Category Archives: Health Care

Obamacare Final Tally For State: Good First Year, Much More Needed

by Categorized: Government, Health Care, Insurance Date:

The final numbers are in for Connecticut residents signing up for health care at Access Health CT, the state’s exchange under the Affordable Care Act. Results for people who met the March 31 deadline show the agency exceeded its goals with a surprisingly high number of Medicaid enrollees.

What we don’t know is how many of the newly enrolled Obamacare customers were previously uninsured. But we do know that on that score, the state still has a long way to go.

Nationally, President Obama announced Thursday that the state exchanges, mostly run by the federal government, reached 8 million enrollees by mid-April — exceeding a 2013 Congressional Budget Office estimate of 7 million. And he said 28 percent were between 18 and 35.

Click here for a White House fact sheet on Obamacare progress.

We’re still hearing reports of problems with the system, including very high prices for people on the individual market who are not eligible for subsidies, and concerns by many that they must keep their incomes under key thresholds.

It’s too soon to say whether the mix of enrollees in the private plans — age groups and health profiles — will be adequate to avert sharp increases for 2015. But with an estimated 47 million Americans lacking health coverage, it’s clear that Obamacare in 2015 will have to accelerate.

OVERALL CT:

  • Total Enrolled: 208,301
  • Unofficial Goal Set In 2013: 100,000-130,000
  • Total Uninsured In Connecticut Before Obamacare: About 300,000
  • Total Uninsured Now: ?????
  • Next Open Enrollment Date for 2015 Coverage: Nov. 15, 2014
  • Who Can Still Enroll In 2014? Residents with life changes such as marriage, divorce, birth, adoption or loss of employer’s insurance coverage

PRIVATE PLANS

  • Total Enrolled In Private Plans Through Exchange: 78,713
  • Unofficial Goal Set In 2013: 70,000
  • Federal Target for Private-Plan Enrollment In CT: 33,000
  • Private Plan Enrollees Receiving Federal Subsidy: 61,400
  • Enrolled And Later Dropped Out (not counted in total): About 7,000

MEDICAID

  • Total Enrolled In Medicaid: 129,588
  • Unofficial Goal Set In 2013: 30,000

 

 

 

 

Aetna Pitching At Fenway Park In New Massachusetts Push

by Categorized: Entertainment/Tourism, Health Care, Insurance Date:

 

It’s Opening Day at Fenway Park in Boston and Aetna is one of the new players on the field. The Hartford-based health insurer, looking to push deeper into the Massachusetts market for large and midsize company plans, figured there’s no better place than the home of the World Series champions.

Aetna at Fenway Jody Osko Lewis photo courtesy of Aetna

Aetna at Fenway
Jody Osko Lewis photo courtesy of Aetna

Aetna’s ad deal with the Red Sox includes a 16-foot center field sign for the whole season; the Aetna logo behind home plate for 15 games; and the right to call itself a “proud sponsor of the Red Sox.”

Fenway will also schedule an Aetna Day at Fenway Park on a date to be announced (no word on whether they’re giving out Aetna yoga mats signed by Chief Meditation Officer Mark Bertolini).

Payment terms were not disclosed and Aetna might add more promotions as the season progresses.

Aetna may have spurned most of the states’ Obamacare exchanges, but the Bay State represents a major opportunity. No other national firm operates in the corporate health plan market there on its own, without a local partnership.

“We want to significantly grow our membership base in Massachusetts and to do that we are investing in a greater presence in that market, securing office space, hiring new managers for sales and network, and additional staff there,” spokeswoman Susan Millerick said.

Aetna is one of at least two large Connecticut-based organizations announcing a big presence in Fenway this year. The other is Foxwoods Resort Casino, a longtime Fenway presence, which just took the main ad position on the Green Monster.

 

State’s Obamacare Exchange Beats Goal, Ranks High In CNBC Efficiency Rating

by Categorized: Health Care, marketing, Public finance Date:

Connecticut’s health exchange enrolled nearly 200,000 people between Oct. 1 and the deadline Monday — and the number will rise as people who eked into the system by March 31 finish their applications.

Here is the final tally from Access Health CT:

Total Enrollment: 197,878

Total Enrolled On March 31:  5,917

Private Plans: 76,597 (informal goal: 70,000)

Medicaid Enrollees: 121,281 (informal goal: 30,000)

Website Visitors Since Oct. 1: 801,509

Call Center Queries: 366,975

Enrollment Fairs: 78

Anyone who left a voicemail message or appeared at one of the state’s two storefront locations but did not complete an application will have a chance to do so by May 1 and still meet the federal deadline for a 2014 subsidy.

