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.

Improving the bottom line: lawmakers, businesses and health care providers are trying an array of approaches to curb the long-term costs of health care.(HEALTH) - State Legislatures

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Next month: Six more strategies to manage the rising cost of health care.

Spiraling health costs grab headlines, create budget shortfalls and plunge families into bankruptcy. America spends $2.6 trillion annually on health care and costs seem to rise inexorably. Every year, state lawmakers face tough choices as health costs eat up 25 percent to 30 percent of total budgets. Costs hit households, too, with family health insurance coverage now averaging $15,073 a year.

At the same time, policymakers are teaming up with innovative local providers, business leaders and consumer advocates to find new and sustainable ways to hold down the cost of health care for the long term.

'Moving away from compensating the volume of care to providing better value is the way to cut costs without harming access or quality,' says Massachusetts Senator Richard Moore (D), chair of the legislature's Joint Committee on Health Care Financing. 'Promoting prevention and wellness, along with improving quality and safety, are fundamental to cutting health care costs.'

In a nutshell, most medical experts agree medical care that does the right thing at the right time to the right people will help save money and improve Americans' health. These actions, coupled with promoting prevention and personal responsibility, should help curb health costs.

'Taming rising health costs is one area where state governments have been out front and where reaching across the aisle has saved real money,' says Senate President Steve Morris (R) of Kansas, NCSL's current president. 'I am pleased that NCSL and state legislators across the country are tackling this complicated issue.'

No magic bullet exists. What works in one locale may not fit another. Yet, lawmakers continue to press for cost-effective strategies--in the individual home and at the state policy level.

Group Health Cooperative in Seattle, Rocky Mountain Health in Grand Junction, Colo., and Geisinger Health System in Pennsylvania have paved the way for documented cost savings.

Group Health houses its providers, clinics and hospitals under one roof. The group receives a monthly capped payment from insurers to manage each patient's care. Its methods include physician consultation by phone and secure email for patients. Washington analysts writing for the health policy journal Health Affairs have estimated that Group Health has saved more than $10 per client per month within this model of care.

In Grand Junction, the average per capita Medicare spending was 24 percent lower than the national average in 2007. Since it was founded in 1974, the Rocky Mountain Health communitywide system has expanded preventive care, including free prenatal care, and treated diabetes and asthma with a comprehensive case management approach. It also provides in-home follow up by nurses and other health professionals. Observers have suggested the cooperative spirit shown by providers, hospitals and health plans helps lower costs.

These promising methods include a payment system that involves equal reimbursement for care of Medicare, Medicaid and private insurance patients; limits on expensive resources, such as hospital beds and specialists; and comprehensive end-of-life care, which has led to 50 percent fewer deaths occurring in hospitals by emphasizing hospice and at-home services.

Pennsylvania's Geisinger Health System is widely celebrated for focusing on coordinating care among providers, peer-review and easy access for patients to routine care. Geisinger motivates providers to use only health care approaches that research has demonstrated are effective, such as team work and peer review. Patients' ability to schedule same-day appointments has increased from 50 percent to 95 percent since 2002. Using a medical home model, Geisinger has reduced overall medical costs by 4 percent--while costs have risen in most plans--and has seen a 29 percent reduction in hospital readmissions overall. For diabetic patients, the system has reduced hospital admissions by 25 percent and days spent in the hospital by 43 percent.

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Medical Homes

Poor coordination of health care services can lead to serious problems. A person who needs a specialist doesn't know how to find one. Another patient must undergo unnecessary medical tests because a specialist doesn't have access to her medical records. A man who can't get an appointment to see his primary care physician goes to the emergency room instead.

Medical homes can avoid many of these problems, while also avoiding unnecessary costs and improving patients' health.

Medical homes, especially for those with complex medical needs, are a way of organizing and delivering health care that is coordinated, comprehensive, efficient and personalized. A medical home provides patient education, resources and referral assistance, while integrating the individual's needs whether medical-surgical, rehabilitative, psychological or supportive services. As of July 2010, at least 29 states had enacted medical home legislation addressing such things as certification, authorization for Medicaid pilot programs, appropriations for care coordination fees, the creation of advisory panels and anti-trust protections.

Initial results from pilot projects indicate they can save money. Community Care of North Carolina covers more than 950,000 Medicaid enrollees. Between 2007 and 2010, preventable hospital admissions declined by 12.5 percent among the 71 percent of patients who were enrolled in the pilot program, but increased by 25.9 percent among patients who were not. A 2011 report calculated that Community Care saved Medicaid nearly $1.5 billion over three years.

Medical home pilot programs sponsored by WellPoint, a health benefits company and licensee of the Blue Cross and Blue Shield Association, have experienced as much as an 18 percent decrease in acute inpatient admissions and a 15 percent decrease in emergency room visits.

Health Savings Accounts

Health savings accounts can help reduce health costs and give people greater engagement in and control over their health issues, according to backers of the accounts.

'A health savings account provides consumers and employers a practical alternative to combat high-cost medical coverage,' says Wisconsin Senator Mary Lazich (R), chair of the legislature's Committee on Public Health, Human Services, and Revenue. 'During an era of skyrocketing medical expenses, HSAs allow and encourage cost-conscious consumers to seek pricing information and shop for competitive services.'

The accounts are similar to personal savings accounts, but account holders can use the money only for health expenses. Most also enroll in high-deductible plans paid for with pretax dollars from employers. This allows them to pay for routine health care from the account, but provides them with insurance in the event of a major illness. Most reports of their success come from insurance industry sources.

An Aetna study found members with the accounts used the emergency room less frequently and had 9 percent lower annual medical costs than those without the savings accounts. In 2010, Cigna found its health savings account enrollees reported better control of and engagement in treatment of their health issues than did non-HSA enrollees, such as a 21 percent higher likelihood of participating in disease management programs. A 2010 study by the University of Illinois School of Public Health reported those with HSAs spent 5 percent to 7 percent less than enrollees without them.

Critics argue the plans are successful because they enlist people who are younger, healthier, better educated and wealthier than the general population.

Prescription Drug Purchasing

More than one-half of Americans take prescription drugs regularly, at a total cost of $260 billion, or just under 10 percent of overall health spending in 2010.

In 2005, the annual increase for all U.S. drug spending was the highest of any health service or product--10.6 percent. Yet, by 2010 this increase had slowed dramatically, to a record low of just 1.2 percent.

Why? In January, actuaries at the Centers for Medicare and Medicaid Services reported 'a continued increase in the use of generic medications and an increase in Medicaid prescription drug rebates' as leading causes of slowed spending. Eighty percent of all dispensed prescriptions in 2011 were FDA-certified generic drugs--up from just 67 percent in 2007. In 13 states, pharmacists are required to dispense the generic equivalent when available. In every state, physicians have the authority to order use of brand name drugs and block a generic substitution--when beneficial to a particular patient.

