Category Archives: Health Care

Clergy Group Presses Waterbury Hospital On Services

by Categorized: Health Care Date:

As Waterbury Hospital’s merger and for-profit conversion nears, the latest group to step up pressure to maintain services is an association of clergy members organized under the Naugatuck Valley Project.

The group, led by Bishop Lionel French of the Gospel Tabernacle Ministries, delivered a letter Wednesday signed by 48 area clergy to the hospital and its chairman, Carl Contadini, requesting a meeting “to discuss the importance of the community benefits that Waterbury Hospital has offered to the community for many years, and our concern that they be preserved in the event of the sale of the hospital to another entity.”

That “entity” is Tenet Healthcare Corp. of Texas, a for-profit, 77-hospital chain that is expected to receive state approval to take over Waterbury Hospital later this year. A bill passed by the state legislature this spring and signed by Gov. Dannel P. Malloy this month clears the way for the transaction, under which Waterbury would lose its not-for-profit status.

Tenet also has agreements with Bristol, Rockville General and Manchester Memorial hospitals to take over those institutions, though those applications are not as far along. The deals have led to concern by community groups that the conversions would lead to lower levels of services.

The hospitals, including Waterbury, have all said they are satisfied that protections are in place to assure that all critical services are kept in place. But no one is able to make promises because even without the mergers, the hospitals are in some cases seeing cutbacks amid financial pressure.

Nationally, studies have shown no clear evidence that conversion of not-for-profit hospitals to for-profit chain ownership has led to cuts in patient offerings.

Saint Francis Hospital, Stop & Shop Teaming Up With Supermarket Clinics

by Categorized: Health Care, Retail Date:

It’s time to roll out the old one-liners about throat cultures in aisle 2, right next to the peanut butter. Saint Francis Hospital and Medical Center said Tuesday it will open permanent clinics this fall in Stop & Shop supermarkets in Simsbury and Manchester — accelerating trends in both industries.

The clinics, branded Saint Francis FastCare, will open at the Stop & Shop locations on Bushy Hill Road in Simsbury in September and on Broad Street in Manchester in October. They’ll be staffed by advanced practice registered nurses, who are licensed to prescribe medications.

The clinics “will provide care for common, non-urgent illnesses and ailments such as cold and flu symptoms; administration of flu and shingles vaccines, or vaccinations for children going to summer camp or school; ear infections, insect bites, poison ivy, minor sunburn, sinus infection, and sore throat. On-site tests for rapid strep, urinalysis, urine pregnancy test, monospots and TB skin tests will also be available,” Saint Francis said in a written release that makes clear they are not for life-threatening situations.

The clinics, with extended hours to 8:30 p.m. on weekdays, will be the only primary care clinics in supermarkets in central Connecticut, Saint Francis said. They will take insurance and Saint Francis and Stop & Shop intend to open more locations in the future, hospital spokeswoman Fiona Phelan said.

Unlike larger, free-standing clinics, the supermarket locations do not need state approval. They are popular in some parts of the country, part of the supermarket industry’s effort to offer more services such as banking to attract customers, and the hospital industry’s effort to expand community-based offerings as a lower-cost, higher-profit option.

The two clinics would add ten full-time positions in total, employees working for Saint Francis Care, the hospital’s parent organization.

FastCare is a brand developed by a third partner, Bellin Health of Green Bay, Wis., in 2006. Around that time, health care providers in Connecticut and elsewhere announced partnerships with supermarkets. But the trend did not explode as some people predicted, perhaps because customers prefer to buy their food and treat their flu in separate places, and perhaps because of concerns by physicians that the clinics were not generally staffed by medical doctors.

“Immediate referrals will be made to a physician when symptoms exceed the clinic’s scope of services,” Saint Francis said Tuesday. “After each visit, a report will be sent to the patient’s primary care physician.”

Pfizer’s Sales Pitch On Research: No Mention Of Groton

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

If the situation weren’t so pathetic, Connecticut’s Pfizer-watchers could laugh as the company tries to snooker British politicians this week into thinking the drug behemoth’s proposed, $106 billion takeover of AstraZenica makes sense.

The Brits ought to be smarter than U.S. officials who stood idly by as Pfizer destroyed value in its $218 billion worth of acquisitions since 2000, in three deals alone — Warner-Lambert, Pharmacia and Wyeth.

Groton, formerly the global R&D headquarters for Pfizer and home to 6,000 employees, is now mainly a large development office — not mentioned as CEO Ian Read touts the company’s top research locations.  Groton still represents a very significant presence for Pfizer, perhaps 3,000, but it’s one of numerous sites the company has shrunk or shuttered after big mergers, where building demolitions and fire sales of facilities rule the day.

