Volume 1, Issue 12

Dear Colleagues,

On January 1, 2014, the Pacific Business Group on Health (PBGH) launched a new program: Employers Centers of Excellence Network (ECEN), which selected Centers of Excellence (COEs) throughout the nation to participate in a travel surgery program for hip and knee replacements.

According to Olivia Ross, senior manager, PBGH, employers see the greatest opportunity of working with COEs in long-term cost savings, which stem from the additional improvement in overall health, reductions in the time it takes for employees to return to work, fewer complications, and so on.

Ross notes that employers tend to opt for travel surgery programs at COEs that offer high quality care at affordable rates, rather than local care that provides the “best deal,” which is what makes PBGH an excellent partner.

Price transparency is becoming a key component of these types of programs. Take a look at the newly announced HCCI, what some states are initiating here, and the private-sector initiatives of companies like vitals.com.

The U.S. Domestic Medical Travel space is on the rise, and I am pleased to report that the Self Insurance Institute of America has invited me to chair a panel on the subject at the annual meeting: www.siia.org/national.

Date: October 5-7, 2014
Location: JW Marriott Desert Ridge Resort, Phoenix, AZ

The SIIA National Conference & Expo is the world’s largest event focused exclusively on the self-insurance/alternative risk transfer marketplace, typically attracting more than 1,700 attendees from throughout the United States and from a growing number of countries around the world. The program features more than 40 educational sessions designed to help employers and their business partners identify and maximize the value of self-insurance solutions.

For additional details about SIIA and the medical travel panel, read the article entitled, “SIIA Panel Discussion: Domestic Medical Travel - Opportunities and Challenges for Self-Insured Employers,” below.

Thank you for your interest in this exciting, growing market space. Please be in touch with your comments and editorial contributions, which can be sent directly to: editor@USDomesticMedicalTravel.com.

Laura Carabello
Editor and Publisher

SPOTLIGHT: Olivia Ross, Senior Manager, Pacific Business Group on Health




About Olivia Ross
Olivia Ross is senior manager with the PBGH Paying for Value team. Her projects include management of the Employers Centers of Excellence Network, which is a multi-purchaser (employer) collaborative established by PBGH as part of its commitment to improving the quality and affordability of healthcare. Additionally, Olivia participates in several ongoing projects focused on changing physician and hospital financial incentives to ensure high-quality healthcare delivery, while also containing costs.

Olivia joined PBGH in 2012 after four years at the Feinberg School of Medicine Center for Healthcare Studies at Northwestern University. She initially served as project coordinator for several programs working with the Chicago Pediatric Patient Safety Consortium to advance patient safety through improved clinician communication and teamwork. Olivia's activities included conducting failure modes effects analysis (FMEA) risk assessments, training and evaluation of clinician handoffs and directing nearly 50 in situ simulations across six local hospitals

Olivia was then recruited to serve as the Research Project manager of the newly formed Northwestern University Transplantation Outcomes Research Collaborative (NUTORC). In addition to managing patient safety projects, she supported strategic planning and oversaw the day-to-day operation of a group tasked with creating innovative health services and outcomes research in organ transplantation.

Olivia holds a master's in Public Health (MPH) from UCLA, and an M.B.A. from the Kellogg School of Management at Northwestern University.

About Pacific Business Group on Health
PBGH is a non-profit business coalition focused on improving the quality and affordability of healthcare. The group represents 60 large healthcare purchaser members with more than 10 million employees, retirees and dependents in California. PBGH works on many fronts to improve the quality and affordability of healthcare, often in close partnership with health insurance plans, physician groups, consumer organizations and others concerned about our healthcare system. www.pbgh.org.

U.S. Domestic Medical Travel (USDMT): Give our readers some background on the Pacific Business Group on Health (PBGH) and the Employers Centers of Excellence Network (ECEN).

Olivia Ross (OR): The PBGH brings employers together with the aim of improving the quality of healthcare while moderating healthcare costs. PBGH serves as a voice for the healthcare purchasers, leveraging the strength of its 60 member companies, who provide healthcare coverage to 10 million Americans and their dependents. PBGH provides employers with a wide array of services that range from advising on relationships with carriers, supporting projects that accelerate price and quality transparency, and advocating for policy initiatives on the Hill. My work in travel surgery falls under our portfolio of paying for value projects. It began when one of our key members and strongest innovators, Walmart, launched a Center of Excellence (COE) travel surgery program for cardiac and spine, and suggested that this type of program could have a stronger impact moving the market if multiple employers joined together. PBGH absolutely agreed, and decided to explore this option together with them.

USDMT: How did you develop the program? What elements were critical to employers?

OR: In early 2013, a group of eight employers came together to help us design a new program, now known as the ECEN, with the aim of selecting COEs throughout the nation for hip and knee replacements.