Maryland to use Connecticut system. Click here for story.

The last-day rush at Access Health CT's New Britain storefront Monday.  Matthew Sturdevant/The Hartford Courant

The last-day rush at Access Health CT’s New Britain storefront Monday.
Matthew Sturdevant/The Hartford Courant

CNBC.com looked at the 14 states plus Washington DC that ran their own exchanges, using federal grant money. California was the most efficient, signing up 1 million people in private plans after receiving $1.07 billion from the feds, for an average cost of $1,046 for every person who signed up for a private plan.

Hawaii was the most expensive, coming in at $35,749 per private-plan enrollee. Obviously, as one commenter pointed out on the CNBC website, bigger states have an efficiency advantage because building a system of any size costs a lot.

Connecticut was more efficient than any small state at $2,552 per enrollee, making us the fifth most efficient state overall.  (Figures did not include the huge last-day rush in Connecticut and elsewhere, which lowered the per-enrollee cost.)

The average cost per enrollee in all of the state-run exchanges was $1,899 — a figure that was brought way down by the size and efficiency of California.

It’s notable that Connecticut barely beat its own informal goal of enrolling 70,000 people in private plans, but crushed its target of 30,000 Medicaid enrollees.  As it turned out, expanded Medicaid brought a much bigger pool than private uninsured residents.

And, said Kevin Counihan, the Access Health CT CEO, Connecticut made a smart decision early on to keep its system simple rather than tying it into the state’s systems for food stamps, temporary welfare payments and other social services. States that failed had more complex databases, he said.

Tallying just the cost of private plan enrollment makes sense if we’re trying to gauge the core goal of Obamacare, but, as Counihan points out, by ignoring Medicaid enrollment it misses the source of the biggest reduction in the ranks of the uninsured.

Any way we look at it, as the final numbers come in, the average cost per person will fall. And future years will cost a whole lot less now that the systems are up and running. That’s the hope, at least.  But remember, the exchanges will have to start charging a tax to operate after 2015.

Magellan Acquisition Highlights Pharmacy Management Profits

by Categorized: Corporate finance, Health Care, Insurance Date:

It really says something that the deal announced today by Magellan Health Services Inc. to buy Newport, R.I.-based CDMI LLC seems routine.

Consider the price Magellan is paying and what that tells us about the profits at CDMI, and at pharmacy management firms generally.

Avon-based Magellan will pay as much as $370 million for the pharma management firm that has health plans as clients. The base price is $205 million in cash and stock and the incentives total $165 million, based on profits and customer retention over the next three years.

With CDMI’s 2013 net revenues totaling $43 million, that’s 8.6 times sales — compared with Magellan’s own market value, at about 50 percent of sales.

And that means that if CDMI had a net profit last year of, say, 30 percent of sales, or $13 million `– a healthy figure — the full price Magellan could pay would translate to a price-to-earnings ratio of 28.6.  A net profit of 20 percent would mean Magellan is paying a whopping 43 times net earnings.

That compares with Magellan’s own value at 13 times trailing 12-month net profits, as the company earned $125 million in 2013.

So CDMI is hugely profitable and it’s not the only privately owned health management or underwriting consultancy that can make that claim. Last year the CEO of South Windsor-based Medical Risk Managers Inc., The No. 1 company among small employers for the Courant/Fox CT Top Workplace awards in 2013, said his firm was more profitable than Google — which had a 31 percent margin.

That’s a great industry for Connecticut to nurture and for companies such as Magellan and Aetna to acquire.

 

 

 

CareCentrix To Add 150 Downtown Hartford Jobs In 2014

by Categorized: Economic Development, Health Care, Real Estate Date:

CareCentrix, the health care management company that moved from East Hartford to downtown Hartford in 2012, is aiming to add 150 local jobs in 2014 and is taking an additional floor of the “Stilts” building at 20 Church St.

The new jobs, largely staffing the company’s call center operations but also including management, would bring the total staff in downtown Hartford to 500 — three years before the company said it would reach that number in an agreement with Gov. Dannel P. Malloy for $24 million in state aid.

It is, in short, one of Malloy’s successes in the First Five program, though the price Malloy paid — $80,000 per new job, or $48,000 per job including those that were already in Connecticut — is considered steep, especially since many of the jobs pay less than $40,000 a year.

