Denver, Colorado
November 13, 2006

Hospitals Called to Improve Treatment After Heart Attack

Kaiser Permanente Emergency Room Physician Among Researchers Pushing for Set of Strategies That Saves Lives


Prompt treatment saves lives when patients arrive at hospitals having heart attacks. A new study has identified simple steps that hospitals can take to speed life-saving treatment. The research, which was led by Elizabeth Bradley and a team of researchers that included David Magid, MD, MPH, Kaiser Permanente emergency medicine physician and researcher, was announced today by the New England Journal of Medicine at the American Heart Association’s annual conference.


It outlines simple hospital strategies that work when patients arrive at the emergency department needing percutaneous coronary intervention or balloon therapy. The team is challenging hospitals to improve what has been dubbed “door-to-balloon” times.


Those strategies include:


Having emergency medicine physicians activate the catheterization lab (cath lab), the hospital room where the balloon treatment is performed.

Activating the cath lab with one-call central page operators who can mobilize the entire medical team at once.

Activating based on pre-hospital electrocardiograms while the patient is still en route to the hospital as opposed to waiting until the patient arrives.

Having interventional cardiologists on location within 20 – 30 minutes.

Using real-time data feedback with emergency department and cath lab staff.


The study of 365 hospitals found that only a handful of hospitals use some of the strategies and none uses all. Researchers say implementing this simple set of effective and feasible strategies holds promise for substantially improving patient care.


Balloon therapy has become the preferred approach to treating certain kinds of heart attacks. While, hospitals have been seeking ways to improve their door-to balloon times, overall performance at most hospitals lags behind the national standard of 90 minutes or less. Dr. Magid practices at Exempla Saint Joseph Hospital and as part of this study partnered with the hospital to adopt the life-saving strategies.


Saint Joseph Hospital is one of the first hospitals in the country to make these important improvements. “The great point about these strategies is that most involve little or no cost to implement,” said Magid.


“The study offers a terrific guide for hospitals to follow as they push to improve door-to-balloon times and the quality of care for patients.”


This study is part of the Health Care Quality Improvement Project initiated by the Centers for Medicare and Medicaid Services, which has encouraged identification of quality improvement projects to improve patient safety.


It also is one of more than 100 research projects conducted every year by the Kaiser Permanente Colorado researchers.


Kaiser Permanente is the largest private health care provider in Colorado. More than 475,000 members in the Denver/Boulder and Colorado Springs areas have access to Kaiser Permanente through an expanded suite of health care products.


Kaiser Permanente physicians and care teams focus on prevention as well as curing disease, all in an effort to help patients live well and thrive.

Compare and find affordable health insurance plans.


Sacramento, California
October 16, 2006


Report Finds Medicare Private Drug Plans Fail to Offer Accurate Information to Consumers - Consumer Groups call for dramatic reform before 2007 Part D enrollment opens on November 15


With the next enrollment period for the Medicare Part D prescription drug benefit looming, California Health Advocates and the Medicare Rights Center are demanding that the Centers for Medicare & Medicaid Services (CMS) require Medicare private drug plans to provide timely and accurate information to people with Medicare who turn to the plans’ call centers for assistance. According to a new report issued today by the two consumer organizations, call center representatives for companies offering Part D coverage remain unable to answer basic consumer questions regarding how the benefit works.


The report found that the call centers frequently could not provide the information people with Medicare needed to make appropriate enrollment decisions. In “Getting the Runaround: Problems with Obtaining Accurate Information from Part D Plans,” the two advocacy groups state that plan call centers are expected to serve as a crucial link to information about Part D coverage, but “independent surveys and anecdotal reports from counselors show serious lapses in the ability of Part D plans to provide accurate and timely information and to successfully guide people with Medicare seeking to access the benefit.”


“Good advice is the only antidote to the convoluted prescription drug benefit that older and disabled Americans are forced to navigate,” said Robert M. Hayes, President of the Medicare Rights Center. “Too often a call to one of the private drug plans does more to mislead, than to help.”
According to the report, CMS has failed to set adequate standards for the accuracy of information given by call centers.


In preparation for the next enrollment period, the report recommends that CMS provide detailed requirements for the information customer service representatives (CSRs) must be able to provide, and take action to ensure those requirements are being met. “The level of frustration expressed by people contacting our office is acute,” remarked Clare Smith, President/CEO of California Health Advocates, “The plans must be required to put resources into the provision of responsive and reliable service to those seeking access to prescription drug benefits.”


