22 March 2011
Midwest Edition
Calendar
April 6-8
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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.
McRaith Named to Federal Post
Illinois Dept. Head to Lead New Insurance Office
Michael T. McRaith, the Illinois director of insurance since 2005, was named on Thursday to be chief of the
new Federal Insurance Ofce, charged with overseeing parts of the Dodd-Frank nancial reform act.
The appointment was announced by Treasury Secretary Timothy Geithner during a meeting of the
Financial Stability Oversight Council. McRaith will serve as a non-voting member of that body. The new
ofce will come under the umbrella of the Treasury Department.
The new ofce will be largely advisory and will not have regulatory power as such. It will compile
reports and analysis, make recommendations to federal agencies on insurance matters, and will have a
limited preemption power over state rules that affect international insurance. McRaith was the subject of a
cover interview in last week’s issue of Payers & Providers. Asked about the likelihood of his being appointed
to the federal post, he declined to comment, except to add that “the creation of this ofce is a signicant
step forward for the country. It involves an intersection of insurance regulation with other nancial sectors.
Health insurance is specically excluded.”
Below is Part 2 of an extensive interview he gave on March 11, just prior to his appointment.
‘We’d Like Health Insurance Consumers to Have
the Same Rights as Auto or Homeowners Policyholders’
!!!!!!!!!!!!!!!!!!!!Y9/>3()2!9>;(/:3
What can you tell us about educating policymakers about
policy rescissions in Illinois? this problem.
On our web site is a study by We’d like health insurance
the National Association of consumers to have the same
Insurance Commissioners of the rights that they have as auto
largest carriers in all the states, or homeowner insurance
looking for rates of rescission. By policyholders in Illinois. You
volume Illinois was highest in the have the right to a hearing with
country. It was 48% higher than the department based on the
the No. 2 state, California. On a cancellation of the auto or
per capita basis Illinois was homeowner policies. A health
second to New Mexico. The insurance policyholder does
notable coincidence is that Blue not.
Cross of New Mexico is owned Under the reform law, how
by Health Care Services Corp., does the core underwriting
which also owns Blue Cross of function change? WellPoint,
Illinois.
for instance, has regarded its
What are your policy tools to ght this? underwriting prowess as a source of
Illinois law reposes with the insurer very competitive advantage.
broad discretion. The federal law, active Sept. The companies will still have to price based
23, 2010, limited the grounds on which on anticipated risk. The factors on which that
rescissions can occur to fraudulent statements pricing can be based, though, will be limited
on the application by the applicant. That’s a to age, geography, and smoking status. No
signicant improvement. We remain
concerned, because the insurers in our state
have demonstrated an inability to act in a
responsible manner with respect to
rescissions. We continue to engage in Continued on Next Page
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 Payers & Providers
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Bottomless Potential
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In Brief
Medical Error Kills
Prominent Chicago
Business Leader
The death of one of Chicago’s most
well-respected business leaders last
week has been attributed to a “never
event” that occurred in the University
of Chicago Medical Center.
James Tyree, 53, chairman and
CEO of Mesirow Financial, a
diversied nancial services
company with $51 billion in assets
under management, died March 16
of an air embolism after removal of a
dialysis catheter, according to a
Chicago Tribune report, citing the
Cook County Medical Examiner’s
Ofce.
An intravascular air embolism can
obstruct a vein or artery and can
occur during a medical procedure. In
some cases it can be absorbed into
the blood, but in patients with
complications or underlying
weaknesses of the heart or lungs, it
can be fatal.
Tyree had suffered from diabetes
for 25 years and had received a
kidney and pancreas transplant in
2006. He was diagnosed with
stomach cancer in the fall and had
been hospitalized last week with
pneumonia.
Tyree organized the investor group
that purchased the Chicago Sun-
Times newspaper when it was in
bankruptcy and on the verge of
collapse in 2009, and was the
newspaper group’s chairman.
Tyree was prominent in civic
organizations in Chicago, and
donated more than $500,000 a year
to diabetes charities and research. He
had served on the board of the
University of Chicago Medical
Center.
Continued on Page 3
NEWS
McRaith Interview, Part 2 (Continued from Page One)
longer will health status or gender be driving
