Winter Health Focus

Monday, 11 January 2010 Gayle Eversole

After the New Year the focus seems to be on cleansing. While cleansing is very important for health, especially at the cellular level, winter is the time to direct your efforts to cleansing the kidneys and bladder. Over 19 million people have some form of kidney disease and it is prevalent in people with diabetes.

Some of the foods that promote kidney health include citrus fruit, cranberries, pomegranate, onion, beans, barley, poultry, sunflower seeds and pecans (Visit Leaf Lady for a complete list).

A simple, easy to prepare kidney cleanse is to drink 2 ounces of unsweetened, pure, organic cranberry juice each morning before breakfast. Although the juice will be tart, it supplies special enzymes and fights infection.

During the winter months remember that vitamin A is very important to health and specifically for the lungs.  Historically, using vitamin A in high doses over a short time can help you recover from pneumonia. It's a good idea to add this fat-soluble vitamin to your daily regimen.  Look for a product that includes both fish oil and beta-carotene – at about 25,000 IU.

Don' t forget vitamin D. Current research shows an epidemic of deficient vitamin D levels and the connection to many health problems.  You can get your health provider to order a 25 OH Test to check vitamin D levels. If you don't get enough sun daily or you are a person of color then you should consider taking 6000 IU daily during low light months of the year. Make sure you also include vitamin D3.

And last but not least, make sure you stay adequately hydrated.  During winter the air is dry, especially indoors. You' re more likely to get a cold or flu if you aren't drinking enough water.  Most well informed health providers encourage you to drink 8 – 8 ounce glasses (1.9 liters) of water each day. If you are exercising or trying to lose weight you'll need to consume more water.  There's more about water at Liquids for Life.

Let’s hope these tips get you off to a good start on your road to health...

Gayle Eversole, DHom, PhD, MH, NP, ND, is a natural health educator and advocate. Celebrating 50+ years blending science and the natural healing arts. Sign up for her herbalYoda newsletter.

This article is for educational and informational purposes only and does not take the place of a consultation with a qualified health care professional. Always consult a physician or other qualified health care professional before taking any herbs or applying any therapies. The reader must assume full responsibility for verifying any information or therapies with a qualified physician or health care professional.

 

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BioCrossroads drops dreams for hospital innovation

Sorry, IU Health.

There’s almost no chance of you becoming the next Cleveland Clinic, according to a report released last week by BioCrossroads, the Indianapolis-based life sciences business development group.
That’s because of the new demands for cost-cutting in health care, which are coming from Congress’ budget battles, the influx of baby boomers into the Medicare program and now Obamacare.
There simply isn’t the money available anymore for a hospital to replicate the 65-person staff and dedicated investment funding that Cleveland Clinic uses to turn medical innovations into high-growth companies.
This is not what IU Health or BioCrossroads wanted to hear. The leaders of both organizations had thought that IU Health individually or Indianapolis-area hospitals collectively could become engines of innovation to produce new life sciences companies.
BioCrossroads CEO David Johnson first mentioned the idea to me in early 2008, when I wrote a story about a researcher at Franciscan St. Francis Health who had stumbled on a way to diagnosis and potentially reverse autoimmune diseases.
That research did turn into a company, Redox Reactive Reagents LLC, which is trying to commercialize the technology as a diagnosis for Alzheimer’s disease. But Franciscan decided it wasn’t going to be in the startup game. It sold its stake in the company to the other owners and walked away.
About a year earlier, IU Health CEO Dan Evans had tapped his longtime friend Matt Neff to launch a venture capital arm, CHV Capital Inc., funded by some of IU Health's large endowment.
The firm has backed several Indiana life sciences companies, including Endocyte Inc., Nico Corp. and Perfinity Biosciences Inc. But it’s one attempt to commercialize research from within the IU Health system—a 2008 investment in CS-Keys Inc.—went nowhere.
The BioCrossroads report concludes that “classic innovation models such as the one resident at the Cleveland Clinic are too capital intensive to replicate.”
But BioCrossroads still sees opportunities for local hospital systems to play a major role in health care innovation, not so much by launching companies themselves, but rather by helping entrepreneurs understand the challenges that need to be fixed and then helping them test, refine and scale up their proposed solutions.
The Infuse Accelerator for digital health startups, which is being launched in Indianapolis, is trying to do exactly that. And so is the Hoosier Healthcare Innovation Challenge, an annual event where health care organizations present problems they have to IT entrepreneurs, who try to invent a solution.
A good example is Indianapolis-based Diagnotes Inc. It won the 2012 Healthcare Innovation Challenge and then worked with Community Health Network to pilot its mobile app, which allows doctors and patients to swap key medical records and images over mobile phones—yet without violating federal medical privacy laws.
Community has now signed a contract to use Diagnotes among some of its physicians.
BioCrossroads also thinks Indianapolis’ hospitals can replicate the kind of collaboration that led to the 2004 launch of the Indiana Health Information Exchange Inc., which allows hospitals to swap electronic patient records as needed from one health system to another.
Indianapolis’ hospitals could collective pitch themselves to drug and device companies to attract more of the clinical trials those companies fund, the BioCrossroads report suggested.
The hospitals could also consider forming a joint clinic that would conduct research, clinical trials and education, such as the Orthopedic Capital Clinic being launched by OrthoWorx, a BioCrossroads offshoot, in Warsaw, Ind.
None of those would have the impact of a Cleveland Clinic. But, as I’ve written elsewhere, in this age of austerity, the nature of health care innovation is going to be different than before.