Preferred drug lists, now used by 48 states for Medicaid and many state-run plans, allow public programs to dispense both generic and brand products and also allow physician discretion to meet individual needs. Especially for the most serious illnesses, unique brand-name or 'innovator' drugs remain a key treatment choice, accounting for $200 billion 77 percent--of U.S. market sales.

Global Payments

Global payment systems allow insurers to pay a fixed amount to a group of providers or a health care system to cover most or all of a patient's care during a specified time period.

In 2009, the largest insurer in Massachusetts, Blue Cross Blue Shield, established a program called the Alternative Quality Contract, which combined global payments with sizeable quality bonuses for medical groups. The groups agreed to an annual budget that included financial incentives if there were improvements in the quality of patient care. Within the first two years, the program included more than a quarter of the primary care physicians practicing in Boston. Together, these practices cared for more than 470,000 Blue Cross Blue Shield patients.

Stuart Altman, a professor of health policy at Brandeis University, and colleagues wrote in 2009 that 'global payment has the greatest potential for encouraging shifts in health care resource use from low-value to high-value services.'

Other examples of successfully integrated systems include the Cleveland Clinic in Ohio and Kaiser Permanente, which is based in California and operates in Colorado, Georgia, Hawaii, Maryland, Ohio, Oregon, Virginia, Washington and the District of Colombia.

Thirty states operate Programs for All-Inclusive Care for the Elderly, which pay a capped rate to provide total care to frail patients covered by Medicare and Medicaid. California, Kansas, Massachusetts, Rhode Island and Vermont are among the states that have or are considering applying for federal waivers to allow global payments. Health economists and others are increasingly promoting global payments as an important strategy to slow growth of health care expenditures. Using global payments in conjunction with performance-based pay, medical homes and accountable care organizations may help control costs better than using a single strategy.

Early Detection and Treatment

What you don't know can hurt you.

When it comes to your health, early detection and treatment can save your life and reduce your health care costs substantially.

Numerous health problems benefit from early intervention: From counseling for problem drinking to tuberculosis screening in high-risk populations, from smoking cessation counseling to STD screening for teens.

Promising new methods of diagnosing and treating early Alzheimer's disease alone could save Medicare and Medicaid a substantial amount of money, in part by delaying nursing home placements. 'The future of this disease is to intervene decades before someone becomes symptomatic,' says Dr. Mark Sager, director of the Wisconsin Alzheimer's Institute. 'This analysis says you can save literally billions of dollars in long-term care costs if you can intervene at an earlier stage.'

Early detection and treatment rates improve when insurance coverage is required, public education campaigns are employed and public providers are given incentives. Experts disagree about the frequency and usefulness of certain screenings, such as breast, prostate and cervical cancer. But most other screenings have broad support among health care practitioners.

The federal Patient Protection and Affordable Care Act requires health plans to cover certain screenings--high blood pressure, alcohol misuse, colorectal cancer--with no deductibles or copayments. At least 14 states require insurance coverage for osteoporosis-related diagnostic and treatment services.

[ILLUSTRATION OMITTED]

Primary care providers who participate in the Illinois Primary Care Case Management Program are eligible for an annual bonus based, in part, on meeting or exceeding benchmark screening rates for developmental disabilities, breast cancer and lead. Utah's colorectal cancer social marketing campaign warns the physical symptoms of colon cancer don't appear early on and that people age 50 and older should be tested regularly.

NCSL Briefs

NCSL's Cost Containment and Efficiencies project has published 16 issue briefs, each four to six pages in length. Go to www.ncsl.org/magazine to download a copy.

Editor's note: This is the first of a two-part story on efforts in the states to hold down health care costs while improving quality. The second part of the story, to appear in the July/August issue of State Legislatures, will include information about patient safety, drug monitoring programs, medical malpractice reform, wellness in the workplace, and approaches to help patients make healthy choices and good medical decisions.

Health Care By the Numbers                $2.6 trillion         U.S. annual health spending.                 $421 billionTotal spent by state and local governments.                  $8,402Average spent per person annually on health.              6.6% to 3.9%Drop in annual growth of health spending           from 2007 to 2010.                   17.9%   Health share of gross domestic product.             572.5 billion  Estimated annual cost of insurance fraud.                    75%   Share of all health care spending that      goes to treat chronic conditions.               $19.5 billionEstimated annual cost of medical errors.                    200%Cost to treat someone with diabetes compared            with a nondiabetic.               $15,073 a year          Average cost of a family          health insurance policy.Source: 2010 National Health Expenditures,Department of Health and Human Services,published 2012.U.S. National Health Care Expenditures 2010 (billions)Professional services                                    $688.6Government administration                                $30.1Nursing care facilities and continuing care retirement   $143.1Other health, residential and personal care              $128.5Investment                                               $149.0Home health care                                         $70.2Net cost of health insurance                             $146.0Government public health activities                      $82.5Total U.S. National HealthCare Expenditures in 2012 was $2.6 trillion.Source: Data released January 2012 the CMS Office of theActuary and the National Health Expenditure AccountsTeam; published in Health Affairs article, 'Growth In USHealth Spending Remained Slow in 2010; Health ShareOf Gross Domestic Product Was Unchanged From 2009.'Authors: Anne B. Martin, Dave Lassman, BenjaminWashington, Aaron CatlinNote: Table made from pie chart.

Learn more about state efforts to curb health costs at www.ncsi.org/magazine.

HEALTH CARE SPENDING VARIES WIDELY IN U.S.(MAIN) - Albany Times Union (Albany, NY)

Byline: ROBERT PEAR - New York Times

The federal government issued new data Wednesday showing huge variations in health care spending from state to state. The figures suggest that the government would have difficulty setting local budgets for health spending, as President Clinton has proposed.

An explicit goal of Clinton's health plan is to reduce variations in the level of medical spending and its growth.

The new data, from the Department of Health and Human Services, show that Clinton's proposal to revamp the nation's health care system will affect different states in very different ways, a fact already complicating the politics of health care legislation.

Health Affairs, a quarterly journal of health policy, published the department's data.

Summarizing the new data, Katharine R. Levit, chief of the government's office of national health accounts, said, 'Per capita spending for hospital and physician services and for prescription drugs ranged from a high of $2,112 in New England to a low of $1,567 in the Rocky Mountain region in 1991 -- a difference of 35 percent.'

For the United States as a whole, spending on these health care items totaled $1,877 per person in 1991, the government reported.

Besides New England, the only region in which per capita spending exceeded the national average was the Middle Atlantic region of Delaware, Maryland, New Jersey, New York, Pennsylvania and the District of Columbia. Per capita spending for this region was $2,105 in 1991. New York state's per capita spending was more than $2,100.

Levit said that personal income appeared to be the most important factor influencing the level of health care spending in a state. In addition, the study said, high levels of health care spending may reflect the presence of large numbers of doctors, a large proportion of medical specialists and a high concentration of elderly people.

