ABL Healthcare Member News & Industry Trendletter * September 6, 2018
Click on Headlines to Read Articles


>>> Matt Diaz is Regional Vice President at Maxim Healthcare Services, Inc, which provides home healthcare, healthcare staffing, behavioral care, and population health and wellness services across the U.S. Additionally, Maxim offers a Transitional Care Program with the main objective of assisting its customers to reduce readmissions to the hospital after 30 days of discharge, while empowering patients to take charge of their own personal healthcare needs. Matt has been in his current role with Maxim since January 2018, Over the prior 14 years, his roles have included Director of Business Development - Health Plans, West Region Director of Business Development - Federal; Area VP for Alaska, Nevada and California; Regional Account Manager in California; GM; Account Manager; and Healthcare Recruiter. Matt has joined the Sacramento Round Table.

>>> Jeff Johnson is Western Region Market Leader and a Partner in WIPFLi LLP, a top 20 national accounting and consulting firm. Now, based out of WIPFLi's Oakland office, Jeff continues to oversee the firm's audit and consulting services to healthcare clients in the Northwest while guiding the larger business's service and industry offerings in its west coast offices. A CPA, Jeff boasts 30+ years of experience working in healthcare practice consulting, providing audit, reimbursement, and specialized services. His areas of focus include: hospital audit and cost reporting; strategic financial planning; hospital/physician integration; operational reviews; reimbursement analysis; medical practice management/performance reporting; fee schedule analysis; physician compensation development and design; Medicare-certified rural health clinic and FQHC development and compliance reviews; board governance education; financial feasibility studies for new services and programs; and OMB Circular A-133 audit services. Jeff has joined the Bay Area Round Table.

>>> Monish Laxpati, MD, is CEO and Medical Director of Alinea Medical Imaging, whose services include mobile mammography and ultrasound, plus in-office imaging services, including X-ray and EKG. FDA-approved and ACR-certified, Alinea utilizes a combination of portable digital equipment that can be brought into a facility, as well as 16 self-contained mobile mammography coaches, which provide the same high-quality imaging and experience as the top breast imaging centers. Alinea also partners with California's Every Woman Counts program to provide no-cost mobile screening services to low-income uninsured patients throughout the state. Alinea screens approximately 50,000 women for breast cancer annually and provides mobile ultrasound services to provide OB and general ultrasound exams to patients within the convenience of their physician's office. A board-certified radiologist, Monish has led Alinea since mid-2013 and has overseen the growth of the practice five-fold. Monish has joined the Orange County Round Table.

>>> Larry Nabb is COO of Remita Health, which provides hospice and palliative care throughout Southern California, Las Vegas, and Tucson. Remita's team-oriented approach to delivering medical care, pain management, and emotional and spiritual support is tailored to the patient's needs and wishes. Prior to becoming COO of Remita in June 2017, Larry was VP of Health Management, Health Services Division, at HMSA, in the Hawaiian Islands, and VP Operations at Healthways Hawaii. He was recruited by Healthways/HMSA to integrate and lead the Healthways Hawaii team and well-being platform into HMSA as a permanent offering. Earlier, he was National Director, Strategic Partnerships at Seasons Hospice & Palliative Care, and VP, Executive Director of Health Essentials. And he was Manager and Underwriter, PMB/The Private Bank at Wells Fargo & Co. - Wealth Management Group, and a Senior Banking Officer/ Regional Consultant at Union Bank. Larry has also joined the Orange County Round Table.

>>> Bob Rose is President and CTO of Medwand Solutions, which developed and distributes the MedWand, a handheld, portable device which captures vital clinical data enabling private video patient exams conducted over smartphones, tablets or computers. The company is a partnership between Bob's other company, Cypher Scientific, an engineering design firm, and Samir Qamar, MD, the founder of MedLion, one of the nation's first direct primary care services. Bob and Dr. Qamar invented the MedWand, which includes a digital stethoscope, sensors to measure temperature, heart rate, and blood oxygen level, and a camera to look into a patient's ears, nose, mouth and throat. MedWand also enables continuous data gathering, using algorithms to predict negative outcomes and allows providers an opportunity for early intervention. In his career, Bob has spent 30+ years in engineering and operations management, and manufacturing. Bob, too, has joined the Orange County Round Table.