We learned that employers want a travel surgery program that offers high quality surgical care at affordable rates, not just an arrangement that provides the "best deal." PBGH was able to lead the process of finding providers that are committed to meeting an extremely high bar and willing to accept a pre-negotiated bundled payment. Rather than focusing on the unit costs, employers see the greatest opportunity of working with COEs that provide high quality care in the long-term cost savings. For example, the additional improvement in overall health, faster returns to work, and fewer complications.

Due to PBGH's extensive background in quality measures and orthopedics, we were well positioned to develop an assessment and selection process for hip and knee replacement COEs. Only after we have a sense of whether a center is a strong candidate for our program, can we move into a negotiation standpoint and talk to different COEs to see what options work best for participating employers.

USDMT: How many employees from Walmart, or other retailers, have taken advantage of this type of program?

OR: Our specific program went live on Jan. 1, 2014, and within the first four months we have received more than 1,000 calls of interest from potential patients. Of those, there have been about 450 potential candidates referred to the COEs.

Of the remaining callers, many had heard about the program and were calling strictly to request more information. Other potential candidates needed to further inquire with their home physicians for additional information, or confirm that they had a caregiver who is able to be part of this process.

ECEN patients first go through the steps of working with our third party administrator (TPA), which helps determine eligibility based on employer and COE-provided criteria. A fairly large percentage of candidates are currently having their medical records reviewed, and we have had 109 completed cases and nearly 80 more scheduled surgeries pending.

This process has moved very quickly!

USDMT: Are patients nationwide eligible for this program?

OR: Considering Walmart is participating, and their distribution is wide-reaching, coverage for patients is available nationwide, although the numbers vary across the country.

To minimize travel for patients, we have placed a COE in each region of the United States and will continue to add centers to meet participating employer demand.

USDMT: In terms of data, are there any recognizable trends such as specific age breakdowns, types of employees, etc.?

OR: Unfortunately, it is too early to identify trends, but this is certainly the kind of data we are collecting, and we are excited to begin reviewing our initial data over the next few months.

USDMT: In the future, will this program extend beyond hip and knee replacements?

OR: Absolutely!

We are currently finalizing our process to assess spine centers, and adding cardiac care is being considered, but we need to do more research. We are also excited about a number of other options we can explore, such as cancer treatment and bariatric care.

USDMT: In terms of cost, what is the potential for savings?

OR: There are initial set-up costs, but we are anticipating that any employer that signs on will receive a complete return on investment within two years and with significant savings thereafter. In addition to the competitive bundled rates, the bulk of savings opportunity is the result of the higher quality of care being provided.

USDMT: Is this program only appropriate for larger-sized employers, such as Walmart?

OR: Right now, we are in the process of figuring out what the threshold is for the current network of hip and knee replacement centers, as well as after our expansion to spines. In order to make sure employers receive a return on investment, we first estimated how much money can be saved per case and then determined the volume minimums.

At this point, we are not seeing many appropriate employers that have below 10,000 total covered lives, but this is going to be an area that we are consistently assessing.

USDMT: Do you see this program expanding to international, corporate medical travel?

OR: We are not exploring international expansion at this time, but are open to that process in the future.

If we were able to find a center in another country that met all quality standards in terms of the clinical quality, as well as a seamless, excellent patient experience, we would be excited to further consider that option.

USDMT: Are there any other groups that are taking this route?

OR: There are definitely others who are moving in a similar path, but as far as I know, there are no other large-scale business groups that have brought self-insured employers together like this to design a COE network.

USDMT: Would you personally travel to have a procedure done?

OR: I would absolutely be willing to travel if I had access to a program with this type of quality standards, as well as a supportive team.

I have been involved in the healthcare industry for nearly 10 years now, and I have definitely experienced my share of problems when going through the system.

For a program like this, the idea of having a patient navigator onsite is a huge appeal to me, personally.

USDMT: How does a company like Walmart educate its employees about this opportunity?

OR: Traditional educational mechanisms provide a foundation.

Walmart, for example, includes ECEN in its open enrollment materials and provides its carriers with information. If an employee requests a pre-authorization, the carriers can direct them to the program.

Walmart also has an internal campaign in place and aims to provide positive patient testimonials to interested employees. For instance, Walmart can connect prospective patients with a co-worker who has been through the program and is willing to share their first-hand experiences.

Employers can also use strategies such as targeted mailings, where a simple postcard can inform appropriate candidates about this program, or integration with other health benefit resources such as Castlight.

USDMT: How would a company go about engaging a TPA?

OR: Our program partners with a fantastic TPA, Health Design Plus (HDP). Their involvement is central to our program's success.

HDP is an experienced care management organization and its team oversees the patient experience across the entire continuum of care. HDP also holds the contracts with each of the centers and employers. This allows an employer to join ECEN with a single contract with HDP and gain access to all of our centers.

USDMT: What will ensure the success of this program?

OR: One element of ECEN that sets us apart is our commitment to continuous improvement and constantly raising the bar. All of the centers involved in this program participate in a collaborative call each month. This provides a great opportunity to communicate the latest evidence, share best practices and learn from each other's experiences. ECEN is truly a network, not just a list of hospitals that qualify!