But some disparities have no simple or obvious explanation. Earlier studies have found large geographical variations in medical practice and prevailing medical wisdom. The frequency of hysterectomies, coronary bypass operations and other surgery varies widely, even in population groups of similar age and income.

In its report on Wednesday, the government made these points:

Two states, New York and California, accounted for one-fifth of all spending on hospital care, doctors' services and prescription drugs in 1991. Spending in California, $58.1 billion, was 51 percent higher than in New York, where it totaled $38.5 billion.

New York and California account for about a fifth of the nation's population. According to the 1990 Cenus, California's population was 29,760,021. New York's population was 17,990,455.

From 1980 to 1991, spending grew faster in New Hampshire than in any other state. Growth was slowest in Illinois. Personal income and population grew rapidly in New Hampshire, but population growth was slow in Illinois. Among regions, the Southeast had the highest growth, while the Great Lakes region had the slowest.

In the Middle Atlantic region, per capita spending for hospital care was 19 percent higher than the national average. But it was 17 percent lower than the national average in the Rocky Mountain states. The Middle Atlantic region ranked first in the nation in hospital admissions per person and in the average length of hospital stays.

The report noted that 'Hawaii has led the nation in health care reform by providing almost universal health insurance coverage for its population since the early 1970s.' But spending per person on health care rose slightly faster in Hawaii at 9.8 percent a year than in the nation as a whole, which was 9.4 percent.

New York state's spending rose an average of 10.1 percent a year during the period covered by the study, 1980-1991.

Near-universal coverage in Hawaii may have encouraged people to use extra health care services, the study said. Nationwide, the use of hospitals (measured by inpatient days per capita) declined 26 percent from 1980 to 1991, but it rose 3.6 percent in Hawaii.

Dear Mr. President ... Colorado business leaders cite looser credit and health care changes and an economic stimulus plan among things they'd like the new administration to work on.(Business) - Rocky Mountain News (Denver, CO)

Byline: John Rebchook, Rocky Mountain News and Joyzelle Davis,

Rocky Mountain News and Jeff Smith, Rocky Mountain News and Gargi

Chakrabarty, Rocky Mountain News and Chris Walsh, Rocky Mountain News

and Roger Fillion, Rocky Mountain News and Joanne Kelley, Rocky

Mountain News

Executives and officials from a variety of sectors in Colorado's business community weigh in on what they want to see - and what they don't - from President-elect Barack Obama's administration.

Pat Hamill President and CEO, Oakwood Homes

'What we need in this country is an economic stimulus plan that focuses on housing. We need lower interest rates. We need to figure out a way that the government can supply 3.9 percent, 30-year, fixed-rate mortgage loans. And we need a tax credit and economic assistance with down payments, which would stabilize the existing housing stock. That would help and go a long way to stabilize the existing housing values.'

What he doesn't want to see: 'I think we're always concerned about

over-regulations.'

Bill Tresham Chief operating officer,

Chicago-based Callahan Partners

'We need to see the Obama administration focus on the loosening up of credit. More than anything else, the banks have to be prodded, cajoled, ordered or forced to lend money on reasonable terms to good businesses. What is happening now is that the banks are taking the money off the table and raising the cost of money. Obama should use every tool available to him from technical methods to moral suasion.

I don't want to see him to go too far to socialize America. Things like health care are definitely worth looking at.'

Lee Goodfriend Co-owner, Racines and Dixons restaurants

'The first thing I would like to see is some help with health care so we can get our employees some coverage without it being unaffordable. I'm concerned it would be too expensive, upward of $1 million a year. But I feel like we should have health insurance, and Obama could come up with a plan where we put in some and the employees put in some and taxes put in some.

'I don't want to see health insurance continue to be so expensive that if they mandate us doing it, small businesses can't afford it.'

Ed Mueller Chairman and CEO, Qwest Communications

'We at Qwest look forward to the new administration addressing the economic challenges - and opportunities - in this country, quickly and decisively.'

Keith Rattie Chairman, president and CEO,

Questar Corp.

'(On Tuesday) voters decided to turn over the economy to the trio - Barry (Barack Obama), Harry (Reid) and Nancy Pelosi. Clearly 2009 will be a tough year for energy producers,' Rattie said, speaking at the annual luncheon of the Colorado Oil and Gas Association. 'COGA needs a big plan for this year. We need to reach out to Democrats and differentiate natural gas from oil, gasoline and coal. Natural gas is a bargain, it's abundant and is the American part of the (energy) solution.'

Bill Lindsay President, Lockton Benefit Group

'My orientation is obviously health care, but more important than health care right now is going to be how the president handles the economic situation, not only the implementation of the current bailout, but the Big 3 automakers are all hurting. It's a significant indication that other industries are going to be caught up in this bailout, and how far can we as a country go protecting businesses rather than letting nature take its course?'

Brian Barish President and director of research,

Cambiar Investors mutual fund firm

'My business is investing, and for people to invest confidently they need to have confidence about the future and the long-term outlook. Social Security and Medicare also have to be reformed. If Obama can set these programs up in such a way that they are fiscally sound and not ticking time bombs, that will immensely improve the long-term attractiveness of the financial markets.'

'It would be a terrible mistake to move toward more protectionist trade policies. At the same time, though, we need to negotiate a little harder with some of our trading partners.'

Wendy Mitchell CEO, Aurora Economic Development Council

'We'd like the Obama administration to invest in industries that will contribute to the growth of Colorado's economy: aerospace and defense, the National Institutes of Health (bioscience) and renewable energy.

Since there's likely to be a second economic stimulus package, we'd like the package to include transportation infrastructure funding.'

What she doesn't want to see: 'Any new taxes on business that could hinder economic recovery.'

Dan Pilcher Senior vice president, Colorado Association of Commerce and Industry

The statewide chamber, which supported a statewide anti-union amendment that failed, ranks federal labor legislation as its top concern. 'The question is how hard will organized labor push? It's fair to say the business community is concerned.'

Mac Slingerlend CEO, Ciber Inc.

Do:

1. Kill earmarks.

2. Give money to states to help them spend in 2009.

3. Put money into public works (bridges, etc.) to create jobs.

4. Get the $700 billion bailout money spent and working.

5. Keep government 'smaller' and private sector 'larger.'

Don't:

1. Start national health care.

2. Raise taxes.

3. Reduce tax rates on anyone, except corporations.

4. Bail out the auto industry, without allowing bankruptcies that would kill current labor and auto dealership contracts.

5. Pass new Sarbanes-Oxley-like accounting laws.

Rob Katz CEO, Vail Resorts Inc.

A priority for the resort operator: immigration reform that deals with everything from 'the folks that are already here to visas' for guest workers.

But to start out, Katz said he hopes for the same thing as other businesses: an administration that will put the economy back on the right path.

'I think we're expecting some calming by having a single voice now with a new direction.'

Mike Boyd President, Boyd Group International aviation consulting firm

Boyd wants a new plan to fix the nation's air traffic control system and a strong, experienced leader in charge of the Department of Transportation.

