearce has

called his ofce, but would not commentfurther.The memo included an apology to the

CalOptima board of directors and the OrangeCounty Board of Supervisors for anyappearances of inappropriate conduct by anyCalOptima representative.

Laer Pearce Associates specializes incommunications consulting for publicagencies. Its client roster includes theMetropolitan Water District and the City ofYorba Linda, according to information postedon its website. According to Chambersmemo, it had been providing consulting

services to CalOptima for the past four years.In e-mail responses seeking a comment

about the memo, Pearce denied that theincident involved Campbell directly, butsuggested that he came under pressure from

Supervisor Janet Nguyen. According to anarticle published earlier this week in theonline publication the Voice of OC, Nguyeclaimed Pearce had slandered her, and askefor his rms contract to be terminated.

In another e-mail sent shortly beforepresstime, Pearce provided a March 30 letteof resignation to Chambers where he issuedcategorical denial of all of Nguyensallegations.

Pearce has been critical ofPayers &Providers reporting in February of potentialconicts of interest involving CalOptimaChairman Edward B. Kacic. It was reported

that a philanthropic organization he headedand an ad hoc organization he co-chairedwere vying for more than $20 million in funto provide care for CalOptima enrollees.

Nguyen criticized Kacic for his conducand was part of a bloc of Supervisors thatvoted 3-2 in late February to delay hisreappointment to the CalOptima board.Another trustees reappointment was deniedafter it was disclosed the organization sheworked for received ofce space and othersupport from CalOptima.

Pearce said Payers & Providers publisheeditor Ron Shinkman himself had a conict

interest by slanting coverage in favor of theHospital Association of Southern CaliforniaShinkman provided communicationsconsulting to HASC between 2002 and 200

HASC supported a plan recently passedby the Board of Supervisors and backed byNguyen to expand the CalOptima board toinclude representation from hospital membeThe measure also extended Nguyens term othe CalOptima board by one year.

Chambers is leaving CalOptima later thmonth for an executive position with MolinHealthcare in Long Beach. Chief FinancialOfcer Michael Ingelhard is serving as inte

CEO until a replacement is found. MichaelEwing has been retained through an outsidefrrm and named interim CFO.

Chambers departure came just a fewmonths after an internal audit by an outsiderm was critical of CalOptimas manageme

Correction !Last weeks issue of Payers & Providers incorrectly gave the name of a winningarchiectural firm in Kaiser Permanentes small hospital design contest as Aditazz, Gresham Smith a

Partners. The firms correct name is Aditazz, and it is based in San Bruno. The article also said ther

were three contest winners. Two of the three firms teamed for one of two winning entries.

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8/2/2019 Payers & Providers California Edition Issue of April 5, 2012

3/8

!"#$%!&'!()*(!+!()*(!,-!./-0#1!2!.#34$50#1!.6,%$17$89'!::;

Page 3Payers & Providers

Longer ALOS!*

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(877) 248-2360, ext. 2

*For our ads, not your hospital

In Brief

According to the report releasedby the Ofce of the Patient Advocate,only 13% of adults and adolescentsreceived appropriate treatment within30 days of being diagnosed.

This is the equivalent of getting13 out of 100 on a test, and nobodyshould nd that acceptable, said

Phillip Greer, executive director ofthe California Treatment AdvocacyFoundation. The score is disgracefulbut sadly not a shock given that for solong health plans have routinelydenied those suffering from substanceabuse access to the care they need.

Greer added that many healthplans have imposed heavy co-payments and deductibles onenrollees seeking substance abusetreatment. His organization hasproposed broadening a bill currentlyin the Legislature, AB 154, that wouldexpand mental health services toinclude similar services for those withsubstance abuse issues.

Medical Societies WarnAgainst Excessive

Testing

An afliate organization of the Boardof Internal Medicine and eight othermedical societies have ofcially comeout against unnecessary medicaltesting, claiming it causes cost to risewithout a commensurate return onhealthcare outcomes.

The group of medical societiessay that unnecessary testing costsupward of $250 billion a year, andthat the money could be better spentelsewhere on other facets of care.

Among the procedures singledout for potential overuse are x-rays forlower back pain (it recommendedwaiting six weeks before orderingthem), prescribing antibiotics for sinusheadaches, pap smears for womenunder the age of 21,electrocardiograms as part of annualcheckups and pre-operative x-rayswhen a patient is ambulatory or hasnot other conditions suggesting otherrisks.

entered into settlement negotiations with the

entities in late 2010.However, SCAN noted in documentatiothat it was unsure whether a settlement will bmade, or if the company or any of itsemployees might face criminal charges.

