Report IDs states with most, least dual eligibles

The Daily Briefing

Report IDs states with most, least dual eligibles

Maine, Alabama have the largest percentage of dual eligibles as a share of Medicaid

May 30, 2012

Eastern states have higher percentages of “dual eligible” patients as a share of Medicaid than Western and Midwestern states, according to a new Kaiser Family Foundation report.

Altogether, about nine million U.S. residents and more than 15% of all U.S. Medicaid beneficiaries are eligible for both the Medicare and Medicaid program.

To determine the geographic distribution of these “dual eligibles,” the Kaiser Commission on Medicaid and the Uninsured and the Urban Institute analyzed Medicaid Statistical Information Statistics data from fiscal year 2008.

Related: The Advisory Board’s primer on new efforts to coordinate care for dual eligibles.

The report found that the 10 states with the highest percentages of dual eligibles as a share of total Medicaid enrollment were:

1. Maine (where 26% of Medicaid beneficiaries are dual eligibles);
2. Alabama (23%);
3. North Dakota (22%);
4. Kentucky (21%);
4. New Jersey (21%);
4. Wisconsin (21%);
7. Florida (20%);
7. Mississippi (20%);
7. Rhode Island (20%); and
7. West Virginia (20%). 

Meanwhile, the 13 states with lowest percentages of all dual eligibles as a share of total Medicaid enrollment were:

1. Arizona (where 10% of Medicaid beneficiaries are dual eligibles);
1. Utah (10%);
3. Alaska (11%);
3. California (11%);
3. New Mexico (11%);
6. Delaware (12%);
6. Colorado (12%);
8. District of Columbia (13%);
8. Illinois (13%);
8. Michigan (13%);
8. Washington (13%); and
8. Wyoming (13%).

A state-by-state map of dual eligibles as a share of total Medicaid enrollment

According to the report, “these variations reflect a state’s demographic profile as well as state policy choices in Medicaid eligibility and coverage.” For example, the report notes that Eastern states generally have larger elderly populations than Western and Midwestern states.

Kaiser notes that 26 states have submitted proposals to test integrated care models for dual eligibles under a three-year, multi-state demonstration project (Kaiser report, 5/24; AHA News, 5/25).

States crack down on prescription-drug “doctor shopping”

Wed, May 30 2012

By Mary Wisniewski

CHICAGO (Reuters) – When a new patient comes into Dr. Shawn Jones’ office in Paducah, Kentucky complaining of pain and asks for a specific drug without talking about other symptoms, Jones gets suspicious.

“The first thing they say is they’re in horrible pain and they need pain medicine,” said Jones. “The other thing that gives it away is they want to tell you what works – they tell you they want Percocet. They don’t talk about their symptoms – they don’t say, ‘Oh, two weeks ago I hurt my back.'”

These are the types of red flags that can send Kentucky doctors to check a state database to see if a patient is “doctor shopping” for addictive painkillers.

Prescription drug abuse kills more people a year in the United States than cocaine and heroin combined, according to the Centers for Disease Control. A CDC report last year said 15,000 people died as a result of overdoses of prescription painkillers in 2008 – more than three times the number in 1999.

Kentucky is a hot spot. Nearly 1,000 people in the state died from prescription drug overdoses in 2010, or about three a day, ranking it among the top states for such deaths.

In America as a whole, about 12 million people aged 12 and older reported non-medical use of prescription painkillers in 2010.

Abusers and dealers typically get drugs by finding doctors willing to prescribe them, forging prescriptions, theft from pharmacies or individuals, or buying from “pill mills” — storefront clinics that sell painkillers for cash up front.

DATABASES

State databases such as one used in Kentucky are designed to address the first problem — to alert prescribers that someone may be abusing drugs or diverting them for illegal sale.

Forty-three states now have databases to keep track of who is getting prescriptions for powerful pain relievers such as oxycodone, Vicodin and Opana.

Pharmacists enter prescriptions for controlled substances into the database, so prescribers can see if patients are getting pills at multiple locations.

Another five states have passed laws to create databases, but have not yet implemented them. Missouri and New Hampshire do not yet have such laws, though they have been introduced in the legislatures, according to Sherry Green, CEO of the National Alliance for Model State Drug Laws. There is no national database, though more states are sharing information.

