15 February 2011
Midwest Edition
Calendar
February 15
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E-Mail
info@payersandproviders.com with
the details of your event, or call
(877) 248-2360, ext. 3. It will be
published in the Calendar section,
space permitting.
Reform May Prompt Coverage Drops
Survey Reveals Misgivings on Probable Cost Trends
As Midwestern employers have become more
familiar with the health reform law passed
almost a year ago, they have grown more
pessimistic on how it will affect their health
care costs, according to a recent survey.
As a result, a startling number of employers Boress said.
--22% across the whole survey -- are now
considering dropping health
insurance coverage for
employees entirely. Among
employers with 50 to 500
workers, 30% are either “likely”
or “very likely” to terminate
coverage and let workers buy
individual insurance on the new
exchanges.
“We didn’t think it would be
that high,” said Larry Boress,
president and CEO of the
Midwest Business Group on
Health, based in Chicago,
which commissioned the
survey. It was 10% to 12%
when the law rst came out, he
added.
The survey, taken in the rst
two weeks of December, shortly after 7(**&!M-*)++
the Congressional midterm election,
sought to identify how large employers’
understanding of the Patient Protection and
Accountable Care Act had altered since an
earlier survey in April 2010. In the months
since then, employers have been able to do
more modeling and forecasting of the law’s
impact on their costs.
Today, the majority expects their costs
would go up even higher than if healthcare
reform had never even passed, Boress said in
an interview with Payers & Providers.
The survey included responses from 437
U.S. employers. Three-quarters of the
employers had more than 50 workers, and
26% had more than 2,000.
Other key ndings:
* Strong support for quality and payment
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reform measures in the law.
* Employers’ focus on wellness will continue
to expand.
“There’s a real belief that if you can keep
people healthy, you can keep costs down,”
Employers are responding in different ways
to the law’s provisions, the
survey revealed. Forty-three
percent of employers have
already increased deductibles or
employee premiums, or have
cut back benets in 2011 in
anticipation of the cost
increases imposed by the new
law. But they are not making
major alterations in retiree
coverage. “We thought the law
would undermine retiree
coverage. Not the case,” Boress
said.
Respondents liked the law’s
emphasis on value-based
benet design, with 62%
favoring its retention and 19%
hoping for repeal. They also like the
idea of paying providers based on
quality and performance instead of
individual units of care, with 55% in favor and
21% for repeal. The medical home concept
found 50% in favor and 26% wishing for
repeal.
A relatively small percentage of
respondents, ranging from 20% to 35%,
depending on the size of the enterprise, think
the law’s cost and quality provisions will
reduce health care costs in the long term.
Those employers who intend to drop
health insurance coverage will not necessarily
increase wages or base salaries to help them
buy insurance on the new exchanges, which
Continued on Next Page
 Payers & Providers
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In Brief
Former Minn. Governor
Predicts Failure of
Obama Reform Law
Tim Pawlenty, who just finished two
terms as a Republican governor of
Minnesota, predicted that the
health reform law passed almost a
year ago will suffer a financial
collapse in about 15 years.
“The healthcare debate is
really a proxy for the larger
political debate overall,” said the
Republican hopeful in the 2012
presidential contest. He spoke in
early February at the City Club of
Chicago during a book signing tour
of the Midwest. The reform act was
“based on a bunch of flawed
assumptions and cooked numbers,”
he said.
The country will have to face
its entitlement problems head-on if
it wants to salvage the economy, he
said.
Most Local Markets
Dominated by 1 or 2
Payers, AMA Says
A new survey by the American
Medical Association found that
99% of health insurance markets in
the U.S. are “highly concentrated,
based on the definition used by the
U.S. Justice Department. In 48% of
metropolitan statistical areas, one
insurer had more than 50% market
share, the AMA found.
The survey was the 2010 edition
of Competition in Health Insurance:
A Comprehensive Study of U.S.
Markets.
