2011bv|ovecs8|covldecs|cb|ls|loq,ttC

Californias rural seniors are considerably

more likely to be overweight and unhealthy
than their urban counterparts, according to a
new study by the UCLA Center for Health
Policy Research.
Using data from the California Health
Interview Survey,
UCLA researchers
concluded that the
states 710,000
rural seniors
experience far more
isolation than those
who live in the cities,
often diminishing
their opportunities to
exercise and purchase
healthier foods.
As a result,
elders living in rural
areas are more than
10% more likely to be
obese than those
who live in cities
and suburbs, and
about 15% more
likely to be
sedentary. At the same time, rural seniors also
have rates of food insecurity about 60% higher
than their suburban counterparts, although
city dwellers experience higher rates of food
insecurity.
"The countryside can have an isolating
effect," said Steven P. Wallace, the Center's
associate director and a co-author of the study.
"When even a trip to the grocery store is a
signicant drive, seniors can become trapped
in their houses."
According to the UCLA data, rural elders
suffered from heart
disease and were
more likely to suffer
a serious fall that
could lead to injuries
at signicantly higher
rates than their urban
and suburban
counterparts.
The study made a
variety of
recommendations.
Among them:

Improve access to
medical providers in
rural areas,
including the
payment of
incentives for
physicians to
practice in such regions

Rural communities should keep better

track of federally-designated health
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July 11-12
June 17-19
Calendar
16 June 2011
June 20-24
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E-Mail
info@payersandproviders.com with
the details of your event, or call
(877) 248-2360, ext. 3. It will be
published in the Calendar section,
space permitting.
www.lakesidecommunityhealthcare.com
California Edition
Rural Seniors In Healthcare Bind
Isolation Leads to Obesity And Chronic Conditions
Continued on Next Page
Heart Disease Diabetes Falls
12.9
16.1
20.9
14.6
19.4
22.8
16.4
18.5
25.1
Rural Urban Suburban
Percentage of California seniors with health conditions,
by region. Source: UCLA
2011bv|ovecs8|covldecs|cb|ls|loq,ttC
Payers & Providers Page 2
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In Brief
Whooping Cough
Seems To Wane, But
Rates Remain Elevated
The number of pertussis cases
reported in California reported this
year is far lower than 2010 figures,
but officials caution that the
numbers remain high compared to
years prior.
As of mid-May, 1,102
Californians had contracted the
disease, which is also known as
whooping cough, according to
date from the California
Department of Public Health. That
is rate of 7.5 cases per 1,000
population. It puts California on
pace to have 2,957 reported cases
for all of 2011.
In 2010, 9,120 cases of
pertussis was reported, a rate of
23.3 cases per 100,000 of the
population and the highest rate
since 1947. More than 800
hospitalizations occurred, and 10
patients died, all of them children.
However, only 1,337 cases
were reported as of June 30 of last
year. The disease mostly thrives
during the summer and early
autumn. More than 1,500 cases
were reported in August of last
year before tapering off.
While it is too early to know
if this year will reach the same
high levels of this debilitating
disease, California is currently
experiencing more cases than
would be typically expected, said
Howard Backer, M.D., interim
director of the CDPH. He added
that the current number of
reported cases is similar to trends
reported in 2005 the last time
incidences of the disease were on
the rise prior to 2010.
Continued on Page 3
NEWS
Rural (Continued from Page One)
professional shortage areas (HPSAs),
medically underserved areas (MSAs) and
medically underserved populations (MUPs)
that would help leverage additional federal
funding for healthcare delivery.