CareCentrix, which manages home health care, also has large operations in the Tampa, Fla. area, where costs are lower. The company could have moved its headquarters there or elsewhere, and then-CEO Eric Reimer told The Courant’s Mara Lee in early 2013 that the labor cost difference was a big factor in the company’s ability to extract the $24 million from Malloy.

For the state, the numbers add up based on the taxes paid and purchases made by the employees. Adding life to downtown Hartford boosts the economic value of the jobs if it helps the city center attract more people from out of the region.

The firm also fits with the economic development strategy for Metro Hartford, and especially downtown, as a center for health care management — anchored by the health insurers.

“Connecticut has a proud history of supporting health care companies. We are honored to be part of this history as we continue to grow,” said John Driscoll, CareCentrix CEO, in a written statement.

The company scheduled an event on Tuesday at 1 p.m. to mark its lease of a new floor at 20 Church Street. CareCentrix now occupies floors 9, 11 and 12 for a total of 73,000 square feet, a spokeswoman said. “Stay tuned for more details on an upcoming job fair,” she said.

Mayor Pedro Segarra, who was set to be at Tuesday’s event, had said recently that a company planned to bring about 200 jobs downtown. He didn’t name the firm.

It’s unclear whether Segarra was referring to CareCenrix, or CohnReznick, the accounting and management consulting firm that said this month it will consolidate offices in Glastonbury and Farmington to Metro Center, down church Street from the Stilts Building, with about 200 employees and the promise to add 40 more in exchange for a state loan of $1.2 million.

Or, Segarra might have been talking about a third firm that we haven’t yet heard about.

Ted Kennedy Jr. Joins Board of Health Consultancy

by Categorized: Health Care, Politics Date:

Ted Kennedy Jr. is bringing his name and health care expertise to a consulting firm that works with hospitals and other service providers looking to boost efficiency and improve patient care.

Ted Kennedy Jr. Press Ganey handout

Ted Kennedy Jr.
Press Ganey handout

The 52-year-old Branford resident, a lawyer and health care advocate, has joined the board of Press Ganey, which is based in South Bend, Indiana but has a significant office in Boston.

Kennedy, who holds degrees from Wesleyan University, Yale and UConn, is active in the Connecticut Bar Association’s health care section and has long experience in hospital and other health regulation.

“As a champion for the health care needs of the disabled and an advocate for the Affordable Care Act, Ted understands the important role of the patient experience, particularly during this pivotal time in our country’s health care system,” said Patrick T. Ryan, the Press Ganey CEO, who lives in Massachusetts and is on the board of Avon Old Farms school.

Kennedy, a registered voter in Branford, kicked around the idea of running for U.S. Senate in Massachusetts in 2013 after former John Kerry was tapped to be Secretary of State.

The Boston Globe in December 2012 cited sources who said Kennedy considered himself a Connecticut resident although he has a home in Hyannis, Mass. — and that he might want to run for office in Connecticut someday.

CT Hospitals: 1,400 Jobs Cut, $175M Income Decline In 2013

by Categorized: Health Care, Public finance Date:

The state’s 30 acute care hospitals have shed 1,400 jobs in the last year and their operating income was down by $175 million in 2013 compared with the year before, the Connecticut Hospital Association said.

The dire report, ahead of official filings, is aimed at lawmakers and Gov. Dannel P. Malloy as the association works to repeal a tax that it says is hurting the public by forcing cutbacks in services.

“Hospitals have done extraordinary things to minimize the impact of the tax on hospital patients.  But it is very challenging,” the Wallingford-based association said in a written release, which also said the hospitals have “reduced staff salaries and benefits.”

The association didn’t break down where the 1,400 job cuts happened. A report from the association last month claimed the hospitals directly employ 55,000 people and account for 9 percent of the state’s economy directly and indirectly.

Click here for my blog post about the hospitals’ economic impact.

The association said its 2013 woes are due to three main factors: A 2 percent cut in Medicare funding, part of the federal sequestration; a $103 million, one-time cut in state funding in the first half of 2013, part of Malloy’s emergency budget balancing efforts; and sharp cuts in state reimbursement for a tax that was enacted as a way of attracting more federal dollars.

The tax is the main issue in dispute. The hospitals pay a state tax totaling about $350 million a year, and in previous years, received all of it back in reimbursement. Starting this fiscal year, the reimbursement was down by $101 million, and it will be town by $235 million a year starting July 1, the association said.

Lawmakers are debating a bill to phase out the tax over five years — a phaseout that was not in Malloy’s budget.