  • 09/11 - Silicon Valley Round Table
  • 09/12 - San Francisco / Bay Area Round Table
  • 09/13 - East Bay / Bay Area Round Table
  • 09/20 - Sacramento Round Table
  • 09/21 - Los Angeles Round Table
  • 10/03 - Orange County Round Table
Alvaka Networks Offers Insights on Buying Cyber Insurance

In his recent blog, Should I buy cyber insurance?, Alvaka Networks' Oli Thordarson presents some detailed information for small- to mid-size enterprises to consider in weighing this decision. In summary, they must consider their risk profile and appetite to carry risk vs. unloading part of that burden. And remember the insurance does not completely absolve them of their responsibility to mitigate risk themselves; it's advisable to do a risk assessment. Oli notes that his analysis is based upon his anecdotal experiences of hacks and losses at dozens of other firms over the years, as well as his own cyber insurance decision. (Oli Thordarson, Orange County)

Choice in Aging Takes Over Senior Services Programs in Solano & Napa Counties

Choice in Aging has shared that, in Solano and Napa counties, the Area Agency on Aging closed their doors in June, and as a result, a number of volunteers and nonprofits have stepped in, including Choice in Aging, which has taken on the Multipurpose Senior Services Program, serving low-income frail elders, with a new home in Fairfield. Choice in Aging will also be providing the Prevention and Early Access Program for Seniors in Solano County starting in October. Meanwhile, on September 13, in Antioch, Debbie Toth is organizing a coordinated senior advocacy event among East County leaders and older adults, on behalf of the East County Senior Coalition. And, on September 15, The Bedford Block Party will take place, a new fundraiser to benefit Choice in Aging's Bedford Center. The event will include small bites, an open bar stocked with beer and wine, silent auction, and a raffle. (Debbie Toth, Bay Area)

Cigna Shareholders Approve Express Scripts Acquisition

Cigna Corporation announced that Cigna shareholders have voted, at a recent special meeting of shareholders, to approve the adoption of the previously announced merger agreement with Express Scripts Holding Company, one of the nation's leading pharmacy services companies. Cigna anticipates that the merger will close by year-end 2018, subject to the satisfaction of customary closing conditions, including applicable regulatory approvals. (Chris De Rosa, Orange County)

El Camino Earns Certificate of Distinction in Management of Sepsis

The Joint Commission has awarded El Camino Hospital its Gold Seal of Approval for the management of sepsis, a symbol of quality that reflects an organization's commitment to providing safe and effective patient care. Sepsis is the third leading cause of death in the U.S., after heart disease and cancer, killing 270,000+ people each year. El Camino underwent a rigorous on-site review in July 2018, in which Joint Commission experts evaluated compliance with national disease-specific care standards, clinical practice guidelines, and performance measures. (Cecile Currier & Jeff Gruer, Silicon Valley)

ElderConsult's Upcoming Events Include Dementia & Finances Conference

On September 11, in San Rafael, ElderConsult Geriatric Medicine will present an ElderConsult Dementia Conference: Protecting Your Loved Ones and Their Finances, suitable for elder care professionals and families. Also, on the evening of September 13, in Santa Clara, Elizabeth Landsverk MD will present Ask Me Anything! Questions For a Geriatrician, as well as Dementia and the Challenging Discharge: Challenges of Early-Onset Dementia, in Foster City, on the evening of October 4. (Elizabeth Landsverk MD, Bay Area)

GeBBS Makes Inc. 5000 Ten Years Straight

GeBBS Healthcare Solutions has been named to the Inc. 5000's 2018 List of the Fastest-Growing Private Companies in the country, for the tenth consecutive year. As an Inc. 5000 honoree, GeBBS shares a pedigree with Microsoft, Dell, Domino's Pizza, Pandora, Timberland, LinkedIn, Yelp, Zillow, and other notable alumni. The 2018 list is ranked according to percentage revenue growth when comparing 2014 to 2017. (Nitin Thakor, Los Angeles)

