Health care cap creating 'bleak' view, advocate says.(Business) - Rocky Mountain News (Denver, CO)

Byline: Jeff Smith, Rocky Mountain News

Steven R. Nickerson, Rocky Mountain News

Mary, or Mimi, Hull lives comfortably in a condominium near downtown Denver. Cuts in her retiree benefits aren't likely to change her lifestyle in the immediate future. But they do have an effect.

As it is, her pension is $21,180 a year and, like other retirees, she hasn't seen an increase for 10 years. She left U S West before she was eligible for a full pension and took a 26 percent penalty.

Her life insurance is being slashed from $84,000 to $10,000.

'I don't have a spouse, but I did want to provide something for my grandchildren,' she said. 'That's all wiped out.'

And, she said, there's no way of predicting the long-term impact of Qwest's decision to cap its contribution to post- 1990, nonunion retiree health care. She noted Qwest already has been shifting more costs to the retirees.

'First they told us they were doing an 80-20 split; now it's at 71-29,' Hull said. With the cap, 'it will get to be a more and more bleak picture.'

Hull, as president of the Association of U S West Retirees, is a strong advocate for retirees and often speaks on their behalf at annual stockholder meetings. She sees Qwest as a company that is 'putting the squeeze on retirees who don't have the opportunity to increase their income.'

'My hot button,' Hull said, 'is that (executives) are doing it to retirees and not doing any contributions themselves. It's just unfair. If there needs to be pain, there needs to be pain everywhere.'

The benefits cuts actually are coming at a time when Qwest is generating more than $1 billion in cash.

'That's why we're chalking it up to greed,' Hull said.

Greed too, retirees group officials say, because the cuts also are coming at a time when top Qwest executives have been cashing out chunks of options - making more than $50 million combined in the process.

'I think it rubs salt into the wound,' Hull said, 'I think it was very insensitive at best.'

Qwest said CEO Dick Notebaert would be donating the after-tax profits of his $18 million stock-option gain to charities.

'Charity begins at home,' Hull responded.

Hull also doesn't buy the argument that Qwest must do this for competitive reasons.

'Let me tell you, it's not happening at the new AT&T. It's not happening at Verizon,' Hull said. 'Comcast probably doesn't have as many retirees, but I'd like Mr. Notebaert to be more specific about who are the competitors.'

INFOBOX

Shrinking benefits

* Qwest is the only former regional Bell to eliminate its stockholders dividend. It did so under former Chief Executive Joe Nacchio in 2001. Retirees traditionally have relied in part on dividend-paying stocks. Many retirees also lost tens if not hundreds of thousands of dollars when Qwest stock plummeted in 2001 and 2002.

* Retirees haven't had a pension increase for 10 years.

* Qwest has required post-1990 nonunion retirees, about 9,000 of them, to pay 20 percent of their health care premium since 2004. Some retirees say the figure now is closer to 30 percent, though Qwest won't comment.

* Starting Jan. 1, Qwest will cap its contribution to health care premiums for post-1990 nonunion retirees - that means that group will have to pay for all increases. Post-1990 union retirees likely will face a similar cap in 2009, while pre-1991 retirees are protected by a court agreement.

* Starting Jan. 1, Qwest will cap life-insurance benefits of all 48,000 retirees at $10,000. Previously, the benefits were equal to a retiree's last year's salary, sliding down to a half- year's salary for some groups.

* Qwest threatened to eliminate the death benefit - a benefit payable to the surviving spouse when a retiree dies. The benefit, which comes out of the pension trust, is equal to a year's pay at 1993 rates. The issue is in litigation.

Qwest's expenses

* Qwest pays a significant amount on retiree health care, $383 million in 2005, according to a regulatory report. But that was down from $391 million in 2004.

* Post-1990 nonunion retirees contributed $26 million to Qwest toward health care premiums in 2005, and a union health care trust provided a reimbursement of $206 million. Qwest also received a Medicare subsidy of $38 million. Those reimbursements or contributions total $270 million.

Mary Hull

Age: 63

Residence: Denver

Career: Worked in benefits and training at Mountain Bell / US

West for 25 years, leaving in 1995.