SCAN has 130,000 enrollees inCalifornia. California Watch rst reported lassummer that the plan was under investigationafter state Controller John Chiang had accusethe plan of eecing as much as $339 millioafter his department had conducted an audit

Should SCAN reach a settlement near thamount it set aside, it would be one of thebiggest recoveries in the history fo the Medi-

Cal program, according to California Watch.

Long Beach-based SCAN Health Plan has

disclosed that it has set aside $125 million tosettle allegations that it overbilled the Medi-Cal and Medicare programs.

The disclosure, rst reported onWednesday by the investigative websiteCalifornia Watch, was included in anapplication SCAN submitted to state regulatorsto serve 54,000 Medicare enrollees in LosAngeles, San Bernardino and RiversideCounties.

SCAN has been under parallelinvestigations by the U.S. Department ofHealth and Human Services Ofce of theInspector General, the U.S. Attorney General

and the California Attorney General. It

NEWS

Robot Surgery Has Better OutcomesUCLA Says Patient Mortality, Complications Lower

SCAN Health Plan Sets Aside $125MMoney May Be Used to Settle State, Federal Probe

A new study by UCLA researchers and partlyfunded by the U.S. Department of Defenseconcludes that the use of robots to assist inbladder cancer surgery lowers mortalityrates.

The research team examined records ofmore than 1,400 traditional surgeries toremove cancerous bladders versus 224robotic-assisted procedures. The procedureswere performed at 1,050 hospitals in 44states during 2009, the most recent year forwhich information was available.

The traditional surgeries were linked toa 2.5% mortality rate during hospitalization.

The robotic-assisted procedures wereassociated with no mortalities at all. Andwhile patients who underwent thetraditional procedure experiencedcomplications at a rate of nearly 64%, the

complication rate among robotic-assistedprocedures was only 49.1%.The average length of hospital stay for

both procedures was exactly the same: eightdays.

The robotic procedures also cost anaverage of $3,000 more. That was no surpriseto the researchers, who factored in longeroperation times, greater use of disposableinstruments and equipment maintenance.

"While we expected to see greaterexpenses associated with the roboticprocedure for bladder cancer, we weresurprised to see the signicant reduction in

deaths and complications, particularly thisearly in its adoption," said the study's seniorauthor, Jim Hu, M.D., the UCLA School ofMedicines director of minimally invasiveurological surgery.

HEALTHCARES BEST ADVERTISING VALU]

PAYERS & PROVIDERS reaches 5,000 hospital, health plan and noprot executives statewide. There is no better venue for marketin

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8/2/2019 Payers & Providers California Edition Issue of April 5, 2012

4/8

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Payers & Providers PageOPINION

A Ballot Initiatives Lasting LegacyProp. 71 Will Lead to Future Stem Cell Breakthrough

Jim Lott is the executive vice president of

Hospital Association of Southern California

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In a sign of our populist, ballot box-driventimes, Kamala Harris received more than 90proposed statewide voter initiatives prior tocirculation for signature gathering to qualifyfor the November election. Certainly, not all ofthem will nd their way to theballot (26 is the current record).

Still, one has to wonderwhat the late Gov. HiramJohnson the early 20thcentury father of our statesinitiative, referendum, andrecall system would say if hesaw how his idea of givingCalifornia voters a degree ofdirect democracy is beingexploited.

Of those initiatives placedon the ballot since the initiativesystem was created in 1911,which would have been

Johnsons favorites and leastfavorites? Would this liberalRepublican have embracedProposition 13, the 1978initiative that robbed localgovernment of access to the well ofproperty tax revenue to dip ever deeper

into to fund ever-increasing demand forcostlier local services?Similarly, how would Johnson have felt

about Proposition 98, which when approvedin 1988, grabbed about half of the statebudget for schools? Though perhaps he wouldhave supported the other Proposition 98, theone that proposed limitations on the use ofeminent domain and the prohibition of rentcontrol that failed passage in 1998.

Of this Im certain, Johnson and theProgressives of the time would have heartilyembraced Proposition 71, which was passedin 2004. Fifty-nine percent of the voters in

that election authorized $3 billion in bonds tofund stem cell research in California.That proposition passed during a

presidential election year. It was a clearrejection of then President George W. Bush'simposition of his personal ideology on federalfunding for stem cell research.

The eventual product of Proposition 71was the California Institute for RegenerativeMedicine.