'I'd like to see someone appointed to the DOT secretary job who has an enormous amount of qualifications, someone who will walk in with a flamethrower or a bulldozer and clear out the place.

But I'm extremely confident that the new administration will appoint yet another semi-qualified hack.

Every administration has done it, and I expect nothing different now. We'll have a semi-activist who muddies it up with more bureaucracy.'

Mike Cerbo Executive director, Colorado AFL-CIO

'The big picture is economic recovery and a key component is labor law reform.

Working families will benefit from greater freedom to form and join unions.

FHP HEALTH CARE HAS NEW OWNER CALIFORNIA COMPANY PAYS OUT $2.1 BILLION.(Business) - Rocky Mountain News (Denver, CO)

Byline: Rebecca Cantwell Rocky Mountain News Staff Writer Rocky Mountain News wire services contributed to this report.

Colorado's biggest health maintenance organization, FHP Health Care, will get a new corporate owner in a $2.1 billion deal announced Monday amid a continuing shakeout in the highly competitive industry .

PacifiCare Health Systems Inc., said it will buy FHP International Corp. for stock and cash in a deal that still needs government and stockholder approval. Both companies are based near Los Angeles.

The two companies plan to combine to form the nation's fifth largest managed care network, with nearly 4 million members in 15 states - and more than $8.6 billion a year in revenues.

Officials say the change won't affect 370,000 Colorado patients, who will continue to see the same doctors and use the same hospitals.

``Down the road, we'll probably see a name change, and we're pros at that,'' said Eric Sipf, president of FHP Health Care.

The organization now known as FHP in Colorado has been known as Comprecare, Peak Health Plan, and Take Care Inc. in recent years.

The competitive marketplace is driving consolidation - and a $9 billion company can offer more than a company half that size, Sipf said.

``Hopefully it will create opportunities for us with more resources that we can devote to development of new products and services to become more competitive and to improve our service to our members,'' Sipf said.

By Oct. 1, FHP will have contracts with all hospitals in metro Denver except St. Joseph's, Sipf said. ``PacifiCare believes, like we do, a key component of our success is relationships with physicians and hospitals,'' said Sipf.

He termed PacifiCare an ``outstanding organization'' that will strive to provide the highest quality health care at the best price. ``I think the combination will be dynamite,'' he said.

While other multibillion dollar health care mergers have been scuttled recently because of conflicts, this one is marked by a willing buyer and seller, said Alan Hoops, chief executive of PacifiCare. The management of his company will be responsible for the combined HMO.

FHP chief executive Bill Price said he will focus on combining the companies, and then isn't sure what he'll do.

Leaders of the two companies stressed they want to increase their Medicare business. Hoops said he'd like PacifiCare's Medicare product, Secured Horizons, to become nationally known. And officials said they expect revenues from Medicare to represent about half the new company's income.

While Wall Street has battered many HMOS lately for not showing enough profit, managed care plans have found it profitable to move into the government program for the elderly.

In Colorado, FHP's biggest Medicare competitor is Kaiser Permanente, the state's second largest HMO, said Allan Baumgarten, publisher of an annual report on Colorado's managed care industry. And the competition is likely to increase for the government program whose cost is rising three times as fast as inflation.

PacifiCare received mediocre grades in the first major consumer report card of California health plans made available to the public in late 1994. The Bay Area Business Group on Health gave PacifiCare B's and C's.

And a local expert said the change might be a bit much for the oft-switching local organization.

``I think there may be some disruption as a result of the merger due to the fact this is the fourth change in the last six years,'' said James Hertel, publisher of ``Colorado Managed Care'' newsletter.

INFOBOX

TOP COLORADO HEALTH PLANS

COMPANY PARTICIPANTS

1. FHP of Colorado 367,054

2. Kaiser Permanente of Colorado 322,751

3. Blue Cross 317,640

4. CIGNA HealthCare of Colorado 164,242

5. United Health Care 160,010

6. Prudential 151,955

7. Aetna 120,617

8. Rocky Mountain 91,885

9. Great West 72,498

10 Antero 70,491

SUIT TARGETS MEDICARE BIDDING HEALTH CARE GROUPS SEEK TO HALT FEDERAL EXPERIMENT DESIGNED TO CUT HMO PAYMENTS.(Business) - Rocky Mountain News (Denver, CO)

Byline: Al Lewis Rocky Mountain News Staff Writer

Nearly a dozen health care groups sued Monday to stop a government pricing experiment they say could mean higher costs and reduced benefits for some Medicare recipients in Colorado.

``Don't impose this unfair demonstration on the thousands of people who rely on Medicare,'' said Steve O'Dell, president of the Colorado HMO Association, which is among those suing the federal Health Care Financing Administration.

The groups seek a temporary restraining order against the agency's Denver Medicare demonstration project, which would put Medicare payments to managed care companies up for competitive bid.

Managed care companies say that, with profits squeezed under the project, they may be forced to cut benefits or raise co-payments and premiums for some Medicare recipients.

A hearing date for the request has not been set, a spokeswoman for the U.S. District Court in Denver said. The health care groups hope to stop the project before a Thursday deadline under which managed care companies must submit their Medicare bids.

Other groups joining in the suit include the Colorado Association of Commerce and Industry, the Colorado Medical Society, Kaiser Foundation Health Plan of Colorado and Rocky Mountain Health Maintenance Organization Inc.

Despite objections expressed throughout the managed care industry, state government and Congress, the Health Care Financing Administration is moving forward with its experiment.

``We can't solve Medicare's financial problems without doing these kinds of demonstrations,'' said a spokesman for the administration in Washington. ``And we are not going to do anything that would harm beneficiaries.''

Health maintenance organizations now receive about $450 a month for every Medicare patient in their systems. But when the project begins Jan. 1, they will receive a lesser amount set by a competitive bidding process.

O'Dell said the concept of competitive bidding was not at the heart of his group's attempt to stop the project. The objections come from the details of the plan, which O'Dell said have not been fully disclosed and violate federal laws regarding bids submitted to government agencies .

The Health Care Finance Administration is ``introducing a bidding process without even disclosing how the bids will be evaluated, or how winners and losers will be decided,'' he said.

Organizations that do not submit bids by the Thursday deadline will be excluded from the Medicare system for three years.

The aim is to reduce the amount Medicare pays to managed care companies, and some observers have said it could mean $40 million a year less for locally operating HMOs.

So far, only one unidentified managed care company has submitted a bid, a Denver-area spokesman for the Health Care Financing Administration said. Karen Ignagni, president of the American Association of Health Plans, said her organization hopes to stop the project before Thursday.

Jim Hertel, publisher of the Colorado Managed Care newsletter, said he thinks HMOs have some legitimate issues with the proposed competitive bidding process, and he notes that state legislators, Gov. Roy Romer and members of Congress have voiced objections to the plan.