For some doctors, running a “PMP” — shorthand for a Prescription Monitoring Program report — has become as normal a part of seeing new patients as measuring blood pressure.

But the programs have not been without controversy, with a major issue being whether doctors should be required to check the database when prescribing addictive medicine, or whether this should be left to their discretion, said Green.

Some doctors have expressed fears that PMPs could breach patient confidentiality and interfere with needed treatment of pain or could be used against doctors who need to prescribe a lot of pain medicine.

Doctors also object to proposals they see as putting law enforcement above health care. Citing privacy concerns, the Kentucky Medical Association fought successfully against a provision that would have moved the state’s database to the Attorney General’s office, the state’s top legal officer.

MANDATORY CHECKS

In Kentucky, fewer than a third of prescribers have an account with the state’s PMP program. However, a new state law, which will take effect on July 12, makes it mandatory to run a PMP for a new patient getting certain kinds of medicine. Nine other states have passed laws that require doctors to access the PMP database under certain circumstances.

“Before we can ever address the prescription-drug problem … one of the things we have to do is to make sure we have full use of the tools we have,” said Van Ingram, executive director of the Kentucky Office of Drug Control Policy.

Enforcement is up to state medical boards and state systems vary. But most allow doctors and pharmacists to access information from neighboring states – something that helps address the problem of abusers driving over state lines to find a willing doctor.

Improved technology, with a push by the National Association of the Boards of Pharmacy, is helping more states share data.

Doctors and pharmacists who suspect a patient is diverting can alert police. “If you recognize someone is a doctor shopper, you report it to the state police diversion agent,” said Sarah Melton, a clinical pharmacist in Virginia. “I have him on speed dial.”

Another issue for doctors is time, so states are trying to increase database speed so that doctors can get information while a patient is still in the office. About a dozen states allow doctors to delegate people to look up information.

Many states allow law enforcement to access the system – in limited circumstances, and a case must already be under investigation for officials to run a PMP report.

“You can’t just pick someone out of the phone book and run them,” said John Burke, president of the National Association of Drug Diversion Investigators and commander of the Drug Task Force in Ohio’s Warren County.

BALANCE NEEDED

Doctors need to strike a balance between treating people who genuinely need pain medication, and making sure it doesn’t go to people who don’t, said Samuel Hughes Melton, the husband of Sarah Melton and the president of a Virginia health clinic.

He used a PMP report to discover that a long-time patient had picked up an opiate from another doctor, and had also obtained a prescription for benzodiazepine. The two can be deadly if combined.

“I was able to confront him in the exam room,” Melton said. “I was able to use that information and nudge him into treatment for substance abuse.”

There is some evidence that the databases are leading to the prescribing of fewer addictive medicines.

According to a study by the emergency department of the University of Toledo’s College of Medicine, doctors or pharmacists who reviewed state prescription drug data changed how they managed cases 41 percent of the time.

The study found that 61 percent prescribed either no opioid medications, or less than originally planned, while 39 percent decided to provide more.

“I know a number of emergency-room physicians tell us how much they appreciate the system to discriminate between real patients with real injuries and those who just want drugs,” said Danna Droz, the administrator of Ohio’s PMP.

Jones, the president of the Kentucky Medical Association, said doctors and pharmacists needed more education on abuse and diversion, as abusers become more sophisticated at fooling professionals.

He said he once got a call from a pharmacist questioning a prescription for 90 Percocet pills – when the pharmacist knew Jones rarely prescribed more than 20 pills at a time.

The prescription was forged. Jones reported it to police and the phony patient was arrested.

(Reporting By Mary Wisniewski; Editing by Greg McCune and David Brunnstrom)

Primary care physician shortage looms in Louisville

Written by
Patrick Howington
The Courier-Journal
2:42 AM, Mar. 28, 2012

They are the quarterbacks of the health care system — generalists who monitor the entire body, give preventive care, spot problems early and send patients to specialists if needed.

Despite their key role, primary care physicians are in increasingly short supply, and a new study says the shortage is expected to become critical soon in Louisville — as it has been in many rural areas of Kentucky for years.