The collaboration among the centers, PBGH and HDP's exceptional partnership, and the ongoing input of participating employers such as Walmart, Lowe's and McKesson will continue to drive the success of this ground-breaking program.

A Healthy Reunion - Miles and Years Apart, Sisters Reconnect at Mercy Springfield for No-Cost Knee Replacements
A Centers of Excellence medical program makes knee replacement surgeries and a family reunion possible for two sisters.

Most family reunions don't happen in a hospital hours away from home after a specialized surgery. But for two sisters with new right knees who hadn't seen each other in years, it's been a wonderful experience.

Judy Howell works for Walmart in Bentonville, Arkansas, and was days away from scheduling a knee replacement surgery when she learned that she could have that surgery, with no out-of-pocket costs, two hours away in Springfield. At the same time, her sister, Jan Senkbeil, who works for Lowe's in Ypsilanti, Michigan, had been putting off a knee replacement for three years.

"As soon as I read the email at work that said we could get knee and hip replacements for no additional costs, I texted my husband," said Senkbeil. "I told him, ‘I'm getting my new knee for free!'"

The benefit took effect on Jan. 1, 2014, after Walmart and Lowe's joined the Pacific Business Group on Health Negotiating Alliance to enhance the medical care their employees receive while reducing costs.

Employees and dependents who are enrolled in the companies' medical plans are eligible for no-cost knee and hip-replacement surgeries at one of four hospital systems that have been named "Centers of Excellence." Those included in this first-of-its-kind national COE network are Mercy Hospital Springfield in Springfield, Missouri; Johns Hopkins, Bayview Medical Center in Baltimore, Maryland; Kaiser Permanente Orange County Irvine Medical Center in Irvine, California, and Virginia Mason Medical Center in Seattle, Washington. Along with no out-of-pocket medical costs, the coverage also pays for travel, lodging and living expenses for the employee and a caregiver.

"When I found out this took effect on January 1, I was on the phone the next day," said Howell.

Meanwhile, Senkbeil started faxing in her paperwork. But the sisters hadn't told each other about their surgery plans. It took a post on Facebook for them to realize they were taking advantage of the same benefit at approximately the same time. "At first I wasn't sure if that was her status or if she liked my status," Howell said. They hadn't seen each other since 2009.

As it turned out, the two had the same coordinator and medical navigators making all their arrangements, so they mentioned the coincidence. "That's when they did some real coordination to make sure we could overlap for at least part of the time," explained Senkbeil.

The sisters both started researching Mercy Orthopedic Hospital Springfield and the doctors who were assigned to their surgery. They traded notes, and read everything they could get their hands on to make sure this was the best decision for both of them. "When I found out this facility really was one of the best in the nation, I was sold," said Howell.

Howell had her surgery on Thursday, Feb. 20, while Senkbeil's surgery took place on Tuesday, Feb. 25. Both are recovering well and looking forward to a better quality of life, which is exactly why the program was designed: to provide the best care while reducing employees' medical expenses.

Family reunion aside, the sisters agree that going away for surgery was actually easier than having it done in their hometowns. Mercy arranged everything from transportation to hotel accommodations and medical appointments. "There were no logistics to worry about, other than getting someone to cover for me at work and stocking the refrigerator for the house sitter," said Senkbeil.

Howell agrees. "I've felt like a celebrity! Plus, being out of the home setting allows you to focus on what you're here for."

Senkbeil added, "At home you do what needs to be done, but this is all about me and I love it."

Howell works in program management for Walmart's information system department, and says she knows a good process when she sees one. "This really is a Center of Excellence. They had a vision for what a facility could be and here it is. Plus, they have the right team in place to make it all happen."

The sisters are not only pleased with the program and their surgeries, but they also have a real appreciation for the employers who made it all possible. "Lowe's is very forward-thinking, and this is a really great benefit to offer associates. When you give great benefits, you get great employees," said Senkbeil. Howell chimed in, "Walmart has found an appropriate way to control costs for its associates while making sure the care is the absolute best. I think it's great."

After this experience, both sisters think other companies should look into destination medicine agreements. "I think it's the future of U.S. healthcare," said Howell. The impromptu family reunion was a great bonus, too. "We got to catch up on the nieces and nephews," Howell said with a smile.

To view the original release click here.

World's Largest Self-Insurance/ART Event Coming to Phoenix!

The Self-Insurance Institute of America, (SIIA) today announced the program for its National Educational Conference & Expo, scheduled for October 5-7, 2014, at the J.W. Marriott Desert Ridge Resort & Spa in Phoenix. The event typically attracts more than 1,700 attendees from throughout the United States and from a growing number of countries around the world.

Detailed event information, including registration forms, can be accessed on-line at www.siia.org, or by calling 800/851-7789. Sign up today and take advantage of discounted early bird registration fees and secure your room at the host hotel. NOTE: This hotel is a SIIA member favorite and always sells out early, so please keep this in mind as you make your arrangements.

The program features more than 40 educational sessions designed to help employers and their business partners identify and maximize the value of self-insurance solutions.