factors in the cost of insurance.
Having said that, the limitation on risk
factors for pricing means that many
companies will have to be large enough to
withstand some risk volatility in the
policyholder pool. The ACA does allow for risk
adjustment.
For example, if Company A and Company B
each have 100,000 policyholders, and at the
end of the year Company B has a high number
of transplants, serious illnesses, babies born
early, ICU before death -- higher claims
experience overall -- then there would be a risk
adjustment. After the fact, insurers who have
higher risk proles will be reinsured by other
participants in the market.
We want to encourage companies to
participate, encourage them to price fairly and
not defensively. If a company is concerned that
it might have a highly risky policyholder base,
it might price more defensively than would be
fair to employers and to families. The risk
adjustment allows this company to be
supported in the market by other companies
that have a healthier policyholder prole.
So there would be some kind of pool?
It’s retrospective, and it can also be
prospective. It’s intended right now for plans
sold on the exchange as a way of incentivizing
companies to participate. Those companies
will support one another and help assure that
no one company assumes too much risk.
The exchanges are primarily intended for
individuals and small businesses, where there
would theoretically be the highest volatility in
claims experience.
Medical loss ratios are capped at 80%. Is this
realistic? Won’t insurers be able to game this?
We have heard that concern since the law
passed. At NAIC, states from all over the
country worked together to develop a standard
by which the 80% will be judged. It’s not
ideologically driven. The numerator is pay-
ments by insurers for health care. The denom-
inator is premiums paid to insurers, less taxes.
We expect most responsible companies
will adhere to the standard and to the
regulation on this topic. It’s possible there will
be companies that try to abuse it.
The number, 80%, is high for many
companies. For small employers and
individuals, it is very difcult for smaller
companies to satisfy. The larger companies, the
UnitedHealthcares and Blue Crosses, can get
to it more easily.
For a company that has 20,000 individual
policyholders, a relatively small bloc, the
volatility from year to year can be tremendous.
For larger companies, it is not going to be as
disruptive. We do believe the loss ratio rule is
going to be helpful to consumers.
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Page 2
This will be regulated on the state level. Is
there an opportunity for insurance companies
to play one state against the other, in terms of
tightness of regulation?
That certainly happens today. But the loss
ratios are calculated on a state by state basis,
not a national basis.
Does it apply exclusively to individual and
small policies, or all policies?
For large-group policies the threshold is
85%. That’s a function of the law of large
numbers. For large employers with 5,000 to
10,000 people insured, it’s much easier to hit a
loss ratio of 85%.
Waivers have been in the news recently. Maine
just requested and received a waiver of the
MLR cap. Does this weaken the impact of the
law?
The law allows the state to request a waiver
if the imposition of the loss ratio would result in
disruption of the individual health insurance
market.
The Maine superintendent determined that if
the companies writing individual health
insurance in Maine had to meet an 80% loss
ratio in 2011, it would be disruptive to the
market. Families and consumers seeking
individual insurance would have fewer options.
What’s the likelihood of a disruption in Illinois?
We’re evaluating data that we received and
intend to make an announcement one way or
another in the near future.
Will Illinois have its own insurance exchange?
The department has engaged with 200
different interested parties, through formal
working groups, and interactions. The decision
that the state should establish its own exchange
is unanimous. The other contours of that
exchange, however, are less unanimous, and
remain open items.
A bill will be introduced soon to establish a
quasi-state agency with an independent board
of directors to operate an exchange. If that law
passes, that board would provide
recommendations to the state legislature, as the
legislature decides whether and how the
exchange should operate.
It would be like a public authority model?
Yes. No members of the legislature or
executive branch would serve as voting
members. Not the director of the Department of
Insurance. There would be ex ofcio members,
such as legislators, serving on the board, but not
as voting members.
The development of an exchange involves
thousands of decisions, large and small. We
want to be of service to the legislature as it sorts
through those difcult issues.
Payers & Providers
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In Brief