“We have hubs of science in La Jolla, and in the Bay Area, and in Cambridge, Massachusetts,” Read says in a newly released video designed to sell the AstraZenica deal as, in his words, “a win-win for society, a win-win for shareholders, and a win-win for stakeholders.”

It’s a win-win for top managers and investment bankers. Period.

Click here and here to watch the videos of Ian Read and Mikael Dolsten, the global R&D president.  Watch Read dance around the issue of the operations in Sandwich, England, which Pfizer gutted.

Many people oppose the merger on the grounds that Pfizer, the world’s biggest drugmaker, is getting too big.  The company, echoing the madness at similar-sized Comcast, claims it needs all that heft to develop hugely expensive, high-risk drugs.  

But unlike Comcast, which actually has gotten too big, Pfizer has declined, when you consider its takeovers. In 2001, one year after acquiring Warner-Lambert for the bubble price of $93 billion, Pfizer had sales of $32 billion. Pharmacia had sales of $19 billion and Wyeth $14 billion, for a total of $65 billion — or $87 billion in today’s dollars.

Compare that $87 billion to Pfizer’s sales over the last 12 months: $51 billion, with a market value of $186 billion, less than it paid for the three companies.

Since the end of 2001, Pfizer’s shares have delivered a total return, including dividends, of 29 percent, compared with 110 percent for the S&P 500 index, and that’s with billions of dollars in stock buybacks. Remember, a stock buyback is just a way of shrinking a company, and for Pfizer that means it’s right where it was, only without its former competitors.

And yet, in the new videos, Read and Dolsten can hardly contain themselves, talking about all the good that will come of the AstraZenica deal — yet another match made in heaven, in their options-driven world.

“A combined company will have products and science that can address in an integrated manner what the patient needs and can take on disease management and offer much more value for patients and health care providers,” Dolsten gushed.

What he’s saying is that Pfizer could make itself into a global force for coordinating pharma development, not just another firm in the business. Basically, a utility, only private, for-profit — like the cable companies, speaking of Comcast.

Well, we already have three industries that are struggling mightily with disease management, thank you very much: The U.S. government through Centers for Disease Control and other agencies; the managed-care insurance industry; and the fractured health care industry itself, with a hospital system that’s under siege.

If we’re going to let the the drug industry turn itself into a public utility, we should regulate profits and executive pay. They’ve had it both ways long enough.

As Chaos Clears, Waterbury Hospital Could Be Acquired By September

by Categorized: Health Care, Labor, Politics Date:

The troubled Waterbury Hospital is poised for a takeover by a Dallas-based corporation as soon as Sept. 30 if Gov. Dannel P. Malloy signs a hastily adopted bill that emerged from chaos in the legislature over the last two days.

The bill allows for-profit hospitals to employ doctors, undoing the major hurdle that had threatened a plan by Tenet Healthcare Corp. to acquire Waterbury, Bristol, Manchester Memorial and Rockville General hospitals.

It also adds a new twist that was not part of the public debate: Any hospital that acquires a practice with eight or more doctors must gain a “certificate of need” from the state Department of Public Health, a process hospitals must follow under existing law whenever they add or close medical services.

The bill does not offer the direct protections for workers that labor groups fought for two years to include. But labor groups signed off anyway, clearing the way for overwhelming votes in the House and Senate, because the bill strengthens regulators’ powers to assure quality of care and adds local hearings that must become part of the official record.

Labor groups were also pleased that the bill adds a “firewall” between a hospital system’s for-profit businesses and core, not-for-profit operations. The shifting of employees from core hospital units to profitable satellite businesses is a fierce battleground in health care.

Waterbury Hospital is the furthest along of four that Tenet is moving toward acquiring. On Thursday Trip Pilgrim, the Tenet senior vice president of development and point man for the deals, said the company is still sorting out everything the bill says, but he’s confident it will not stop the mergers.

“We’re pleased,” Pilgrim said Thursday. “We got a bill that we think allows us to continue to pursue these transactions. We’re going to do that.”

That was not assured. Tenet had said all along that it would pull out of the state if lawmakers added new regulations, and at 11:44 p.m. Wednesday, just after the bill passed, the company issued a statement casting doubt.

Tenet and Waterbury Hospital are about halfway through the rigorous certificate of need process with state regulators. That approval could come within two to five months, Pilgrim estimated, and with other state and federal reviews, the deal appears likely to close in 2014.

