St. Joseph’s Simplifies Knee Surgery; Mussallem, Wareham Team Up
“Defined contribution” strategies,in which employers offer workers a wide choice of healthcare plans but cap their premium contributions,have been getting a lot of attention because of their potential savings to businesses.
The approach is an alternative to traditional benefit plans, where employees are limited to one or two offerings from their employer. As with traditional plans, employers still pay for a percentage of a healthcare service plan’s cost with defined contribution. But if employees opt for a richer plan, they pick up the difference. The wider range of choices for employees increases competition among plans and is an incentive for them to keep premiums down.
Defined contribution is at the core of Orange-based CaliforniaChoice, a privately held administrator for employers that works with many health plans. CaliforniaChoice, founded four years ago, is an offshoot of Word & Brown Insurance Administrators.
John Word, CaliforniaChoice’s co-founder and managing director, likened the concept to “coming together and offering a common shopping area.” Participating health plans include Aetna U.S. Healthcare, Blue Shield of California, Cigna, Health Net, Inter Valley, Maxicare, Sharp and Universal Care.
CaliforniaChoice now has some 130,000 members statewide, according to marketing vice president David Duker. It is designed for groups of two to 50 people,in other words, for small-business owners who often complain that they cannot provide their workers with insurance because of cost issues.
“The primary advantage to the employer is that you can set a budget and define how much you are going to pay,” Duker said. “Then, you allow the employee to use the contribution like a voucher.”
CaliforniaChoice came about because Word & Brown wanted to give its small-group health insurance clients the same type of flexibility as large employers or government agencies, Duker said.
“It gives us the ability to reach a large number of small-business owners with a competitive plan design from one source,” said Jim Harris, a Cigna spokesman.
Word said 94% of CaliforniaChoice employers renew the plan vs. an industry renewal rate of 75% to 80%,”if you are lucky,” he said.
CaliforniaChoice is distributed via independent insurance brokers. Word, a former president of the California Association of Health Underwriters, added that it does “a huge number of seminars” to introduce the concept, prices and benefit offerings.
Replacing Knee Replacements
Robert Gorab, a physician who practices at St. Joseph Hospital, Orange, recently developed a less invasive alternative to traditional knee surgeries. Gorab is involved with the hospital’s joint replacement program.
Gorab’s technique works like this: A surgeon can align an inserted knee implant more accurately with a patient’s tibia and femur, which reduces the chance of failure. The procedure is unicompartmental, meaning that only the bad part of the knee is replaced.
St. Joseph also is touting the surgery as an alternative to total knee replacements for people in their 40s, 50s and 60s. Some say that complete knee replacements are associated with high blood loss and extensive long-term restrictions on recipients, with an overall durability of 10 to 20 years.
Bits and Pieces:
Michael Mussallem, chief executive of Edwards Lifesciences Corp., Irvine and John Wareham, chief executive of Beckman Coulter Inc., Fullerton, are on the steering committee of “Phoenix 2000,The Future of Creating Value,” an Oct. 12-14 Las Vegas invitation-only conference for chief executives in the medical-device and diagnostic industries Orange County resident Danna Campbell is the new president and chief executive of iMammogram.com, a Westlake Village company that makes FDA-approved computer aided detection technology for mammograms ChromaVision Medical Systems, San Juan Capistrano, said it started developing three new automated cellular imaging devices to address a wide variety of cancer types. The tests are designed to help oncologists determine if new and aggressive drug therapies are appropriate for patients and to guide the use of existing treatments Medison America, Cypress, launched its SonoAce 9900 ultrasound system at the recent World Congress of the Federation of Obstetricians and Gynecologists in Washington, D.C. Monarch HealthCare, Mission Viejo, was the subject of a talk late last month concerning the Internet and physician practices. Monarch is a client of Physician WebLink; a Physician WebLink official talked about it during the “e-Volution of Managed Care” seminar in San Francisco.