We'll cover self-insured group health plans from every angle, including plan design and cost containment, financial risk transfer, broker involvement and healthcare reform compliance. Extra content has been incorporated this year that should be of specific interest to TPA executives and their key management teams. And you won't want to miss our panel discussion sessions featuring top thought leaders talking about the future of the self-insurance marketplace.

Another focus will be stop-loss captive programs (also known as employee benefit group captives). An increasing number of smaller and mid-sized employers have been considering self-insured group health plans and stop-loss captive programs can help facilitate this transition. SIIA has become the recognized industry leader in this fast-growing captive insurance market niche and the session speakers for this topic area will be many of the industry's top experts.

Also within the Alternative Risk Transfer track, additional sessions will focus on Enterprise Risk Captives, also known as 831(b) captives, which have become an increasingly popular self-insurance solution for many companies.

Given the rapidly involving business and regulatory environment for group workers' compensation self-insured funds (SIGs), we have incorporated a series of roundtable sessions where SIG leaders from around the country will provide a unique opportunity to share perspectives on how their organization should be positioning itself for future success. These SIG-focused roundtables will be supplemented by additional timely sessions of interest to both groups and individual workers' compensation self-insurers.

Rounding out the program will be some sessions addressing key self-insured issues, including healthcare reform compliance requirements for companies with global operations and/or workforces, giving the conference an added international flavor.

This top notch educational program will be supplemented with quality networking events, including an exhibit hall with more than 150 companies showcasing a wide variety of innovative products and services designed specifically for self-insured entities. If you are searching for a self-insurance business partner, they will be waiting for you at this event. For more information about exhibiting and sponsorship opportunities, please contact Justin Miller at 800/851-7789, or jmiller@siia.org.

Your can get a head-start on your networking by participating in the conference golf tournament the morning of Sunday, October 5. And then cap things off with an incredible social event on the closing night of Tuesday, October 7, so be sure that you make your travel arrangements accordingly.

New to Self-Insurance/Alternative Risk Transfer? SIIA Welcomes You!....While the conference will be packed with industry experts and many advanced-level educational sessions, SIIA warmly welcomes those who are new to self-insurance/alternative risk transfer and want to learn the basics. To help you get started, we have scheduled "beginner" sessions immediately before Sunday night's welcome reception to help you more fully participate in the overall event. Additionally, for employers (non-industry service providers) considering self-insurance, you can take advantage of a highly discounted registration fee.

If self-insurance is important to you in any way, this is simply a must-attend event. We look forward to seeing you in Phoenix.

Register Now: www.siia.org/national

SIIA Panel Discussion: Domestic Medical Travel - Opportunities and Challenges for Self-Insured Employers

Description: While international medical travel has been highly publicized over the past several years, domestic medical travel has been more quietly gaining traction among a growing number of self-insured employers.   This panel discussion will explore the latest trends in domestic medical travel and what employers need to consider when evaluating whether to incorporate this strategy as part of their health plans.

Moderator: Laura Carabello
                           Editor and Publisher:  National and International Newsletters
                           U.S. Domestic Medical Travel:  www.USDomesticMedicalTravel.com
                           Medical Travel Today:  www.MedicalTravelToday.com


  • Ruth Coleman, CEO, Health Design Plus
  • G. Keith Smith, M.D., CEO, Surgery Center of Oklahoma
  • Olivia Ross, Senior Manager, Employers Centers of Excellence Network
  • Pacific Business Group on Health

About Ruth Coleman

Prior to founding Health Design Plus in 1988, Ruth Coleman had almost 20 years of experience in HMO and hospital management, patient care, and nursing education. Her experience includes several executive HMO and hospital management positions with responsibility for network development, utilization management, customer service, quality management, marketing, strategic planning, and operations. Coleman used this breadth of managed care and care delivery experience to create an organization that provides high quality management for employer-sponsored health benefit plans.

Her experience, expertise and leadership have guided Health Design Plus through incredible growth, recognized by numerous awards, including the prestigious Inc. 500 and 11 consecutive years as part of the Weatherhead 100, along with being named one of the Top Ten Women Business Owners in Northeast Ohio, and a finalist for the Ernst and Young Entrepreneur of the Year Award.

About G. Keith Smith, M.D.

G. Keith Smith, M.D., is a board-certified anesthesiologist in private practice since 1990. In 1997, he co-founded The Surgery Center of Oklahoma, an outpatient surgery center in Oklahoma City, Oklahoma, owned by 40 of the top physicians and surgeons in central Oklahoma. Dr. Smith serves as the medical director, CEO and managing partner while maintaining an active anesthesia practice.

In 2009, Dr. Smith launched a website displaying all-inclusive pricing for various surgical procedures, a move that has gained him and the facility national and even international attention. Many Canadians and uninsured Americans have been treated at his facility, taking advantage of the low and transparent pricing available.