Costs: Will lose $74,000 in life insurance. Paid $120 a month for health care and dental in 2006, will see that increase to $161 in January.

CAPTION(S):

Photo

CONSUMERS HOLD KEY TO BETTER HEALTH CARE.(Editorial) - Rocky Mountain News (Denver, CO)

Byline: Dr. Joel Karlin

Over the last two years we have seen a flurry of anti-managed care legislation introduced in both Congress and state legislatures all over this country.

Recently, the president received recommendations from a blue-ribbon commission, which he appointed to create a Patients' Bill of Rights in managed care. A recent Rocky Mountain News editorial questioned the advisability of implementing those suggestions into law, and proposed instead to give individuals the right to select their health insurance. As a practicing physician for 23 years, I have seen both the good and bad of managed care. The goals of managed care are laudable: maximize quality and patient service and minimize the total cost per patient per year. The problem is that no health plan has been able to achieve all of these goals.

Among those health plans that have received the highest grades in patient satisfaction - as Rocky Mountain HMO did in a recently published patient survey by the Colorado Business Group on Health - their premiums have not been low enough to achieve high market share.

Among those health plans that have purchased market share with low premiums, often selling in certain markets below their cost to provide care, quality and service have suffered.

So what's the answer? Listen to some CEOs of health maintenance organizations and they will call for less government and praise the ability of the ``free market'' to change what health plans do. But if the free market works so well, why has it become necessary for the managed-care industry to come forth with programs like ``Put Patients First'' and ``The Code of Ethics in Managed Care''? Listen to the horror stories of patients and physicians who have been negatively impacted by ``tightly managed'' managed care, and they would have the government regulate everything managed care does.

The long-term answer is neither of the above options. First, we must admit that there is no single delivery system or health plan that works for everyone. Different people have different needs.

Second, we must recognize the limitations of our current employer-based health insurance system and make the necessary changes to accommodate those differing needs.

Since the overwhelming majority of people obtain health insurance through their place of employment, the financial impact of providing such insurance weighs heavily on the employer. The employer's answer, increasingly, has been to limit employees' choice of plans, often seeking the lowest-cost, most tightly managed HMO.

Here lies the tragic conflict. The employer tries to manage the cost of providing health insurance to employees, while the employee may not be able to choose his desired health-care delivery system, let alone health plan or physician. So much for allowing free market forces to change how health plans treat patients.

Today, the employee loses the employer's contribution for health insurance if the employee does not accept the employer's selection. And the employer loses the beneficial tax treatment if the employee should take that contribution and purchase insurance away from the workplace.

The Colorado Medical Society and American Medical Association believe there will be greater value and efficiency by involving patients more directly in their own health care. Several successful models exist currently in both the public sector (the Federal Employees Health Benefit Plan) and the private sector. By making patients into true ``health-care consumers'' market forces can better help restrain prices and improve the quality of care delivered.

In such a system, individuals would select the delivery system and health plan that best meet their needs and the needs of their family. Federal legislation would be required to provide the employer with the same tax treatment for voluntary payment of health insurance premiums whether the employer provides the health insurance plan for the employee or whether the employer provides a financial contribution to the employee, which could only be used to purchase individually selected and individually owned health insurance. Group purchasing co-ops, a more competitive individual insurance market and medical savings accounts could be the purchasing vehicles.

In such a system, cost, quality and access would determine the winners. No longer would government be asked to intervene. Health plans would become more responsive to individual patient needs or lose market share - both acceptable outcomes.

Obama To Push Health Care In Colorado - NPR Morning Edition

LINDA WERTHEIMER
NPR Morning Edition
08-14-2009
Obama To Push Health Care In Colorado

Host: LINDA WERTHEIMER
Time 11:00-12:00 PM

Play Audio


LINDA WERTHEIMER, host:

It's MORNING EDITION from NPR News. I'm Linda Wertheimer.

STEVE INSKEEP, host:

And I'm Steve Inskeep. Good morning.

President Obama continues his effort to sell an idea: getting better health care for less. The concept is easy to endorse. The problem is getting there.

WERTHEIMER: In a moment, we'll meet a Democrat trying to defend the health care overhaul against attack. We begin with the place where the president travels this weekend.