As stated on CIRMs website, stem cellshave incredible potential to treat disease.Embryonic or iPS cells can turn into any cell

in the body, creating an endless resource foreplacing diseased or damaged tissue. Stecells within our own bone marrow, brains,muscles and other tissues can repair damaafter injury if properly activated. In a lab d

stem cells can mimic humandiseases, pointing the way tnew drugs. The challenge generating a new therapy iswhether or not the cells canthe job, its understanding tbest way to get the job don

After overcoming legalchallenges in 2006, CIRM since set up shop. It has maCalifornia home to the rstclinical trials based onembryonic stem cells. Theagency has funded the effoof more than 450 Californiascientists with more than $billion. It also recentlyannounced a collaborationwith leading research scienin South America. Thats in

addition to existingcollaborations with Canada, the UniKingdom, Germany, Australia, Japan,

China and India.All of CIRMs work has a single goal:Develop new stem cell-based therapies foincurable diseases and injuries. Forty-threeprojects are now in various stages of progrtoward helping people with chronic diseasand conditions in California and worldwidBecause of Proposition 71, we are closer toobtaining effective therapies if not cures fochronic, debilitating and costly diseases likdiabetes. And its not beyond the possibilisee patients with spinal chord injuries todabe freed from their wheelchairs and otherconnements in their lifetimes.

This is a terri

c gift to the quality of lifhumankind. And for any naysayers out thethis investment will do more than all otherinterventions combined to reduce the risincost of healthcare plaguing our nation.

ByJim Lott

Op-ed submissions of up to 600 words ar

welcomed. Please e-mail proposals to

editor@payersandproviders.com

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8/2/2019 Payers & Providers California Edition Issue of April 5, 2012

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MARKETPLACE/EMPLOYMENTPayers & Providers Page 5

MAY 17-20, 2012DESERT SPRINGS JW MARRIOTT, PALM DESERT

Register Now For The2012 CAPG ANNUAL

HEALTHCARECONFERENCE!Online Registration Ends May 3rd

Join 1400+ attendeesfor this comprehensive healthcare event.

Keynote speakers include:Donald Berwick, M.D.

Shannon Brownlee

Harold Miller

www.capg.org/conference2012

IF YOU PLAN TO ATTEND ONLY ONE CONFERENCE IN 2012, MAKE IT THIS ONE!

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8/2/2019 Payers & Providers California Edition Issue of April 5, 2012

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Payers & Providers MARKETPLACE/EMPLOYMENT Page 6

SENIOR HEALTHCARE ANALYST

JOB SUMMARY: This position will support the HCC andEncounter Team in Health Care Informatics by collecting and ana-lyzing healthcare related data by performing data management,quality improvement studies and by conducting statistical analysisand generating reports for the organizations decision makers.

ESSENTIAL JOB RESULTS: Support operational needs byperforming complex analyses on a wide range of organizationaldata - investigate and uncover root causes, identify trends, etc.

and propose solutions. Achieve results by effectively leverag-ing expertise in healthcare/managed care data including, butnot limited to, membership, provider, claims, authorizations,pharmacy, and financial information. Commitment to customerservice achieved through timely, accurate, and supportabledeliverables. Support customer needs for what-if scenarioanalysis by developing analytical tools/models. Ensures under-standing of customer needs by proactively clarifying scope andrequirements and keeps customers apprised of project statusthrough effective communication. Achieves high-quality deliv-erables by assuring accuracy and thoroughness in executingprojects. Manages multiple (department) projects by effec-tively prioritizing work and communicating workload issues tomanagement. Develops and maintains up-to-date knowledge

of the Data Warehouse and other organizational data sources.Maintains professional and technical knowledge by attendingeducational workshops; reviewing professional publications;establishing personal networks; participating in professionalsocieties. Contributes to team effort by accomplishing relatedresults as needed.

QUALIFICATIONS: Bachelors Degree, or equivalent experiencerequired. 4+ years of proven analysis experience highly pre-ferred, or 2+ years of proven analysis experience in a Healthcare/Managed Care environment highly preferred. Ability to effec-tively interact with, and present findings to customers at all levelsof the organization including operational managers, medical direc-tors and executives required. Proficiency with MS SQL (queries)highly preferred. Clinical code knowledge related to claims/utili-

zation highly preferred. Experience with managed care contractterms/analysis a plus. Experience in a Medicare Advantage envi-ronment a plus. Experience with MS BI products a plus. Expertskills in MS Office productivity software, especially MS Excel.Excellent technical, interpersonal, written and oral communica-tion skills required. Superior analytical skills required.

FT position, M-F 8 AM to 5 PM, with extended work hours andpossible travel, as needed. Apply to www.scanhealthplan.com

Job Opportunities Req. #11-540

MARKET EXPANSION PROFESSIONAL

JOB SUMMARY: Plan, design, and complete processes t

achieve business objectives for network and membershgrowth via market expansion. Manage and perform a broarange of tasks using resources effectively and efficiently tmeet identified timeframes for planned product and servicexpansions. This includes coordination of efforts and collabortion with external entities to meet all regulatory requiremenand to ensure market expansion filings are fully compliant anapproved.