The impending Louisville shortage is due to a perfect storm of factors — an aging population that will need more care, a large number of doctors approaching retirement, and medical students shunning primary care practices for specialties with higher pay and better hours.

By 2020, Jefferson County will need 455 new primary care doctors — almost as many as the number that work in local medical practices now. The new doctors will be needed to replace current doctors who are expected to retire and to meet federal guidelines for serving the projected 2020 population, according to the study the Louisville Primary Care Association commissioned.

And that doesn’t take into account the extra demand for more doctors when health reform could cause millions more Americans to have health insurance in 2014 if upheld by the Supreme Court.

“We see a real workforce crisis in the future — in the immediate future,” said Bill Wagner, executive director of Family Health Centers, a group of community clinics serving low-income residents. “It is a perfect storm.”

Family Health Centers is a member of the primary care association. Others are the Park DuValle Community Health Centers, the Louisville Metro Department of Public Health & Wellness, and the University of Louisville’s dental school and primary care centers.

The study, conducted by REACH Inc. and based on a survey of local physicians, found that about one-third of all the primary care doctors — general internists, family practitioners and pediatricians — are 56 or older and plan to retire within 10 years.

The combination of impending retirements, expected population growth and the trend toward doctors working strictly inside hospitals or urgent-care centers rather than holding office hours means that:

• Jefferson County will need to attract 220 new family practitioners by 2020, or more than the current supply of 167 who don’t work solely at institutions such as the VA Medical Center or hospices.

• An additional 192 general internists and 43 pediatricians will be needed.

• While Louisville has 697 primary care doctors overall, only 517 of them are in typical office settings where they can have an ongoing relationship with patients — and 178 of those are expected to retire by 2020.

To replace those retirees and add other new doctors to meet federal guidelines calling for 100 primary care physicians per 100,000 people, the study projected that 455 new primary care doctors will be needed by 2020.

And not enough younger doctors are in line to fill that gap.

Shift to higher pay

Saddled with $100,000 or more in medical school loans, graduates in recent years haven’t chosen lower-paying primary care as often as older generations did, statistics show.

In the past 15 years, the number of U.S. medical school seniors who entered residencies in family medicine has fallen from 17 percent in 1997 to 8 percent last year, according to the Association of American Medical Colleges. However, the number has rebounded slightly since 2009.

The picture is similar at the U of L School of Medicine. The number of entering medical students the school believed would go into primary care upon graduation, based on statements at the time of admission, has declined 50 percent in the past 11 or 12 years, said Dr. Steve Wheeler, associate dean for admissions.

“The debt load in medical school has increased, the ability to repay debt is influenced by salary once you get out, and primary care is at the low end of that spectrum,” said Wheeler, who is also associate professor of family and geriatric medicine.

On average, primary care doctors are paid as little as half as much as specialists, such as radiologists and invasive cardiologists, according to a national compensation survey.

Yet they typically see many more patients a day and must complete exhaustive paperwork to oversee patients’ overall care.

The time demands and administrative burden are perhaps as important as the pay gap in students’ decisions to shun primary care in recent years, experts said.

“I think it has become a much more difficult environment to enjoy working with your patients in,” Wheeler said.

“It’s more difficult, more stressful, and less rewarding” than it used to be, Dr. Greg Ciliberti, a Louisville internist for 26 years. “And then you’ve got the other stress of, you’re trying to run a business and you never get a raise.”

Not just rural

In Kentucky, physician supply has typically been seen as a rural problem, given that some counties are served by a handful of doctors — while Louisville is home to large hospital companies and a university medical school.

But both in Louisville and nationwide, “I don’t think there’s any question that it’s not just a rural issue,” said Dr. Dan Varga, chair of the Kentucky Medical Association’s physician workforce committee.

“No matter where you’re talking about, we clearly have an aging primary care workforce,” because primary care has been “so unpopular” a career choice in recent years, said Varga, chief medical officer of Kentucky’s St. Joseph hospitals and a former Louisville internist.

“There just aren’t as many students who see that as their call,” Wheeler said.

Given that trend, Wagner said he doubts that medical schools will train enough primary care doctors to fill the gap.