Judge Bars Wisconsin
Budget Law from
Entering into Effect
A Wisconsin judge issued a temporary
restraining order prohibiting the
recently passed state budget law from
being implemented. The budget bill
contained provisions to shrink labor
union negotiating rights and to re-
quire public employees to pay more of
their health benet costs, as reported
in Payers & Providers on March 15.
Judge Maryann Sumi, of the circuit
court in Madison, said she plans to
hold a hearing in April on a lawsuit
that claims Republican legislators
failed to honor the Wisconsin open
meetings law in their rush to pass the
bill, which was ercely opposed by
Democratic lawmakers and their labor
union allies.
HealthPartners Mails
Food Coupons to
Alter Eating Habits
About 80,000 people insured through
HealthPartners in Minnesota will soon
receive coupons in the mail giving
them discounts on healthier foods. But
these won’t be discounts on beets,
bok choy, or quinoa.
Instead, they’ll get coupons for
things like sugar-free Jell-O, diet
V-8, or high-protein pasta – all
processed foods.
The idea is to encourage people to
make easy, step-by-step changes in
their diets, instead of expecting them
to switch from high-salt, high-fat diets
to healthy fruits and veggies in one
leap. Such a dramatic change in
eating habits isn’t likely to happen,
experts say.
An associate medical director at
HealthPartners said that approaching
lifestyle changes in absolutists terms
doesn’t generally work.
Members with diabetes will
receive packets of coupons targeting
low-sugar foods, while those with
high blood pressure will get coupons
for low-sodium items.
NEWS
Ohio Governor to Reform Medicaid
Kasich Favors Outcomes Measures in Payments
Medical providers in Ohio will see their
payments reduced under a budget proposal
unveiled last week by Gov. John Kasich, a
Republican.
Medicaid spending would increase but the
health system would be restructured with the
intent to save $1.4 billion over the next two
years, compared to what would have been
spent by the state. More than 2 million Ohioans
are covered by Medicaid, and it accounts for a
third of state spending. The state faces an $8
billion budget decit, assuming no changes to
Medicaid.
The governor’s proposal would continue to
pay for dental and vision care for poor people,
and would shift funding toward home care and
away from nursing homes. By contrast,
hospitals, physicians, nursing homes, and
managed-care plans would sustain
reimbursement cuts totaling almost $1.1 billion
over two years.
Kasich wants providers to practice outcome-
based medicine. Under a suggested pricing
system, quality of care will gure in the
payment amount.
In his introductory letter, Kasich said that
Medicaid had come to be regarded as the “third
rail of budget policy. A perpetual unwillingness
to tackle the difcult work of trying to contain
programs’ costs may have appeased certain
inuential groups but it has only led to higher
and higher tax burdens for Ohioans and
MedPAC Suggests 1% Rate Rise
Advises Tighter Rein on Home Health, Hospice
The Medicare Payment Advisory Commission
has recommended that hospitals and
physicians receive a 1% payment increase in
2012. The advisory to Congress came as part
of MedPAC’s annual March review for
payment updates.
The commission also targeted home health
agencies and hospice providers for enhanced
scrutiny. It said Secretary of Health and
Human Services Kathleen Sebelius should
alter the home health payment system to
enforce quality guidelines and introduce
prospective payment methodologies. HHS
should change the payment to hospices so
they receive more per diem at the beginning
of a stay than at the end.
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Page 3
broken, less responsive programs for
vulnerable Ohioans. That mindset ends with
this budget.”
Without reforms, Kasich said, Medicaid
costs would rise by 15.4% over the next two
years and crowd out other priorities. “Such
runaway growth isn’t the hallmark of a
compassionate society but of a neglectful one.
Making sure Medicaid is sustainable allows
the care that vulnerable Ohioans need to
continue, and gives taxpayers the
accountability they deserve,” he wrote.
The Ohio Hospital Association said the
policy changes would probably reduce
payments to hospitals by $478 million. The
association supported the governor’s proposals
by proposing to extend the hospital franchise
fee, which had been due to expire. The fee
helps the state obtain matching funds from the
federal government and will raise $1.2 billion
in extra revenue.
“Hospitals look forward to working with
the administration and Ohio General
Assembly to achieve a mutual goal to
transform healthcare in Ohio,” said
association President James R. Castle.
The Ohio State Medical Association also
pledged to work with the governor’s ofce on
the budget. The Ohio Health Care
Association, the lobby for nursing homes, said
the budget “threatens the quality of care for
