Payers & Providers California Edition – Issue of March 8, 2012

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

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In Brief

Scripps Study LinksSleeping Pills To Higher

Rates of Cancer,Death

Researchers at the Scripps Clinic in

San Diego have linked a reliance oncommonly prescribed sleeping pillsto an elevated risk of cancer anddeath.

Death rates among patients 18years and older were elevated 3.6times even when they wereprescribed as few as one sleeping pillper year.

Among those who wereprescribed 132 or more sleeping pillsper year the risk of cancer waselevated by about 35%.

The study focused on the eightmost commonly prescribed hypnoticdrugs, including Ambien and Restoril.

"We tried every practical

strategy to make these associations goaway, thinking that they could be dueto use by people with more healthproblems, but no matter what we didthe associations with higher mortalityheld," said Robert D. Langer, M.D.,of the Jackson Hole Center forPreventive Medicine in Jackson,Wyoming.

Langer co-authored the researchwith Scripps physicians. It wasrecently published in the journal BMJOpen.

Kaiser Plans To Reduce

Greenhouse EmissionsBy Nearly A Third

Kaiser Permanente has announced abold new plan to reduce its carbonemissions by nearly a third by 2020.

Kaiser said it would achieve thereduction by investing in clean andrenewable energy sources while alsofocusing on conservation. It is usingcogeneration technology at its

Continued on Page 3

NEWS

For years, the Department of Managed HealthCare has posted copies of enforcement actions

against health plans, medical groups andunscrupulous insurance agents on its website.More than 1,400 are available, with a dozenor so new actions routinely added everymonth.

That routine abruptly halted in mid-October. DMHC spokespeople gave vagueexplanations as to why. One mentioned awebsite redesign; another of errors involvingsome of its enforcement actions.

It turns out in its zeal to be transparent,the regulator had indeed erred.

According to documents obtained byPayers & Providers as part of a Public Records

Act Request, the DMHC had posted thecondential medical information of sevenpeople enrolled in Medicare Advantage planswho had provided information to the agencyas part of its investigations into unscrupulousbusiness practices. Another individual hadled a grievance against Anthem Blue Crossof California.

DMHC spokesperson Marta Bortnerconrmed earlier this week that a breach hadoccurred. She said the documents werenormally posted for the public but had beeninsufciently redacted. They were takendown immediately after the error wasdiscovered last October, she added.

The seven Medicare Advantage enrolleeshad been victims of agents who had enrolledthem in new plans using deceptive marketingpractices and sometimes without theirconsent. In many instances the change leftthem without access to their regularphysicians and thousands of dollars of medicalbills they would not have had with theiroriginal coverage.

One agent, Stuart Chesler of Marina DRey, had been the subject of a cease and

desist issued order by the agency in March2010. Another agent, Brenda Ridley ofBakerseld, had been the subject of a similaorder in March 2011. Agents Dinah SalcidoVictor Chervin and Sandy Rosales hadreceived orders in September 2011.

The DMHC had disclosed to theindividuals that in posting the documentatioof the orders, their normally condentialmedical information had been revealed,including the names of their physicians, themedical conditions and the medications thewere taking. In the case of the Anthemenrollee, a medical procedure they had

received was disclosed.None of the enrollees had their full

medical records posted.Along with the enrollee disclosures, the

DMHC had also disclosed the Social Securinumber, birthdate and previous address of ainsurance agent it had ordered to stop sellinpolicies last fall due to his agencys deceptivmarketing practices and his failure to disclostate and federal criminal convictions.

The name of the agent was redacted in correspondence released by the DMHC, buother information available conrmed it wasHussein Osman Ali of Fresno.

The DMHC had played up the ordersagainst Chesler and Ali in press releases, anhad recently held an extensive pressconference on the subject of deceptivepractices among brokers of MedicareAdvantage plans. In recent years it had taken

DMHC Admits Consumer BreachVictims Medical Data Was Posted On Agency Sit

Barriers (Continued from Page One)

neighborhoods and promote varioushealthcare options and services in Spanish.

Both Gans and Wu indicated that

ofcials with the nascent Health BenetsExchange are committed to aggressivelymarketing its services in linguistically andculturally sensitive manner.

The exchange board seems to be verycommitted to target these populations, and tryand make the transition process from current

to future programs smoother, Gans said. Peter V. Lee, the exchanges executivedirector, was out of town on Wednesday andnot immediately available for comment.

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Page 3Payers & Providers

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NEWS

In Brief

hospitals and installing more energyefcient lighting and window lms,among other efforts.