INSKEEP: He's visiting a Colorado city that has one of the nation's most cost- effective health care systems. NPR's Scott Horsley reports on what the country might learn from Grand Junction.

SCOTT HORSLEY: Grand Junction, Colorado has long been known for its spectacular scenery and lush fruit orchards. More recently, it's been getting attention as one of the country's great bargains in health care. According to the Dartmouth Atlas of Health Care, which ranks Medicare spending around the country, Grand Junction's cost are among the lowest - about 30 percent below the national average. What's more, Dartmouth's Jim Weinstein says even while saving money, Grand Junction manages to produce healthier patients than most other parts of the United States.

Dr. JAMES WEINSTEIN (Dartmouth Atlas of Health Care): The fact of the matter is that their quality is quite good. And when you see places like this that are performing really well, we can learn from them.

HORSLEY: The Grand Junction success story begins back in the 1970s, when area doctors agreed with a local nonprofit insurance company to treat all patients for a similar fee, regardless of whether they had private insurance, Medicare or Medicaid. Steve ErkenBrack, who heads the insurance company Rocky Mountain Health Plans, says thanks to that agreement, even the poorest resident has access to just about every doctor in the county. And because most patients have a personal doctor, they're more likely to get vaccinations and prenatal care and better able to manage chronic conditions like high blood pressure and diabetes.

Mr. STEVE ERKENBRACK (Chief Executive, Rocky Mountain Health Plans): And, of course, the interesting component of health care is once you get ahead of this curve, a healthier population doesn't access the health care system as much. And so it winds up saving money over the passage of time.

HORSLEY: The doctors in Grand Junction still practice independently and charge fees for their services, unlike the salaried physicians at the Mayo Clinic, which President Obama has also held up as a model. But with encouragement from the insurance company, the Grand Junction doctors do get together regularly. They compare notes and look for ways to improve care, while keeping costs in check.

Mr. ERKENBRACK: A core concept since the 1970s, when we started, is that medical decisions should be made by a physician and a patient. But those decisions should be not made in a vacuum. They should be made with an idea of the whole community.

HORSLEY: No one talks about pulling the plug on grandma. The doctors do ask, collectively: are we ordering too many diagnostic scans, for example, or prescribing too many brand-name drugs? Data is shared freely, so all the doctors know how their peers are performing. Family physician Greg Reicks has been practicing in Grand Junction for 20 years and says by now, the collaboration has come to be second nature.

Dr. GREG REICKS (Family Physician, Grand Junction): I think there's a true sense of accountability amongst the physicians in this community. The data's fairly transparent amongst the physicians, so that if a physician is - appears to be an outlier in terms of their cost, that physician faces some scrutiny. That tends to keep physicians from over-utilizing or utilizing services that are, you know, maybe marginally necessary.

HORSLEY: The doctors have some financial incentives not to run up the bill. Part of their payment from the insurance company depends on keeping costs in check. But Reicks says it's also just part of the medical culture in Grand Junction to discourage excessive fees.

Dr. REICKS: When new physicians come into town, they're brought into this culture and they sort of understand that physicians in the community are concerned about costs, are concerned about medical appropriateness, are concerned about quality.

HORSLEY: For all the focus on competition as a way to lower the cost of health care, in Grand Junction, it's cooperation that's made the difference. A few years ago, the doctors, hospitals and insurance company teamed up to invest in electronic health records. That's made it easier to share information, cutting costs even further while improving quality. Researchers at Dartmouth have identified similar pockets of cost effective care in other places around the country. Together, they offer hope for an improved health care system nationwide.

Scott Horsley, NPR News, The White House.


Copyright 2005 National Public Radio, Inc.. All rights reserved.

Health care spending rising fastest here - The Boston Globe (Boston, MA)

Spending on health care increased er in New Hampshire than inany other state between 1980 and 1991 according to a study conductedby the federal Health Care Financing Administration. The study waspart of the Clinton administration's Task Force on Health CareReform's effort to collect state-by-state estimates of how much ofAmerica's health care dollar each state and region consumes. Thelast such effort was published in 1985.