Wagner said his clinics already have a difficult time recruiting primary care doctors in the face of competition from higher-paying hospital operations that increasingly are hiring doctors as full-time employees.

That can leave doctors at Family Health Centers and similar clinics stretched even further to handle their patient load.

“There’s not enough of us,” said Dr. Sarah Fortuna, a staff doctor at FHC’s Iroquois clinic on Taylor Boulevard, during a brief break between seeing patients, updating charts and conferring with a medical technician. “We’re getting more and more patients, but we’re not getting any more staff.”

Fortuna said she probably doesn’t get enough time with her patients.

“I try,” she said. “But is the clock ticking in the back of my head? Yes. I know I have to get to day care at the end of the day, and my techs have other things they have to get to as well.

“I try to stop long enough to give them the time, but there’s days when I go home and go, ‘I know I’ve made (patients) come back in three weeks because I want to talk to them more.’ ”

Fortuna, 39, a single mother and former Air Force doctor, said she doesn’t regret her decision to go into primary care. She likes treating a wide variety of conditions and is “a people person, so I wanted to have long-term relationships with my patients.”

Making the switch

Fortuna said it would be nice to make more money, but that’s not enough to make her switch to a specialty.

But many primary care doctors have done just that.

Fortuna said she trained in a group of eight primary care residents at Eglin Air Force Base in Florida, ending in 2003 — and four of them have since entered specialties.

“They were faced with longer and longer hours in private practice, and most of them didn’t want to do that,” she said. “They wanted to have a life. So they opted out.”

Dr. Dan Garcia, a Louisville allergist, was a pediatrician for 17 years before becoming an allergist in the early 1990s — a move he said he made for his health and to see his family.

With long hours at the office combined with hospital rounds, “I wasn’t getting to see my children” because of caring for other people’s children, said Garcia, 64.

“We had our fifth child, and I came down one morning … Patrick was about 4 months old, and he looked at me like I was a complete stranger, because I hadn’t seen him for over a week,” Garcia said.

A heart bypass operation convinced Garcia he needed a slower pace, and he underwent two years of training to become an allergist. Instead of working 12 hours or more a day, he now works 8 to 10.

“It’s been well worth it,” he said. “The tail doesn’t wag the dog any more.”

Cost of solutions

Though there is a consensus that more primary care doctors are needed, the solutions aren’t easy — and often call for money that isn’t there.

Medical associations have advocated repaying emerging doctors’ medical-school debt as an incentive for them to enter primary care. The National Health Service Corps has such a repayment program, but only for doctors who agree to practice in underserved areas.

And national proposals to increase medical schools’ federal funding for training primary care physicians have lost out to deficit-cutting measures in recent years, said Christiane Mitchell, director of federal affairs for the Association of American Medical Colleges. She said the organization’s top priority is to avoid cuts to existing funding, though it believes federal training money should actually be increased.

With pay levels persuading many doctors to leave primary care or not enter it, some private health insurers and the federal Medicare program are moving to boost reimbursements for primary care physicians compared with specialists.

Last year, the Obama administration established a Medicare pilot program, called for under the 2010 health reform law, to pay primary care doctors to supervise teams of “physician extenders,” such as nurse practitioners, to treat target populations. The so-called “patient-centered medical home” program would directly reward primary care doctors for their time-consuming role in coordinating patients’ care.

Health insurer Aetna announced a pilot program in January to give extra monthly pay to physicians whose practices qualify as patient-centered medical homes, while last July Louisville-based Humana announced a program to award nearly $10 million to primary care practices that show quality improvements.

WellPoint, the parent company of Anthem health plans, also announced a national program in January to pay more to some primary care doctors who keep patients healthy.

But Anthem’s Kentucky organization took a broader and earlier approach in 2008 by boosting all primary care office-visit reimbursements to a level higher than specialists get, said Mike Lorch, an Anthem vice president.

“What we’re counting on, and what we firmly believe, is that … as you improve reimbursement so they can take better care of the patient, you’re going to see a payback in cost of care,” Lorch said.

Without regular access to a primary care doctor, he said, “a lot of times you’re going to end up in the (emergency room), and that’s the most expensive setting.”