The Internet and the use of

telemedicine should be employed on a
larger scale to guarantee better access to
preventive care

Rural transportation agencies should

assure that there are service routes
between residential areas and grocery stores
The UCLA research is supported in part
by a new study of life expectancy issued by
the Institute for Health Metrics at the
University of Washington. California provides
one of the starkest contrasts among states.
Among the coastal and urban areas, life
expectancies routinely rose among women
between 2.6 and four or more years between
1987 and 2007, with Bay Area residents
enjoying one of the longest life expectancies
in the nation. But in the mostly rural San
Joaquin Valley and rural areas north of
Sacramento, life expectancy increased
grudgingly, often two years or less. In Lake
County, life expectancies for women actually
declined slightly.
That trend was replicated across the
United States, which ranked just 35th
worldwide in life expectancy. Coastal urban
areas saw greater gains in life expectancy,
while large swathes of the Southeastern
portion of the country, along with the Las
Vegas and Phoenix metropolitan areas, saw
declines.
Despite the fact that the U.S. spends
more per capita than any other nation on
health, eight out of every 10 counties are not
keeping pace in terms of health outcomes,
said Christopher Murray, the institutes
director and one of the studys co-authors.
Thats a staggering statistic.
WellPoint To Acquire CareMore
$800M Deal Gives Foothold Into Medicare Market
Indianpolis-based WellPoint, Inc., one of
Californias largest health insurers, has agreed
to acquire Cerritos-based Medicare Advantage
insurer CareMore Health Group for $800
million.
CareMores size is relatively small, with
just 44,000 lives in California and another
10,000 in the neighboring states of Arizona
and Nevada. That compares to Wellpoints
approximately 8 million lives statewide
through its Anthem Blue Cross of California
afliate. It also operates 26 clinics, whereas
WellPoint operates none.
However, Caremores experience in the
Medicare market makes it a prime prize for
WellPoint, which has huge market share in the
Medicaid market but few senior lives a
segment expected to boom in the coming
decades.
Currently, WellPoint has just over a half-
million Medicare Advantage enrollees, less
than 2% of its nationwide enrollment of 33
million. That places it fourth among the
nations largest Medicare Advantage carriers.
"The Medicare market is particularly
signicant for WellPoint's growth strategy,"
said WellPoint Chief Executive Ofcer Angela
F. Braly. She added that more than 1 million
Continued on Next Page
2011bv|ovecs8|covldecs|cb|ls|loq,ttC
Page 3
Payers & Providers
Longer ALOS!*
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*For our ads, not your hospital
NEWS
In Brief
HEALTHCARES BEST ADVERTISING VALUE
]
PAYERS & PROVIDERS reaches 5,000 hospital, health plan and non-
prot executives statewide. There is no better venue for marketing
your organization or conference, or recruiting new staff.
LEARN MORE HERE
OR CALL (877) 248-2360, ext. 2
At rst glance, it appeared Hoag Memorial
Hospital Presbyterian had had its tax
exemption revoked last week by the Internal
Revenue Service.
The Newport Beach hospital was listed
among more than 30,000 non-prot
organizations in California that had had its tax
exemption automatically revoked for not ling
annual reports for three years in a row.
An IRS ofcial conrmed the revocation
this week, but would not comment on specic
revocations as a matter of policy.
However, Hoag had regularly led 990
Form tax returns, according to public records.
Moreover, the employer identication number
listed with the revocation did not match the
one used by the 498-bed hospital on its tax
returns.
It turned out that the revocation had been
for a self-insured dental insurance trust Hoag
had discontinued for employee use back in
Nurses Cost Hospitals
$98K A Year Apiec e
The average cost of a hospital-
based nurse is $98,000 a year,
according to a new survey by
KPMG.
KPMG surveyed more than
120 hospital chief executive
officers for the survey. Of the
direct costs, $55,739 is tied to
wages, while the rest is connected
to lost productivity, employer
taxes, vacation, recruitment and
insurance costs. The overall
average attrition rate for the vast
majority of respondents was in the
10% to 20% range.
Payment for overtime wages
for nurses averaged four hours per
week. And 65% of the CEOs say
they use traveling nurses,
primarily for seasonal needs and
to address local nursing shortages.
The survey did not provide
specific data for California or
other portions of the country.
IEHP Charac ter Wins
Advertising Award
Super Nutricia, a superhero-
oriented advertising campaign
created by San Bernardino-based
Inland Empire Health Plan in
2009 to combat obesity, received
top honors from the American
Advertising Federation.
The Gold AddyAward was
from the AAFs Inland Empire
chapter.
A Latina character dressed in
a yellow costume, Super Nutricia
encourages children to take a
pledge to stop eating junk food
and eat more fruits and
vegetables.
Super Nutricia is among
several superhero characters IEHP
has developed to promote
healthier living for its Medi-Cal
and Healthy Families enrollees.
members of the Baby Boomer generation are
expected to enter Medicare every year in the
14 state where WellPoint operates between
now and the year 2030.
The price WellPoint paid for entre into
this market is steep: about $15,000 per life to
buy CareMore more than double the
industrys typical purchase price and far
more than the $3,000 or so per life WellPoint
typically paid to acquire health plans in the
1990s and early last decade.
WellPoint acquired an attractive
business that has grown substantially in the
past few years, but they paid up to do it,
Citibank analyst Carl McDonald wrote in a
research report released last week analyzing
the deal.
"In the last ve years we have worked
diligently to create and demonstrate the
CareMore model can produce superior
clinical and nancial results in diverse
markets," said CEO Alan Hoops an old hand
at managed care, having helped launch
PaciCare, one of the states rst health
maintenance organizations, in the 1970s. "We
are excited about the opportunities to
combine our capabilities with the market
presence nationwide of WellPoint and expand
the CareMore model within WellPoint's
markets."
The deal is expected to close by the end
of 2011, and is subject to both state and