'Spending in New Hampshire increased faster (13.4 percentannually) than spending in any other state. High growth in personalincome (second in the nation) and in population 10th in the nation)contributed to this trend,' said the authors of an article on thestudy that appeared in the latest issue of HCFA's quarterly journal,Health Affairs.

Illinois, where increases averaged 8.2 percent annually duringthe study period, experienced the slowest growth in health carespending.

The study estimated state spending in three areas: hospital care,physician services and retail purchase of prescription drugs. Thoseexpenditures account for 70 percent of personal health care spendingand are areas most likely to be covered by Clinton's emerging healthcare reform plan, the authors said.

Regional spending was highest in New England, which paid $2,112per capita for hospital care, doctors services and prescription drugsin 1991. The region with the lowest per capita health care bill,$1,567 in the Rocky Mountain states, spent 35 percent less on healthcare. However, because New England's per capita income was so muchhigher, the regions spent essentially identical shares of theirincome for health care -- 9.3 percent in New England and 9.2 percentin the states of Colorado, Idaho, Montana, Utah and Wyoming.

'These statistics suggest that the cost of health care was notnecessarily more burdensome when measured as a share of income inregions with high health costs than in regions with low costs,' theauthors said.

Within New England, New Hamsphire's annual increase led in allthree spending categories. Nationally, New Hampshire easily placedfirst in the increase in spending for physician services, which rosean average of 15.7 percent during the study period. The study didnot, however, take into account patients who crossed state borders toreceive health care, something HCFA plans to address in laterresearch.

Several reasons may have contributed to New England's ranking asNo. 1 and the Mideast region's (Delaware, Maryland, New Jersey, NewYork, Pennsylvania and the District of Columbia) No. 2 ranking.'The two regions had more physicians per capita in 1991 than otherregions -- 18.2 and 18.8 physicians per capita respectively, comparedwith 15.7 physicians per 10,000 natiowide,' the authors said. Bothregions also have a higher percentage of elderly residents who tendto use more health care services.

Higher per capita incomes in the East also made it easier forresidents to spend more on health care. Those spending levels,however, are likely to attract the attention of budget cutters.While the study provides useful insights, the authors said, it'smajor value may lie in helping to 'design policy options to curb costgrowth in the future.'Inventions transport Dartmouth students

The necessity to pass Dartmouth Professor John Collier's entrylevel engineering course has become the mother of four inventionsbeing considered for patents. Collier is so enthusiastic aboutseveral of the inventions that he predicts they will be on the marketwithin two years. These are the best products the 78 young men andwomen who worked in teams of four or five to design inventions thatfocused on the general theme of transportation.

TRAILblades -- a go-anywhere version of in-line roller skates --permit wearers to take to dirt trails and mountain sides and wasjudged by a panel of Thayer School professors as the best inventionto come out of the fall semester.

TRAILblades consist of two seven-inch pneumatic wheels mounted onboots with 20-inch frames. Stopping is achieved by braking theback wheel with a hand-held device that the inventors assertprovides more control than offered by traditional skates.

'The Bike Buddy' allows bicyclists to talk to one another withoutthe use of headphones or transmitters. It consists of a cross-barthat connects two bikes by attaching just beneath the handlebars.The device is cheaper than the traditional tandem bicycle andpresumably eliminates the problems that may occur when the frontbicyclist turns to inquire whether his companion has heard what hesaid.

Stolen bicycles, a common phenomenon now that mid-range bikes run$400 or more, may be located before they are sold if the owner hasinstalled a hidden homing device invented by one Dartmouth team. Thecellular tracking device is designed to be hidden in the bike'stubing or seat post. It will broadcast the bike's approximatelocation within a radius of 5 to 10 miles. With luck, a bicyclethief will not have already installed 'Enable 1' on his vehicle.This invention uses hydraulic power and folding arms that extend toground level to assist bike owners with the daunting task of mountingbicycles on roof-top car carriers quickly and easily.

Still another invention, a modified wheelchair that allows theuser to move easily from the chair to a seated position elsewhere,won the engineering school's Philip R. Jackson Award for the bestinvention to emerge from Engineering Sciences 21.