GHG's Dave Sayen Talks Telehealth, Robust MA Enrollment & ACO Changes

Recent blogs from Gorman Health Group's Dave Sayen include: > The Doctor Will Call You Now, where Dave enthuses, "We are on the cusp of experiencing major digital disruptive innovation in healthcare with the rapid expansion of telehealth as the regulatory barriers to expansion are falling." > Robust MA Enrollment Numbers Signal Opportunity, in which Dave shares that the U.S. has reached 21.44 million Medicare Advantage members - 35% of the entire Medicare pie, and is on a trajectory to reach 50% by 2025. Year-over-year enrollment grew a robust 7.8%. > New CMS Proposal Overhauls ACO Program, where Dave discusses updates to the Medicare Shared Savings Program and other ACO demonstration models. (Dave Sayen, Bay Area)

Hospice East Bay Anticipates Upcoming Art & Wine Benefit

On the evening of September 24, the Friends of Hospice Rossmoor and Creekside Grill will present the annual Art & Wine Benefit, a fundraiser for Hospice East Bay's Rossmoor Respite Fund. The event will feature local artwork, fine California wines, delicious appetizers, and a silent auction. (Nitin Thakor, Los Angeles)

IIC Provides Its 2018 Highlights So Far

Brad Schmidt, CEO of Inglewood Imaging Center, LLC (IIC), recently shared some "real practical examples of how IIC is transforming healthcare locally, just in 2018 alone, with the goal to connect the fragmented 'dots' in care with the goal to provide a hospital-quality radiology access point for Southern California." IIC has: > Aligned with Torrance Memorial Medical Center with a strategic cancer imaging collaboration. > Interfaced Providence Health's (Epic Software) to improve managed care. > Bridged Independent Physicians to a "virtual health system radiology hub" that mimics IT workflows found only at large health systems (like Kaiser). > Introduced radiology consumerism to LA County for cash price transparency. > Eclipsed 2,800 referring offices referral locations - and supported 400+ MDs for cancer imaging care. > Pioneered advanced artificial intelligence to support clinical interpretations. > Partnered with KJLH Radio & Susan G. Komen to support breast cancer population health. (Brad Schmidt, Los Angeles)

Kaiser Permanente Hospitals in NorCal Declared "High-Performing"

The latest study of hospital care performance by U.S. News & World Report gave 16 Kaiser Permanente (KP) Northern California hospitals a "high performing" ranking, and named KP Santa Clara Medical Center one of the top 50 hospitals in the country for treating kidney disease. Meanwhile, KP members in Northern California are 52% less likely to die from colorectal cancer since the healthcare system launched a comprehensive, organized screening program, according to a new study in the specialty's top journal, Gastroenterology. And, KP Chairman and CEO Bernard J. Tyson was recognized by Modern Healthcare as one of the "100 Most Influential People in Healthcare" in 2018. Tyson is ranked No. 2, along with 11 other leaders, as "disrupters" shaping the future of healthcare. (Walt Meyers, Bay Area)

Kindred & UC Davis to Team on Inpatient Rehab Hospital

Kindred Healthcare, LLC and the University of California, Davis have signed a definitive agreement to create a joint venture to construct and operate a 40-bed inpatient rehabilitation hospital, to be located on the UC Davis Sacramento campus. The hospital will treat patients recovering from conditions such as stroke, traumatic brain injury, and spinal cord injury. Kindred will manage the day-to-day operations of the hospital, and patients will enjoy leading-edge care provided by UC Davis physicians and clinical staff, along with all private rooms. Subject to several regulatory and other approvals, the partners expect the inpatient rehab hospital to open by the third quarter of 2020. (Adam Darvish, Los Angeles)