federal regulatory review, WellPoint said in a
prepared statement.
Hoag Seemed To Lose Exemption
IRS Names Hospital, But Dental Plan Was Revoked
the late 1990s, according to hospital
spokesperson Andrea Burgess.
Burgess added that Hoag had regularly
led paperwork with the IRS for the dental
plan.
Hoag was not the only California hospital
that appeared on the revocation list. Other
facilities included Barstow Community
Hospital, California Hospital Medical Center
in Los Angeles and Pacic Hospital of Long
Beach.
Pacic and Barstow had converted to for-
prot ownership in recent years, and
California Hospital afliated with Catholic
Healthcare West, which les a single tax
return for every hospital in its system.
Typically, the only time the IRS revokes a
tax exemption for a not-for-prot hospital is if
it coverts to a for-prot, according to Jim Lott,
executive vice president of the Hospital
Association of Southern California.
CareMore (Continued from Page Two)
2011bv|ovecs8|covldecs|cb|ls|loq,ttC
Payers & Providers Page 4
OPINION
Using Reform To Drive Job Creation
PPACA Has Provisions For Physician, Nurse Incentives
Jim Lott is the executive vice president of the
Hospital Association of Southern California.
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Op-ed submissions of up to 600 words are
welcomed. Please e-mail proposals to
editor@payersandproviders.com,
For all the debate about whether the Patient
Protection and Affordable Care Act should
proceed full steam or be repealed post haste,
some of its lesser-known provisions confront
what is a growing crisis in healthcare: a
persistently shrinking number of doctors and
nurses.
Although the Great Recession has
eliminated many of the signing bonuses
hospitals had to hand out to recruit new
employees, the crimped economic
environment masks the fact that the U.S.
population is becoming older and
sicker. Physicians and nurses are as
intertwined with this demographic
trend as everyone else.
Hundreds of thousands of these
critical professionals plan to retire in
the next decade including up to a
third of physicians and about 20% of
the nurses.
Meanwhile, younger physicians
do not want to put in 18-hour days
like the previous generation,
particularly in already short-handed
specialties such as primary care. In what
appears to be an inverse of the law of supply
and demand, it is among the lowest-paying
specialties in medicine, making it more
challenging to pay off the $150,000 or more in
student loans required to complete medical
school. Although many organizations help
newly minted doctors pay off their student
debt, there are simply not enough professional
schools extant to keep up with demand.
The only specialty that pays less than
primary care is geriatric medicine, and
government studies suggest the U.S. will need
36,000 more of these specialists by 2030.
Add to this demographic time bomb the
hissing fuse of healthcare reform. Thirty-two
million Americans including as many as 6
million Californians are expected to receive
insurance coverage within the next three years.
While reform will provide a badly needed
nancial boost to the healthcare system, it
means that a group that predictably sought
care in emergency rooms will soon need their
own cadres of primary care physicians and
specialists.
Fortunately, an anticipation of this was
baked into the reform legislation President
Obama signed into law last year. The ACA will
spend hundreds of millions of dollars to widen
the primary care safety net.
Many of the nancial inducements within
ACA are aimed directly at primary care
physicians, who will receive higher Medicare
payments, as well as bonuses for practicing in
rural areas. The National Health Services loan
repayment program was also expanded. The
NHS offer loan repayments of up to $170,000 to
physicians who choose to serve for ve years,
and total repayment for those who serve for six
years or more. Obtaining such nancial freedom
in a relatively short period of time
could prove an attractive inducement
to primary care, rather than pursuing
higher-paying specialties such as
radiology and orthopedics.
Moreover, the ACA also allows for
the re-provisioning of vacant slots for
medical residents, allocating more of
them for primary care. And the U.S.
Department of Health and Human
Services will fund teaching health
centers to offer primary care
residencies in non-traditional
settings, such as outpatient clinics.
The ACA also sets aside $50 million to
expand the number of primary care clinics
managed by nurse practitioners, who are
allowed to tend to patients and prescribe drugs
under a physicians close supervision. This wont
directly address the nursing shortage, but the
enhanced availability of such positions which
usually pay six-gure salaries and often prove
deeply satisfying to those who hold them
could draw more people into the nursing
profession.
None of these measures will cure the
chronic shortage of healthcare professionals on
their own. But its a start, and one that is likely to
accelerate as more provisions of the ACA are
implemented. Should the U.S. Supreme Court
invalidate ACA, it will spell grim news not only
for healthcare delivery, but for those charged
with delivering it.
By Jim Lott
2011bv|ovecs8|covldecs|cb|ls|loq,ttC
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Payers & Providers Page 5
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HEALTH PLAN MEDICAL DIRECTOR (Los Angeles)
Physician licensed by the State of California, with board certication in primary care or medical subspecialty.
Have ve (5) years of Medical Director experience in a managed care setting, such as a HMO or IPA/Medical Group.
Medical oversight and physician liaison in the areas of: Utilization review, credentialing, quality improvement, peer review, case
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Works under the direction of the CMO to ensure the delivery of high quality and efcient care for all members. Provide
Administrative Management of patient care with specic responsibility to provide direction and assistance in achieving optimal
medical performance in an efcient manner. To participate and lead in the review of all inpatient admissions. Direct and review
all inpatient utilization activity at hospitals by interfacing with the clinicians and UR nurses. Oversee the review process of prior
authorization (medical and pharmacy) requests in a timely manner. All denials must be individually reviewed and signed by the
Medical Director or physician reviewer.