SOURCE:

http://www.courier-journal.com/article/20120327/NEWS01/303280053/Louisville-primary-care-physicians-shortage?odyssey=tab|topnews|text|News

Region’s hospitals, insurers keep close eye on impact of federal decision

9:21 PM, Mar. 26, 2012  |  

Written by

Laura Ungar for the Louisville Courier-Journal

It’s been cited as a driving force behind the proposed but thwarted merger involving University Hospital and a Catholic health care system.

It’s inspired new partnerships called “accountable care organizations,” including one being piloted by Norton Healthcare and Humana.

And it’s been hailed as providing extended coverage for more than 35,000 young adults in Kentucky.

The federal health reform law has already started making an impact locally — so area health advocates and officials are tuned in to this week’s Supreme Court proceedings.

“I think the entire health care sector and insurance sector are watching this closely because it has significant implications on both industries,” said Stephen Williams, chief executive officer of Norton. “This is very far-reaching.”

Jodi Mitchell, executive director of Kentucky Voices for Health, a coalition of health advocacy groups, said her organization takes no position on the arguments before the Supreme Court, instead concentrating on educating the public about health reform. But she added: “We expect the law will be upheld.”

One of the most well-known provisions of the Affordable Care Act, as the reform law is called, requires insurers that offer coverage to children on their parents’ plans to make that coverage available until the child is 26.

That portion of the law took effect in September 2010. According to the U.S. Department of Health & Human Services, 35,610 young Kentuckians already have gained coverage through that provision. In Indiana, 38,480 young adults gained coverage.

“This is helpful for college students going to school who can’t afford coverage,” Mitchell said. “And because they’re generally healthy, they’re advantageous on plans where you’re trying to spread out the risk.”

This week’s arguments before the Supreme Court won’t involve that provision, nor several others of the broad-ranging law, but instead will focus on a key and controversial provision — requiring nearly all Americans to have health insurance by 2014.

According to the U.S. Census Bureau, an average of 15.5 percent of Kentuckians — or 663,000 people — lacked health insurance from 2008-2010, as did 12.8 percent of Hoosiers, or 813,000 people. Nationally, 15.8 percent of Americans lacked health insurance during that period.

Health care experts say the reform law eventually would bring the rate of uninsured Americans down by about 60 percent.

Louisville-based Humana Inc., one of the nation’s largest health insurers, said it has long supported universal health coverage for all Americans.

And the company said that other parts of the reform law, such as requiring insurers to cover all applicants regardless of their health condition, cannot work without the “individual mandate” provision. Otherwise, healthy people could pass up insurance while sicker people would get it, raising premiums for all.

Officials at local hospital systems, which provide charity care for many uninsured patients and have unpaid bills from others, have said projections of how many people would gain coverage under the reform law are encouraging.

But they add a caveat — saying it’s unclear if projected gains in patients who would get insurance under health reform would be offset by funding reductions in a state and federal program for hospitals that treat large numbers of low-income people.

Officials at University Hospital, which cares for large numbers of uninsured patients, talked about this uncertainty during the debate involving the proposed merger with Jewish Hospital & St. Mary’s HealthCare and Lexington-based St. Joseph Health System, which is part of Catholic Health Initiatives of Denver. Gov. Steve Beshear ultimately rejected the proposed three-way merger, and Jewish and St. Joseph merged without University to create KentuckyOne Health.

Officials at those health care organizations — as well as others such as Norton and Baptist Hospital East — have said the reform law encourages them to partner with others to become more efficient, improve care and reduce costs.

Norton and UK leaders said the law is one of the main reasons behind their partnership, announced in June. That partnership includes a statewide stroke collaboration and a cancer program that would share resources.

Norton and Humana are also piloting an “accountable care organization” for commercially insured patients, a program that establishes financial incentives for health care providers to improve quality, eliminate waste and control costs. Louisville is one of four national sites in the ACO Pilot Project of The Engelberg Center for Health Care Reform at the Brookings Institution and The Dartmouth Institute for Health Policy and Clinical Practice. Officials said the program brings a emphasis on wellness and preventive care for patients.