“The market power of health
insurers places physicians and
patients at a significant
disadvanage,” 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 Obama
administration. Twenty percent said they
probably would boost pay, but 36% said
they probably wouldn’t.
That nding contradicts a widely held
belief among economists and consultants
that the costs of health benets are in
reality being diverted from wages, and that
if benets costs could be reined in, wages
would rise.
Employers showed a deep skepticism
about the law’s ultimate purpose. Asked
whether they thought the law’s intent was
to dismantle the employer-based insurance
system and move the population into a
single payer system, 60% said yes, and
only 20% said no. Smaller employers were
more likely to agree with the statement
than large employers.
Employers, How will health reform affect your benefits costs?
0% 10% 20% 30%
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
Further Erosion in Employer Insurance
Percent of Population Covered Hits New Low: 44.8%
The percentage of Americans receiving health
coverate through their employer declined to a
new low of 44.8% in November, according to
a Gallup poll. In January 2008, when Gallup
began tracking it, the rate was 50%.
About 26% of the population receives
healthcare through government sources, the
survey said. The percentage of people with
government-provided care or insurance
(Medicare, Medicaid, or military and veterans
benets) rose from 22.5% in January 2008.
Nearly one in six (16.1%) said they did not
have health insurance at all. The rate of
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Page 2
The survey didn’t inquire whether
respondents support or don’t support the
reform law.
“My feeling is, they would have preferred
it never passed,” Boress said. “They’re really
concerned about all the burdensome
administrative costs that have been added
onto employers, and potential taxes. That’s
where they see the costs going up.
“Employers believe the system should
have been xed rst, and deal with quality,
safety, payment methodologies, before you
start covering another 32 million people.”
The survey can be obtained through the
Midwest Business Group on Health, at
www.MBGH.org. The organization’s 100
members spend more than $3 billion on
health benets annually and cover more than
3 million lives.
40%
Source: Midwest Business Group on Health
uninsured jumped in late 2008, from 14% to
15.8%, when the recession hit and mass
layoffs deprived many people of health
benets. Since then, the rate has stayed
roughtly constant, in the range of 16% to
16.8%.
The increase in the rate of government-
provided care may derive in large part from
the beginning of the baby boomer generation
becoming eligible for Medicare, as well as the
unemployment rate, which pushes people
toward relying on Medicaid. The poll is based
on a telephone sample of 27,218 adults.
Payers & Providers
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In Brief
“When insurers dominate a market,
people pay higher health insurance
premiums than they should, and
physicians are pressured to accept
unfair contract terms and corporate
policies, which undermines the
physician role as patient advocate.”
The AMA said the public and
regulators should seriously
question proposed mergers by
health insurers.
Ohio Nurses Produce
‘Just Culture’ Guide
The Nursing 2015 initiative in Ohio
has published a Just Culture guideline
on the Web for registered nurses.
The toolkit is a collection of resources
for use by hospitals and nursing staff
interested in implementing a Just
Culture in their working
environments.
“Just Culture” is a set of values and
norms about how people should
behave and make decisions when
people make errors or near-misses in
the medical setting. Just Culture
encourages open reporting and
participation in prevention activities,
and acknowledges that errors are
often the result of system failures, and
works to support process
improvement.
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 into
policy at St. Rita’s Medical Center in
Lima, Ohio. Videos on patient safety
are also provided. A decision tree
helps nurses understand the difference
between individual accountability and
organizational accountability.
The Nursing 2015 program aims to
transform the profession of nursing
in Ohio. Facing a predicted 19%
shortfall in nurses by 2015, the
initiative is trying to improve the
nursing work environment, alter care
delivery patterns, and reinvigorate
nursing education and leadership.
NEWS
Illinois Expands State Insurance Plan
Higher Premiums for Pre-existing Conditions Option
Illinois is offering new options for state residents
with pre-existing conditions. The state will now
make available a $1,000 deductible plan to
people who have been uninsured for six months
or longer. Previously, the only option was a
$2,000 deductible plan.