King & Spalding Lauded + Announces Webinars & Summit

Best Lawyers in America has once again selected over 100 King & Spalding (K&S) lawyers from 50+ practice areas for inclusion in its 2019 list recognizing leading practitioners from across the country. Meanwhile, the latest issue of K&S Health Headlines is available, and upcoming webinars include: Insurance Coverage for Government Investigations and Lawsuits: The Devil in the Details, on September 18, at 10 a.m. Pacific, which will discuss issues relating to insurance coverage in the healthcare space; and New Strategies to Combat Prescription Drug Diversion from Foreign Markets, on Sept. 25, at 9 a.m. Pacific, which will explore strategies to combat diversion of products from foreign markets into the U.S. Also, on October 30, K&S will hold its annual Women In Compliance Summit, in San Francisco, an interactive event focused on exchanging ideas and benchmarking best practices with women in leadership roles across the compliance and investigations spectrum. (Marcia Augsburger, Sacramento & Travis Jackson, Los Angeles)

Maxim Chosen by CMS as Care Transformation Organization

CMS has selected Maxim Healthcare Services as a Care Transformation Organization (CTO) for the Maryland Primary Care Program (MDPCP) beginning in January 2019. Under the program, Maxim and other CTOs will provide care coordination resources and infrastructure to participating primary care practices with the goal of improving health outcomes for Medicare patients while reducing costs. Maxim will draw upon its experience using community health workers and other community-based care management resources to help patients address non-medical factors that often contribute to poor health outcomes - such as insufficient housing or lack of transportation - and connect patients with existing community resources. Maxim implemented a similar program in partnership with the University of Maryland St. Joseph Medical Center beginning in 2015, which reduced hospital readmissions by 66% in the first two years. (Matt Diaz, Sacramento)

Mazzetti Merges with William Tao & Associates

Mazzetti Inc. and St. Louis-based William Tao & Associates (WTA), multi-disciplinary engineers serving nationwide clients, have merged. The merged company will retain the Mazzetti Inc. name. "As our clients nationalize, they need expertise in close proximity to their many locations. WTA brings us expertise in the Midwest to better serve clients in this geographical location," said Walt Vernon, Mazzetti CEO. The combined firm will have a staff of 206 and 11 locations: Irvine, Sacramento and San Francisco, CA; Denver, CO; Atlanta, GA; St. Louis, MO; Portland, OR; Nashville, TN; Dallas, TX; Seattle, WA; and Bengaluru, India. (Walt Vernon, Bay Area)

Mission Hospice Looks Forward to Fall Dinner/Dance

On the evening of September 29, in Foster City, Mission Hospice will put on its 2018 Fall Gala, Diamonds & Denim - Dancing to Pride & Joy. The gala will include dinner, wine, dancing, and live and silent auctions. Sponsorships are available. Funds raised support Mission's Hospice House Campaign. (Dwight Wilson, Bay Area)

Nelson Hardiman Joins Team to Address Legal/Policy Issues for Behavioral Health

Nelson Hardiman (NH) has joined forces with Behavioral Health Association of Providers (BHAP) and Epstein Becker Green to present programming and thought leadership that will address topics highlighting the accelerating legal and policy issues for the behavioral health industry. The team will kick off their collaboration with a fall webinar series. Meanwhile, sparked by the law firm's rapid growth in recent years, NH has relocated its offices to 1100 Glendon in the Westwood area of Los Angeles, where it's leasing two floors and 40,000+ square feet. The move supports the firm's growth strategy by providing multiple larger presentation spaces for NH's frequent calendar of educational and networking events for the healthcare and life sciences communities. (Harry Nelson, Los Angeles)

NorthBay Healthcare Utilizes eConsult with Mayo & Gets NICU Award

NorthBay Healthcare continued its collaboration with Mayo Clinic at an active clip during the first six months of 2018, during which time 20 NorthBay physicians across 14 specialties submitted 74 eConsult requests to Mayo Clinic. These electronic requests allow NorthBay and Mayo Clinic clinicians to connect and consult on complex medical cases. Meanwhile, NorthBay's Neonatal Intensive Care Unit was recently honored by the California Perinatal Quality Care Collaborative with the "Follow Up Award" for the care the NICU team gives its babies even after they've gone home - seeing to that high-risk infants are seen in outpatient care during the next three years, through the California Children's Services' High Risk Infant Follow-up Program. (Elnora Cameron, Bay Area)