``It's surprising that the Health Care Financing Administration has been unresponsive not only to concerns being raised by HMOs, but the concerns being raised by political leaders,'' he said.

But even if the suit succeeds, the issues behind it will hardly be resolved.

``At the heart of the matter, the Health Care Financing Administration is going to have to find alternatives to current Medicare system, which is projected for bankruptcy early in next decade,'' Hertel said.

CAPTION(S):

Color Photo

State Senate shows its new colors in action ; Bills vetoed by Owens on contraception, health care advance - The Gazette (Colorado Springs, CO)

DENVER - Democrats on Wednesday fast-tracked two proposals vetoedby Bill Owens when he was governor, a sign of the new era votersushered in in November.

A Senate panel approved a bill requiring hospitals to providerape victims with information about the socalled morning-after pill,an emergency contraception. Owens vetoed similar legislation in eachof the past two sessions.

Another Senate committee approved a plan to cut health care costsby having the state negotiate lower prices on generic prescriptiondrugs -- another bill vetoed twice by Owens. The SenateAppropriations Committee also earmarked $146,000 in startup moneyfor the program.

The program is aimed at people who can't afford health insurancebut earn too much to qualify for Medicaid. About 264,000 Coloradanscould sign up in the first year, legislative analysts said.

Evan Dreyer, a spokesman for Gov. Bill Ritter, said the governorwould probably sign the emergency-contraception bill if theDemocratic-controlled General Assembly approves it.

The Colorado Catholic Conference has opposed the bill in thepast. A representative of the organization was unavailable forcomment Wednesday.

The bill, SB60, says individual health care workers who have areligious or moral objection to providing information aboutemergency contraceptives are not required to do so, but thatinstitutions cannot claim that exemption.

The bill applies only to emergency contraceptives that preventpregnancy and not to drugs such as RU-486 that terminate apregnancy.

Tamika Payne, executive director of the Colorado CoalitionAgainst Sexual Assault, said the bill would provide rape victimswith the means to make an informed decision about whether to takethe risk of pregnancy.

'When a woman is victimized, she is having the choice over whatto do with her body taken away,' Payne said. 'To compound that fearwith a pregnancy should be that person's choice.'

Republican members of the committee opposed the bill, arguing itwould create a precedent allowing the Legislature to intrude intothe relationship between doctors and their patients.

The bill's sponsor, Sen. Betty Boyd, D-Lakewood, disagreed.

'This information is part of what a crime victim needs to know inorder to protect themselves,' Boyd said.

Boyd said it's no longer necessary to require emergency rooms todispense contraceptives.

'Because of an FDA (Food and Drug Administration) ruling thatcame down earlier this year, contraception is available over thecounter,' Boyd said. 'You don't generally need the prescription toget it now.'

The effectiveness of emergency contraception decreases as theamount of time after intercourse increases, said Katie Groke-Ellis,spokeswoman for Planned Parenthood of the Rocky Mountains.

'We recommend that people take it in the first 12 to 24 hours,'Ellis said.

Mesa County offers a model for state, nation's attempts at health care reform - The Gazette (Colorado Springs, CO)

In Colorado, we don't have to guess at what the future of healthcare is supposed to look like: We've got a pretty good model justover the mountains in Grand Junction.

Grand Junction provides some of the lowest costs - nearly a thirdlower than the national average for Medicare patients - and some ofthe best health outcomes anywhere.

The Federal Trade Commission once sued the Mesa Countyphysicians' association on anti-trust grounds. Now, thecollaboration going on in Grand Junction is a national model.President Barack Obama even visited Grand Junction in 2009, when hewas promoting what became the Patient Protection and Affordable CareAct (PPACA).

In Mesa County, doctors work with the region's dominant insurer,the nonprofit Rocky Mountain Health Plans. They receive lowerpayments at the front end, but can earn bonus payments based on theoverall performance of the system.

Doctors are paid the same for every patient, including Medicareand Medicaid patients. The emphasis is on primary care, nothospitals or specialty care, and on preventative care. Costs,outcomes and effectiveness of treatments are tracked at every stepand physicians promote best practices and protocols.

It's exactly what the state's Medicaid Regional CareCollaborative pilot program is shooting for and what the accountablecare organizations called for in the PPACA hope to achieve.

The system in Grand Junction was built up over decades, saidPatrick Gordon, director of government programs for Rocky MountainHealth Plans. You can't wave a magic wand and make the rest of thestate and country look or work like Grand Junction.

'Creating something like that in other communities is possible,but it's not something you do from the top down,' Gordon said.

Nevertheless, Rocky Mountain Health Plans is trying to duplicateits success. It's signed on to run one of the seven MedicaidRegional Care Collaboratives in the state. However, Rocky Mountainisn't simply signing up people it already sees and calling it good.Most of the patients in Rocky Mountain's territory for the pilotproject will come from Larimer County in northern Colorado - a longway from Grand Junction.

In Mesa County, the Rocky Mountain way of business may be oldhat, but it's a new challenge for groups in Larimer. But thehospitals, specialists and primary care Medicaid providers thereunderstand the problems and want to find solutions, Gordon said. Andthe success or failure of the state pilot will hinge on thoseproviders, he said, not an insurance company. Rocky Mountain's rolewill be to provide experience, coordination, data analysis andaccountability.

'The way that people are approaching these problems, comingtogether around the table, is very similar to what's happened inwestern Colorado over the years,' he said.

Will it work? It has already, both in Grand Junction and in otherplaces around the country, Gordon said. It's too important not totry in all of Colorado, he said.

COMMUNITY-FOCUSED COLORADO HEALTH CARE SYSTEM TOUTED AS NATIONAL MODEL. - States News Service

LEAWOOD, KS -- The following information was released by the American Academy of Family Physicians:

By David Mitchell

3/30/2011

During the past few years, a highly integrated, community-focused health care system unique to Grand Junction, Colo., has been held up as a model to the rest of the country by sources ranging from medical journals to mainstream media, and from public policy think tanks to President Obama and other health care reform advocates.

Family physician Michael Pramenko, M.D., evaluates a patient in his Grand Junction office. According to Medicare data, the Colorado town had the sixth-lowest health care costs out of more than 300 U.S. cities evaluated in 2005 while ranking 31st in quality of care.

According to Grand Junction family physician David West, M.D., who wrote about his hometown last year in the New England Journal of Medicine, or NEJM, such regionally run, regionally financed health care systems represent the sole pathway to achieving the twin goals of providing high-quality health care and holding down costs.

'We will never solve health problems comprehensively until we somehow escape profit centers and the current reimbursement system,' he said.

With those goals in mind, a group of primary care physicians and subspecialists in Grand Junction got together nearly 40 years ago and started the independent benefits provider Rocky Mountain Health Plans, known locally as 'Rocky,' and Mesa County Physicians Independent Practice Association, or MCPIPA. Both are nonprofit organizations, as are both local hospitals, two mental health centers, a hospice and a handful of other vital health care entities.

