Passport Health Plan Appoints New Medical Director

Dr. James Mumford hired effective January 30, 2012

 February 29, 2012 Louisville, Kentucky – Passport Health Plan is pleased to announce that Dr. James Mumford has accepted the position of Medical Director effective January 30, 2012. Dr. Mumford is joining the Plan’s medical affairs team and will be responsible for improving the Plan’s quality and clinical processes. Dr. Mumford was most notably a previous surveyor for the National Committee for Quality Assurance (NCQA).

Dr. Mumford is also a seasoned pediatric executive with extensive medical management experience from McNeil Consumer Products in Fort Washington, PA; FHP health plan in Ogden, Provo and Salt Lake City, Utah; Humana in Louisville KY; United Healthgroup/AmeriChoice Health Services in Philadelphia, PA and most recently Carolina Healthcare Clinics in Union, South Carolina. He has also served as a pediatrician in Hazard, KY.

Dr. Mumford is a published author of “How to Cut Your Children’s Medical Costs,” and received his Masters of Business Administration and MD degrees from the University of Utah. He also holds a Bachelor of Science degree in Chemistry from the University of Utah. Dr. Mumford has a lovely wife and eight children.

“We are excited to have Dr. Mumford join us. He’s an accomplished clinician and physician executive who brings a wealth of knowledge and experience, particularly related to quality health outcomes,” said Dr. Stephen Houghland, Chief Medical Officer for Passport Health Plan.

Dr. James Mumford

New Passport Medical Director Dr. James Mumford

Passport Health Plan is a unique public private partnership with the Commonwealth of Kentucky as a provider-sponsored, community-based, member-focused Medicaid health plan that serves more than 170,000 members in 16 Kentucky counties. The Plan has operated successfully over the past 14 years. The counties of service include Breckinridge, Bullitt, Carroll, Grayson, Hardin, Henry, Jefferson, Larue, Marion, Meade, Nelson, Oldham, Shelby, Spencer, Trimble and Washington. Passport Health Plan is sponsored by the University of Louisville Medical School Practice Association, University of Louisville Hospital, Jewish and St. Mary’s Healthcare, Norton Healthcare, and the Louisville/Jefferson County Primary Care Association, which includes the Metro Louisville Department for Health and Wellness and Louisville’s two federally qualified health centers, Family Health Centers and Park DuValle. For additional information, please visit www.passporthealthplan.com.

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Private Insurers look at 1%

February 27, 2012

At-Risk Patients Gain Attention of Health Insurers

By

Who doesn’t want to be in the top 1 percent of wage earners, political discomfort aside?

No one, though, is especially envious of another group of 1 percenters: the heaviest users of health care.

One percent of patients account for more than 25 percent of health care spending among the privately insured, according to a new study. Their medical bills average nearly $100,000 a year for multiple hospital stays, doctors’ visits, trips to emergency rooms and prescription drugs.

And they are not always the end-of-lifers. They are people who suffer from chronic and increasingly common diseases like diabetes and high blood pressure.

As the new federal health care law aims to expand care and control costs, the people in the medical 1 percent are getting more attention from the nation’s health insurers.

“The huge opportunity is the at-risk people who are chronically ill,” said Dr. Alan Muney, the chief medical officer for Cigna, a large health insurer. “The problem in the health care system today is there is often too little too late or too much too often.”

Studies have already shown that Medicare spending is concentrated on a small group of individuals who are seriously ill. But an analysis by the IMS Institute for Healthcare Informatics, the research arm of IMS Health, a health information company in Danbury, Conn., provides a rare glimpse into the medical problems of people with private health insurance who are under 65. About three-quarters of them suffer from at least one chronic condition that could spiral out of control without proper care.

Health insurers are likely to have little choice other than to monitor these cases more closely, said Daniel Malloy, an executive at IMS Health. Under the federal health care law, which is expected to go into effect in 2014 if it is not struck down by the Supreme Court, insurers will no longer be able to deny coverage to anyone with a potentially expensive medical condition or put limits on how much they will pay in medical bills.

And avoiding these patients altogether will no longer be an option. Insurance companies will be required to enroll millions of new customers without the ability to turn them away or charge them higher premiums if they are sick. They will prosper only if they are able to coordinate care and prevent patients from reaching that top 1 percent, Mr. Malloy said. “The insurance model is fundamentally changing,” he said.

