It’s been a busy month for Cypress-based PacifiCare Health Systems Inc.
Federal regulators recently cleared PacifiCare to sell its Medicare Advantage health plans in more areas in Alameda and Contra Costa counties, as well as in greater Denver.
The moves are part of PacifiCare’s bid to bolster service after 2003’s Medicare Prescription Drug Improvement and Modernization Act, which upped funding for Medicare plan providers in exchange for added services and lower prices.
PacifiCare is offering its Medicare Advantage plan in Northern California and Colorado. Those in the plan don’t pay monthly premiums and have unlimited prescription drug coverage with low copayments. For doctor’s office visits, they pay $15 to $30.
The Denver metropolitan area has more than 200,000 Medicare-eligible residents. Besides Denver County, suburban counties such as Adams, Arapahoe, Boulder, Broomfield, Douglas and Jefferson fall under PacifiCare’s Medicare Advantage network.
The company already serves some 8,000 Medicare beneficiaries in parts of Alameda and Contra Costa. Now PacifiCare can serve all of the two East Bay counties. Members there pay $10 to $15 for doctor’s visits.
Medicare’s been a core part of PacifiCare for years. Earlier this decade, Wall Street fretted about the company’s reliance on the federal health plan for seniors for a good portion of its income and profits.
When Chief Executive Howard Phanstiel took over about four years ago, he made it one of his charges to help PacifiCare diversify and wean itself away from heavy dependence on Medicare.
In January, PacifiCare said that it sees its commercial membership,enrollment of workers via their employers,growing 3% and 3.5% this year.
PacifiCare has come out with several plans, including a preferred-provider organization and an entry in the nascent “consumer-driven” healthcare market, to grow its commercial business.
The company also operates specialty businesses such as Prescription Solutions, its Costa Mesa-based pharmacy.
Gregory Scott, PacifiCare’s chief financial officer, gave a presentation about the company last week during the UBS Health Services conference at New York’s Plaza Hotel.
Plaque Linked to Strokes
Plaque in the neck’s main artery plays a critical role in creating blood clots that up the risk of a stroke, according to researchers at the University of California, Irvine Stroke Center.
Plaque can form lesions in the neck’s carotid artery, the main source of blood to the brain, according to Dr. Mark Fischer, the stroke center’s director, and his colleagues.
Those lesions support blood clots’ growth, they found. The clots can block the carotid artery or break off and travel through into the brain, the researchers said.
In a release, Fischer said the findings suggested a need for early identification and treatment of plaque growth in people who are at risk for strokes.
Strokes are one of the leading causes of disability and death in the U.S., and more than 80% of strokes are caused by blood clots.
Researchers from the University of Southern California, the Wake Forest School of Medicine in Winston-Salem, N.C., the John P. Robarts Research Institute in London, Ontario, and the St. George Hospital Medical School in London joined UCI in the study.
The National Institutes of Health provided funding for the project. Results appear in the online edition of Stroke, a peer-reviewed journal of the American Heart Association.
New Gig for Ex-Tenet Exec
Kenneth Westbrook, a San Juan Capistrano resident who was the former head of Tenet Healthcare Corp.’s Orange County operations, became chief executive of CareMore Medical Enterprises, a Downey-based health maintenance organization and medical group.
Westbrook most recently was senior vice president of Santa Barbara-based Tenet’s Valley Coastal region. His experience also includes serving as senior vice president of OrNda HealthCorp., which Tenet bought in 1997.
CareMore is made up of a medical group, an independent practitioner association, a medical management company and managed healthcare service plans that serve Medicare beneficiaries.
Bits and Pieces:
Memorial Health Services, which has four OC hospitals, was tapped as one of the country’s top 100 integrated healthcare networks in a report in Modern Healthcare magazine. Verispan, a Chicago-based research firm, ranks the networks on things such as clinical and financial performance Hill Physicians Medical Group, San Rafael, said that NextGen Healthcare Information Systems, a division of Quality Systems Inc., Irvine, provided software for its newly unveiled electronic medical record and practice management system Paul Viviano, chief executive of Alliance Imaging Inc., Anaheim, and R. Brian Hanson, the company’s chief financial officer, presented last week at the Smith Barney Citigroup Small & Mid-Cap Conference at the Four Seasons Hotel in Las Vegas.