OneLegacy to Host Nation's Largest Donation and Transplantation Symposium

On October 30, in Pomona, OneLegacy will host its annual Donation & Transplantation Symposium, with attendance expected to exceed 1,200, making it the largest gathering of its kind in the country. Physicians, nurses, transplant center staff, pastoral care professionals, palliative care professionals, and social workers are among those expected to attend and share messages designed to positively impact donation activity at their hospitals and within their communities. Topics to be discussed include caring for donor families, referral and family support, palliative care, the dynamics of death by neurological criteria, and best practices for aligning donors and recipients. (Tom Mone, Los Angeles)

Oscar Health Gets $375 Million from Alphabet

Alphabet Inc. is putting $375 million into health insurance start-up Oscar Health, the latest healthcare investment from Google's parent company. Oscar, which has been selling health plans under the Affordable Care Act since 2013, plans to use the funds to help fuel its entrance into the market for privately administered health insurance plans for seniors, known as Medicare Advantage, in 2020. Also, Salar Kamangar, the former CEO of YouTube, will join Oscar's board. (Los Angeles Times, 8/14/18) (John Puente, Sacramento)

Pathways Honored by Veterans & Announces Annual Breakfast

Pathways Home Health recently achieved Level 4 stars from the We Honor Veterans organization, denoting its dedication to providing outstanding service to veterans, and enabling VA staff and vets to easily identify Pathways hospice as one who has made a commitment to offer veteran-specific care and services provided by a competent and highly skilled workforce. Meanwhile, on October 25, Pathways will present its annual fundraiser, One From the Heart Awards Breakfast, in Palo Alto. This year's featured speaker is Maxine Hong Kingston, celebrated author and memoirist, and this year's awardees are Gunilla and Tom Follett of Los Altos, who will be honored for their many years of service to Pathways and the cause of hospice. (Barbara Burgess, Silicon Valley)

PreludeDx's Positive Study Highlighted in Cancer Journal

Prelude Corporation (PreludeDx) announced that Clinical Cancer Research has published results from a large cross validation study of DCISionRT in patients with DCIS (ductal carcinoma in situ), also referred to as stage 0 breast cancer. The multi-site study demonstrated that DCISionRT - The DCIS Test - was a strong predictor of radiation benefit and was able to identify patients with significantly elevated recurrence risk who would be considered low risk by traditional clinical assessment. (Dan Forche, Orange County)

SAVI Group on How to Run a Medical Practice Like a Successful Business

Recent blog posts from SAVI Group include How to Run Your Medical Practice Like a Successful Business, which discusses creating a solid business plan, front and back office success, staying in touch with your community, and building your reputation; and Outsource Medical Billing is Changing the Future of Healthcare, which covers revenue cycle management solutions and expected continuous industry innovations. (Sumit Mahendru, Orange County)

SCU Awarded NIH Grants for Researching Spine Pain Treatment

Southern California University of Health Sciences has announced the award of two National Institutes of Health grants for work to be undertaken in collaboration with Dartmouth College. The first pursues research into the effectiveness of spinal manipulation services as compared to prescription drug therapy for the long-term treatment of chronic low back pain in Medicare patients. And the second will assess the risk of cervical artery tears in patients receiving cervical spine manipulation. Current recommendations from The American Heart and American Stroke Associations on this risk are based on flawed methods that the present research seeks to correct. (John Scaringe, Orange County)

Share Our Selves Heralds Upcoming Celebrity Chef Dinner

On Friday evening, October 5, Share Our Selves will present its annual Celebrity Chef Dinner, in Huntington Beach, a fundraising event to benefit SOS and the many services it provides to meet the basic needs of homeless and low-income individuals and families living in Orange County. The evening will include hors d'oeuvres, beer and wine tastings, a three-course gourmet dinner, live music, silent and live auctions, and stunning ocean views. (Karen McGlinn, Orange County)