Last October, the U.S. Centers for Medicare & Medicaid Services finalized new rules under the health reform law to help doctors and hospitals better coordinate care for Medicare patients through ACOs. The Medicare program is designed to reward ACOs that lower the growth of health care costs while still providing quality care.

Williams said Norton will still go forward with the ACO and partnerships no matter what happens with the health reform law.

“Even if major parts of it get repealed, I believe what we are doing and what other providers are doing we will continue to do,” he said. With health care expenditures making up 18 percent of the Gross Domestic Product in the United States, “we have to bend the cost curve or we are going to cripple the economy.”

SOURCE:

http://www.courier-journal.com/article/20120326/NEWS01/303260073/Region-s-hospitals-insurers-keep-close-eye-impact-federal-decision-

Passport, Leadership host Chamber breakfast

by Brittany Wise – Grayson County News Gazette
03.25.12 – 12:00 pm

Representatives from Passport Health Plan, along with Leadership Grayson County hosted Thursday’s Chamber of Commerce breakfast at the Centre on Main, where a new local Passport board member was announced, along with the 2012 Leadership class and the new Executive Director of the Grayson County Chamber of Commerce.

Passport’s Chief Executive Officer, Mark B. Carter, spoke to the group about the non-profit organization’s service in central Kentucky. The group serves 16 counties, including Grayson, and provides health care for around 5,000 Grayson County residents – about 20 percent of the county’s population.

Carter explained that through the group’s partnerships with hospitals, primary care providers and a large number of specialty physicians, they are able to provide excellent quality healthcare to residents who would otherwise not have healthcare.

Carter boasted of the group’s #13 ranking among similar agencies country-wide, adding that all but two of the top 100 ranked companies were located in either New England or the West Coast, which makes Passport’s excellent slot an even more powerful accomplishment.

It was also announced that local business-owner Steven Elder has joined the Passport Health Plan Board.

Elder said of the group, “Passport Health Plan truly brings the community together. Their committee and board structures allow concerned citizens like myself to bring perspectives to the table and work collaboratively to find innovative solutions that work for everyone.”

Another exciting announcement for the Elder family was the reveal of the new Executive Director of the Grayson County Chamber of Commerce, his wife, Tara Elder.

Tara will be stepping into the shoes of former Director Caryn Lewis, who is leaving the position to work for the Grayson County School System.

Before Caryn’s departure, however, she had the opportunity to announce this year’s Leadership Grayson County class, which includes: April Bowman, with Wilson & Muir; LaShawn Cole-Hack, with Head Start; Tara Elder, with Grayson County Chamber of Commerce; Kindra Ewing-Jones, with Grayson County Extension Office; Valerie Farris, with Elder Wealth management; Alicia Harrell, with City of Leitchfield; Lisa Jones, with Grayson County Public Library; Amanda Joyce; Jessica Kelley, with Carter Harrell State Farm; Ellis Kiper, with Rocky-K Log Homes; Harold Miller, with WRECC; Trish Niles, with Mid-Park, Inc.; Carrie Petrocelli, with Twin Lakes Home Health; Natalie Taul, with Grayson County Extension Office; and Christopher Wilborn, with United Way of Central Kentucky.

SOURCE:

http://www.gcnewsgazette.com/view/full_story/17984858/article-Passport–Leadership-host-Chamber-breakfast?instance=popular

Passport employee’s award to benefit OVEC’s Head Start

By The Staff
Friday, March 23, 2012 at 3:00 am       (Updated: March 23, 3:06 am)

Marcelline Coots, one of the first individuals to be hired at Passport Health Plan in 1997, has been named the 2012 Making A Difference award winner by the Association for Community Affiliated Plans (ACAP), and that’s going to benefit the Ohio Valley Educational Cooperative’s Head Start program.

She was selected from a pool of candidates submitted by the national organization’s 57 affiliated health plans located throughout 27 states. ACAP serves more than 10 million Medicaid and CHIP members across the country.

In her honor, ACAP is presenting a $500 donation to her charity of choice, OVEC, in a ceremony Wednesday at the cooperative’s office on Alpine Drive in Shelbyville.

Coots, whose daughter attends  Christian Academy of Louisville, serves on the advisory council and community board of the OVEC.

She is the main member outreach event planner for Passport Health Plan and has participated in or planned numerous special events.