the most vulnerable among us.”
MedPAC suggested that the Ofce of the
Inspector General should review activities in
“counties that have aberrant home health
utilization” and should suspend payment and
enrollment of new providers where signicant
fraud is found. OIG should also look into
nancial relationships between hospices and
long-term care facilities, to see whether
conicts of interest are inuencing admissions
to hospice, and also investigate hospice
marketing and admissions practices.
The commission recommended rate
increases of 0.5% for ambulatory surgical
centers and 1% for outpatient dialysis, but no
increase for inpatient rehabilitation and long-
term care hospitals.
Payers & Providers
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OPINION Page 4
Medical Homes Work for Docs, Too
Learnings from Blue Cross Blue Shield of Michigan
Many payers are actively promoting patient- incentivize implementating medical home
centered medical home (PCMH) initiatives processes. When the practice has made enough
through planning and development assistance, progress, its physician organization can nominate
staff training, and ongoing nancial support. it for PCMH designation. Currently, 11,000
Blue Cross Blue Shield of Michigan (BCBSM) physicians participate in the program.
has the largest PCMH program of its kind in the Results. BCBSM’s early results illustrate the
country and has been a leader in primary care impact that the routine application of PCMH
innovation. This article describes the work of principles can have on cost. In 2010, BCBSM
the BCBSM’s medical home designated 500 primary care
program and their early results, practices throughout Michigan,
and suggests next steps for those and the designated units have
contemplating a PCMH. 23% lower cost for ambulatory-
Why Medical Home? care-sensitive conditions, 23%
Medical homes have been lower pediatric and 7% lower
proven to promote continuity adult hospital readmission costs,
and coordination of patient care and 52% lower self-referral rate
by establishing a continuing for low-tech imaging by the
relationship with a primary care primary care physician
physician. The medical home What Makes a PCMH?
addresses wellness care and BCBSM has identied those
seeks to prevent unnecessary characteristics that are essential
emergency room visits and for PCMH sucess and has
hospital readmissions. These organized them in 12 domains,
results are primarily driven by which are similar to those
the use of evidence-based identifed by other organizations
guidelines to improve chronic
disease management, care
By Claire F. Heideman evaluating and designating
medical homes. To be eligible to
coordination, and to advocate participate in the PCMH
a culture where the patient is responsible for initiative, each practice seeking designa-tion is
managing his or her health. evaluated based on more than 100 criteria.
According to Jann Caison-Sorey, M.D., Practices are also evaluated based on quality
senior medical director, PPO and Care metrics that focus on use and efciency, such as
Management at BCBSM, medical homes help generic drug dispensing, emergency-room use for
bring evidence-based medicine to the forefront. primary-care treatable conditions, and
PCMH is reteaching providers about the compliance with national preventive-care
importance of a systematic approach to patient guidelines. The quality metrics and the PCMH
care and helps them stay current with treatment elements each count as 50% of the overall
recommendations. “Evidence-based medicine practice score. Once PCMH designation is
is the wave of the future,” said Caison-Sorey. achieved, enhanced reimbursement for ofce
“Either it is going to drive improvements in the visits and care coordination is provided to ensure
quality, coordination, and delivery of health continued viability.
care, or health care will be unaffordable.” BCBSM learned the value of PCMH in
Development Support for the Medical transforming the healthcare system and has been
Home Model. According to Margaret Mason, in the forefront of propagating the model by
MHSA, Health Care Manager, Clinical Program partnering with Michigan physicians. They have
Development of BCBSM, 60% to 70% of also recognized that there are many ways to
Michigan physicians belong to one of the 40 achieve PCMH designation, and their framework
BCBSM-designated physician organizations. allows practices to carve their own path. The
These organizations have access to the success of PCMH in Michigan suggests that the
Physician Group Incentive Program (PGIP) model will continue to gain traction.
through which PCMH development is funded.
Investment in IT infrastructure, health coaches,
Claire F. Heideman, FACHE, is senior consultant
and physician leadership are examples of how
with The Camden Group in Chicago.
funds are spent. Funding is intended to
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Payers & Providers MARKETPLACE/EMPLOYMENT Page 5