Tulare Regional Medical Center to Reopen in October

Tulare Regional Medical Center is on track to reopen in mid-October under new management after the board and a bankruptcy judge recently provided several key approvals, the Visalia Times-Delta reports. Becker's Hospital Review has published "6 things to know," including: Adventist Health will manage the facility once it opens through January 1, on behalf of the board. Officials will conduct a study to determine how much Adventist Health will pay Tulare Regional's board to lease the hospital. Adventist will also lend Tulare Regional $10 million to be used toward hiring and paying staff, financing projects, supply-related costs, and consulting and legal bills. For the plan to go into effect, Tulare residents must approve the terms of Adventist's contract, which will be placed on the region's November ballot. (Larry Blitz, Silicon Valley)

WIPFLi Named Among Top Firms in Multiple Rankings

National accounting and consulting firm WIPFLi LLP has earned the number 19 spot on the "2018 Top 100 Firms" list recently published by INSIDE Public Accounting, the second consecutive year the firm has ranked in this top 20 position. The IPA list is based on U.S. net revenue and the submissions of more than 550 firms across the country. WIPFLi, which experienced a 6.3% increase in revenue year over year, has been intentional in its growth through new service-line offerings and firm combinations across the U.S. Also, WIPFLi has placed within the top 15 on two separate top 100 value-added resellers rankings for 2018 from Accounting Today and Bob Scott's Insights report. (Rich Gianello & Jeff Johnson, Bay Area; Tony Taddey, Los Angeles; & Larry Blitz, Silicon Valley)

PCIHIPAA Partners to Help Health Providers Navigate Regulations

PCIHIPAA and DMA Tech Solutions have partnered to protect DMA healthcare provider clients from the onslaught of ransomware attacks, HIPAA violations, and data breaches impacting medical and dental practices throughout the U.S. The collaboration comes on the heels of a recent announcement surrounding HIPAA compliance regulation in which the Director of the U.S. HHS Office for Civil Rights said, "Just because you are a small medical or dental practice doesn't mean we're not looking and that you are safe if you are violating the law. You won't be." Meanwhile, protected health information continues to be under attack as hackers strive to monetize stolen data on the dark web. DMA determined that PCIHIPAA's OfficeSafe Compliance Program is the right solution for its clients. (Jeff Broudy, West Los Angeles Technology)

Tanner Research CEO to Present Nutrition Science Workshop

On the evening of September 19, John Tanner, Ph.D., CEO of Tanner Research, will present a Nutrition Science workshop, where he will share his story about how he suffered a near-fatal cardiac arrest in 2009. Since then, he has studied intensely the causes of heart disease, and found that it can be completely avoided through a proper diet - while cancer, stroke, diabetes, high blood pressure, and about 30 other diseases can be reduced, avoided, or reversed by this same diet. John will field questions and participants will continue nutrition discussions in small groups. The free workshop, to be held at Tanner Research in Monrovia, includes a meal and your choice of one of the top books on nutrition science. (John Tanner, Ph.D., Downtown Los Angeles Technology)

Verity Health System of California Files for Bankruptcy

Verity Health System of California Inc, a non-profit operator of six California hospitals managed by billionaire former surgeon Patrick Soon-Shiong's NantWorks LLC, filed for bankruptcy on August 31 to help resolve a cash crunch while it seeks a buyer. The health system's bankruptcy filing follows a series of deals that left it saddled with more than $1 billion in pension liabilities and bond debt. Verity, which serves low-income communities in Los Angeles and San Jose, secured a $185 million loan to help it stay operational through the bankruptcy. Verity CEO Richard Adcock told Reuters he expected the operator to remain in bankruptcy protection from creditors for a couple years as it restructures and works with potential buyers. He said potential suitors include large national operators, and could include deals for individual facilities. He emphasized the bankruptcy would allow the operator to maintain patient care while restructuring. Soon-Shiong, who has founded and sold multiple biotech companies, acquired Verity's management company in 2017 with the goal of helping to revitalize the hospital chain. Adcock said Verity will examine all of its contracts, including the management deal with Soon-Shiong. (Read Article: Reuters, 8/31/18)