Many insurance executives say they are already developing programs to better address the needs of these patients. The insurers often work with employers that are self-insured to manage their workers’ medical conditions, and companies are already demanding they do what they can to control costs.

“Once we’ve got patients, we’re responsible,” said Dr. Lonny Reisman, the chief medical officer for Aetna, another large insurer. “We’ve always managed them as aggressively and effectively as we can.”

Insurers are becoming increasingly sophisticated in being able to identify those who are high spenders and those who are at risk of developing serious complications. “It’s important to know who they are and manage their conditions,” said Dr. Pat Courneya, the medical director for the health plan offered by HealthPartners, a large health system based in Bloomington, Minn., which is a client of IMS. People with high medical bills often continue to be costly throughout the years, he said.

While diabetes, for example, typically costs about $12,000 a year to cover, a diabetic whose condition rages out of control can become one of the top spenders with expenses that average $102,000 a year, according to the IMS report. Uncontrolled, their diabetes may lead to a heart attack or stroke or they may lose their eyesight or have a limb amputated.

When Wendy Meath, a 59-year-old with diabetes, was hospitalized a year ago, she was identified by HealthPartners as someone who needed help to control her disease. She had been admitted for kidney stones, one of many possible complications of diabetes. Although she had insurance through her husband, she was unemployed.

Since leaving the hospital, where she was admitted for 12 days for a series of complications from the surgery to remove the stones, Ms. Meath has been in regular contact with one of HealthPartners’ nurses, who serves as a case manager. The nurse calls at least once a month and checks in after she goes to the doctor for any developments. The health plan also assigned a social worker to help her with the cost of medications and other obstacles that were preventing her from taking better care of herself. “It makes me feel like I’m not alone,” Ms. Meath said.

“They’re trying to prevent the big things from happening, which is great,” she said.

The next challenge, say insurers, is to figure out how best to work with a person’s doctor. Because many of these patients seem to be seeing many doctors and taking many medications, there may be no one who is accountable for the patients’ overall health. “You’re going to see some gaps in care that led to this kind of progression,” Mr. Malloy said.

Insurers say they are experimenting with different ways to pay doctors so they are more responsible for overseeing these patients. Cigna, for example, says it plans to pay doctors more to coordinate care or develop ways for the doctors to share in the savings generated when someone does not go to the hospital if the visit could have been avoided through better treatment.

But insurers are also still grappling with their understanding of human nature — why some people simply don’t take care of themselves or take their medicine or go to the doctor, even when it is clear that they should.

Aetna, for example, recently eliminated the co-payments in some of its health plans for certain medicines for people who have recently suffered a heart attack. In a recent study, however, many patients who got these medicines free were still not taking them.

“The reality is if we don’t figure out how to get to the patients, we’re not going to get where they need to be,” Dr. Reisman said.

 

The Incidental Economist on H.C. Exchange

What will consumers make of health insurance exchanges?

I and many others lament that the new health insurance exchanges won’t be operative until 2014. Millions of uninsured Americans need help now. It’s heartbreaking that so many need to wait.

In part, exchange implementation was delayed to hit ten-year budget targets valued by moderate and conservative Democrats. Yet implementation was delayed for other reasons, too. Elected officials and policymakers understood that there will be a myriad of political and administrative challenges—not to mention various administrative glitches–as the new exchanges come online. Behind closed doors, many Democratic office-holders were happy to see these challenges and glitches put off beyond the 2012 presidential election.

The challenges and glitches won’t arise because the Affordable Care Act was poorly crafted; they will arise for other two reasons, called to mind by a recent story in the conservative webzine Daily Caller. First, one must implement really complex regulatory and assistance policies across fifty states. And because health reform is the centerpiece initiative of a Democratic president, it will be implemented in a politically polarized environment that will permit few administrative fixes. That’s a reality of American politics.

Second, we don’t exactly know what millions of Americans who will participate in the new exchanges will think about the insurance they will secure. Exchanges will be a balm for the medically uninsured, previously-uninsured people, and for many others paying high administrative costs and (perhaps) extra premiums due to health difficulties in the individual and small-group market. If you wonder whether this is a real problem, visit the cancer ward of any large public hospital.