“Marcelline embodies the mission of Passport Health Plan – to improve the health and quality of life of our members,” Passport Health Plan CEO Mark B. Carter said in a press release announcing her award. “She’s done things like learn to drive a truck for some of Passport’s large outreach events. That’s the kind of commitment that Marcelline has demonstrated every day during the length of her service here, and I’m delighted that she is being recognized in this manner.”

SOURCE:

http://www.sentinelnews.com/content/business-briefcase-march-23-2012

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.

#####

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

To view this article in its original context, please visit:
http://www.marketwatch.com/story/walgreens-launches-smoking-cessation-program-for-passport-health-plan-members-in-louisville-2012-02-21
OR
http://www.4-traders.com/WALGREEN-COMPANY-14843/news/WALGREEN-COMPANY-Walgreens-Launches-Smoking-Cessation-Program-for-Passport-Health-Plan-Members-in-Lo-14033472/

OR

http://www.drugstorenews.com/article/walgreens-partners-kentucky-medicaid-health-plan-smoking-cessation?utm_source=GoogleNews&utm_medium=Syndication&utm_campaign=ManualSitemap

OR

http://www.tmcnet.com/usubmit/2012/02/21/6133737.htm

OR

http://www.pharmiweb.com/pressreleases/pressrel.asp?ROW_ID=54603

Physician praises Passport

By Special to The Sun
Tuesday, February 14, 2012 at 2:31 pm

When I started practicing medicine in Bardstown almost 35 years ago, I was optimistic about my opportunity to make sick children well and to watch healthy children grow into strong adults.

Even though I started out with a slightly naïve view, I’m very proud to say I’ve had a hand in caring for thousands of Kentucky’s children. I made a commitment to serve Medicaid patients at the very beginning of my career, but I was not enthusiastic when managed care arrived in 1997.

Both my staff and the staff at Passport Health Plan will attest to my reservations during the start up. On one hand, I was right to be cautious; there were administrative and technology issues that created burdens on my practice.

On the other hand, Passport worked hard to fix what wasn’t working so doctors could focus on providing patient care. But, the gap between where we were with Medicaid managed care then and where we are now is enormous. Several recent articles point out that the state’s attempt to save money by introducing three other Medicaid managed care plans outside the Passport region isn’t going well. Maybe it was too much too soon.

My practice, Physicians to Children and Adolescents, serves over 4,700 patients on Medicaid.  Because of our locations in Bardstown and Springfield, some are covered by Passport, some by the other plans.

I’m not a managed care expert, but my staff and I see and experience the differences daily.
I suspect part of the difference is that Passport is a nonprofit and therefore never has to put the expectations of shareholders before the needs of members.

I’ve been impressed enough with Passport’s commitment to the Commonwealth to accept an offer to join their Board of directors.  From this vantage point, I’ve been able to confirm what I have long suspected: Passport Health Plan has a strong and engaged provider network, and an intense focus on delivering services at a cost that doesn’t diminish quality. In fact, engaging with providers is one of the hallmarks of Passport’s remarkable success.

I feel that Passport’s effectiveness, including their impressive clinical outcomes, are directly due to physicians and other health professionals (from throughout the service area) sitting  at the table making key decisions and sharing sacrifices for the good of the plan and the members.

The National Committee on Quality Assurance recently ranked Passport as the 13th best Medicaid plan in America, which could not have been accomplished without an invested provider network and a top-notch staff. As a member of the board of directors, I want to say Passport stands willing and ready to help the state get Medicaid back on track.

In addition to Jefferson, the plan has been successfully serving 15 rural counties for 14 years and respects and understands their unique needs.  Claims are paid on time, and members have access to the doctors, pharmacies, hospitals and specialists.

Passport is a strong and cost effective Medicaid plan that could be easily replicated throughout the Commonwealth.

——-

Dr. James Hedrick, MD, practices pediatrics in Bardstown and received his medical degree from the University of Chicago, Pritzker School of Medicine in Chicago, Ill.

SOURCE:

To view this article by Dr. James Hedrick, MD for The Springfield Sun please visit http://www.thespringfieldsun.com/content/physician-praises-passport