Operation of this free-market medical practice, arguably the only one of its kind in the United States, has gained the endorsement of policymakers and legislators nationally. More and more self-funded insurance plans are taking advantage of Dr. Smith's pricing model, resulting in significant savings to their employee health plans. His hope is for as many facilities as possible to adopt a transparent pricing model, a move he believes will lower costs for all and improve quality of care.

The Surgery Center of Oklahoma is a 32,535 square-foot, state-of-the-art multispecialty facility in Oklahoma City, owned and operated by approximately 40 of the top surgeons and anesthesiologists in central Oklahoma.
If you have a high deductible or are part of a self-insured plan at a large company, you owe it to yourself or your business to take a look at our facility and pricing which is listed on this site. If you are considering a trip to a foreign country to have your surgery, you should look here first. Finally, if you have no insurance at all, this facility will provide quality and pricing that we believe are unmatched.

It is no secret to anyone that the pricing of surgical services is at the top of the list of problems in our dysfunctional healthcare system. Bureaucracy at the insurance and hospital levels, cost shifting and the absence of free market principles are among the culprits for what has caused surgical care in the United States to be cost-prohibitive. As more and more patients find themselves paying more out-of-pocket, it is clear that something must change. We believe that a very different approach is necessary, one involving transparent and direct pricing.

Transparent, direct package pricing means the patient knows exactly what the cost of the service will be upfront.

About Olivia Ross
Olivia Ross is senior manager with the PBGH Paying for Value team. Her projects include management of the Employers Centers of Excellence Network, which is a multi-purchaser (employer) collaborative established by PBGH as part of its commitment to improving the quality and affordability of healthcare. Additionally, Olivia participates in several ongoing projects focused on changing physician and hospital financial incentives to ensure high-quality healthcare delivery, while also containing costs.

Olivia joined PBGH in 2012 after four years at the Feinberg School of Medicine Center for Healthcare Studies at Northwestern University. She initially served as project coordinator for several programs working with the Chicago Pediatric Patient Safety Consortium to advance patient safety through improved clinician communication and teamwork. Olivia's activities included conducting failure modes effects analysis (FMEA) risk assessments, training and evaluation of clinician handoffs and directing nearly 50 in situ simulations across six local hospitals

Olivia was then recruited to serve as the Research Project manager of the newly formed Northwestern University Transplantation Outcomes Research Collaborative (NUTORC). In addition to managing patient safety projects, she supported strategic planning and oversaw the day-to-day operation of a group tasked with creating innovative health services and outcomes research in organ transplantation.

Olivia holds a master's in Public Health (MPH) from UCLA, and an M.B.A. from the Kellogg School of Management at Northwestern University.

Greater Healthcare Price Transparency Could Save $100 Billion Over 10 Years
New West Health Policy Center report finds transparency alone won't control spending, but can support changes in health plan design and payment reforms


Providing patients, physicians, employers and policymakers more information on healthcare prices could reduce U.S. healthcare spending by an estimated $100 billion over the next decade, according to a new analysis from the Gary and Mary West Health Policy Center.

Most healthcare transparency initiatives focus solely on providing patients with information on out-of-pocket costs. "While healthcare transparency is typically viewed through the lens of patient-facing transparency tools to drive comparison shopping, our analysis suggests even greater impact could be achieved by expanding the audience for such information," said Dr. Joseph Smith, chairman of the West Health Policy Center Board of Directors. "We've found that providing price information to three key stakeholders-physicians, employers and policymakers-may have a far greater impact. And we have identified a range of new policy proposals, including three that, if implemented, could save $100 billion over 10 years."

Conducted by researchers at the former Center for Studying Health System Change (HSC), the analysis, Healthcare Price Transparency: Policy Approaches and Estimated Impacts on Spending, quantifies the potential savings from three policy initiatives:

  • Use state all-payer health claims databases (APCDs) to report hospital prices

This initiative could save up to $55 billion in several ways: by using claims data to make employers more aware of price differences and realize savings from narrower provider networks and tiered benefits; by increasing pressure on high-price hospitals to reduce or justify their prices; and by informing the discussion of policy options for controlling costs.

  • Require electronic health record systems to provide prices to physicians when ordering diagnostic tests

Physicians play a key role in recommending which tests and treatments are necessary, but they are often unaware of the cost of the services they are ordering. Providing cost information to physicians would enable informed, shared decision making about the relative value of discrete tests or treatments when developing patient-specific treatment plans. This is estimated to produce up to $25 billion in savings over 10 years.

  • Require all private health plans to provide personalized out-of-pocket expense information to enrollees

Estimated to reduce health spending by $15-20 billion over the next decade, this initiative would have a relatively modest impact because most private plans already offer a personalized price tool, but few consumers actually use them. More effective patient-facing transparency tools and/or steeper incentives for their use could increase the impact of this initiative.

"Price transparency alone isn't going to change the structural factors that support excessive spending in our healthcare system, but in concert with the transition to newer health plan designs, and newer ways of paying providers, it plays an essential role," said Chapin White, Ph.D., lead author of the analysis and a former HSC senior researcher now at the RAND Corp.