“Phasing out the tax will protect patient care, save jobs, and reduce the cost of healthcare for the people of Connecticut,” the association said.

The Malloy administration disagrees, saying the hospitals will receive $1.7 billion this year from the state, the same amount as last year and $400 million higher than just three years ago. Some people in the administration also point to high salaries for hospital CEOs and other executives.

In October, the hospitals reported improved financial condition for the 2012-13 fiscal year, with operating surpluses totaling $513 million in fiscal 2013, up sharply from the prior year.  Five hospitals showed deficits from operations, down from eight in 2011.

The deterioration is happening despite the flat funding, the association said, in part because of rising Medicaid services in addition to Medicare cuts. The association did not release a breakdown of employment changes by hospital, though many of the hospitals have announced layoffs and cutbacks.

 

Hospitals Fire Back At Malloy: We Are 9 Percent Of CT Economy

by Categorized: Economy, Health Care, Jobs, Public finance Date:

Fresh from another snub by Gov. Dannel P. Malloy, the Connecticut Hospital Association is waving around a new report that claims its member hospitals account for nearly 9 percent of all economic activity in the state, and that every dollar the state gives them brings $2.33 from the federal government.

The first statement seems hard to believe, though without question hospitals are a huge part any region’s economy, especially the hard-hit cities.  The second statement about federal reimbursement is not exactly true but isn’t always wrong.

The hospital association’s report says the hospitals employ 55,000 people directly, with a direct payroll of $5.3 billion, or $96,000 per job. By spending money in the community, those employees indirectly create another 56,000 jobs for a total of 111,000 jobs, and $11 billion in payroll.

Separately, the hospitals themselves buy goods and services that directly or indirectly create another $8.1 billion in activity, and they spend another $530 million on buildings and other capital projects which multiplies to $1.1 billion in the economy, the report said.

Grand total: $20.2 billion in a state economy that’s $235 billion a year.

That’s a rebuke to Malloy, who, the hospital association says, shorted the hospitals by just over $500 million in Medicaid reimbursements and other costs last spring that they said they would need to keep providing the same level of services.

Then, when Malloy’s budget chief, Ben Barnes, was asked by reporters on opening day at the Capitol last week whether there was anything for hospitals in this year’s proposal, he said simply, “No.”  When pressed, he said he had looked at the state filings and thought the hospitals were doing fine.

They of course disagree.

As for the $20.2 billion, we see a handful of these economic output reports from industries, and this one seems to push toward the high side. For example, I know there are formulas to get there but it’s still not clear to me how a group of employees with $5.3 billion in their pockets can give rise to another group of people who earn $5.7 billion.

Yes, we are all connected in the economy.

And as for the federal reimbursement, the hospital association appears to be referring to the Medicaid formula when it says the federal “match rate” is 70/30. That means for every additional dollar we spend on Medicaid, we get $2.33 back.

But Malloy and Barnes say their plan did not cut back on Medicaid spending, only on the amount the hospitals wanted to receive from the state. They say the $1.7 billion for hospitals is actually up slightly, but of course the hospitals argue that Medicaid spending is up more than slightly.

To be continued this spring at a state Capitol near you.

With Goldie Hawn At Davos, Aetna’s Bertolini Brings Mindfulness To Mainstream

by Categorized: Education, Health Care, Insurance Date:

You could say Mark T. Bertolini knows about stress, not only from his 24/7 job as Aetna CEO but also as a kidney donor to his son who nearly died, and survivor of a ski accident that left him partly paralyzed.

He’s arguably the most prominent advocate of naturopathic medicine, yoga and meditation in corporate America.

Now Bertolini is bringing Hollywood glitz to the science of de-stressing, teaming up with Goldie Hawn, a fellow mindfulness maven who also believes in the evidence behind emotional awareness for improved health.

Hawn, left, with Julia Roberts and Gwyneth Paltrow at the San Penn & Friends HELP HAITI HOME gala in Beverly Hills Jan. 11.  Getty Images

Hawn, left, with Julia Roberts and Gwyneth Paltrow at the San Penn & Friends HELP HAITI HOME gala in Beverly Hills Jan. 11.
Getty Images

At the World Economic Forum at Davos, Switzerland on Thursday, the CEO and the Academy Award-winning comedic actress will advance meditation and mindfulness in a discussion moderated by Arianna Huffington, who’s written a book on the topic.  Aetna and Hawn will launch a partnership designed to expand an education-based stress reduction program called MindUP that’s sponsored by The Hawn Foundation.