Hospital Consolidation in California Linked to Higher Healthcare Prices

Growing consolidation among hospitals and doctors' practices in California is linked to higher health insurance premiums and higher prices for specialty and primary care, according to a study by UC Berkeley researchers published Tuesday. In California, between 2010 and 2016, the percentage of doctors in medical practices owned by hospitals grew from 25% to 40%. The shift is associated with a 12% increase in Affordable Care Act insurance premiums, a 9% price increase for outpatient doctors' visits in four specialties - cardiology, oncology, orthopedics and radiology - and a 5% price increase for primary care office visits, the study in Health Affairs found. (Read Article: San Francisco Chronicle, 9/5/18)

Why Americans Spend So Much on Healthcare - in 12 Charts

The U.S. will soon spend close to 20% of its GDP on health - significantly more than the percentage spent by major Organization for Economic Cooperation and Development nations. What is driving costs so high? As the series of charts in this article shows, Americans aren't buying more healthcare overall than other countries. But what they are buying is increasingly expensive. Among the reasons is the troubling fact that few people in healthcare, from consumers to doctors to hospitals to insurers, know the true cost of what they are buying and selling. Providers, manufacturers and middlemen operate in an opaque market that can mask their role and their cut of the revenue. Mergers give some players more heft to enlarge their piece of the pie. Consumers, meanwhile, buoyed by insurance and tax breaks, have little idea how much they are really spending and little incentive to know underlying costs. (Read Article: Wall Street Journal, 7/31/18)

GM Aligns with Henry Ford Health System to Cut Costs, Improve Quality

General Motors Co. has struck a deal with Detroit-based Henry Ford Health System to offer a new coverage option to employees, upending the traditional benefits setup in an attempt to lower costs and improve care. The auto maker's agreement with Henry Ford covers everything from doctor visits to surgical procedures. By signing a contract directly with one healthcare provider, as other companies have done, GM says it can offer a plan that costs employees less than other options while also promising special customer-service perks and quality standards. Under the five-year contract, Henry Ford agreed to goals for quality, cost and customer service, such as same-day or next-day appointments with primary-care physicians. Among the objectives are reducing hospital admissions and improving management of high blood pressure. The contract includes targets for the total cost of enrollees' care. If the six-hospital healthcare system meets or beats certain goals, it can win extra payments, but if it falls short it might owe money back to GM. The existing insurance choices offered by GM will still be available to employees, but the new Henry Ford plan, called ConnectedCare, will save them approximately $300 to $900 a year compared with the current cheapest option, depending on how many people the worker is covering. (Read Article: Wall Street Journal, 8/6/18) EDITOR'S NOTE: The CEO of Henry Ford Health System is Wright L. Lassiter III, a former ABL Member as the CEO of Alameda Health System (until he moved to Detroit); Wright and AHS also won an ABBY Award for their Innovative Approach for Delivering Healthcare (by turning around their ER).

San Diego's Heart Attack Rate Is 20% Lower Than Rest of State

Be There San Diego, an organization leading a wide-ranging effort to reduce heart disease by getting doctors from different organizations to work together, is getting national attention for reducing the region's heart attack risk. A newly published study highlights a 22% drop over five years in the number of local heart attack hospitalizations, a result that is a full 14% better than the 8% decrease observed across the state. The paper's authors estimate that San Diego County saw 3,826 fewer heart attack hospitalizations than expected from 2011 to 2016, saving nearly $86 million in avoided medical costs. (Read Article: San Diego Union Tribune, 9/4/18)

New Lab Allows Surgical & Non-Surg Procedures to be Performed in Same Room

Dignity Health Memorial Hospital in Bakersfield, CA has a new lab that will allow for multiple procedures to be completed around the same time. The new lab, unique to the hospital, is a mixture of a cath lab and operating room that allows for surgical and non-surgical procedures to be done at the same time or one right after the other. Patients will no longer have to be moved from one room to another. The lab is located at the Sarvanand Heart & Brain Center at the hospital and was paid for as part of a $3.5 million donation provided by the Lajpat and Kailash Munger family to establish the center. (Read Article: Bakersfield Californian, 8/29/18)