The economic and political calculus will be more complicated for millions of others: people now gambling by going without coverage, relatively healthy people (especially those under 30) who will now pay community-rated premiums to support coverage, millions of others who may pay a bit more in premiums because they will be purchasing a richer package of coverage that will actually cover an essential package of care in the event of costly illness.

Myles Miller, writing in Daily Caller, highlighted these issues in a recent story, pugnaciously titled: Obamacare architect: Expect steep increase in health care premiums. Last year, officials in Wisconsin, Minnesota, and Colorado hired Gorman Actuarial and noted MIT economist Jonathan Gruber to help examine the impact of ACA on health insurance markets. Drawing on a Powerpoint presentation prepared in Wisconsin, and companion pieces for Minnesota and Colorado, Miller writes that these reports “offer a drastically different portrait in 2012 from the one Obama painted just 17 months ago.”

These Powerpoints are worth reading alongside Miller’s original story. Not surprisingly, Miller focuses on the politically unpalatable findings:

During his presentation to Wisconsin officials in August 2011, Gruber revealed that while about 57 percent of those who get their insurance through the individual market will benefit in one way or another from the law’s subsides, an even larger majority of the individual market will end up paying drastically more overall.

The Daily Caller’s Miller underplays more favorable findings. On average, the financial benefits to those whose premiums will decline are larger than the changes for those whose premiums will rise. After accounting for affordability credits, average premiums fall in each state.

As Gruber notes by email, “ALL of this analysis refers only to those who were already buying nongroup insurance.  It completely ignores the enormous reduction in premiums for people who were shut out of the market because they were sick.”

Miller’s piece also exemplifies the partisan divide in its limited discussion of the uninsured. The word “uninsured” occurs once, in a quote from Gruber. Yet all three Powerpoints note dramatic declines in the ranks of the uninsured and the large average financial transfers to households that join the new exchanges. In Wisconsin, the ranks of the uninsured are projected to drop by 65%, (340,000 people). The corresponding projections for Colorado and Minnesota are 55% (480,000 people) and 58% (290,000 people), respectively. I didn’t see household finance numbers for Wisconsin. The average estimated financial impact of the exchanges in Colorado was $790 per family. In Minnesota, the comparable improvement is $500 to $700 per household.

Gruber adds an especially interesting wrinkle, noted in an email to the Daily Caller he graciously forwarded to me:

CBOs analysis did not account for states folding their high risk pools into the exchanges, but in each of these three states that happens. So for example in Minnesota this is about a 15% rise in rates, which explains most of the increase. But it is important to remember that states are currently spending a lot of money to support these high risk pools (more than $100 million in MN).  If this money were instead directed to the exchanges, it could greatly reduce any premium impact [from] merging in the high risk pools.

Once again, those high risk pools bring mischief in health reform. These pools include highly- concentrated groups of individuals with costly and complex health concerns who may be quickly folded in the new exchanges, even as these exchanges incorporate millions of uninsured and other participants entering from the small-group and individual insurance markets.

Miller’s piece rather crudely frames health reform from the perspective of its political opponents. It still raises important points. The political and perceptual issues it raises are fundamental in health reform. Millions of people will join health insurance exchanges. Most will be relatively healthy. They will see certain relatively small and immediate things, such as contraceptive coverage and clinical preventive services. They will not (yet) experience chronic illness and thus the resulting interactions with their insurer. They will pay slightly less or slightly more for a richer, more transparent and secure package of health coverage.

Will they perceive and value the improved actuarial value of this insurance? Two years ahead of time, it is impossible to answer this basic question.

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Posted by on Sat, Feb 25, 2012.

Medicaid troubles in Illinois

From this week’s Greg Hinz

A liberal’s lament: Medicaid ‘is screwed up’

By Greg Hinz February 27, 2012

Ask Julie Hamos about Medicaid and, within about 10 seconds, she starts sounding like a GOP presidential candidate.

“The system is going bankrupt. It’s going to collapse. I really believe that,” she says. The traditional fee-for-service medical delivery system “is killing us,” and key stake-holders are gaming a program filled with “abuse.” She concludes, “It’s soooo screwed up.”

 Read more of Greg Hinz on his blog.