'I can't stress enough the importance of a health plan that's community-oriented,' said Grand Junction family physician Michael Pramenko, M.D. 'I don't think this would have happened in Grand Junction without Rocky. Physicians made their own health plan and made it a nonprofit.'

Upcoming One-day Session to Kick Off PCMH Training Program for Colorado FPs

The Colorado AFP is helping its members take the first steps toward earning patient-centered medical home, or PCMH, recognition from the National Committee for Quality Assurance, or NCQA, by offering an all-day session April 14 in conjunction with its Annual Scientific Conference in Colorado Springs. That session, which covers the requirements for NCQA recognition, marks the beginning of a 10-week program, said Angel Perez, B.S.N., the Colorado AFP's PCMH resource adviser.

Practices follow up by participating in three one-hour webinars during a seven-week period. The practices also participate in conference calls with PCMH trainers a week after each webinar and peer-to-peer conference calls with participating practices two weeks after each webinar.

In addition, practices have the option of receiving weekly in-office coaching at no cost through HealthTeamWorks, a Lakewood, Colo.-based nonprofit organization that helps practices transform their procedures and culture.

The Colorado AFP and HealthTeamWorks are part of a collaborative -- the Systems of Care/Patient Centered Medical Home initiative -- that received a two-year grant from the Colorado Health Foundation in 2009. The collaborative is seeking an extension that would make additional training possible, said Perez.

The April 14 session kicks off the second PCMH training program funded by the grant. The first started with 20 practices, and 18 completed the program. Perez said the Colorado AFP likely will take 20 practices again this time. As of March 24, 10 practices had registered.

Perez said practices that complete the 10-week program should be prepared to submit an application for PCMH recognition to NCQA within six months.

'The transformation process takes about two years,' she said. 'We want to make sure they have tools and resources to start that transformation.'

How Does the Model Work?

Specifically created to accept Medicare and Medicaid patients, as well as those who are privately insured, Rocky and MCPIPA work together to keep costs low. The organizations withhold 15 percent of physician fees in a risk pool. If health care costs are kept low, physicians receive the withheld funds at year's end.

The two organizations also are part of a consortium that subsidizes a health program for pregnant women and their infants, providing them access to insurance. The program actually lowers health care costs for the community by improving outcomes and reducing the need for intensive care services for newborns, Pramenko said.

And at the other end of the life spectrum, primary care physicians in the area encourage patients to have advance directives, thus decreasing costs by allowing patients to avoid unwanted procedures at the end of life.

The upshot of these and other cost-containment measures is that when Medicare ranked more than 300 cities for quality of health care in 2005, Grand Junction ranked 31st. At the same time, the town had the sixth-lowest costs.

Rocky, which is the largest private payer in the region, has several other distinctive features.

Physicians are paid similar rates for both commercially insured and publicly insured patients, improving access to care.

Incentive contracts reward physicians for quality performance.

Individually identified performance data from each physician is shared with all physicians in the system for peer review, largely eliminating overutilization of services.

Primary care physicians are paid to see their patients in the hospital, even if those patients are under the care of a subspecialist, resulting in improved follow-up care and reduced readmission rates.

'It's another set of eyes looking in on a patient, and it's someone who knows that patient better than anyone at the hospital because of the long-term relationship you have as a primary care provider,' said Pramenko, who added that the arrangement saves money, shortens hospital lengths-of-stay and improves outcomes.

Pramenko also noted that subspecialists in Mesa County don't balk at having primary care physicians checking in on patients.

'When a patient sees their primary care doctor,' he said, 'their experience is improved and they feel better taken care of. Most specialists appreciate the primary care physician's involvement.'

Pilot Program Aims to Engage Colorado FPs in Combating Childhood Obesity

Obesity affects one-fifth of U.S. children ages 6-11 years, according to the CDC. The Colorado AFP and several partner organizations are planning a pilot program that will address this growing public health problem.

'There are not a lot of systems in place or tools for primary care physicians to treat childhood obesity,' said Cara Coxe, the Colorado AFP's wellness programs manager. 'Some physicians shy away from dealing with childhood obesity because it's an overwhelming issue. We're offering tools to diagnose and treat it.'

Eighteen primary care practices, including 13 family medicine practices, will participate in the pilot, which begins with a training session on April 9. Coxe said practices then will recruit patients and their families for the Fit Family Challenge: Addressing Childhood Obesity in Colorado. Implementation of the pilot in practices is scheduled for the fall.

The project will evaluate the use of a clinical guide designed to help physicians diagnose and treat obesity in children ages 6-12 years. A later phase of the pilot will seek to link efforts of physicians, schools and community organizations.

In addition to developing a specific office intervention for addressing childhood obesity and developing protocols for diagnosis and treatment, the pilot aims to:

develop a pediatric patient registry;

increase body mass index assessment of pediatric patients;

train physicians and staff members in motivational interviewing and behavior change techniques;

develop a proven process to educate and motivate families and children to make healthier food, activity, and sleep choices;

mobilize physicians to be proactive in their patients' and community's health education;

create community-based interventions and access to obesity prevention and intervention opportunities through a myriad of community settings, as well as at home and in school; and

create a replicable, scalable model based on research.

The pilot, which is being funded by the Colorado Health Foundation, also will provide patients and families with resources based on the '5210' approach, which stresses that children should eat at least five servings of fruits and vegetables each day, watch no more than two hours of television, get at least one hour of physical activity and drink zero sweetened beverages.

Coxe said the department of family medicine in the University of Colorado School of Medicine, Aurora, will evaluate what works and what doesn't and will disseminate that information to physicians statewide and, possibly, nationally after completing the nearly three-year study.

Grand Junction -- a town of about 50,000 people -- has just two hospitals, and Pramenko acknowledged that making rounds might not be possible in a larger community.

'In a bigger city, my patients could be at three or four hospitals,' he said. 'Logistically, it would take all day, and you'd be better off with a hospitalist. It's easier in a small town. I wouldn't be doing this in a big city.'

Can the Model Work Elsewhere?

In their NEJM article, West and his co-author -- Thomas Bodenheimer, M.D., M.PH., co-director of the Center for Excellence in Primary Care at the University of California-San Francisco -- pointed out seven features of the city's health care system that could be replicated elsewhere:

leadership by the primary care community;

a payment system that involves risk-sharing by physicians;

equalization of physician payment for the care of Medicare, Medicaid and privately insured patients;

regionalization of services into an orderly system of primary, secondary and tertiary care;

limits on the supply of expensive resources;

payment of primary care physicians for hospital visits; and

robust end-of-life care.

West, who is vice president of medical affairs for Hospice and Palliative Care of Western Colorado, told AAFP News Now that effective hospice care might be one of the least difficult measures to duplicate in another setting.

Conversely, he added, the most difficult is changing the payment system.