According to data released bythe Oakland-based hospital operator,it released 837,000 metric tons ofgreenhouse gas emissions in 2010,versus 819,000 tons in 2008. It

projects it will reduce its emissions by264,000 metric tons a year by 2020.It is our responsibility to reduce

our impact on the environment sothat we can better protect people'shealth, said Raymond J. Baxter,Kaisers senior vice president forcommunity benet. Our efforts tominimize our impact on the climatereect a commitment to the totalhealth of our members and ourcommunities.

CDC Says ManyAmericans Are

Struggling With MedicalDebt

New data released by the Centers forDisease Control and Preventionconclude that one in ve familiesduring the rst half of 2011 wasexperiencing nancial burdens due topaying medical bills. About 10% oftotal families could not pay theirmedical bills at all.

People in lower income bracketswere three times more likely to havetrouble paying their medical bills overthe past year than other incomebrackets surveyed.

It was the rst time the CDC hasqueried Americans over medical debt.Its numbers are similar to thosearrived at in recent years by theWashington-based Center forStudying Health System Change.

"As the number of uninsuredincreased, and there was higherunemployment, you'd expect thatmore people would report havingproblems paying medical bills," saidthe CSHSCs Peter Cunningham.

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unauthorized charges. In Alis case, itrecommended ongoing credit monitoring,although it did not offer to pay for the servic

Attempts at telephonic contact to theindividuals were also made, Bortner said.

At least one of the victims has led alawsuit against the DMHC. Bortner could nprovide any details about the litihation.

As a result of the error, the DMHC hasstopped posting ongoing enforcement actioIt has created new internal policies forredacting documents prior to posting.

Bortner said the postings of newenforcement actions may not resume until tspringtime at the earliest.

disciplinary actions against more than 20brokers after documenting illegal sales tactics.The agency is also investigating numerousdata breaches disclosed by insurers.

In the DMHCs case, the sensitiveinformation remained publicly available on itswebsite for as long as seven months, althoughin most instances it was posted for about amonth beginning in mid-September, accordingto documentation.

In November, the DMHC sent disclosureletters containing expressions of regrets orapologies to the enrollees and an apology toAli. It recommended that the victims monitortheir explanations of benets for any

Health Net Revamps Low-Cost PlanAdds Enrollees, Access to Complementary Care

Health Net has revamped one of its low-costhealth health maintenance organizationproducts, adding wellness incentives forenrollees and opening up access tochiropractors and acupuncturists.

The insurers Bronze HMO has beenrenamed SmartCare. The Bronze HMO is anarrow network health plan, wherein theprovider panel is considerably smaller than a

traditional health plan in order to cut costs.As part of the retooling, enrollees will

receive nancial incentives to engage in whata statement called healthy habits.

Health Net spokesman Brad Kieffer saidthe plan is to provide enrollees with a $50retailer gift card if they visit their primary carephysician and ll out a health riskquestionnaire. Such a document allowsproviders to obtain a fuller prole of apatients personal habits and makerecommendations to improve their overallhealth.

The idea is to increase the level ofengagement with the providers, Kieffer saidnoting that many enrollees do not often visitheir physician.

In addition to the gift card incentive,enrollees will have access to as many as 10chiropractic or acupuncturist visits per yearwith a $15 co-payment.

The SmartCare plan will be used in

conjunction with 40 medical groups in LosAngeles, San Bernardino and San Diegocounties.

They share our vision of creating strategprovider partnerships that, in many cases, wresult in effective accountable careorganizations delivering care that is personasimple and local, said Steve Sell, presidentHealth Nets western region.

SmartCare will be available to small anlarge employer groups. It is expected to cossome instances to cost as much as 25% lessthan other Health Net HMO products.

DMHC (Continued from Page Two)
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Payers & Providers PageOPINION

Having The HENS Rule The HenhouseHospital Engagement Networks Can Cut Errors, Deat

Michael Millenson is president of Health

Quality Advisors LLC in Highland Park, Ill. H

a member of the Payers & Providers Midw

editorial board. A version of this op-ed firs

appeared in Kaiser Health News

(www.khn.org).

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MARKETPLACE/EMPLOYMENTPayers & Providers Page 5

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 organizational

data - 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 membershigrowth 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 collaboration with external entities to meet all regulatory requirementand 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 tmanagement, escalating risks as appropriate. Develop anmaintain positive relationships with internal departments anexternal entities, creating partnerships to achieve programobjectives. Effectively communicate and assign deliverableand timelines. Monitor and manage the assigned tasks tachieve timely completion. Monitor quality of tasks performed, develop and recommend process improvements foimplementation. Assure a quality market expansion procesoutcome 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 professionapublications; establishing personal networks; participating i

professional societies. Contribute to team effort by accomplishing 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 skillwith the ability to compromise, persuade, and negotiatebe well-rounded and have excellent communications skillsSolid 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, flexibleand 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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Payers & Providers MARKETPLACE/EMPLOYMENT Page 6

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. 2Or e-mail: [email protected]

Or visit: www.payersandproviders.com

*New England Journal of Medicine, 2004.