Good right-wing red meat, no? The only thing is Ms. Hamos is a liberal Democrat from the North Side. And in one of those odd twists that life sometimes throws, the former union lobbyist and state legislator is the lady in the bucket on the crucial task of somehow saving a Medicaid system that is nearly drowning Illinois in red ink.

As director of the Department of Healthcare and Family Services, Ms. Hamos, 63, has been tasked by Gov. Pat Quinn to hammer out a deal to slash spending by $2.7 billion this year, the minimum she says is needed to pay overdue bills and get spending back to a sustainable level. Though Ms. Hamos got the job about two years ago and pushed through some changes last year, it’s only now that Mr. Quinn has decided that reining in Medicaid outlays is a priority.

Mr. Quinn’s shift may have something to do with a recent report by the Civic Committee of the Commercial Club of Chicago that says Illinois is on track to tote up a staggering $21 billion in Medicaid IOUs by fiscal 2017. Whatever. Ms. Hamos’ job is to avoid that fate, against long to extremely long odds.

How does she intend to do that?

Ms. Hamos already has gone after the Obama administration, challenging federal bureaucrats whom she says are making it needlessly difficult to keep ineligible people from getting government-supplied health insurance.

Ms. Hamos has
circulated a $3.5 billion
menu of cuts.

But the main attack now—one that’s drawing a fierce counterattack from almost every medical special interest group in Springfield—is a $3.5 billion “menu” of possible cuts that she has been circulating.

Increased use of managed care—the state already has a goal of enrolling 50 percent of Medicaid recipients in lower-cost managed care—could save $750 million, she says. Reducing eligibility to focus the system more narrowly on the poor rather than the near-poor cuts another $70 million, and slashing reimbursement rates across the board is valued at $550 million. Then there’s possible cost-sharing, like co-pays for certain services.

But the really big money, she says, would come from dropping certain services that the state offers but is not required to offer by federal law, such as pharmaceutical coverage ($800 million), hospice care ($100 million) and medically unnecessary nursing home treatment ($50 million). All told, these services cost $1.9 billion a year, according to Ms. Hamos.

Both she and the governor seem particularly pumped at dinging care and service providers. “The providers run Springfield, and they always have,” says Ms. Hamos, referring to at least a dozen well-funded lobbying groups. “It’s not going to be easy.”

When Ms. Hamos last made big news, she was running for Congress, in the northern suburbs. She lost by a couple of points. But this refugee of the 1956 uprising in Hungary doesn’t give up easy. Although she and the speaker later had a falling-out, she was Michael Madigan’s point person in rescuing the financially collapsing Chicago Transit Authority pension plan with a combination of new taxes and deep worker concessions. (Ms. Hamos’ husband, former judge and Madigan lieutenant Al Greiman, remains tight with the speaker.)

Not everyone in Springfield admires her. “She, like her boss, doesn’t recognize the depth of the problem,” says Matt Murphy, the chief bud-get watcher for Illinois Senate Republicans.

But Ms. Hamos says she is not deterred—even if remaking the public health system isn’t exactly her cup of tea.

Crisis can force change, she says, and in this case we already have a crisis. Now comes change. Saving Medicaid “is the major social justice issue of our time. I love a challenge.”

© 2012 by Crain Communications Inc.

Centene Wins MO Medicaid

Clayton-based Centene wins Missouri Medicaid contract

BY JIM DOYLE • jdoyle@post-dispatch.com > 314-340-8372 | Posted: Wednesday, February 22, 2012 8:49 am

Centene Corp. has won a major contract to manage health care and behavioral health services for Medicaid beneficiaries across Missouri, the Clayton-based company announced today.

The firm will share the business with two other companies, Missouri Care Inc. and Health Care USA, which is a subsidiary of Maryland-based Coventry Healthcare Inc., state officials said.

Missouri’s Medicaid program, serving 427,000 patients, spends $1.1 billion annually, said Wanda Seeney, a spokeswoman for the state Office of Administration. Centene did not release an actual contract value, and company officials could not immediately be reached for comment.

The companies will compete for Medicaid enrollees during an annual open enrollment period, Seeny said.

Centene is the nation’s fourth-largest Medicaid contractor, and among the most successful companies in the region, with about 5,300 employees nationwide, including more than 900 in the St. Louis area. With the award of the Missouri contract, those numbers are expected to grow.