Colorado Springs Doctors Drop Out of Health Care Plan.(Knight Ridder/Tribune Business News) - Knight Ridder/Tribune Business News

Aug. 12--Nearly 50 Colorado Springs doctors are dropping out of PacifiCare's Secure Horizons Medicare program following a July notice that Secure Horizons patients no longer would be treated at Memorial Hospital.

The news affects about 828 of the doctors' patients, who will have to find new doctors or switch insurance plans.

PacifiCare will notify the patients by mail.

PacifiCare is Colorado's largest health insurer. Secure Horizons is the plan it offers to senior citizens.

Effective Sept. 1, Secure Horizons' 16,251 El Paso County members will have to use Centura Health's three area hospitals -- Penrose Community, Penrose Hospital or St. Francis Health Center.

About 7,000 members who had used Memorial received letters in July informing them that the hospital no longer would be an option for them.

PacifiCare surveyed 240 Springs physicians in July about moving their Secure Horizons patients to Centura. PacifiCare reports that 48 doctors -- two primary care physicians and 46 specialists -- said they would rather end their participation in Secure Horizons.

'Only 828 members out of 16,251 will be affected,' said PacifiCare spokeswoman Janet Reese. 'We have sent letters to these members indicating their doctor is leaving.'

One primary care physician who dropped out of Secure Horizons is internist Dr. Andrew Ellias. On July 21, Ellias sent a letter to 300 of his patients telling them he could no longer do business with Secure Horizons.

Although he has doctor privileges at Centura, he said he prefers Memorial.

'The choice I had was to either comply with this decision or no longer participate in the care of Secure Horizons patients,' Ellias said. 'Once again, we are just all impersonal pieces in a profit-driven system. I am tired of everyone telling me what I can and cannot do in the care of my patients.'

Ellias' patients can choose another doctor in the Secure Horizons directory or switch to another health plan, including Medicare, which Ellias accepts.

But Medicare does not pay for prescriptions, which is why many seniors use Medicare HMO plans.

Two other HMOs offer Medicare programs in El Paso County, the Department of Defense's TRICARE and Rocky Mountain HMO. Ellias accepts Rocky Mountain HMO members, but because of open enrollment laws, Secure Horizons members cannot receive Rocky Mountain prescription coverage until Jan. 1.

Rocky Mountain's Gold Plan, which covers prescriptions, will have an open enrollment period later this year, pending federal approval.

Four of the 46 specialists opting out of Secure Horizons are the cardiologists at the Heart Center of Colorado. Like Ellias, the Heart Center sent its Secure Horizons patients a letter about the Sept. 1 change. Between 75 and 100 patients were notified, said L.D. Jacobson, Heart Center's chief financial officer.

Jacobson said the physicians did not think they could provide the kind of care they wanted without Memorial.

He said senior plans like Secure Horizons are doomed because they try to cover more expenses with less money than straight Medicare pays. 'These plans appeal to patients who are very ill and need a lot of care,' Jacobson said. 'I believe this is a prelude to PacifiCare pulling out of all of southern Colorado.'

Heart Center patients can seek a different Secure Horizons cardiologist, seek a different Medicare HMO or switch to Medicare. Three of the four Heart Center doctors also participate in the Rocky Mountain HMO.

State Medicare officials were not aware of the Memorial-related doctor terminations, but will be watching to make sure PacifiCare can adequately treat its Medicare members. 'We want to know if they have enough physicians and specialists to handle the needs of the members,' said state Program Coordinator Penny Finnegan. 'Our staff is monitoring the situation to make sure the members are being taken care of.'

To see more of The Gazette, or to subscribe to the newspaper, go to http://www.gazette.com

Colorado Springs, Colo., Doctors Drop Out of Health Care Plan.(Knight Ridder/Tribune Business News) - Knight Ridder/Tribune Business News

Aug. 12--Nearly 50 Colorado Springs doctors are dropping out of PacifiCare's Secure Horizons Medicare program following a July notice that Secure Horizons patients no longer would be treated at Memorial Hospital.

The news affects about 828 of the doctors' patients, who will have to find new doctors or switch insurance plans.

PacifiCare will notify the patients by mail.