The Illinois Pre-Existing Condition Insurance
Plan, known as IPXP, will charge slightly more
in monthly premiums for the new option. A 45-
year-old Chicago resident who is a non-smoker
would pay $323 a month, compared with $280
a month for the higher-deductible plan.
IPXP was launched last August and has
signed up more than 1,000 people so far. It is
part of the federal push to enroll more people in
Hospital Labor Costs Continue to Rise
2.1% Increase Exceeds Rate For Overall Economy
The total cost of employing a hospital worker
in the U.S. went up 2.1% in 2010, compared
with a 2% increase for workers in the general
economy, according to the Bureau of Labor
Statistics’ Employment Cost Index.
Wages and salaries increased 1.6% in
2010. The survey doesn’t make a separate
estimate on benet costs. Wages and salaries
in hospitals usually comprise about 70% of
compensation costs.
Over the past 10 years, hospital
compensation costs have followed a steadily
diminishing rate of increase, starting at 6.3%
in 2001. In the same period, the growth in
hospital wages and salaries has fallen from
5.9% in 2001 to 1.6% in 2010, the federal
government said.
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Page 3
high-risk pools. Nationally, those pools
registered about 8,000 new enrollees by Nov.
1, which is seen as a disappointment to those
who lobbied for the plans. Congress
appropriated $5 billion to fund the high-risk
pools as part of the Affordable Care Act.
Michael McRaith, the state’s insurance
department chief, said Illinois’ relatively
affordable premiums gave the IPXP plan the
highest or second-highest enrollment in the
country.
The state wants to unveil a plan with a
$5,000 deductible in the summer.
For the economy as a whole,
compensation for civilian employees rose 2%
in 2010, an increase from 1.4% in 2009. The
rate of increase for wages and salaries was
1.6% in 2010 and 1.5% in 2009. For benet
costs, the rate of increase was 2.9% in 2010,
up from 1.5% in 2009. The BLS said the
increase was due to retirement costs.
Hospitals still created 50,100 jobs in
2010, which was almost twice as many jobs as
they created in 2009. The overall healthcare
sector created 265,800 jobs in 2010.
The BLS looked at 63,000 occupational
data points chosen from 12,900 private sector
employers, and 11.500 data points taken from
1,800 bureaus in state and local governments.
]
Payers & Providers
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OPINION Page 4
Health Reform is Worth Defending
Advocates for the law must step up their efforts
As anticipated, an effort to repeal health reform many critics have stooped to baseless attacks to
was defeated in the U.S. Senate in early oppose the law. Some critics call health reform a
February, largely along party lines. Even if the job-killer, although there is no evidence to
repeal effort had passed both chambers, support their claim. The nonpartisan
President Obama was expected to veto the bill Congressional Budget Ofce says that health
once it arrived on his desk. In the face of efforts reform is unlikely to raise insurance premiums for
to derail the nearly year-old law, advocates most businesses, and repealing it could increase
must continue to educate the public and the country’s decit by $230 billion over the next
policymakers about its benets. 10 years.
One in ve Americans under Challenges to the Affordable
the age of 65 has a pre-existing Care Act have also been built
condition, according to a report around the disputed constitutionality
published last year. That’s one of the law’s individual mandate.
out of every ve of your Thirteen cases brought before
neighbors who might be denied district courts have been dismissed
health insurance because of a outright. But two judges have
mental illness, cancer, or other declared the mandate
chronic disease. In our current unconstitutional, including a district
health care system, one in court judge in Florida who threw
seven applications for health out the law in its entirety.