The managed care company’s subsidiary, Home State Health Plan, was chosen by Missouri officials after submitting a competitive bid to provide services.

“We expect to commence operations in the third quarter of this year,” Centene said in a news release.

Centene and the other companies will provide coordinated healthcare and behavioral health services to Medicaid patients including those receiving benefits under categories of aid for parents and caretakers, children, newborns, pregnant women and refugees. It will also provide services for children in the care and custody of the state pending adoption, and the Children’s Health Insurance Program.

“We are honored to be awarded a Medicaid managed care contract to begin serving managed care members here in Missouri,” said Jesse Hunter in the release. Hunter earlier this week was named Centene’s executive vice president of operations of Centene. “We believe our strategic provider partnerships in Missouri will help us deliver improved health outcomes for our members at a lower cost for the state.”

“For more than 15 years, we have called Missouri home to our corporate headquarters. We have added hundreds of jobs and made significant investments into the region,” said Michael Neidorff, Chairman and Chief Executive Officer of Centene, in the release. “We embrace the opportunity to bring our award-winning quality programs and healthcare services to our most vulnerable neighbors across the state.”

Centene lobbied hard for the Missouri Medicaid contract. It has fielded a dozen registered lobbyists, including attorney Chuck Hatfield, one of Democratic Gov. Jay Nixon’s closest advisers, according to Missouri Ethics Commission records. Since January 2006, Centene and its executives have given more than $400,000 in campaign contributions to dozens of Missouri politicians.

A growing number of states have privatized their Medicaid programs, paying fixed per-patient rates and letting contractors assume the risk of rising health care costs.

Centene’s network of providers tries to reduce costly use of emergency rooms by encouraging patients to see primary care physicians, take the medications, and pursue healthy lifestyles.

But Centene came under scrutiny last year because one of its affiliated businesses, the embattled Missouri contractor SynCare LLC, was ousted as a state contractor after high-profile failures in delivering eligibility assessments of homebound Medicaid patients. Centene provided nearly $2 million in business loans to SynCare and its owner.

Seven companies submitted contract bids to participate in Missouri’s Medicaid managed care program known as MO HealthNet Managed Care, said Jim Miluski, a purchasing director with the state’s Office of Administration.

Three of the bidders were awarded contracts on Feb. 17, he said, and all three firms will be able to operate in the state’s central, west, and east managed care regions.

Health Care USA has participated in the Missouri Medicaid market for about 16 years.

“This award extends that relationship and represents another major step forward for Coventry as we continue to expand our Medicaid presence,” Allen Wise, chairman and chief executive of Coventry, said in a news release.

Centene previously held a Missouri Medicaid contract, but left the state’s market in 2006.

For the latest contract award, Miluski said, the state’s evaluation panel considered factors including the bidders’ organizational experience, method of performance, quality, and access to care. He also said that bidders could win extra points if affiliated with a certified business owned by a minority group or women.

The successful bidders including Centene were awarded one-year contracts and the potential of two additional one-year renewals.

The new contracts are scheduled to begin on July 1.

Supreme Ct. Denies CA Medicaid case

Article published February 22, 2012
Calif. Medicaid case heads back to lower court
By Gregg Blesch Posted: February 22, 2012 – 12:45 pm ET
The U.S. Supreme Court sent a widely watched California Medicaid case back to a lower court, declining to rule whether providers can sue states to enforce the federal statute.
California hospitals and other providers argued in five lawsuits that state amendments to the Medicaid program, including a 10% reimbursement cut, violated language in the federal law that payments are sufficient to sustain quality and access for beneficiaries. The 9th U.S. Court of Appeals agreed and issued injunctions
blocking the state from making the changes.
In the meantime, however, the CMS approved some of the plan amendments and the state withdrew most of the others.
“While the cases are not moot, they are now in a different posture,” Justice Stephen Breyer wrote in an opinion for a 5-4 majority. “The providers and beneficiaries continue to believe that the reductions violate the federal provision the agency’s view to the contrary notwithstanding.” The 9th Circuit’s injunctions remain in place.
Breyer noted, however, that the providers may now more appropriately seek review of the CMS’ decisions rather than basing their challenge on the supremacy of federal law over the state actions. Breyer noted that the administrative review requires deference to the agency’s decisions and “to permit a difference in result here would subject the states to conflicting interpretations of federal law by several different courts (and the agency), thereby threatening to defeat the uniformity that Congress intended.”
The Supreme Court remanded the case to the 9th Circuit.