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Blue Cross reaches out over insurance law changes

Just down from the Target and Gander Mountain big-box stores and between a nail salon and dental office, North Carolina's largest health insurer opened its first retail store.

It has some exercise offerings — step aerobics classes and stationary bike workouts — but for now, its main product is providing in-person information about changes coming in October with the health insurance overhaul law.

Blue Cross and Blue Shield of North Carolina is opening half a dozen of these offices in strip malls statewide to first educate and then, starting in October, enroll consumers shopping for coverage because of the federal Affordable Care Act, also known as "Obamacare." Blue Cross affiliates in Florida and Pennsylvania have had similar stores open for years.

The North Carolina company also hauls an air-conditioned showroom trailer to fairs and farmers markets to reach out to the estimated 600,000 people who will be newly shopping for individual policies — some of them subsidized by the government for consumers who might have trouble affording a policy. Many of the individual policies will be sold on a statewide Internet marketplace designed to make buying coverage comparable to finding a hotel room or rental car.

North Carolina's Republican General Assembly and governor oppose the law and so the federal government is running the state marketplace where insurers will sell policies.

As people who have been uninsured or had their coverage provided by employers start shopping around, BCBSNC is reaching out like never before to expand on its 375,000 insurance policies for individuals, marketing director Bruce Allen said. The goal is explaining the federal law, which requires everyone to have coverage or pay a fine and subsidizes many middle-class consumers who might otherwise not be able to afford policies on their own. The law also prohibits insurers from rejecting customers who have pre-existing health conditions.

"There's a big segment of the population that really wants to talk to someone face to face about it," Allen said. "It's a new market that's entering that doesn't have health insurance, never had it, and really needs kind of that step-by-step walk-through to understand a really critical decision for them to make."

Across the country, Blue Cross companies are among the health insurers most aggressive in reaching out to build consumer trust and capture their spending on policies. Spots for a broad new print, television and online advertising campaign are multiplying. Meetings with civic organizations community groups, and religious institutions are taking place from Vermont to Texas. The North Carolina company has rented movie theaters and invited guests to watch first-run films, with the addition of a 15-minute ad explaining the Affordable Care Act and laptop-ready staffers in the lobby offering individual guidance on the law.

The Blue Cross and Blue Shield Association, the umbrella organization for the country's 38 Blue Cross companies, launched a campaign last month with the Walgreen Co. drugstore chain, with signs and brochures in about 8,000 stores.

Indianapolis-based WellPoint, the largest operator of Blue Cross Blue Shield health plans, is teaming up with Spanish-language TV and radio network Univision in California, New York, Colorado and Georgia for meetings, broadcast advertisements, and newscast segments describing what coverage means and how to buy insurance on an online exchange.

Blue Cross Blue Shield companies already are some of the country's biggest sellers of health insurance policies for individuals. Seven Blue Cross companies, including North Carolina's, were among the top 10 at the end of 2011, according to Atlantic Information Services Inc., which specializes in health industry data and news.

"For other insurers, the majority of their experience is in the employer-provided market, so they don't know the individual market as well and are unsure whether this will be profitable, so they're moving very carefully," said David Ridley, director of the health sector management program at Duke University's Fuqua business school. "In contrast, Blue Cross Blue Shield — with their experience in the individual market, its experience interacting with government as the insurer of last resort — is moving much more aggressively and creatively."