SUPERVISOR, CLAIMS RESOLUTIONThis position assists in the day-to-day supervision of Claimsstaff and claims work flow ensuring that all claims are adju-dicated within appropriate time frames. This position willtrain Claims staff and advise management on opportunities toimprove claims processing procedures. Medicare claims pro-cessing experience is required. Must have detailed knowledgeof claims coding and forms and the ability to correctly interpretand communicate claims processing rules, regulations, and

procedures to staff and external customers. 3 years of experi-ence in a medical managed care claims processing environmentand 1 year of supervisory experience is required. A High SchoolDiploma and relevant experience is required with a B.S. degreepreferred. Excellent salary & benefits.

DIRECTOR, APPLICATIONS & CONFIGURATIONThis position will oversee the application portfolio and be respon-sible for the overall functionality and configuration of systemsthat support the organization. The position will also manage theperformance and functions of analysts who are responsible forconfiguration including planning, reviewing and controlling activi-ties of project team members. Will also identify solutions thatresult in high quality, cost effective support to all levels of usersincluding support for both the technology and business processes.

Must have a minimum of 7 years managerial and professionalexperience in the applications or information systems field andtechnical work experience in positions such as configuration/development analyst, business analyst, systems analyst, etc., in amanaged care organization. Excellent salary & benefits.

Alameda Alliance for Health is a public, not-for-profit managed

care health plan for lower income people in Alameda County.

The Alliance provides healthcare coverage to over 130,000children and adults through four programs: Medi-Cal, Healthy

Families, Alliance Group Care, and Alliance CompleteCare.

Please visit our website at www.alamedaalliance.org and click on the Careers buttonfor more specific job information and toapply for these positions. EEO.


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Page 7Payers & Providers MARKETPLACE/EMPLOYMENT

SEEKING A NEW POSITION?

CAN HELP.

We publish advertisements for those seekingnew career

opportunities for just $1.25 a word.

If you prefer discretion, well handle allresponses to your ad.

Call (877) 248-2360, ext. 2, or [email protected].

DIRECTOR OF PROVIDER NETWORK

DEVELOPMENT & SERVICES(Managed Care)

The Health Plan of San Mateo (HPSM), an innovative Medicaid Medicare health plan, seeks a strategic thinker and doer to gdevelopment of its network strategies as it embarks on signifinew program ventures and prepares for health reform. Reporto the Chief Executive Officer and as a senior manager of the onization, the Director will maintain responsibility for the stratdevelopment and management of HPSMs provider network, inclucontracting, compliance, quality, provider relations, and associactivities and data analysis; and provide direction to department sRequires a Bachelors degree in Business Administration, HealthAdministration or a related field; a Masters degree is preferreyears contracting and network development/management experiin a managed care setting (HMO, IPA/Medical Group or equivalen

a senior management level.

Please visit www.hpsm.org for more information about the posand the excellent benefits offered. For immediate consideration, sua resume and cover letter with salary expectations to: Health PlaSan Mateo, Human Resources Department, 701 Gateway Blvd., S400, South San Francisco, CA 94080. Email: [email protected]. (650) 616-8039. Phone: (650) 616-0050. EOE

MDS Consulting is a national health-care consulting firm with substan-tial healthcare management experi-ence working in and with hospitals,medical groups, health systems,and other healthcare organizations.Qualified candidates should email

their rsums and expectations [email protected]

VICE PRESIDENT OF PHYSICIAN SERVICES

MDS Consulting is seeking a consulting leader that is highly experi-enced in medical group, medical foundation, and physician practicedevelopment and operations. The successful candidate will havedepth of knowledge regarding compensation plans, informationtechnology, organizational structure and finance related to medi-cal groups, IPAs, and ACOs. Development skills in client relations,team management, communications, and report writing a neces-sity. Position located in Southern California and requires a Mastersdegree in related field and at least 10 years of related experience.

SENIOR MANAGER OF PHYSICIAN SERVICES

The Senior Manager of Physician Services manages client engage-ments related to medical group operations, physician/hospitalalignment models, physician contracts, compensation and fairmarket value studies, etc. Candidate will have excellent ana-lytic and communication skills and a strong financial background.Masters degree with at least 5 years of related experiencerequired. The position is based in Los Angeles.

Payers & Providers California Edition – Issue of March 8, 2012

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