PacifiCare Ranks Medical Groups; Insurers Convene in Buena Park
Remember last year’s election campaign, when then-candidate George W. Bush and others were calling for sweeping Medicare reforms? Well, a big overhaul isn’t likely this year, but incremental change may be down the road.
Sens. John Breaux, D-La., and William Frist, R-Tenn., have renewed proposals put forth in the past two years. Back in 1998, the pair served on a bipartisan commission that looked at reforming the federal health insurance program for senior citizens.
Breaux and Frist’s legislation would restructure Medicare into a premium-supported program similar to those covering federal employees. Beneficiaries would be able to choose from a variety of private plans or the traditional fee-for-service Medicare program.
The plan also would establish what’s described as a “new, competitive system” for paying Medicare Plus Choice plans. Many Medicare Plus Choice operators, including Santa Ana-based PacifiCare Health Systems Inc., have called for higher payments for delivering services to seniors, who use healthcare more than younger folks.
Medicare reform is a big issue for PacifiCare: the managed care company derives the majority of its profits from the program. Even though PacifiCare’s shares have rebounded in recent weeks, Wall Street still is cautious about Medicare’s uncertain outlook.
“Wall Street does not place a high multiple on the Medicare business, which represents 60% of our profits and balance sheet,” Chief Executive Howard Phanstiel recently told the Business Journal. “There is simply not a clear line of sight in regard to stability of federal funding in the Medicare Plus Choice program.”
PacifiCare in Pacific Northwest
Two service plan units of PacifiCare Health Systems are looking at service quality. PacifiCare of Oregon and its counterpart in Washington recently published the first PacifiCare Quality Index for the Northwest.
The index is available in two forms,a detailed one for medical groups and a more simplified version for customers. It ranks 34 medical groups that contract with PacifiCare and the Secure Horizons Medicare HMO in 14 measures relating to clinical, service and administrative quality. The index represents more than 3,000 physicians serving 300,000 members in Oregon and Washington. PacifiCare first introduced the index in California in 1998 to provide information to healthcare consumers.
Separately, PacifiCare said it began working with Protocare Inc., a Santa Monica-based clinical research and strategic consulting company. Protocare is being tapped to help PacifiCare in its bid to evolve from an HMO to a full-service managed care company.
Protocare and PacifiCare initially plan to create clinical research centers within medical groups serving PacifiCare members. The centers are set to offer patients access to drugs still in the evaluation stage and not otherwise available to them. They’re also set to offer doctors the opportunity to participate in medical research involving new drugs and treatments.
Underwriters in Buena Park
The Orange County Association of Health Underwriters is presenting its annual sales exposition March 29 at the Sequoia Club in Buena Park. The association represents various insurance professionals.
A variety of healthcare executives are slated to speak at the event. The morning session is called “Provider Contracting: A New Center of the Managed Care World,” and is set to feature Edward Tanida, general manager for Aetna U.S. Healthcare’s Orange County and Inland Empire operations, and Darrin Montalvo, vice president of contracting for Orange-based St. Joseph Health System. Tanida and Montalvo are slated to share their thoughts about recent contract negotiations between some of OC’s largest medical providers and their health plans.
D. Mark Weinberg, group president of individual and small group businesses for Thousand Oaks-based WellPoint Health Networks Inc., is set to be the lunch speaker. Weinberg’s address is titled “Health Insurance, Technology and Futurity,Where to 2001?” Breakout sessions also are scheduled on prevailing wage markets, small-group self-funding, benefit management/consumer rights and the future of the agent/general agent insurance distribution system.
Bits and Pieces:
InSight Health Services Corp., Newport Beach, said it has tapped UBS Warburg LLC as its exclusive financial advisor “to assist the company in exploring strategic alternatives to enhance shareholder value, including a possible sale, merger or recapitalization.” InSight also presented at UBS Warburg’s Global Healthcare Services conference Mission Hospital Regional Medical Center, Mission Viejo, received $4 million from Coto de Caza residents Edward and Ann Muldoon for its cardiac care unit, which is under construction. The Muldoons have been actively involved in the hospital’s philanthropic foundation for several years; Edward Muldoon is chairman and chief executive of Bivar Inc., an Irvine electronics manufacturer Dale Macrae, a principal with William M. Mercer Inc.’s Orange office, will discuss Mercer’s national health plan survey at the March 8 meeting of the Orange County Employee Benefit Council. The meeting is set from 7:30 a.m. to 9:30 a.m. at the Irvine Marriott, 18000 Von Karman Ave. For information: (714) 573-8605. James Greenfield, executive director of Hoag Hospital Foundation, Newport Beach, has retired after 14 years of service.