Walgreens Launches Smoking Cessation Program for Passport Health Plan Members in Louisville

Pharmacists trained by Kentucky Cancer Program to provide education, support and follow-up to help smokers through cessation process

DEERFIELD, Ill., Feb 21, 2012 (BUSINESS WIRE) — Walgreens /quotes/zigman/245520/quotes/nls/wag WAG +0.43% /quotes/zigman/245520/quotes/nls/wag WAG +0.43% pharmacists at eight of the drugstore chain’s convenient Louisville locations are partnering with Passport Health Plan, a local Medicaid health plan, on a new smoking cessation program which launched in early January 2012. The program is free to Walgreens customers and Passport members and aims to improve the community’s health by giving smokers the tools, resources and ongoing clinical pharmacist counseling to help achieve their cessation goals.

Participating Walgreens pharmacists and technicians have undergone specialized training provided by the Kentucky Cancer Program at the University of Louisville’s James Graham Brown Cancer Center. The program provides further education on tobacco treatment, and helped in the development of Walgreens formal, 12-month process for helping those interested in tobacco cessation.

“The harmful effects of tobacco use are well-documented, and by working closely with our community pharmacists who people know and trust, we hope to encourage more smokers under Passport Health Plan to improve their health through this free program to help them quit,” said Greg Baker, Walgreens pharmacy supervisor for Louisville. “The cessation process can be very challenging. We believe the ongoing dialogue with pharmacists, who are among the most accessible health care professionals in the community, can be an effective tool in working with and supporting people to overcome those challenges.”

“Smoking and tobacco use are complex problems that require different approaches to adequately address,” said Stephen Houghland, M.D., chief medical officer for Passport Health Plan. “We believe that addressing this critical driver of negative health outcomes in as many areas where our members are, and with people they trust, is a great opportunity to truly make a difference in their health and quality of life.”

Passport Health Plan members identified as tobacco users can enroll by visiting one of the eight participating Walgreens pharmacy locations. Upon enrollment, pharmacists will work with patients through a multi-step process that includes:

— Information and education on smoking cessation

— Cessation options and tools, products and therapies

— Regularly-scheduled patient follow up for the next 12 months

The program is now offered at the following Louisville Walgreens stores:

— 3421 W. Broadway

— 3980 Dixie Highway

— 1475 Dixie Highway

— 700 Algonquin Parkway

— 200 E. Broadway

— 1008 N. Mulberry St.

— 1602 N. Dixie Highway

— 550 W. Dixie Highway

Walgreens will be sharing program results with Passport Health Plan on a monthly basis and will also be measuring the program’s effectiveness for individuals enrolled over a six- and 12-month period.

“We applaud Walgreens for stepping up to help patients in two districts of Kentucky and Southern Indiana end tobacco use, in this pilot initiative,” said Celeste T. Worth, Professional Education and Training Manager at the Kentucky Cancer Program. “We are pleased to work with Walgreens pharmacies in their efforts to help customers get the medications and counseling they need to successfully overcome nicotine addiction.”

About Walgreens

Walgreens ( http://www.walgreens.com ) is the nation’s largest drugstore chain with fiscal 2011 sales of $72 billion. The company operates 7,830 drugstores in all 50 states, the District of Columbia and Puerto Rico. Each day, Walgreens provides nearly 6 million customers the most convenient, multichannel access to consumer goods and services and trusted, cost-effective pharmacy, health and wellness services and advice in communities across America. Walgreens scope of pharmacy service includes retail, specialty, infusion, medical facility and mail service, along with respiratory services. These services improve health outcomes and lower costs for payers including employers, managed care organizations, health systems, pharmacy benefit managers and the public sector. Take Care Health Systems is a Walgreens subsidiary that is the largest and most comprehensive manager of worksite health and wellness centers and in-store convenient care clinics, with more than 700 locations throughout the country.