Outside the Blue Cross Blue Shield world, Humana Inc. has signaled plans to station representatives in grocery stores and pharmacies in the 14 states where its policies will be sold on online insurance marketplaces. Pittsburgh-based UPMC Health Plan has set up kiosks in six western Pennsylvania malls to reach insurance consumers with questions, and it launched a computer application in an effort to offer a fun way to understand the details of the law and its polices.

Spokesmen for Assurant Health and Aetna described no novel marketing twists tied to the upcoming changes.

Government, too, is ramping up efforts to reach the working poor, young people and others with no health coverage. President Barack Obama's administration and many states are launching campaigns this summer to get the word out. Grassroots organizers are recruiting pastors, barbers and mothers to convey the message. In some neighborhoods, volunteers organized by a coalition of health companies and advocates hand out brochures.

But any company marketing efforts come as most Americans are confused or uninformed about what the new health insurance law means to them. Only about one in five had heard about the health insurance marketplaces as of June, according to a poll by the Kaiser Family Foundation.

"There is a lot of misinformation out there. One of the things that we hear often is that I have to go buy a government plan on the marketplace," Allen said. "We spend a lot of time explaining to people, 'You're going to buy a private insurance plan. There is no government plan.' "

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Board suggested busy Evans let go of AIT

Michael Evans was juggling two companies and two newborn twins when his board of directors suggested it was time for a new CEO of AIT Laboratories.

“I was shocked first of all,” said Evans, 69, a professor of toxicology who founded AIT 23 years ago and led it for all but six months of those years. “The entire board came to me and said, ‘Mike, we think Matt [Neff] should be the president.”

Neff, a local venture capitalist who has been chairman of AIT since October, became its CEO and president Monday, taking Evans’ place.

Between the board’s suggestion and the leadership handoff, Evans had many discussions with Neff. Over time, Evans said, he grew more comfortable with the idea.

“I said to myself, ‘Mike, you were a lab rat trying to run a business. And this is a business that has a lab,’” Evans said. “Matt, he’s a business guy.”

Evans also acknowledged Friday he has not been giving AIT Labs his full-time attention. Evans and his wife have four-month-old twin daughters, and he is also CEO of AIT Bioscience, a 26-person contract research laboratory that turned profitable this year as its revenue runs at double the pace of a year ago.

“AIT’s got a tremendous future. It just needs some good leadership at the top,” Evans said. “It needs a full-time leader and I can’t run it full-time.”

Evans will remain chairman emeritus. But he said he’s “trying” to stay out of Neff’s way, something that he ultimately could not do the last time he handed AIT’s reins to someone else.

In early 2012, Evans stepped down as CEO in place of Ron Thieme, who had been vice president of information technology.

At the time, AIT was just beginning to realize it was suffering a body blow from a reimbursement cut instituted by the federal Medicare program.

On Jan. 1, 2011, the federal Medicare program cut reimbursement 47 percent for basic drug screening tests. Over the following year, most private health insurance plans followed with similarly drastic cuts.

Those cuts affect the urine-drug-analysis tests that make up 90 percent of AIT's revenue. Doctors use such tests to make sure patients suffering from chronic pain are taking the narcotic painkillers at the prescribed dose—not taking too much of them and not diverting them to friends or for sale on the black market.

In late summer of 2012, Evans decided AIT was not turning around fast enough, so he returned as CEO and Thieme left the company.

Evans said he expects this succession to work better because he vetted the decision with many counselors.

“Last time, I made the decision in a vacuum,” Evans said, adding, “I don’t blame Ron, but the financials were not coming around.”

Around the same time as Evans’ return, AIT started forming its first independent board. Neff came on as chairman, along with Dr. Ben Park, CEO of American Health Network, and local venture capitalists David Mann and Carrie Bates.

AIT’s losses in 2011 forced it to restructure its debt with BMO Harris. The bank insisted that AIT bring on Bob Bosar, a local turnaround expert. Bosar led a round of layoffs and cost-cutting moves.

In January, Bosar said the company employed about 350 people, down from nearly 500 in 2011. The company had about $55 million in revenue last year, but has been predicting strong growth this year.

Neff, in a prepared statement, said ongoing reforms to the health insurance industry continue to present difficulties for AIT, but that he likes the base Evans has built.

“I am pleased to be in a position to build upon the work of Dr. Evans, and to collaborate with him to continue the successful growth of AIT Laboratories,” Neff stated. “As health care reform takes hold, addressing the needs of the laboratory testing market will be a challenge.”