Along with specific policy examples, the analysis identified three overarching themes:

  • Price transparency is not a silver bullet that alone can tame excessive health spending. Rather, price transparency is likely to be most effective in supporting other reforms, such as shifts to health plan benefit designs that steer patients to higher-value providers, and changes in payment policy that put medical providers at greater financial risk for the total costs of care.
  • Patients are just one audience for price information, and one with a limited ability to respond. Employers, physicians and health plans can have a significant influence on spending if they make decisions based on what care costs.
  • Price data can help healthcare stakeholders better fulfill their expected roles. Physicians, for example, are increasingly being held responsible for the total costs of care their patients receive.

As a result of the analysis, the West Health Policy Center announced today that it is in the process of contracting with the University of New Hampshire to create a "Manual for APCD Development." The University of New Hampshire and the National Association of Health Data Organizations supports and staffs the APCD Council, which, since its inception in 2007, has worked with many states to facilitate the planning and implementation of state-based APCDs. Over the years, states have requested guidance in several common areas, and the Council has developed a number of white papers and presentations to address these issues.  Packaging these materials and lessons learned into a manual will formally collate the collective learnings from states, and promote uniformity in a structured document to guide all facets of APCD planning for states.  

This project and the healthcare price transparency analysis will be the focus of a West Health IDEA series panel discussion moderated by Scott Hensley, host of National Public Radio's "Shots" on Thursday, May 15, at 8:30 a.m. EST in the Knight Studio at the Newseum in Washington, District of Columbia. It will also be available via live webcast. Panelists will include David Lansky, Ph.D., CEO, Pacific Business Group on Health; Josephine Porter, M.P.H., deputy director, Institute for Health Policy and Practice at the University of New Hampshire; and Dr. Joseph Smith.

About the Gary and Mary West Health Policy Center
The Gary and Mary West Health Policy Center is a nonprofit, non-partisan resource in Washington, District of Columbia, providing education, expertise and policy proposals to transform the American healthcare experience. We're wholly funded by philanthropists Gary and Mary West as part of West Health, four organizations with a common mission-pioneering new and smarter technologies, policies and practices, to make high-quality healthcare more accessible at a lower cost to all Americans.

Along with the Policy Center, West Health includes the Gary and Mary West Health Institute, a nonprofit medical research organization working to create new, more effective ways of delivering care; and the for-profit Gary and Mary West Health Investment Fund and West Health Incubator, providing investments and expertise to businesses that share our mission. For more information, find us at www.westhealth.org and follow us @westhealth.

Nancy Ives Schroeder

Report: Federal Exchange A Comparative Bargain
by Julie Rovner

Kaiserhealthnews.org-Sometimes there really are economies of scale. And the nation's health insurance exchanges may be a case in point.

As rocky as its rollout was, it cost the federal exchange,healthcare.gov, an average of $647 of federal tax dollars to sign up each enrollee, according to a new report.  It cost an average of $1,503 - well over twice as much - to sign up each person in the 15 exchanges run by individual states and Washington, District of Columbia.
The report, released Wednesday, was compiled using data from federal enrollment figures and federal exchange funding for both the federal and state exchanges. It was written by Jay Angoff, a former Missouri Insurance Commissioner and one-time director of the Health and Human Services office in charge of implementing the health exchange program.

Even California, the most efficient of the state-run exchanges, at $758 per enrollee, still spent more than the average in the federal exchange. And California was the only state-run exchange with a per-person average under $1,000.

Hawaii, with a combination of a poorly-functioning website, a small population overall, and a small population of uninsured, brought up the rear in the study. It cost the Aloha State an average of $23,899 per enrollee covered. Washington, District of Columbia, came in next to last at $12,467 per person.

What was not expected, said Angoff in an interview, is that the five states whose governors and/or legislatures were among the most adamant about resisting the Affordable Care Act - Florida, Texas, Georgia, Virginia, and Michigan - ended up with the lowest per-person enrollee costs. Florida's cost per enrollee was just $76; Texas' was $102, and Michigan's $427."The states that fought the ACA the hardest ended up with exchanges that have been very efficient," he said.

All of the states with very high per-enrollee costs have one thing in common - relatively small populations. Yet it took millions of dollars to set up each exchange, so the smaller states couldn't spread the costs. "Below some size, it doesn't make sense for a state to run its own exchange," Angoff said.

For example, "Hawaii got $200 million in grant funding," he said. "For a state of a little less than 1.4 million," it enrolled 8,592 people. At the same time, New York, with 19.7 million people, "got a little more than twice as much money" - $429 million - and enrolled 370,000 people.

Angoff said it does make sense to let states whose exchanges are functioning well to continue, but the federal government might want to reconsider letting other states establish their own exchanges, and encourage those whose exchanges aren't doing so well to become part of healthcare.gov.

Oregon, for example, whose website failed somewhat spectacularly, and whose exchange is now under investigation by the FBI, according to The Oregonian, has already decided to join the federal exchange.
Maryland, on the other hand, which has also suffered from serious problems with its exchange, has decided to retool using technology pioneered by Connecticut.