About Passport Health Plan

Passport Health Plan is a unique public-private partnership with the Commonwealth of Kentucky and a provider-sponsored, Medicaid health plan serving more than 170,000 members in 16 Kentucky counties. The Plan has operated successfully over the past 14 years. The counties of service include Breckinridge, Bullitt, Carroll, Grayson, Hardin, Henry, Jefferson, Larue, Marion, Meade, Nelson, Oldham, Shelby, Spencer, Trimble and Washington. Passport Health Plan is sponsored by the University of Louisville Medical School Practice Association, University of Louisville Hospital, Jewish and St. Mary’s Healthcare, Norton Healthcare, and the Louisville/Jefferson County Primary Care Association, which includes the Metro Louisville Department for Health and Wellness and Louisville’s two federally qualified health centers, Family Health Centers and Park DuValle. For additional information, please visit http://www.passporthealthplan.com .

About the Kentucky Cancer Program (KCP)

Their mission is to promote education, research and service programs to reduce the heavy burden of cancer in our state. KCP is recognized nationally as a unique program that is state-funded, university-affiliated, and community-based. KCP is the state-mandated cancer control program, jointly administered by the University of Louisville and the University of Kentucky. For more information, contact (502) 852-6318 or visit the Kentucky Cancer Program online at http://www.kycancerprogram.org .

SOURCE: Walgreens

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Medicare and Politics – Analysis

Feb, 20, 2012

Mixing Medicare and mudslinging

By DOYLE MCMANUS / Los Angeles Times


Don’t look now, but the 2012 election is turning into a national referendum on what to do about Medicare.

Democrats want to run on the issue – and to charge that Republican proposals to change Medicare into a voucher-based system would end the current guarantee of virtually unlimited healthcare for the elderly.

The chairman of their House campaign committee, Rep. Steve Israel, D-N.Y., has told candidates to stress three issues: “Medicare, Medicare and Medicare.”

At least some Republicans – such as Rep. Paul D. Ryan, R-Wis., author of a leading GOP Medicare proposal – say they welcome that fight. “Medicare is the issue,” Ryan told reporters last week.

Ryan believes Republicans can only lose if they play defense and allow Democrats to “scare seniors.” Instead, he argues that if the party spells out its ideas clearly, it can win a mandate to transform Medicare from a government-run plan to one run mostly by insurance companies.

That means voters may face a choice this fall not only over who should be president but also over how Medicare, the biggest driver of the federal deficit, should cut its costs: through government jawboning and regulation (the method prescribed by President Obama’s healthcare reform law) or via free-market pressure applied through insurance companies (Ryan’s prescription, endorsed by the GOP presidential candidates).

In simplified terms, Ryan’s plan issues every senior citizen a voucher to buy a private insurance policy and relies on insurance companies to keep costs down. Last month he added a new element: the option of retaining old-fashioned Medicare. But the system would still rely on competition to keep basic costs below the value of the voucher, which would rise within a limit set by Congress.

Sen. Ron Wyden, D-Ore., has signed on to cosponsor Ryan’s latest scheme, but most Democrats reject it, charging that it would shift much of the burden of rising costs onto the elderly.

In his budget proposal last week, Obama suggested cuts of about $300 billion in Medicare spending over the next 10 years, but said they should be borne mostly by drug companies and other providers. And he called for strengthening the new Independent Payment Advisory Board, a federal panel that is supposed to make healthcare spending more efficient but is barred from recommending restrictions in benefits.

“What I will not support are efforts to turn Medicare into a voucher,” the president said, planting his feet in opposition to the Ryan-Wyden plan.

And there, in a nutshell, is the problem: A heated, polarized election campaign isn’t the best forum to debate complex, competing proposals for bringing down health-care costs.

Presidential and congressional candidates aren’t likely to look for ways to combine the best of each approach. Instead, they’re heading into their ideological corners.

There’s a lot of merit in the Ryan-Wyden proposal. “It’s a good compromise,” notes Alice Rivlin, an early proponent of Medicare vouchers and the former director of the Office of Management and Budget under President Clinton. “It preserves traditional Medicare; it gives people more options. But now that the Republican presidential candidates have endorsed it, the Democrats feel they have to reject it.”