California Healthcare Bills Would Blunt Trump's Actions

California is poised to become the first state in the nation to ban cheap, short-term health insurance plans pushed by the Trump administration as a low-cost alternative to the Affordable Care Act. New federal rules, finalized Aug. 1, allow insurers to deny coverage to people with pre-existing conditions and institute annual and lifetime caps on how much money they are required to spend on covered benefits over the course of a year or the life of a plan. Insurers can also sell health insurance plans that do not cover prescription drugs, and can exclude a broad scope of services. Under the ACA, the short-term plans were allowed for three months, primarily to cover consumers transitioning between coverage. The new Trump administration rule allows insurers to extend them for up to three years. A California bill, authored by state Sen. Ed Hernandez, D-Azusa, would outlaw them altogether. Gov. Jerry Brown has until Sept. 30 to veto it or sign it into law. Brown is also considering bills that would prohibit low-income people on Medi-Cal from being required to work to receive benefits, require health plans to spend at least 80% of their revenue from insurance premiums on healthcare rather than profits and administrative costs, and ban individuals from creating their own so-called "association health plans," which allow employers to join forces to form plans that can also exclude coverage for maternity and mental healthcare, prescription drugs, and pediatric care. (Read Article: Sacramento Bee, 9/4/18)

Safe Injection Site Supporters Urge Gov. Brown to Sign Bill

San Francisco officials, as well as healthcare and substance abuse service professionals, are urging California Gov. Jerry Brown to sign a bill allowing the city to open the country's first supervised injection site for drug users. State Sen. Scott Wiener, co-author of Assembly Bill 186 - "controlled substances: overdose prevention program" - said he's hopeful that the governor will sign it, because Brown believes in progressive alternatives to incarceration. If adopted, the supervised sites will give users access to clean needles, counseling and treatment services in a three-year pilot. But federal law prohibits illicit drug use, as well as owning or renting facilities for drug consumption, so the bill faces stiff opposition. For example, in an op-ed in the New York Times last week after the California State Senate passed AB 186, U.S. Deputy Attorney General Rod Rosenstein railed against the dangers of injection sites, and said that those who open them should expect penalties. (Read Article: KQED, 9/4/18)

Medicare ACOs Saved CMS $314 Million in 2017

CMS made a profit from the Medicare Shared Savings Program last year as more accountable care organizations moved to risk-based contracts and gained experience, new federal data show. About 60% of the 472 Medicare ACOs generated a total of $1.1 billion in savings in 2017, according to the CMS data set released last week. CMS paid $780 million in bonuses to the ACOs, but the agency still scored a $313.7 million gain from the program. The substantial savings comes just weeks after CMS proposed overhauling the program, claiming it wasn't generating enough savings. CMS has argued that ACOs aren't moving quickly enough to risk-based contracts, which is costing Medicare money. (Read Article: Modern Healthcare, 8/30/18)

Healthcare Marketplace Premiums Will Stabilize in 2019: Analysts

Consumers who buy insurance through the Affordable Care Act markets may be pleasantly surprised this fall as average premiums are forecast to rise much less than in recent years. The price of a 2019 policy sold on the ACA exchanges will increase less than 4% according to an analysis of preliminary filings from insurers in all 50 states by ACASignups.net, a web site and blog run by analyst Charles Gaba that tracks ACA enrollment and insurer participation. And those insurers are expanding their offerings. (Read Article: NPR, 9/3/18)

CMS Finalizes Changes to Empower Patients and Reduce Administrative Burden

CMS has finalized a rule to empower patients and advance the White House MyHealthEData initiative and the CMS Patients Over Paperwork initiative. This final rule and others issued earlier will help improve access to hospital price information, give patients greater access to their health information, and allow clinicians to spend more time with their patients. (Read Press Release: CMS.gov, 8/2/18) EDITOR'S NOTE: In reaching out to ABL Member Adam Darvish, Sr. VP, Physician Network Development for Kindred Healthcare's Hospital Division, he commented, "It's a small step, but it should help us and our clinicians to spend more time with the patients."

207 East Memory Lane
Santa Ana, CA 92705

Phone: 714-245-2400 | Fax: (714) 245-1428
Email: Janet@abl.org

Copyright © 2018 Adaptive Business Leaders Organization. All Rights Reserved.