Harriman Jones Hires Premier Practice Management; UCI Buys Purchasing System
Cigna HealthCare of California, a subsidiary of the Philadelphia-based insurance giant, joined the Medicare health maintenance organization boom relatively late in Orange County and three other Southern California counties. And a company spokesman cited that as one of the reasons why the insurer decided to stop selling its Medicare HMO locally as of Dec. 31.
“We were never able to achieve significant market share,” said Jim Harris, Cigna’s Western regional public relations director. A U.S. Health Care Financing Administration Web site showed Cigna had 2,701 Medicare HMO members in Orange County. The site also showed that Orange County had 292,746 Medicare-eligible residents.
Harris acknowledged Santa Ana-based PacifiCare Health Systems Inc.’s Secure Horizons and Kaiser Permanente were aggressively marketing in the area for some time before Cigna came.
“With a small membership, it is very hard to be profitable in any kind of business,” Harris said.
Harris also talked about reimbursement,one of the most-mentioned reasons by the industry for cutting and running out of the market.
“The reimbursement was inadequate and did not keep up with medical inflation,” he said, adding it has been running between 6% and 10%.
The U.S. Health Care Financing Administration’s Web site showed Orange County’s Medicare HMO rate per patient at $610 in 2000, going up to $622 per patient in 2001. Data were current as of July 21. The Balanced Budget Act of 1997 basically capped yearly raises for Medicare HMO reimbursement at around 2%. The situation is known as the “fairness gap” by the American Association of Health Plans, the industry’s major lobbying group.
This year, many HMOs nationally have curtailed their Medicare offerings or left the market altogether.
Some industry watchers note that HMOs that entered the Medicare market late often did not accurately calculate the amount of money needed to take care of seniors. Senior citizens consume more healthcare services than the general population.
“Medicare HMOs promised all the benefits of Medicare and more for less cost. I don’t think they’ve been able to fulfill that,” said Joe Baker, associate director of the Medicare Rights Center in New York
Baker said the pullouts, coming at a time when Congress is debating Medicare prescription-drug benefits, show a need to embed a prescription drug benefit into traditional, fee-for-service Medicare. Pharmacy benefits have been a major lure for seniors who join Medicare HMOs.
Meanwhile, federal figures show that nearly 1 million seniors in the U.S. will lose Medicare Plus Choice coverage in 2001. That’s touched off a campaign by the American Association of Health Plans to urge Congress to provide an additional $15 billion in funding over five years for the program.
“In district after district across the country, we’re going to put a human face on the Medicare Plus Choice crisis,” said Karen Ignagni, American Association of Health Plans president and chief executive, in a news release.
Harriman Jones Signs Manager
Harriman Jones Medical Group, which has an Orange County affiliate, inked an agreement with Premier Practice Management Inc. for management services. Premier Practice Management is a business unit of Premier Inc. of San Diego.
Harriman Jones has more than 50 physicians and 350 employees at its offices in La Palma, Seal Beach and Long Beach. Northwest Orange County Medical Group, its local affiliate, has provided medical care to 20,000 patients since 1986.
New Procedure in Fountain Valley
Dr. David Glaser, a gastroenterologist who is affiliated with Fountain Valley Regional Hospital and Medical Center, introduced the Bard endoscopic suturing system to treat gastroesophageal reflux disease, a condition that causes acid to back up in the esophagus. The outpatient procedure involves inserting a thin tube down a patient’s throat.
The tube is outfitted with a small device that drops stitches near a valve that is close to the gastroesophageal junction. The suturing material is then tied together to tighten the valve, which prevents stomach contents from flowing back up into the esophagus.
Bits and Pieces:
UCI Medical Center, Orange, is among 19 healthcare facilities that signed contracts with Neoforma Inc. of San Jose and Novation LLC of Irving, Texas, to use technology powered by Neoforma for purchasing purposes Prescription Solutions, Santa Ana, added Excedrin Migraine to its over-the-counter medicine program. Prescription Solutions, a pharmacy benefit management company, is a PacifiCare Health Systems Inc. subsidiary Hycor Biomedical, Garden Grove, said it added user-defined software on its Hy-Tec 288 Plus automated immunoassay system. The software permits medical laboratories to run certain immunology tests, such as ones for Lyme disease and measles Thehealthchannel.com, Newport Beach, moved its servers to the Exodus Internet Data Center’s Irvine location from one in Weehawken, N.J. MyDrugRep.com, Newport Beach, joined Siebel Systems Inc.’s alliance program. Siebel is a supplier of e-business applications software; MyDrugRep.com is a pharmaceutical industry sales channel for physicians Logic Nutrition, Irvine, published a second edition of its Nutrition Program workbook.