There’s a lot of merit in Obama’s advisory board too. Republicans denounce it as an unelected board of 15 that would dictate healthcare decisions, but that’s not true; the healthcare law limited its influence over medical practices, and Congress retained the right to overrule the board’s recommendations.

“These plans will have bad results only if you implement them badly,” Rivlin said. “There’s no reason to assume the worst outcomes.”

Which is no doubt what both sides will do. Last week Mitt Romney attacked Obama for failing to “take any meaningful steps toward solving our entitlement crisis,” even though the health-care act does just that. He also slammed Obama as “the only president in modern history to cut Medicare benefits,” even though Romney’s proposals cut benefits too.

There’s a shred of good news buried in this shrill debate: Both sides agree that Medicare’s costs need to be reined in. Many on both sides support raising the eligibility age and increasing the cost of Medicare for affluent users.

Both sides recognize that Medicare spends billions of dollars wastefully and that some mechanism must be found to end that waste. Most Americans, however, still don’t think Medicare needs to be cut at all. In a National Journal poll released last week, 80 percent said just that.

It would be a great service if the presidential candidates of both major parties disabused voters of that notion and helped them focus on the real choices we face. But don’t hold your breath.

In the end, unless one party wins big and takes both halves of Congress as well as the White House, there won’t be a very clear mandate at all – and the difficult work of Medicare reform could be even harder than before.

ABOUT THE WRITER

Doyle McManus is a columnist for The Los Angeles Times. Readers may send him email at doyle.mcmanus@latimes.com.

Medicaid Fraud Bill Introduced

Medicaid Fraud Doesn’t Pay, Yet

A bill that would allow Kentucky to collect money from Medicaid fraud busts has again been introduced in Frankfort. House Speaker Greg Stumbo filed the bill, which would also protect and possibly reward whistle blowers who report fraud in Medicaid or any other areas of state government. Stumbo says the bill is needed to help Kentucky get money that usually ends up in federal coffers.

“It’s a choice of revenues, state or federal, the states that don’t have a state law don’t have the option to get any of that forfeiture money or penalty money,” Stumbo says.

The bill passed the House last year. The Senate passed a similar bill that only dealt with Medicaid fraud, but the two sides couldn’t come together for a compromise.

Stumbo says he thinks some form of legislation that deals with fraud revenues will pass both chambers this year.

My Routine – Sandy Roland, talking about health

 Public affairs coordinator for Passport Health Plans, Sandy Roland is a producer and on-camera spokeswoman in the company’s television health segments, works as a liaison to clients, vendors and managers, and creates written communications and print material.

Book she’s currently reading: I do almost all of my reading on my iPhone, lots of news updates, work-related blogs. For enjoyment, I read Health magazine and also US Weekly, a guilty pleasure.

Online addiction: I go to the usual YouTube, Twitter, Facebook, but I also check on my eBay auctions every day. I sell a lot of perfumes, colognes and anything else I want to recycle! Want to buy some? My seller name is Thoroblader. I also go on Pinterest.com every day, the online pin board where you can look for things that inspire you.

Biggest time-waster: Angry Birds, the online game, and Words With Friends, which is a lot like Scrabble but you play electronically.

Staple refrigerator food: This is going to sound like a lie, but vegetables — carrots, broccoli, corn, peas. I’m one of those people who enjoys healthy food; it’s not a chore for me. I’m always prepared: vegetables and chicken, vegetables and fish.

Person from history she’d most like to meet: My grandfather had a sister that I never got to meet. She died at an early age, and people say I have many of the same characteristics and interests. We’re both athletic, both enjoy writing. Her name was Kathleen Lawless.

Favorite dish in a Louisville restaurant: When I used to work downtown, I loved going to lunch at Sapporo for their Salmon Bento Box. The combination of foods are divided into sections of the “box” and they are all delicious and incredibly beautiful — vibrant colors, it’s edible art!

Favorite apparel: I’m a fashion girl, so jeans and heels for sure. It’s kind of the best of both worlds. It’s a way to add a splash of spice to something comfortable and everyday.

Hobby: Exercise. I’m at the gym about four days a week. I mix it up — cardio, weights, yoga as I get older. I also rollerblade in the summers. I just love to stay active. … It’s good living!

Home section she’s fussiest about: The kitchen counter — it’s a pile-up for junk mail!

SOURCE:

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