Evans had nothing but praise for Neff, who has led CHV Capital Inc. since the Indiana University Health hospital system formed it in 2007. Neff is a longtime friend of Dan Evans, the CEO of IU Health.

“He’s done a great job for Dan Evans at IU Health,” Mike Evans said of Neff. “He’s going to take AIT to the next level.”

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Baldwin & Lyons posts 21-percent boost in profit

Indianapolis-based Baldwin & Lyons Inc. on Thursday reported healthy jumps in second-quarter profit and revenue, spurred by record premiums from the company’s insurance subsidiaries.

The insurer of trucking and auto fleets recorded profit of $4.9 million, or 33 cents per share—a 21-percent jump from $4.05 million, or 27 cents per share, in the second quarter of 2012.

Profit was boosted by investment gains of $467,000. In the same quarter last year, investment losses of $3.5 million dragged down the bottom line.

Revenue jumped 13 percent to $66 million.

The company said premiums written by its insurance subsidiaries hit a record $92.8 million, an increase of 18 percent.

Baldwin & Lyons shares slipped nearly 2 percent in early trading Thursday, to $26.24.

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Already a wreck, the worst is yet to come with Obamacare

In this post on Obamacare in Indiana, I argue why the law will fail. You can read my argument for why Obamacare will succeed here. A third post, arguing why Obamacare will be a “non-event,” will be published on Aug. 8. No single post should be read as my personal view on Obamacare, but rather as my best attempt to analyze the available evidence for three potential outcomes of the law.

Obamacare is destined to fail for one key reason: it will make health insurance cost more and buy less.

Consider other sectors where prices rose sharply while the quality of the product sank. Suburban housing circa 2006. Your daily newspaper since 2006. How’d those work out—for both businesses and consumers?

Well, expect Obamacare to do the same thing for health insurance.

Obamacare has created millions of pages of new rules and billions of dollars in new taxes—all of which contribute to driving up the cost of health insurance.

That will be true of the 685,000 Hoosiers that are expected to buy insurance through the newly created insurance exchanges. More importantly, it will also be true for the 3.7 million Hoosiers that continue to get health insurance through an employer.

That’s about three-quarters of the population. Repeat the same story in all 50 states, and there will be a lot of angry people out there. Enough to spark a political backlash.

Employers should expect to see their health benefits costs rise at the same pace they have for the past half decade, plus an additional 20 percent as some Obamacare icing on the top.

Why? Because Obamacare taxes health insurers, who will likely pass that on to employers as a 2-percent to 3-percent premium increase. Because employers must pay new taxes to help the federal government pay for new kinds of medical research and for a “transitional reinsurance” fund to offset the liklihood that the exchanges will attract more sick people than healthy ones. And because penalties on individuals who don’t buy insurance will push more people into employer plans, also driving up overall costs.

The increasingly unaffordable insurance that Obamacare will produce will push numerous employers into Obamacare's “Cadillac" tax. In 2018, any employer or health insurer will be forced to pay a whopping 40 percent excise tax on the cost of their health plan that exceeds $ 10,200 for an individual and $ 27,500 for a family.

Companies such as Columbus-based Cummins Inc. have been raising their deductibles in order to keep their benefits from triggering the tax. Obamacare is also pressuring many union health plans to shift significantly more financial risk onto workers.

Indeed, one of the oddest sights this year has been the calls by several unions—some of Obama’s staunchest political supporters—for the outright repeal of Obamacare. Why? Because they know the rich health benefits they have negotiated for so diligently for the past 30 years will vanish.

That’s the future Obamacare will bring: pay more, get less.

The changes to employers are important because they affect more people. But it’s Hoosiers in the exchanges that have the most to worry about.

New rules in the exchanges will make health insurance more affordable for those with very expensive conditions, such as cancer, and will most likely make insurance cheaper for older patients, childbearing women and those making below-average wages.

But for everyone else, there will be rate shock, as Obamacare drives up the average cost of insurance in Indiana by 72 percent. And it could get far worse than that.

That’s because Obamacare requires health insurers offering plans in the exchanges to cover everyone, with no consideration of anyone's health status in the price of the product (other than factoring in tobacco use and age).

That is a sure-fire recipe for the exchanges becoming a magnet for sick people and a no-go zone for healthy people. In insurance speak, that’s called a death spiral.