Hartford-based Aetna and The Hawn Foundation, of Miami Beach, London and Santa Monica, don’t have a formal plan for their collaboration, dubbed “Mindful Works.”  “It’s in the very preliminary stages of the relationship. It’s open-ended at this point,” Aetna spokesman Ethan Slavin said.

What’s all this about? “MindUP consists of tools and strategies based on neuroscience, social and emotional learning, mindfulness and positive psychology to help people center, focus and thrive,” Aetna and the foundation said in a joint release.

Mindfulness, with its roots in Buddhist meditation, is a hot topic in psychotherapy. Basically it teaches people to maintain hyper-awareness of their feelings and sensations, and to focus intensely in the present moment.

Bertolini, a regular at Davos and other global forums, typically talks about health care technology or changing over to a results-based payment system for medical services, but audiences have certainly heard him on alternative health.  He’s also scheduled this week to speak about “hyperconnectivity,” the fast-advancing world of apps and other ways to link medical information.

HC ct-Mark-Bertolini.jpg

He’ll still be the straight man in the Thursday show as he pushes the science behind mindfulness, which Aetna is leading.

It’s not a new push. Back in 2010 and 2011, Aetna divided employees into quintiles by stress markers such as heart rate, and found that the most stressed group had average medical costs $2,500 a year higher than the least-stressed group, Bertolini said at a conference in Arizona last month:

We put them through mindfulness and yoga training for 12 weeks and we saw the costs drop like a rock in the post-testing, so we know this stuff works,” Bertolini said.

The company pegged the added cost for the most-stressed employees in the study of 458 people at “nearly $2,000″ in a 2012 press release, but the point is made. That figure even seems a bit low if you consider that obesity could be linked to stress.

The company has had 6,000 employees go through its “Mindfulness at Work” training, and offers it to all of its clients, including employers that use Aetna to administer self-insured plans. So far, mindfulness has not changed the way Aetna actually approves medical procedures but that could happen.

“We’ve got to pioneer somewhere…We’ve got to challenge the norm,” Bertolini said on a video of the Arizona conference. “And so we believe in this, it’s just building the evidence base.”

And building the fan base. I see Warren Beatty playing Bertolini in the movie and Hawn playing herself. Daughter Kate Hudson can play the over-stressed young professional.

It’s a modern sequel to Shampoo. Call it  “The Mindful Conditioner.”  The storyline: On the day Obamacare goes into effect, a health insurance executive comes to terms with his love of alternative medicine as he’s confronted by multiple yoga partners.

 

 

State Names Board For Bioscience Fund

by Categorized: Economic Development, Health Care, Public finance, Technology Date:

The state’s newly created, $200 million Bioscience Innovation Fund now has an advisory committee filled with some of Connecticut’s high-powered figures in the field.

The fund, overseen by Connecticut Innovations, the state’s quasi-public technology investment and assistance arm, was created by the governor and legislature earlier this year as a way to target drug development projects and other bioscience innovations, at firms or universities, with public money that could also attract private investment.

Chairing the committee is Claire Leonardi, CEO of Connecticut Innovations.

The board, with members appointed by Gov. Dannel P. Malloy or legislative leaders, includes Peter Farina, Ph.D., executive in residence at Canaan Partners; Steven Hanks, M.D., vice president of medical affairs for the central region at Hartford HealthCare; Joseph Kaliko, CEO of Gaming Innovations International; Marc Lalande, Ph.D., chairman of the Department of Genetics and Developmental Biology, and head of genomics and personalized medicine programs at UConn; William LaRochelle, Ph.D., an executive at Roche 454 Sequencing Solutions International; Charles Lee, Ph.D., scientific director at The Jackson Laboratory;  Alan Mendelson, general partner of Axiom Venture Partners; Edmund Pezalla, M.D., national medical director for pharmaceutical policy at Aetna; Carolyn Slayman, Ph.D., professor of genetics and cellular and molecular physiology and deputy dean at Yale School of Medicine; and Eleanor Tandler, founder and CEO of Novatract Surgical.

Jewel Mullen, M.D., the state’s public health commissioner, and Catherine Smith, commissioner of economic and community development, are ex-officio members with voting rights. The fund is run by Jeremy Crisp, Ph.D., the CI executive vice president and chief innovation officer.

The fund, to be disbursed over 10 years to projects that show commercial promise, is scheduled to award $10 million the first two years, $15 million for the third and fourth years, and $25 million in years five through 10.