The report recommends that CMS ensure that the training and scripts provided to call center operators enables them to provide information about the following:

Enrollment process

How the specific plan works, including explanations of the coverage gap and important information for people eligible for the low-income subsidy

Plan formulary, including which drugs are covered and specifics on any coverage restrictions and limitations


The report also recommends strengthening Medicare private drug plans’ capacity to communicate with non- and limited-English speakers and designating staff as experts in specific subject matter, such as enrollment, premium/cost-sharing, and coverage appeals.


California Health Insurance

September 27, 2006
Washington


New report calls for expanding accountability for 100 million who do not benefit


More than 70 million Americans enrolled in private health plans saw the quality of their health care improve in 2005, according to a new report by the National Committee for Quality Assurance (NCQA). One in four Americans are enrolled in health plans that collect and report data on the quality of care.


Among private commercial plans, 2005 marked significant improvements in childhood and adolescent immunizations.


People enrolled in Medicare health plans saw important gains in smoking cessation while those in Medicaid plans benefited from a sharp increase in childhood immunizations. “All of us have a stake—collectively and individually—in safeguarding our nation’s health,” said NCQA President Margaret E. O’Kane. “The past decade has demonstrated the benefits of measurement, reporting and accountability, but three out of four people don’t enjoy those benefits today. It’s time to ask, ‘Why not?’” The report documents the tremendous gains in health care quality achieved over the past decade that NCQA has been reporting on health care quality. Among them:

Children in commercial health plans are nearly three times more likely to receive all recommended immunizations than eight years ago;

Diabetics are more than twice as likely to have their cholesterol controlled to recommended levels as in 1998; and

More than 96 percent of patients who suffered a heart attack were prescribed beta-blockers to help prevent a second, often fatal, heart attack, up from 62 percent in 1996—saving between 4,200 and 5,300 lives over the past decade.


While most aspects of care improved in 2005, the quality of care for Americans with mental health problems remains as poor today as it was a decade ago.


New approaches must be developed to bring mental health care quality to the level of clinical effectiveness that evidence shows is possible.
100 Million Americans ‘Left Behind’ - The report also highlights the fact that Americans in health maintenance organizations (HMOs) and point of service (POS) plans are significantly more likely to benefit from quality measurement than those in other plans.


More than 73 percent of such plans submitted performance data in 2005—the highest proportion in history. But enrollment in such plans has declined to 33 percent today.


Most Americans – more than 6 in 10 – are now in preferred provider organizations (PPOs) and consumer directed health plans (CDHPs). The overwhelming majority of those plans do not collect and report data on the quality of their care. In 2005 NCQA asked PPOs to voluntarily report their performance using HEDIS® measures; a total of 80 commercial PPOs did so in 2005. This has helped to reverse a three-year decline in the number of Americans in accountable health plans: 12 million more Americans are now in accountable plans than last year.


This holds promise for dramatic improvements in care and quality of life for millions. But more than 100 million insured Americans still do not enjoy the improved care that results from quality reporting. “Working families deserve accurate and relevant information about the quality of their health plans, doctors and hospitals. The PPOs that have stepped up to the plate deserve applause, but there is much more work to be done,” said Ann Kempski, Director of Health Systems Policy at Service Employees International Union.


“Health care is concern number one for families, and they deserve a high quality health plan that makes such information available. Quality improvement will accelerate if workers use tools such as those developed by NCQA to choose an affordable, high-quality plan that meets their families’ needs.”


Quality Gaps Remain - Despite the reported gains, enormous differences persist between the performance of the health care system as a whole and the top accountable health plans. NCQA estimates that if the entire health care system performed at the level of the top plans, between 37,600 and 81,000 lives would be saved each year.


These quality gaps also lead to over $10 billion in lost productivity and almost 65 million avoidable sick days. “The health of our workforce is a precious asset,” said Mary Bradley, Director of Healthcare Planning at Pitney Bowes. “Measuring and improving quality healthcare for our employees is a core corporate value at Pitney Bowes.”


New strategies needed to maintain improvements - After seven consecutive years of quality improvements there are signs that the pace of improvement may be slowing: fewer measures showed statistically significant year-over-year gains than in 2004.


This may indicate that in some cases, there is less room for improvement. NCQA is pursuing new strategies to achieve continued gains. One key to further improvement is increasing the number of accountable health plans that report quality data.