The only thing standing between Obamacare and death spirals in all 50 states is a tax on individuals that tops out at $695 in 2016. That fine is expected to force young, healthy patients to buy expensive health insurance, so they can cover the costs of all the older, sick people who will flood into the exchanges.

Imagine you’re just out of college and you can only find part-time jobs paying $10-$12 an hour—an increasingly common reality since Obamacare, by requiring employers to look back 12 months to determine their number of full-time workers on Jan. 1, 2014, has already begun to discourage the hiring of full-time workers.

You’ll still have to pay $1,100 to $1,600 for health insurance—even after Obamacare’s subsidies. And that’s for a plan with a good-sized deductible—meaning you’ll pay out of pocket for the first $2,000 or so of your expenses.

If you were young, poor and healthy, would you spend $100 a month extra on something you don’t use or which, if you do use it occassionally, still makes you pay the doctor’s bill anyway? I don’t think so.

But let’s say, by some miracle, Obamacare avoids death spirals in the exchanges. Even so, the real-value of health insurance will actually go down. That’s because insurers believe that in order to have any chance of signing up healthy people, they need to keep the price as low as possible. So they are offsetting the increased costs created by Obamacare’s rules and taxes by sharply limiting the number of doctors and hospitals their policyholders can visit.

Oh, and the health plans are paying those doctors and hospitals less, too.

Indianapolis-based WellPoint Inc. expects the health plans it sells through the exchanges to pay health care providers at close to Medicare rates—which are typically about 30 percent less than what individual insurance policies pay now.

If exchange plans pay low rates, expect hospitals and doctors to find ways to avoid those patients. They have lots of options. Some doctors are simply leaving the third-party insurance system altogether, setting up concierge practices that run primarily on cash retainer payments. That’s a problem for anyone that wants to pay with health insurance.

Other doctors are splitting their practices into two sides—one that takes insurance and one that operates on cash. If you’re paying with insurance, expect the wait times to grow—and grow and grow. In Massachusetts, which enacted a law similar to Obamacare in 2006, it still takes about six weeks to see a doctor—and half of physicians aren’t accepting any new patients at all.

Hospitals, especially in Indianapolis, have been quite adept at following the migration patterns of customers with employer-sponsored insurance, making the best health care abundant in Hamilton County but non-existent in Haughville.

And I haven’t even talked about the access problems that patients with Medicaid—if Indiana even decides to expand the program, as Obamacare calls for—will have seeing a doctor or finding a convenient hospital facility.

Obamacare may expand the number of people with health insurance, but it will leave those people fighting to actually get care. And once Hoosiers and Americans realize that, they will turn on the law.

The only question is if the Obamacare train wreck happens in high speed or slow motion. Said another way, Obamacare is certain to tarnish the president’s legacy, but will it fail so hard and so fast that he is literally chased from the White House in 2016, sort of like George W. Bush was in 2008, by a candidate promising over and over again to reverse “the failed policies of Barack Obama”?

The answer lies in how bad things go with the nitty-gritty technical functions of Obamacare. So far, the Obama team has an awful track record on implementation. Almost no part of the law has been rolled out smoothly, if at all.

Obamacare’s long-term-care insurance program was scotched because its actuarial assumptions were so bogus (the entire thing was used to help the law get a better budget score from the Congressional Budget Office).

Obamacare’s high-risk pool got going but only helped a fraction of the people it was supposed—and, in a harbinger of things to come, incurred costs far higher than projected.

In May, the Obama team delayed a plan to offer a choice of health plans to workers at small businesses that buy through the Obamacare federal exchanges. And in June, Obama’s IRS simply decided to take a year’s break in enforcing the tax penalty against employers that don’t offer health insurance.

Not only that, but the Obama team is not actually going to check if your income qualifies you for one of exchanges’ tax credits. They’re just going to take your word for it initially, and then let you sort it out on your taxes. Which means you could end up having to write a multi-thousand-dollar check back to the government in 2015.

So with that inspiring record, the Obama team has promised—and promised and promised and promised again—to have exchanges up and running by Oct. 1 in 33 states—including Indiana. And God bless them, they just might do it—if they change the definition of the word “running.”

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Amid Obamacare's changes, WellPoint keeps old playbook

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A dose of light reading

Health care is a complicated mess.

So much so, that even top CEOs of large health care organizations tell me privately that they feel overmatched by it.

I certainly do. Which is why I read as much as I can about health care.

So starting with this post, I’m going to periodically give you a peek at my reading list. I’ll highlight reports and reportage that I have found either helpful or provocative. I hope you do too.