Bristol is the next furthest along but has not yet sought a certificate of need, and Manchester and Rockville are not far behind Bristol in the process, Pilgrim said.

All four not-for-profit hospitals have signed letters of intent with Tenet, a for-profit, publicly traded chain of 77 hospitals.  All four would be owned by a new joint venture that’s partly owned by Yale New Haven Health System, with YNH, already Connecticut’s largest hospital system, helping to coordinate the statewide care.

The bill passed overwhelmingly by bleary-eyed lawmakers in the last hour before the session expired, with little or no debate and with little chance for rank and file members to review it and ask questions. But people who had been on both sides of the issue said it represented a fair solution for now, with more battles likely to come.

“The compromise bill passed late last night is a good start toward protecting patients and local economies faced with conversion of their community hospitals,” said Melodie Peters, president of AFT Connecticut, which represents hundreds of nurses, and a former state senator. “There is still much work to be done to assure a clear, transparent process for holding health management corporations seeking to take over our acute care facilities accountable.”

Peters noted that the bill “comes up short” on protections.

The issue at the heart of the bill is the measure allowing for-profit hospitals to employ doctors — a relationship that could create incentives for docs to make decisions based on finances, not just health.  To avert those potential conflicts, existing law allows hospitals to affiliate with and essentially control “medical foundations” that employ doctors — but that system is only available to not-for-profit hospitals, a limit in place only in Connecticut.

The new bill extends it to for-profit hospital companies such as Tenet.

Tenet had originally fought hard for the bill, then changed course — saying it could affiliate with doctors at all of its Connecticut hospitals through Yale New Haven Health System.  Attorney General George Jepsen, in a strongly worded letter to lawmakers last week, warned that there was no assurance he would approve that scheme.

Jepsen’s letter drove both sides to reach a deal. Labor groups accepted lower protections because they feared the Tenet-Yale plan would work, leaving them with nothing.

And supporters of the merger feared a long, bloody court battle if Jepsen rejected the plan — so they agreed to protections such as the new regulation on doctors’ groups and new limits on shifting work.

 

 

 

As Lawmakers Wind Down, Three Languishing Business Bills Prove A Point

by Categorized: Economy, Government, Health Care, Politics Date:

Among the more than 250 bills hanging on with fading hopes as the last day of the state legislative session dawns, three with significance to Connecticut business illustrate different ways a bill can hang on a cliff.

And all three help make the case that a legislature meeting for three or five months a year doesn’t cut it.

The first, a bill that would allow social entrepreneurs to easily establish “benefit corporations,” has not come to a vote in the House or the Senate despite having only minor opposition and broad, bipartisan sponsorship.

The bill would make it possible to incorporate “Type B” businesses explicitly for social benefits beyond just profits for the owners. On Jan. 14, I said the bill “seems like a lock to pass” after Gov. Dannel P. Malloy trekked downtown to the Pratt Street office of reSET, the Social Enterprise Trust, to declare his support after two tries fell short in 2012 and 2013.

The social enterprise bill passed through three committees by a total vote of 95-7. Yet its best hope now is a back-door route, sneaking under the coattails of a broader bill. If it fails amid horse-trading and delay tactics, it would reflect the worst of the legislative process. The only controversy has been over whether to include a provision that locks in a social benefit incorporation irrevokably, something no other state has.

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Forums Scheduled on Hospital Takeovers In Rockville, Manchester

by Categorized: Health Care, Labor, Politics Date:

The Eastern Connecticut Health Network, which includes Rockville General and Manchester Memorial hospitals, has scheduled community discussions about the proposed sale of the hospitals to a for-profit chain.

Under the plan, ECHN, a not-for-profit corporation, would become part of a joint venture majority owned by Tenet Healthcare Corp., based in Texas. The Yale New Haven Health System would have a minority ownership and would be a “clinical partner,” helping to coordinate care.

Many are wondering how the sale would affect local employees and medical services. My in-depth column published Sunday makes it clear it’s too soon to know, but that there is no clear evidence that for-profit conversions lead to service reductions in former not-for-profit hospitals.

Eastern Connecticut Health Network has signed a letter of intent with Tenet but has not yet negotiated a sale agreement — which could be a crucial way of protecting services. Representatives of ECHN, Tenet and Yale New Haven will be at the meetings.

The public sessions are tonight, Tuesday, at 6 p.m. at Rockville High School and Thursday at 6 p.m. at the Manchester Memorial Hospital auditorium, which has limited seating.

 

 

 

 

 

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.