NCQA is working with consumers, employers and health plans to expand the number of accountable PPOs and CDHPs. That effort will receive a significant boost in 2007: The Centers for Medicare & Medicaid Services (CMS) has required PPOs participating in the Medicare Advantage program to report HEDIS measures for public reporting in 2007.


In addition, the Office of Personnel Management (OPM) has required PPOs and other fee-for-service plans serving 9 million federal employees to report five HEDIS measures in 2007 for public release in 2008. In August, President Bush recently signed an Executive Order directing federal agencies sponsoring or administering health plans to provide information on cost and quality to beneficiaries.


“President Bush has urged greater accountability and transparency in health care in the public and private sectors,” said Thomas Barker, Counselor to the Secretary of the United States Department of Health and Human Services.


“People have a right to know the price and quality of their health care. By providing information about cost and quality, we can meet the needs of all Americans.” The State of Health Care Quality 2006 may be downloaded at no cost from NCQA’s Web site, http://www.ncqa.org.


For each measure of clinical quality, the report includes complete year-over-year performance data and highlights the top-performing state. Print versions can be purchased by calling (888) 275-7585. NCQA is a private, non-profit organization dedicated to improving health care quality. NCQA accredits and certifies a wide range of health care organizations, recognizes physicians and physician groups in key clinical areas and manages the evolution of HEDIS, the tool the nation’s health plans use to measure and report on their performance.


NCQA is committed to providing health care quality information through the Web, media and data licensing agreements in order to help consumers, employers and others make more informed health care choices.

If you are shopping for an affordable health insurance plan, make sure that you are dealing with a legitimate insurance provider or broker before purchasing coverage. Whether you are looking for health insurance in California, or another state, you can contact your department of insurance with any questions or concerns.


California Department of Insurance (CDI)
Sacramento, California
October 30, 2006

The California Department of Insurance (CDI) is Warning California consumers not to purchase health insurance offered by Prime Med Care or Prime Star Health Care.

The companies and their owners, Jesse Casares and Joe Casares of Houston, Texas, are not licensed to sell insurance in California. According to investigators, the Casares’ have sent faxes to consumers advertising their discount healthcare plans.”

The marketing solicitation advertised a “New Health Plan” and “7-day OPEN ENROLLMENT with NO HEALTH QUESTIONS” for the Medical, Dental and a “$10-$40 MAX-PAY PRESCRIPTION CARD” at “ONE LOW PRICE” which “COVERS INDIVIDUAL OR ENTIRE FAMILY.” Insurance Commissioner John Garamendi announced Monday that CDI has issued an Order to Cease and Desist, which demands that Prime Med Care, Prime Star Health Care, Jesse and Joe Casares stop transacting any and all insurance business in California. “We are warning consumers that if they have paid for insurance provided by Prime Med Care, Prime Star Healthcare, Jesse or Joe Casares, they may find they have no coverage,” said Commissioner Garamendi.

“These companies are not licensed to sell health insurance, and consumers should not purchase insurance from any of these individuals or companies.” Those who may have already purchased insurance from Prime Med Care, Prime Star Health Care, Jesse or Joe Casares are urged to contact Senior Investigator Chris Lewis at 916/492-3432.

The CDI urges all consumers and interested parties to check the Department’s website at www.insurance.ca.gov or contact the CDI Consumer Hotline at (800) 927-HELP to verify the license of a company or agent/broker before entering into an insurance transaction.

California Health Insurance Legislation

Fresno, CA--Today, Governor Schwarzenegger took an important step toward ensuring that more of California's children get the health care they need by signing Senate Bill 437.


Authored by Senator Escutia and sponsored by the 100% Campaign (a collaboration of Children Now, Children's Defense Fund-CA, and The Children's Partnership) and the PICO California Project, this bill increases enrollment of children in California's Medi-Cal and Healthy Families Programs--by approximately 94,000--by making important and substantive improvements to the programs. "We applaud the Governor for his commitment to the health of California's children, our most vulnerable population," said Wendy Lazarus, founder and co-president, The Children's Partnership.


"Our collective next step to ensuring that all children have access to health coverage is the passage of Proposition 86 in November. Proposition 86 will provide on-going funding and the policy framework to allow all of California's uninsured children to have access to health coverage this year and in the future."


SB 437 makes improvements to Medi-Cal and Healthy Families, helping to increase enrollment for more uninsured children who already qualify for these health insurance programs, by simplifying the application and enrollment processes. SB 437 also helps children already enrolled in Medi-Cal and Healthy Families stay insured without experiencing gaps in coverage.