"If a state exchange is working, great," Angoff said. But if not, "does it make any sense to throw good money after bad?"

Kaiser Health News is an editorially independent program of the Henry J. Kaiser Family Foundation, a nonprofit, nonpartisan health policy research and communications organization not affiliated with Kaiser Permanente.

To view the original article click here.

Supply of Primary Care Physicians Varies Widely by State
by Robert Lowes

Recently, MedScape.com published an article which spotlights the state-by-state variation of primary care physicians throughout the United States.

To view the article click here.

PLEASE NOTE: A free, one-time registration is required in order to view the entire article and all other content on the Medscape site.

Obamacare 2015 Pricing Remains a "Guessing Game"
Uncertainty among health insurance actuaries is pervasive according to a Munich Health study

Health insurance actuaries lack adequate data to confidently submit 2015 pricing plans to the state insurance boards for enrollment under the Affordable Care Act (ACA), according to a study released today. The study was conducted by Munich Health North America, Inc. a subsidiary of Munich Re, one of the world's largest reinsurers.

Among the actuaries surveyed, two-thirds (66 percent) lack enough information regarding demographics or utilization rates of those who enrolled in healthcare exchanges in 2014 to accurately formulate pricing decisions for the year ahead. The deadline for submission was recently extended from May 1, 2014, to May 31, 2014, by the Centers for Medicare and Medicaid Services.

"With only preliminary data available, pricing the costs of healthcare has been more difficult than ever for some of the best and brightest actuaries in the country," said Brad Anderson, chief actuary of Munich Health North America's Managed Care Division. "As the May deadline approaches, health insurance actuaries are facing increased pressure to accurately price plans for 2015. However, the impact on health insurance companies could be dramatic if actuaries are unable to appropriately price this risk."

Managing Demographic Risk

Based on current data, most health insurance actuaries believe that the demographics of individuals moving onto the exchanges will create a riskier health insurance market. According to the study, 86 percent foresee a shift in the relative morbidity of the newly insured and predict a significantly less healthy group of people joining the exchanges. Of those actuaries polled, 84 percent felt that the age mix was a cause for concern from a risk perspective, and 62 percent noted anti-selection was occurring. Further, 93 percent anticipate a spike in utilization by the newly insured due to ‘pent up' demand among those who didn't previously have or qualify for health insurance, in turn creating a riskier market.

"Risk is going to be increasingly managed by medical providers. But hospitals are not going to have the actuarial ability to do that well, and most won't have the financial reserves - they will need reinsurance," said Howard Dean, former Governor of Vermont and former Chairman of the Democratic National Committee, at the recent Munich Health Symposium.

Shifting Risk, Higher Costs

The vast majority of actuaries (83 percent) noted that the overall impact of the ACA has been negative on health insurance costs. Additionally, nearly half of the respondents (45 percent) noted that there will likely be an increase in pricing for the commercial market in 2015, as a result of the ACA.

"Expect premiums to go up, cost to go up, spending to go up, utilization to go up, and that will all be directly attributable to Obamacare," said Bill Frist, former U.S. Senate Majority Leader, at the 2014 Munich Health Symposium.


Munich Health surveyed 90 actuaries who specialize in the field of healthcare and are currently working for health insurance plans or for healthcare consulting firms. The survey was conducted between March 5, 2014 and March 20, 2014. A copy of the results can be found at http://www.munichhealthnare.com/pdf/MHNA_Actuarial_Survey.pdf.

Note for editorial departments in case of enquiries, please contact: Media Relations Munich Health North America Bob Aristarco Tel.: (609) 243-4343 raristarco@munichhealth.com.

Munich Health is one of three business segments of Munich Re. Here all international healthcare business in insurance and reinsurance operations, as well as related services, are pooled under the Munich Health brand.

Munich Re stands for exceptional solution-based expertise, consistent risk management, financial stability and client proximity. This is how Munich Re creates value for clients, shareholders and staff. In the financial year 2013, the Group - which combines primary insurance and reinsurance under one roof - achieved a profit of €3.3bn on premium income of over €51bn. It operates in all lines of insurance, with almost 45,000 employees throughout the world. With premium income of around €28bn from reinsurance alone, it is one of the world's leading reinsurers. Especially when clients require solutions for complex risks, Munich Re is a much sought-after risk carrier. Its primary insurance operations are concentrated mainly in the ERGO Insurance Group, one of the major insurance groups in Germany and Europe. ERGO is represented in over 30 countries worldwide and offers a comprehensive range of insurances, provision products and services. In 2013, ERGO posted premium income of €18bn.

Media Relations
Robert Aristarco
Munich Health North America
1 (609) 243-4343

Munich Health North America, Inc.
555 College Road East Princeton, NJ 08543 United States

Ambulatory Surgical Centers Cheaper than Hospitals
by Ron Shinkman

Fiercehealthfinance.com-The use of ambulatory surgery centers spiked in recent years, partly because they're more convenient for patients than hospitals. It turns out they're cheaper as well.