Although Grand Junction's successful system has been around for decades, it hasn't been duplicated. Pramenko said the Health Maintenance Organization Act of 1973 led to the creation of new health plans, but, in time, many were sold to for-profit insurance companies or larger nonprofit insurers.

'That didn't happen with Rocky,' he said. 'It stayed focused on the community.'

Pramenko hopes more nonprofit insurers will result from a provision of the Patient Protection and Affordable Care Act that calls for $6 billion in loans to start nonprofit, consumer-oriented, privately run, local insurance plans.

'The only reason it hasn't happened before is people haven't had the start-up money to cover the risk,' said Pramenko, who is a member of an advisory board that is writing guidelines for HHS regarding the application process for such loans. 'If you want to start your own health plan, the best opportunity in a lifetime is in Section 1322 (of the Affordable Care Act).'

Another obstacle to creating a Grand Junction-type system is the scrutiny the county's physicians had to withstand from the Federal Trade Commission, or FTC, in the 1990s. Eighty-five percent of Mesa County physicians belong to MCPIPA, and that caused antitrust concerns for federal regulators. Although the matter eventually was settled by a consent order and the organization was permitted to continue almost all of its operations, the prospect of violating antitrust regulations raises a significant barrier to collaborative health planning among community-focused organizations.

FP Michael Pramenko, M.D., is one of more than 1,500 users of the Quality Health Network in western Colorado and eastern Utah. The online repository of patient data is a collaboration of the local physicians' association and Rocky Mountain Health Plans.

New regulations regarding accountable care organizations are expected by the end of summer. Pramenko said those regulations could be another force to help build better health care systems.

'You need to have collaborative effort,' he said, 'but people are wary of collaborating based on historical rulings of the FTC and the Department of Justice. It's going to be important to see that there are safe harbor provisions in the regulations, like if you stay community-oriented or share risk.'

The collaborative spirit in Grand Junction is easy to see. After Rocky won a $21 million judgment against the state's Medicaid department in 2002 because of underpayments made to the plan during the 1990s, physicians were due $2.5 million in interest. Instead of divvying up that money, Rocky and MCPIPA agreed to invest in the Quality Health Network, a shared repository of patient data.

Facts About the Colorado AFP

Chapter executive : Raquel Alexander, M.A., C.A.E.

Number of chapter members : 1,899

Date chapter was chartered: 1948

Location of chapter headquarters : Aurora, Colo.

Website : http://www.coloradoafp.org/index.html

2011 annual meeting date/location : April 14-17, Colorado Springs

'Everybody agreed to do something with the money to continue the progress we've made,' Pramenko said.

In addition to Grand Junction's health care model, Pramenko said the outdoor lifestyle of western Colorado -- complete with skiing, hiking and great scenery -- boosts physician retention. West said there are about 75 family physicians in Mesa County, including more than 50 who are graduates of the family medicine residency program at St. Mary's Hospital in Grand Junction.

Perhaps most importantly, as Grand Junction continues to garner attention for its health care system, medical students are beginning to take notice. Michelle Jimerson, M.D., a second-year family medicine resident at St. Mary's, told AAFP News Now about her experiences during the interviewing process for prospective residents in which she, like her peers in the residency, is involved.

REP. SALAZAR, SENS. UDALL, BENNET ANNOUNCE $12 MILLION IN RECOVERY ACT FUNDING FOR NEW HEALTH CARE PILOT PROGRAM IN GRAND JUNCTION - US Fed News Service, Including US State News

WASHINGTON, May 4 -- Rep. John T. Salazar, D-Colo. (3rd CD), issued the following news release:

Today, Congressman John Salazar and Senators Mark Udall and Michael Bennet announced that $12 million in federal funding has been allocated for Colorado Beacon Consortium in Grand Junction, CO. On March 15, the three federal legislators wrote a letter to U.

S. Secretary of Health and Human Services Kathleen Sebelius highlighting the efforts of the Grand Junction medical community and identifying it as a worthy recipient of Recovery Act funds. Only 15 communities across the country were chosen to serve as pilot communities for the 'Beacon Communities' program. Grand Junction was chosen today as one of those 15 communities today.

The Colorado Beacon Consortium will be led by Rocky Mountain Health Plans, and include Quality Health Network, Mesa County Independent Physicians' Practice Association, and St. Mary's Regional Medical Center. The proposed service area will include Mesa, Garfield, Montrose, Rio Blanco, Delta, Gunnison, and Pitkin Counties. Over 17,000 square miles, this area includes 300,000 residents and 12 hospitals.

The Beacon Community Cooperative Agreement Program will provide funding to communities to build and strengthen their health information technology (health IT) infrastructure and exchange capabilities to demonstrate the vision of the future where hospitals, clinicians and patients are meaningful users of health IT, and together the community achieves measurable improvements in health care quality, safety, efficiency, and population health. Specifically, the funding for Rocky Mountain Health Maintenance will help the organization enable robust collection of clinical data from health systems, providers, and hospitals in order to inform practice redesign to improve blood pressure control in patients with diabetes and hypertension, increase smoking cessation counseling, and reduce unnecessary emergency department utilization and hospital re-admissions.

The $220 million in Recovery Act funding awarded nationally today will not only help achieve meaningful and measurable improvements in health care quality, safety and efficiency in the selected communities, but also help lay the groundwork for an emerging health IT industry that is expected to support tens of thousands of jobs.

Congressman Salazar, Senator Udall and Senator Bennet offered the following comments on today's announcement that $12 million in Recovery Act funding has been allocated for Rocky Mountain Health Maintenance:

'This funding will help grow our economy, save lives and bring the region the resources and recognition it deserves. I have been working very hard for the past year to make sure that the successes of the Grand Junction medical system are used as an example for other communities across the nation,' said Congressman Salazar. 'I'm glad to have helped bring this funding to the Colorado Beacon Consortium, so they can continue to improve the industry standard for health care delivery and provide much needed jobs.'

'Mesa County has long been a leader in the use of health IT, and this funding will ensure that leadership continues. This grant money will allow the members of the Colorado Beacon Consortium to improve the quality of the care they provide, helping to save lives and improve the health of individuals all over the Western Slope while providing the region with a valuable economic boost. I am happy that I could join with Congressman Salazar and Senator Bennet to help bring this money to Colorado,' said Senator Udall.

'Rocky Mountain Health Plans has revolutionized health information technology to bring down costs and improve the quality of care for its patients,' said Senator Bennet. 'Health IT is a critical part of RMHP's collaborative and highly-effective approach to clinical care - an approach that brings doctors, nurses and patients together to improve patient care at a lower cost. This funding will help RMHP serve as a national model in collaborative care and provide it the resources it needs to improve the quality and delivery care at a lower costs to the patients it serves.'For more information please contact: Sarabjit Jagirdar, Email:- htsyndication@hindustantimes.com.