HEALTHCARE CONSULTING OPPORTUNITY

Project Manager / Senior Consultant

For Consulting Practice
Health Dimensions Group is one of the nation’s leading rms advising hospitals, post acute providers and managed long
term care providers in all aspects of post acute operations. We are leading the development of innovative care models
that will thrive under a reformed health care system.

The Project Manager will have a high degree of direct client interaction, be responsible for managing multiple projects,
and participate in the business development and sale of consulting projects.

Responsibilities include preparing and managing projects to include: strategic plans and feasibility studies for a range of
post acute providers, such as long term acute care hospitals, rehabilitation hospitals, skilled nursing facilities, and
assisted living communities. In addition the Project Manager will be involved with PACE (Program for All-Inclusive Care
for the Elderly), as well as health care reform planning projects and operational reviews.

The position requires a Masters degree in business or related eld and a minimum of 5 years of consulting and/ or
hospital, post acute or managed care planning or operational experience. Prior consulting experience in long-term/acute
care preferred. Health Dimensions Group is based in Minneapolis, MN, but this position may be home based and work
from any location as the job will require substantial travel to work with clients throughout the nation.

Health Dimensions Group is a values driven organization and offers a competitive wage and benet package. Please
send resume to: hrinbox@hdgi1.com.

Human Resources
Health Dimensions Group, Inc.
4400 Baker Road, Suite 100
Minneapolis, MN 55343
Phone: 763-537-5700

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Payers & Providers MARKETPLACE/EMPLOYMENT Page 6

VICE PRESIDENT OF MANAGED CARE

Established over half a century ago, Indianapolis, Indiana based Community Health Network ("the Network") is a leading not-for-
prot health care system. A member of the VHA, the Network is focused on improving the health and well-being of Indiana
residents. The Network is comprised of 5 hospitals, 90 sites of care, 5 nursing homes, Indiana's largest home care company, 15
ambulatory surgery centers in Indiana and Michigan, 500+ physicians and nurse practitioners, including a 250+ member primary
group practice; and is supported by more than 11,000 employees. The Network ranks among the top integrated health care
networks in the nation; and has the prestigious distinction of being among the top most wired health systems for the past ten
years.

Indianapolis is the state capital of Indiana and is Indiana's largest city; the 14th largest city in the U.S., and the fastest growing
region in the Midwest. Indianapolis has a diversied economy, contributing to the elds of education, healthcare, and nance.
Tourism is a vital part of the economy of Indianapolis, and the city plays host to numerous conventions and sporting events. Of
these, perhaps the most well known are sporting events such as: the annual Indianapolis 500, the outstanding Colts football and
Pacers basketball games. Indianapolis is in close proximity to many recreational sites, state parks and beautiful lakes. The
population of the metropolitan area is estimated at more than 2,000,000.

The Vice President for Managed Care plans, develops, and executes strategic initiatives that optimize linkage among Community,
payers, and provider networks and products. Specic responsibilities include:

• Developing a vision of the optimal relationship of the Network with each prospective payer partner.
• Designing strategies and initiatives to optimize linkage among the Network, payers, and provider networks and products.
• Building and strengthening professional and organizational relationships with payers, employers, and business coalitions.
• Providing leadership for the operational and nancial analysis and evaluation of payer and provider contracts.
• Serving as the chief negotiator and organizational spokesperson in contract negotiations with payers and provider
networks.
• Spearheading Network discussions with the appropriate internal clinical and administrative constituencies to determine
optimal contract terms, including quality and nancial performance standards.

Successful candidates will have a Bachelor' Degree, and will also possess the following:

• At least ten years of experience working in developing and strengthening payer-provider relations, including contract
negotiation experience.
• Demonstrated excellent relationship and communication skills.
• Demonstrated strength in inspiring condence with internal and external constituencies.
• Demonstrated ability to engage colleagues in deliberations about issues, challenges, and positioning, with an interest in
listening and achieving consensus on direction.
• Demonstrated ability to incorporate quantitative research as key element of payer negotiation strategies.

Prospective candidates should submit a cover letter and resume by March 31, 2011 to:

Annie Freeman
8180 Clearvista Parkway, Suite 109
Indianapolis, In 46256
amfreeman@ecommunity.com
!

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Payers & Providers MARKETPLACE/EMPLOYMENT Page 7

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! !

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

will do it for a lot less.

Employment listings begin at just $1.65 a word

Call (877) 248-2360, ext. 2

Or e-mail: advertise@payersandproviders.com

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

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Payers & Providers MARKETPLACE/EMPLOYMENT Page 8

SEEKING A NEW POSITION?

CAN HELP.
We publish advertisements for those seeking
new career
opportunities for just $1.25 a word.

If you prefer discretion, we’ll handle all

responses to your ad.
Call (877) 248-2360, ext. 2, or e-mail
advertise@payersandproviders.com.

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