"The Legislature and now the Governor have taken important first steps to insure more of California's children," said Jim Keddy, director, PICO California Project. "We believe that Californians will now express their deep support for ensuring that all 800,000 uninsured children have access to affordable, comprehensive health insurance by voting yes on Proposition 86 on November 7th." "Comprehensive health insurance for children is cost-effective, and it provides access to early, less-costly preventive care and treatment," said Ted Lempert, president, Children Now. "Children with health insurance also perform better in school."


The public support for covering all children is widespread. Approximately 83 percent of California voters support a plan to "ensure that every child in California has health insurance," according to a recent statewide poll conducted by United Way of California.

The Kaiser Permanente Northern California Region serves almost 3.3 million members. It includes 6,000 physicians in The Permanente Medical Group (TPMG) and about 54,000 employees. The region has 19 major medical centers. Each year, Kaiser Permanente donates about $300 million to a variety of community programs and agencies in Northern California.


Kaiser Permanente Northern California once again earned high marks on the 2006 report card released from the California Office of the Patient Advocate – scoring more four-star excellent ratings than any other surveyed plan. The Healthcare Quality Report Card, released today by officials with the state Office of the Patient Advocate (OPA), is the latest in a series of reports and surveys that demonstrate Kaiser Permanente’s quality leadership in Northern California.


"We are very proud of these results,” said Robert Pearl, MD, executive director and CEO of The Permanente Medical Group, which cares for members in Northern California.


“Our performance reflects the outstanding quality care we provide to our patients and the communities we serve. These high marks are a tribute to the clinical excellence of our physicians, nurses and staff." For the sixth year in a row, Kaiser Permanente received the most stars in the Healthcare Quality Report Card.


In addition, Kaiser Permanente’s Southern California Region and Northern California Region were the only two health plans this year to earn six stars of a possible eight in each of the two overall ratings: providing quality care and members rate HMO. Kaiser Permanente Northern California earned excellent ratings in clinical quality measures including asthma care, heart care, and screening for sexually transmitted infections.


Kaiser Permanente Northern California also received top scores on several measures of patient satisfaction including how members rate their HMO, getting appointments and care easily and getting information from a doctor about ways to quit smoking.


On a patient satisfaction measure about member complaints, 92 percent of enrollees reported they did not have a complaint that would lead them to call or write their HMO.


In the area of clinical quality, Kaiser Permanente Northern California rated or tied for first, in ten of 28 clinical measures including meeting national standards for asthma care for adults, teenagers and children; child immunizations; treating children with throat infections and upper respiratory infections; testing and controlling cholesterol for diabetes patients; visits during pregnancy and seeing that patients continue to receive beta blocker drugs following a heart attack. This year’s Healthcare Quality Report Card rates 9 health plans in California on the quality of care enrollees receive, based on their record of health services provided to members, and in some cases, reviews of members’ medical charts.


Ratings are also based on what members say about their experiences with their health plans and medical groups.


Kaiser Permanente, founded in 1945, is a non-profit integrated health care organization, with physicians, nurses and staff working in collaboration to provide high quality care to patients and address the health care needs of communities served by the organization.

LifeWise Health Plan of Oregon is a member of a family of companies with operations in Portland and Bend, Oregon; Mountlake Terrace and Spokane, Washington; Anchorage, Alaska; and Scottsdale, Arizona.


LifeWise and its affiliates employ about 3,000 people and provide health insurance coverage and related services to 1.5 million subscribers and their families.


Portland, Oregon:


The Oregon Association of Health Underwriters (OAHU) has named LifeWise Health Plan of Oregon its Carrier of the Year Award for the second consecutive year.


The statewide organization announced this honorable designation earlier this month at its annual state convention in Seaside, Oregon. "Our sales teams actively participate with OAHU to broaden awareness and seek solutions to health care issues," said Majd El-Azma, LifeWise President/CEO.


“We are proud to again receive OAHU’s recognition, particularly since collaboration is key to encouraging better health and slowing health care costs.” The award recognizes association support, leadership, and participation in OAHU’s local chapters and Board of Directors. It also considers community service, volunteering and sub-committee involvement.


The Association considers all health insurance carriers operating in Oregon for the prestigious title, with the winning recipient determined through nomination and a Board member poll. “We are pleased to recognize carriers that willingly support our association and realize that we are partners in this business we call health insurance,” said Ruppert Reinstadler, OAHU President and award presenter.


“Without their help, most of our member services would not be possible. LifeWise has consistently supported our efforts – not only financially but also with the time and talents of their staff.”