PacifiCare is Colorado's largest health insurer. Secure Horizons is the plan it offers to senior citizens.

Effective Sept. 1, Secure Horizons' 16,251 El Paso County members will have to use Centura Health's three area hospitals -- Penrose Community, Penrose Hospital or St. Francis Health Center.

About 7,000 members who had used Memorial received letters in July informing them that the hospital no longer would be an option for them.

PacifiCare surveyed 240 Springs physicians in July about moving their Secure Horizons patients to Centura. PacifiCare reports that 48 doctors -- two primary care physicians and 46 specialists -- said they would rather end their participation in Secure Horizons.

'Only 828 members out of 16,251 will be affected,' said PacifiCare spokeswoman Janet Reese. 'We have sent letters to these members indicating their doctor is leaving.'

One primary care physician who dropped out of Secure Horizons is internist Dr. Andrew Ellias. On July 21, Ellias sent a letter to 300 of his patients telling them he could no longer do business with Secure Horizons.

Although he has doctor privileges at Centura, he said he prefers Memorial.

'The choice I had was to either comply with this decision or no longer participate in the care of Secure Horizons patients,' Ellias said. 'Once again, we are just all impersonal pieces in a profit-driven system. I am tired of everyone telling me what I can and cannot do in the care of my patients.'

Ellias' patients can choose another doctor in the Secure Horizons directory or switch to another health plan, including Medicare, which Ellias accepts.

But Medicare does not pay for prescriptions, which is why many seniors use Medicare HMO plans.

Two other HMOs offer Medicare programs in El Paso County, the Department of Defense's TRICARE and Rocky Mountain HMO. Ellias accepts Rocky Mountain HMO members, but because of open enrollment laws, Secure Horizons members cannot receive Rocky Mountain prescription coverage until Jan. 1.

Rocky Mountain's Gold Plan, which covers prescriptions, will have an open enrollment period later this year, pending federal approval.

Four of the 46 specialists opting out of Secure Horizons are the cardiologists at the Heart Center of Colorado. Like Ellias, the Heart Center sent its Secure Horizons patients a letter about the Sept. 1 change. Between 75 and 100 patients were notified, said L.D. Jacobson, Heart Center's chief financial officer.

Jacobson said the physicians did not think they could provide the kind of care they wanted without Memorial.

He said senior plans like Secure Horizons are doomed because they try to cover more expenses with less money than straight Medicare pays. 'These plans appeal to patients who are very ill and need a lot of care,' Jacobson said. 'I believe this is a prelude to PacifiCare pulling out of all of southern Colorado.'

Heart Center patients can seek a different Secure Horizons cardiologist, seek a different Medicare HMO or switch to Medicare. Three of the four Heart Center doctors also participate in the Rocky Mountain HMO.

State Medicare officials were not aware of the Memorial-related doctor terminations, but will be watching to make sure PacifiCare can adequately treat its Medicare members. 'We want to know if they have enough physicians and specialists to handle the needs of the members,' said state Program Coordinator Penny Finnegan. 'Our staff is monitoring the situation to make sure the members are being taken care of.'

To see more of The Gazette, or to subscribe to the newspaper, go to http://www.gazette.com

Health-care center gets award - Deseret News (Salt Lake City)

Rocky Mountain Care, a Utah nonprofit health-care company,received the Agency of the Year award for 2006 given by the Societyfor Social Work Leadership. Andrea Bailey, a licensed clinical socialworker for Rocky Mountain Care, also received the Emerging SocialWorker of the Year award. Both awards were presented at the society'sannual banquet recently.

The agency award is given for commitment to using social workersin both traditional and nontraditional settings, and for a commitmentto providing important continuing education for social workers.

The individual award goes to a licensed clinical social workerwith five or fewer years of experience in health care social work whodemonstrates extraordinary ded- ication to service, dignity, worth ofthe individual patient, social justice, importance of humanrelationships, integrity and competence.

Rocky Mountain Care employs social workers in the company's FaithIn Action Program, as hospice administrators, directors of socialwork, and with patient care coordination. They employ social workersin urban and rural areas and are the only agency that serves Utah'sIndian populations in Blanding, Montezuma Creek and Monument Valley.