I’ll start with something fun: New York Times’ reporter Elisabeth Rosenthal’s thorough look at the orthopedic implant industry, centered in Warsaw, Ind., which some economists call a "cartel." Aggressive markups, by both the device makers and the hospitals that implant the devices, have driven some American patients to fly to Europe, where government price controls help them get hip and knee replacements at a fraction of the cost they would pay in the United States. If such medical tourism becomes a trend, it’s bad news for the folks in Warsaw, where three of the world’s five largest implant makers are based.

While Rosenthal focuses on the orthopedic implant makers, another study shows hospitals have lots of air in their orthopedic pricing. An analysis by two UC-Berkeley researchers of Indianapolis-based WellPoint Inc.’s reference-based pricing experiment in California, which I wrote about earlier, shows that hospitals do respond—quite rapidly—when patients are enabled and encouraged to factor price into their decisions. This study has been getting lots of attention by the press and by health policy researchers. If you want one economist’s take on its significance, look here.

If you're a consumer thinking about buying health coverage in Obamacare's exchanges later this year, the Indiana Department of Insurance came out with a helpful document that is full of examples of how the cost of insurance will change for Hoosiers buying coverage next year. The upshot of the department's analysis is this: healthy people will pay (a lot) more, unhealthy people will pay (a lot) less. I would skip to page 13 of the report to read Appendices 2 and 3, which lay out numerous examples of premium increases and decreases and then more examples that factor in Obamacare’s subsidies.

Finally, if you’re really into the numbers, I suggest you read the actuarial memos filed by each of the three health insurers that will be offering exchange plans in central Indiana. These memos explain each insurer’s assumptions about why costs will rise and for whom:

Anthem Blue Cross and Blue Shield actuarial memo.

MDWise Inc. actuarial memo.

Physicians Health Plan of Northern Indiana Inc. actuarial memo.

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Buffett joins opening ceremony for Geico center

Billionaire investor Warren Buffett joined in a ceremony Monday morning opening a new customer service center for the Geico insurance company in suburban Indianapolis.

Gov. Mike Pence also took part in the ribbon-cutting ceremony with Buffett at the center in Carmel. Geico announced plans for the service center in March, saying it could have up to 1,200 workers in the next few years.

Geico is among numerous businesses owned by Buffett's Berkshire Hathaway holding company.

Geico said those working at the Carmel service center would include agents, trainers, supervisors and support staff.

State officials say the office opened in April and has about 250 workers.

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CNO Financial gung-ho on share buybacks

CNO Financial gung-ho on share buybacks | 2013-08-03 | Indianapolis Business Journal | IBJ.com@import url("/css/shared/default.css");/* START: Codes for all IE6+ browsers */#menu {font-size: 12px;position: absolute;z-index: 99;top: 142px;left: 0px;height: 35px;margin: 0px;padding: 0px;display: block} #menu ul.level-1 {display: inline-block;margin: 0;padding: 0;list-style: none;zoom: 100%;height: 42px;background-repeat: no-repeat;}#menu ul.level-1 div.sub-menu {position: absolute;left: -9999px;display: none;white-space: nowrap;}.new {background-color:#000099;}#menu ul.level-1 .left div.sub-menu {position: absolute;right: auto;left: -9999px;display: none;}#menu ul.level-1 .right div.sub-menu {position: absolute;left: auto;right: -9999px;display: none;}#menu ul.level-1 li.level-1-li {float: left;display: block;position: relative;padding-top: 0;height: 42px;}#menu TABLE a {font-size:12px;} #menu ul.level-1 li.left {float: left;display: block;position: relative;padding-top: 0;margin: 0;}#menu ul.level-1 li.right {float: left;display: block;position: relative;padding-top: 0;margin: 0;} #menu ul.level-1 li.level-1-li a.level-1-a {color: #FFFFFF;font-weight: bold;float: left;display: block;height: 35px;line-height: 35px;text-decoration: none;padding: 0 15px 0 15px;text-align: center;background-image: url(/images/global/nav_bg.jpg);background-repeat: repeat-x;border-right: 1px solid #2a5290;}#menu ul.level-1 li.level-1-li.hover a.level-1-a,#menu ul.level-1 li.level-1-li.active a.level-1-a{color:#69AAf1;}#menu ul.level-1 li.left a.level-1-a {float: left;display: block;height: 35px;line-height: 35px;text-decoration: none;padding: 0 15px 0 15px;text-align: center;}#menu ul.level-1 li.right a.level-1-a {float: left;display: block;height: 35px;line-height: 35px;text-decoration: none;font-weight: bold;padding: 0 15px 0px 15px;border-right: 0px none;} #menu ul.level-1 li.first a.level-1-a {background-image: url(/images/global/nav_bg_left.jpg);background-repeat: no-repeat;}#menu ul.level-1 li.last a.level-1-a {background-image: url(/images/global/nav_right.jpg);background-repeat: no-repeat;background-position: top right;}#menu ul.level-2 li.first, #menu ul.level-2 li.last {background-image: none;} /* END: Codes for all IE6+ browsers */ /* START: This block of CSS is only used by post-IE6 browsers */ #menu ul.level-2 {display: inline-block;margin: 0;padding: 0;list-style: none; 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Print & Online Subscriptions   IBJ Daily & Other eNews Alerts   Trial Subscriptions   Subscription Renewals & Address Changes   Subscription Services Q & A     CNO Financial gung-ho on share buybacks The Carmel-based financial services company said that, during the second quarter, it repurchased $59.4 million of its securities, including 4.4 million common shares for $50 million.