A procedure performed at a surgery center not only gets patients back to their homes quicker, it's significantly less expensive, according to a study published in Health Affairs.

To view the original article in its entirety click here.

Arizona Creates Hospital Price Comparison Website
By Ron Shinkman

Fiercehealthfinance.com - Arizona's Department of Health Services unveiled a website last week that provides both quality and pricing data for the state's hospitals.

To view the original article in its entirety click here.

MERS Virus Spreads, But Not Yet a Global Health Emergency
WHO says seriousness of situation grows
by Katie Sullivan

Fiercehealthcare.com-The Middle East Respiratory Syndrome (MERS) virus does not yet constitute a global public health emergency, the World Health Organization (WHO) said this week, but the disease may be spreading.

There are more than 500 reported cases of the virus--which causes coughing, fever and sometimes fatal pneumonia--in Saudi Arabia alone, and it has spread to neighboring European and Asian countries, killing about 30 percent of those infected, Reuters reported.

To view the original article in its entirety click here.

CDC Updates Interim MERS Infection Prevention Recommendation
by Anuja Vaidya

The Centers for Disease Control and Prevention has updated its Interim Prevention and Control Recommendations for Hospitalized Patients with Middle East Respiratory Syndrome Coronavirus (MERS-CoV).

To view the original article in its entirety click here.

New Medical Procedure Reduces Strokes, Boots Medical Tourism
By Lorena Inclan

A brand-new medical procedure is not only reducing the risk of strokes but also helping to position Jacksonville as a medical tourism hub.

Dorothy Stratton faced a grim prognosis. Not only was she diagnosed with atrial fibrillation, an irregular heart rate that causes poor blood flow to the body, but she wasn’t eligible to take blood thinners to prevent blood clots from forming and going to her brain.

To top it off, she knew exactly what would happen if left unattended.

“My father had a massive stroke and I saw what it did to him. He couldn’t talk, he couldn’t walk, he couldn’t use half of his body and it just terrified me” said Stratton.

Stratton was out of options until she met Dr. Saumil Oza, who explained there is one last chance to prevent the same fate as her father.

It’s called the Lariat. Oza is the first doctor in the area to perform procedure.

“What the Lariat does is it actually ties off the left atrial appendage and eliminates that risk for stroke without the use of blood thinners,” said Oza.

Stratton’s surgery lasted about two hours at St. Vincent’s Riverside. Using two magnets attached to needles, Oza cinched off the part of Stratton’s heart where clots could form.

Oza said this groundbreaking operation can now be added to Jacksonville’s arsenal of medical procedures while helping to make it a hub for medical tourism.

“We have patients coming from as far as south Florida, South Carolina, as far west as Valdosta, Georgia. So our radius for getting patients is increasing and this procedure is going to increase it further,” said Oza.

Oza believes Stratton is the first of many patients who will undergo the Lariat procedure.

Like Stratton, many who suffer from the same condition now have a chance to live a normal life.

“I feel like he gave me a new beginning,” said Stratton.

It’s been a week since Stratton had the procedure. In about a month, she will return to St. Vincent’s Medical Center to be cardioverted, which means her heart will be reset to get it back to normal rhythm.

According to Oza, there are 2-3 million people suffering from atrial fibrillation in the United States but only 50 percent of patients that are supposed to be blood thinners actually are, leaving the other half potentially eligible for the Lariat procedure.

To view the original article in its entirety click here.

Help Save a Life and Support MatchingDonors
100 percent of all donations on MatchingDonors.com go to help people get organ transplants on MatchingDonors.com.

MatchingDonors is a 501c3 nonprofit organization and the nation's largest online living organ donor organization finding living organ donors for people needing organ transplants.  In conjunction with various health organizations throughout the United States we have created a very successful Public Service Announcement campaign to help people recognize that they can save lives by being a living organ donor, to encourage them to register as an altruistic living organ donor, and to make them realize they can help save the lives of people needing organ transplants by donating other things. This MatchingDonors Living Organ Donor Initiative program has already saved thousands of lives.

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Spotlight Interview

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News in Review

A Healthy Reunion - Miles and Years Apart, Sisters Reconnect at Mercy Springfield for No-Cost Knee Replacements

World's Largest Self-Insurance/ART Event Coming to Phoenix!

SIIA Panel Discussion: Domestic Medical Travel - Opportunities and Challenges for Self-Insured Employers

Greater Healthcare Price Transparency Could Save $100 Billion Over 10 Years

Report: Federal Exchange A Comparative Bargain

Supply of Primary Care Physicians Varies Widely by State

Obamacare 2015 Pricing Remains a "Guessing Game"

Ambulatory Surgical Centers Cheaper than Hospitals

Arizona Creates Hospital Price Comparison Website

MERS Virus Spreads, But Not Yet a Global Health Emergency

CDC Updates Interim MERS Infection Prevention Recommendation

New Medical Procedure Reduces Strokes, Boots Medical Tourism

Help Save a Life and Support MatchingDonors