coverage from the largest As differing opinions mount, it is
insurers is denied for a pre- likely that the nal verdict on the
existing condition, with pregnancy By Anna law will rest with the U.S. Supreme
one of the reasons given for denial. Lambertson Court. But the inevitability of that
For these Americans denied court’s hearing the case has not deterred
affordable coverage, the day-to-day uncertainty some states from pursuing constitutional amend-
of how they will receive and afford treatment ments to exempt their citizens from the individual
without coverage and how they will get their mandate. In 2010, the Missouri House of Re-
prescriptions lled, is stressful. The nancial presentatives passed an early resolution against
and emotional security of entire families is the mandate. The vote came just days before the
affected. ACA passed Congress. Conservative leaders in the
Health reform will put an end to this Kansas House introduced a constitutional
scenario, as insurance companies will no amendment that failed in 2010 but was
longer be able to deny coverage for pre-existing reintroduced this year. A key health committee of
conditions. Ending these unfair denials will the Kansas House passed the proposed
help give peace of mind to hundreds of constitutional amendment two weeks ago.
thousands of hard-working Americans. This is It is clear that efforts to stop health reform will not
just one example of how health reform can end with last week’s vote by the U.S. Senate. But
help us, our co-workers and our neighbors. ongoing challenges to the law only rekindle the
In Kansas, the health reform law is already commitment of advocates to press forward in
improving the lives of ordinary people. More educating consumers and our elected ofcials
than 30,000 Kansas seniors received rebate about the merits of health reform. We will not
checks to help them purchase medications stop. We want families throughout the Midwest to
once they reached the cut-off point at which keep the consumer protections they have waited
their Medicare drug plans no longer pay so long for and so richly deserve.
benets. As of January 1, seniors on Medicare
can now receive preventative health benets
without co-pays or deductibles. Being able to Anna Lambertson is executive director of the
have wellness checks, mammograms and other Kansas Health Consumer Coalition, which
preventative measures gives comfort to seniors advocates for affordable care.
and their families and helps avoid costly
treatment for preventable illnesses that can Op-ed submissions of up to 600 words are
now be detected early. welcomed. Please e-mail proposals to
Despite the benets of health reform, dmoore@payersandproviders.com,
!!!"#$$!%&!'(&)*+!,!'*-./0)*+!'1%2/+3/456!778
Payers & Providers MARKETPLACE/EMPLOYMENT 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, nancial
and regulatory challenges involved in the management of pharmacy cost and utilization. Responsible for the supervision and
management 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 experience
in third party reimbursement, formulary and clinical programs. Government program experience (Part D and Medicaid) is
desirable. Previous experience in pharmaceutical rebates/discount contracting negotiation with pharmaceutical manufacturers.
Previous 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 communicate
issues to physicians, pharmacists, employers, administration, and Health Alliance staff. Ability to create and utilize cost benet
analysis (pharmacoeconomics) of therapeutic selection and available alternatives. Must be able to anticipate and take corrective
action in response to changes in pharmacy regulations, prescribing patterns, new therapeutic technologies, etc. Ability to
maintain a credible professional image with physicians and drug manufacturers. Must be adept at persuasion and direct
confrontation. Working knowledge of claims systems, pharmacy operations, and managed care required. Ability to positively
address issues from dissatised enrollees and pharmacists.

Contact:
Lesley Schacht
Professional Recruiter
Human Resource Services
Carle and Health Alliance Medical Plans
lesley.schacht@carle.com
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 effective
operations.
• Ensure cost effective programs are developed and maintained throughout the business unit.
• Identify operational efciencies 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 Medicare
managed care operations with emphasis on nance and information technology preferred. Project management, administration
or operations in the Healthcare industry preferred. Master’s degree preferred.

Contact:
ES&P SEARCH!!!!
Sonia Varian at (818) 707-7118, or espsonia@pacbell.net

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-)!B)&%!3;#-!)-%!;)5&:!/#77!4)-!M;+-AB#-!#3!VWWE<XVE<YZ=I!%F3:!>I!)&!%EB#+7!;+B!#3!%,+3)&[2#$%&'#-,2&)*+,%&':9)B:!
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Payers & Providers MARKETPLACE/EMPLOYMENT Page 7

It costs up to $27,000 to fill a healthcare job*

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Or visit: www.payersandproviders.com
*New England Journal of Medicine, 2004.

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