 

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Most Read Most E-mailed Recent Comments Snooty Fox restaurant closes after 29 years Weatherman Wright feels wronged, leaving WTHR, report says Meteorologist Buchman leaves WISH-TV, as expected FBI searches City-County Building, makes multiple arrests in Land Bank probe WTHR meteorologist leaving for position in Texas Most Read Most E-mailed Recent Comments Group eyes vacant Illinois Street building for charter school A2SO4 architectural firm reopens after temporary closure Anthem tries new 'narrow network' strategy Chrysler confirms state investment of $374 million IU, Marian set to launch wave of docs Most Read Most E-mailed Recent Comments Jake's creepy obsession with every word I type aside, Carter also makes some giant leaps of stereotype. "Disciple, are you basically saying no one is in control at IMS?" No. Mark Miles is the latest guy in charge. "Whenever something you seemingly do not like occurs, you always start blaming it on things like 'the same self interested fools that have been trying to kill the sport for thirty years.' Who is in control at IMS? I thought it was the George family." Uh, the George family OWNS the track (and ultimately the series). The day-to-day management falls to Mark Miles and his team. "Wasn't one of the whole ideas behind Tony Jr's move to control the sport was to actually control the sport? Amazing, they run the show and they still can't control it. What does that say?" It says Mark Miles is allowing himself to be unduly influenced by Euro-centric road racing enthusiasts without regard for history and the approaches that have failed multiple times. "Sorry, you can keep trying to pass the buck to 'cart' and 'champcar' owners. 17 years since the second split, 8 years of total control after the merger. The buck stops with IMS and the Georges. They allowed Junior to run it, they put Bernard in, they brought Miles as the Sports Marketing Savior. It's theirs." One hallmark of those who are militantly pro-cart and whose only frame of reference post-dates 1979 is knee-jerk defensiveness whenever anything that could even remotely be construed as a slam on two of the series that did, in actual fact, die is uttered anywhere. The issues with which we must deal today have little to do with cart. They have been dead and gone for a long time. My big problem is a giant imbalance in scheduling in favor of non-ovals. I want a true balance. I do not want another futile attempt to try and make a form of racing popular in this country that has never been accepted by the mainstream long term. As long as people like Dan Anderson are going to be allowed to purge ovals to please road racers, and owners hire formula specialists from abroad, and the venue imbalance continues being top heavy with twisties I will continue urging common sense and respect for history. It may not do any good, but someone needs to speak up. There are plenty of great choices to allow ten ovals, five natural terrain road courses and five festivals o' speed. 50/50. That makes IndyCar more unique and versatile than anything else, could be an inspired marketing theme and would attract a great cross section of casual fans. IMHO it is high time for IndyCar to quit screwing around and kowtowing to owners who have a proven history of failure where running a series is concerned. Chris was fine. He is professional and polite- but his presentation -especially during dangerous weather-was nothing special while Angie's broadcasts were engaging and very helpful. The best weather person in Indy is Chuck Loftus -love idea of flat Chuck! Welcome Angie to a great team. Thank you Chris time for something new also. Greg, your comments in regards to renters are absurd. Lumping all renters into the category of 'frat boys' is very ignorant. In addition, you do realize that people can rent houses in Broad Ripple. Why aren't you up in arms about people that decide to rent their house out? Greg, renters can and do have an interest in their communities. The younger generation (read: me) doesn't feel the need to buy a permanent location for the long-term, and we've seen what "property values" are good for. But that doesn't mean we want to live in a pit. Renters want nice furnishings, good parks, proximity to necessities, and safe neighborhoods just like homeowners do. To say that all renters are frat boys is extremely ownist of you. The ignorance on display in some of these posts is astounding! This project is absolutely justified. I would assume from the comments here that several of you rarely, if ever, actually make it to downtown and have very little clue about an urban environment. To "The Burbs": Please, stay there! Or, you might want to actually check out Georgia St. on any Friday night during the summer, whenever there is Pacers game or tournament in town... its hardly the forlorn place you make it out to be. To "Fuzzy": Nevermind..... The circle, even if not the largest public space in the city, is certainly the most high profile. In fact, Monument Circle was recently named one of the great public spaces of the entire country. Anyone who would dismiss the need for this investment is simply out of touch. 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CNO profit jumps 17 percent