CONGRESSMAN SALAZAR, SENATORS UDALL AND BENNET ANNOUNCE $12 MILLION IN RECOVERY ACT FUNDING FOR NEW HEALTH CARE PILOT PROGRAM IN GRAND JUNCTION. - States News Service

WASHINGTON -- The following information was released by the office of Colorado Rep. John T. Salazar:

Congressman Salazar, Senators Udall and Bennet announce $12 million in Recovery Act funding for new health care pilot program in Grand Junction

Stimulus bill funds awarded following a March 15 letter of support

from the three federal legislators

Washington, DC-- Today, Congressman John Salazar and Senators Mark Udall and Michael Bennet announced that $12 million in federal funding has been allocated for Colorado Beacon Consortium in Grand Junction, CO. On March 15, the three federal legislators wrote a letter to U.S. Secretary of Health and Human Services Kathleen Sebelius highlighting the efforts of the Grand Junction medical community and identifying it as a worthy recipient of Recovery Act funds. Only 15 communities across the country were chosen to serve as pilot communities for the 'Beacon Communities' program. Grand Junction was chosen today as one of those 15 communities today.

The Colorado Beacon Consortium will be led by Rocky Mountain Health Plans, and include Quality Health Network, Mesa County Independent Physicians' Practice Association, and St. Mary's Regional Medical Center. The proposed service area will include Mesa, Garfield, Montrose, Rio Blanco, Delta, Gunnison, and Pitkin Counties. Over 17,000 square miles, this area includes 300,000 residents and 12 hospitals.

The Beacon Community Cooperative Agreement Program will provide funding to communities to build and strengthen their health information technology (health IT) infrastructure and exchange capabilities to demonstrate the vision of the future where hospitals, clinicians and patients are meaningful users of health IT, and together the community achieves measurable improvements in health care quality, safety, efficiency, and population health. Specifically, the funding for Rocky Mountain Health Maintenance will help the organization enable robust collection of clinical data from health systems, providers, and hospitals in order to inform practice redesign to improve blood pressure control in patients with diabetes and hypertension, increase smoking cessation counseling, and reduce unnecessary emergency department utilization and hospital re-admissions.

The $220 million in Recovery Act funding awarded nationally today will not only help achieve meaningful and measurable improvements in health care quality, safety and efficiency in the selected communities, but also help lay the groundwork for an emerging health IT industry that is expected to support tens of thousands of jobs.

Congressman Salazar, Senator Udall and Senator Bennet offered the following comments on today's announcement that $12 million in Recovery Act funding has been allocated for Rocky Mountain Health Maintenance:

'This funding will help grow our economy, save lives and bring the region the resources and recognition it deserves. I have been working very hard for the past year to make sure that the successes of the Grand Junction medical system are used as an example for other communities across the nation,' said Congressman Salazar. 'I'm glad to have helped bring this funding to the Colorado Beacon Consortium, so they can continue to improve the industry standard for health care delivery and provide much needed jobs.'

'Mesa County has long been a leader in the use of health IT, and this funding will ensure that leadership continues. This grant money will allow the members of the Colorado Beacon Consortium to improve the quality of the care they provide, helping to save lives and improve the health of individuals all over the Western Slope while providing the region with a valuable economic boost. I am happy that I could join with Congressman Salazar and Senator Bennet to help bring this money to Colorado,' said Senator Udall.

'Rocky Mountain Health Plans has revolutionized health information technology to bring down costs and improve the quality of care for its patients,' said Senator Bennet. 'Health IT is a critical part of RMHP's collaborative and highly-effective approach to clinical care - an approach that brings doctors, nurses and patients together to improve patient care at a lower cost. This funding will help RMHP serve as a national model in collaborative care and provide it the resources it needs to improve the quality and delivery care at a lower costs to the patients it serves.'

Low-income women will pay more for health care - The Gazette (Colorado Springs, CO)

More than 13,000 low-income women in Colorado, including hundredsin Colorado Springs, will begin paying more for reproductive healthcare services beginning Jan. 1, officials of Planned Parenthood ofthe Rocky Mountains said this week.

Planned Parenthood employs a sliding-fee scale, based on theclient's income. Women who were receiving routine services such asbreast or pelvic exams for free will pay $20.

Prices could jump as high as $99 for other clients who now arepaying reduced prices for services.

The price changes could force thousands of women to look elsewherefor key preventive health services or lose them altogether, advocatesfor poor women say.

Planned Parenthood's decision comes after the Colorado Departmentof Health decided to cut off about $382,000 in funding to PlannedParenthood this month.

State health officials accused Planned Parenthood of subsidizingabortions with public money. An independent audit, paid for by thestate health department, said Planned Parenthood used state money tohelp pay rent for its abortion clinics. That was interpreted by statehealth officials to be a violation of Colorado's constitution.

Planned Parenthood denied the charges but has decided not to sueover the decision. Instead, the group will keep open its 13 clinics,including one in Colorado Springs, where it offers women routinehealth services such as annual checkups, cancer screenings and birthcontrol.

About 1,300 low-income women in Colorado Springs used PlannedParenthood for the health-care services this year.

'These sites are now going to become independent health centers,'said Cindy Shealy, spokeswoman for Planned Parenthood in ColoradoSprings. 'In order to function, they're going to have to ask women topay more for these services.'

Shealy said Planned Parenthood will try to defray the cost withfund raising and offer payment plans for clients.

Visitors to the Planned Parenthood clinic on south AcademyBoulevard on Friday let out sighs of disappointment as workers toldthem of the change.

'I probably could afford a little bit more, but (not much). Thisis it.' said Cori, 21, who didn't want her last name used. 'That'swhy I come here. If I had to go to a regular doctor, I couldn'tafford it. I don't know where else to go.'

In some areas of the state, such as Trinidad, Planned Parenthoodis the only provider that offers a sliding-fee-schedule to poorwomen. Shealy said they probably won't be able to pay more and won'tseek services.

In Colorado Springs, low-income women have alternatives. They cango to the state Department of Health, which has a women's clinic anddoes family planning at its clinic in Fountain.

Local and state health officials said they have expanded theirfamily planning services and will be able to absorb new clients fromPlanned Parenthood. Other options are the Community Health Centers.

Some women say the health department clinics aren't as convenientas Planned Parenthood.

'You have to wait a long time to get an appointment with (thehealth department). They are so booked up,' said Deborah Fernandez,34, a disabled mother.

Fernandez said she uses the Planned Parenthood clinic because it'scheap and comfortable.

'It's like a family. It's a shame that they lost the funding.'

ALTERNATIVES

After Jan. 1, the Planned Parenthood clinic at 3029 S. AcademyBlvd. will charge more for routine health services such as cancerscreenings and birth control. Call Planned Parenthood at (800) 230-PLAN.

Alternatives for low-income women seeking such services:

The Colorado Department of Health Women's Clinic, 301 S. Union.Hours - 8 a.m. to 8 p.m., Monday through Thursday; 8 a.m. to 5 p.m.Friday. Call 575-8500. There's a two-week waiting list.