HEALTH PLAN, MANAGER, MEDICAL MANAGEMENT (So. California)

Graduate from an accredited RN program with three or more years of recent acute hospital nursing experience
Three or more years of recent managed care utilization management and case management experience
Three or more years of staff supervision/management experience. The Manager of Utilization and Case Management is responsible
for the day to day operations of the utilization and case management department, including the Medi-Cal and Medicare Program
staff. The Manager of UM /CM collaborates with the Director of UM/CM and the Team Leader and with the staff Medi-Cal Waiver
Case Management Programs to promote continuity between programs, teamwork and collaboration.
Maintains effective administration of UM and CM functions. Coordinates staff schedule to assure effective coverage of UM and
CM functions, including after hours, weekends and holiday coverage by Nurse Advice. Trains, implements and evaluates UM and
CM policies and procedures, guidelines and action plans. Monitors and evaluates through monthly quality assessments the
performance of the Case Management and Utilization Management staff against established productivity and quality guidelines.
Provides timely educational feedback to staff on performance Assists the Director of UM/CM to ensure the programs are compliant
to DHCS contractual and regulatory requirements for Medi-Cal and to CMS regulations for Medicare.
Please Contact:
Executive Search & Placement
Sonia Varian at 818.707.7118, or espsonia@pacbell.net
2011bv|ovecs8|covldecs|cb|ls|loq,ttC
Payers & Providers
MARKETPLACE/EMPLOYMENT
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