ESSENTIAL JOB RESULTS: Coordinate and execute completasks related to network and membership growth via markeexpansion, in order to ensure the successful completion oongoing cycles of work. Utilize detailed work lists to managthe timely completion of tasks for each phase of a particulamarket expansion process and provide necessary updates t

management, escalating risks as appropriate. Develop anmaintain positive relationships with internal departments anexternal entities, creating partnerships to achieve prograobjectives. Effectively communicate and assign deliverableand timelines. Monitor and manage the assigned tasks tachieve timely completion. Monitor quality of tasks peformed, develop and recommend process improvements foimplementation. Assure a quality market expansion proceoutcome by making sure that each finished task meets threquired level of quality. As needed, troubleshoot issues anprovide innovative solutions, focused on continuous qualitimprovement. Maintain professional and technical knowledgby attending educational workshops; reviewing professionpublications; establishing personal networks; participating professional societies. Contribute to team effort by accom

plishing related results as needed.

QUALIFICATIONS: Bachelors Degree required. Preferred areof study: Business or Health Administration, Managemenor Process Engineering. Experience within HealthcareManaged Care, preferred. Demonstrated interpersonal skilwith the ability to compromise, persuade, and negotiatbe well-rounded and have excellent communications skillSolid leadership skills, excellent written and verbal communications skills and ability to establish effective workinrelationships with many different people, ranging from managers, supervisors, and professionals, to administrative ansupport staff personnel. Analytical, detail-oriented, flexibland decisive. Ability to coordinate several activities at onc

quickly analyze and resolve specific problems, and managdeadlines. Ability to work with minimal supervision, so neeto be self-motivated and disciplined. Expert skills in MOffice productivity software and strong computer skills aressential.

FT position, M-F 8 AM to 5 PM, with extended work hours andpossible travel, as needed. Must maintain valid drivers license,

automobile insurance and reliable transportation. Apply towww.scanhealthplan.com - Job Opportunities Req. #12-612

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8/2/2019 Payers & Providers California Edition Issue of April 5, 2012

7/8

6

!"#$%!&'!()*(!+!()*(!,-!./-0#1!2!.#34$50#1!.6,%$17$89'!::;

Page 7Payers & Providers MARKETPLACE/EMPLOYMENT

Since 1959, Presbyterian Intercommunity Hospitalof Whittier has been committed to building a mutu-ally supportive health care team consisting ofpatient care givers, medical staff, volunteers and theboard of directors that have ensured our local popu-lation the highest quality of medical services in Los

Angeles County.

Our Home Health & Hospice departmentis currently seeking an

ASSISTANT DIRECTOR OF PATIENT SERVICES.

The Assistant Director of Patient Services is respon-sible and accountable for services provided topatients through Home Health and Hospice. Withdirection from the Director of Patient Services, theAssistant Director will assess and assist the Director

in all areas of operations, compliance, professionalstandards and IDS relationship.

Requirements include: Bachelors degree in Nursingor other health-related field. Valid CA RN license;BLS certification. At least 7 years of experience,5 of which must be in a home health agency. 3years of experience in a supervisory or administrativecapacity. Able to direct nursing, therapy and socialwork within the framework of regulations to care forpatients while understanding the rationale of rule-making in the industry. Must have an active interestin improving current level of skill and knowledge.

Beyond the benefits that come with working forthe areas leading community health care provider one that also recognizes the need to ensure patientsafety and comfort youll enjoy an extremely com-petitive compensation and benefits package. Plus,we use team concepts to encourage professionalgrowth and development.

Please apply online at www.pih.net,or recruitment@pih.net.

Providence is calling aSENIOR FINANCIAL ANALYST OF REPORTIN

BUDGETING & PRACTICE ANALYSIS

to Providence Medical Institute, Torrance, CA.

In this position you will: Develop and maintain monfinancial reporting, prepare the annual budget, and supOperations management to identify and resolve finaopportunities in physician practices. The position willcreate, manage and track results of the annual OperaBudgets. Analyze physician compensation based on methodology.

Required qualifications for this position include:10 years of experience within a large healthcare orgation. Bachelors Degree in Accounting or Finance. Stanalytical skills with and expertise in using MicroOffice Access, Excel, PowerPoint, & Outlook. KnowledgLawson Financial Software.

Preferred qualifications for this position incluPhysician Compensation Analysis experience. MedGroup experience.

Providence Health & Services Southern California is furdeveloping its physician integration strategy. Historithe largest asset has been Providence Medical Institumedical foundation that provides administrative and osupport services to affiliated medical groups. ProvidMedical Institute is expected to grow significantly innext several years, bringing with it facilities, staff and sician growth to support that objective.

PROVIDENCE IS CALLING!

For immediate consideration, qualified candidates areencouraged to apply on-line at www.ProvidenceIsCalling.

Apply Onlinehttp://bit.ly/providence06640Healthfax

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