CNO Financial Group's profit rose 17 percent in the second quarter, partly on lower expenses and higher investment income.

The Carmel-based insurer and financial services company reported on Monday morning earnings of $77.1 million, or 34 cents a share, for its second quarter—compared with $65.7 million and 24 cents a share in the second quarter of 2012. On average, nine analysts polled by Thomson Reuters expected earnings per share of 26 cents for the quarter.

Net operating income per share was 30 cents in the quarter, a 50-percent rise from 20 cents in the period last year.

Total revenue for CNO grew 1.5 percent to $1.08 billion.

“The vitality and stability of CNO’s business model continues to produce solid results, with sales momentum increasing, and consistent growth in core business premium income and profitability,” CEO Ed Bonach said in a statement. 

Sales, as defined by new annualized premium, rose 5 percent to $102.3 million. 

Bankers Life, CNO’s Chicago-based unit that sells insurance to consumers at or near retirement age, saw a gain of 6 percent in new annualized premium, totaling $63.2 million.

Bankers Life opened nine new sales offices in the first six months of this year, CNO reported.

By contrast, new premium at CNO's Colonial Penn unit rose 1 percent to $15.8 million, “in line with our expectations given our advertising spend this quarter,” the company said.

Colonial Penn life insurance products are heavily touted over television and sold direct to consumers.

CNO shares were up about 2 percent at midmorning amid a broader market decline.

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House GOP seeks delay in health care provisions

U.S. House Republicans pressed ahead Wednesday on delaying key components of President Barack Obama's signature health care law, emboldened by the administration's concession that requiring companies to provide coverage for their workers next year may be too complicated.

The House has scheduled votes later Wednesday to delay the law's individual and employer mandates, the 38th time the GOP majority has tried to eliminate, defund or scale back the program since Republicans took control of the House in January 2011.

The votes were a chance to score political points and highlight public skepticism over the law. The legislation is going nowhere in the Democratic-controlled Senate and the administration said emphatically Tuesday the president would veto the measures.

Republicans seized on the administration's abrupt decision earlier this month to delay for one year, until after the 2014 elections, the requirement that businesses with 50 or more employees provide health coverage for their workers or pay a penalty.

Republicans insisted that the president couldn't unilaterally decide to enforce only portions of the law. They planned votes on one bill that would essentially codify the administration's plan as well as a second bill that provides a similar grace period for individual Americans.

"If the president believes the employer mandate is too much for the employer community, how about basic fairness for American families and individuals?" House Speaker John Boehner, R-Ohio, told reporters at a news conference.

Democrats insisted it was all political theater and another attempt by the GOP to undermine the law.

Rep. Joe Crowley, D-N.Y., said Republicans weren't simply trying to delay the requirements. "It is their intention to destroy the Affordable Care Act ... to do away with it, to annihilate it entirely," Crowley said.

He said the "the definition of insanity ... is doing something 38 times and still getting the same results."

The goal of the health care law was to provide coverage to nearly 50 million Americans without health insurance in a massive overhaul of the current system. In a surprise move earlier this month, the Obama administration announced a one-year delay in the employer mandate.

"We have heard concerns about the complexity of the requirements and the need for more time to implement them effectively," Treasury Assistant Secretary Mark Mazur said in a blog post. "We have listened to your feedback and we are taking action."

Republicans seized on that decision as new evidence that the law is unworkable and should be repealed. The GOP also accused a Democratic president of favoring businesses over average Americans, who will still be required to carry health insurance starting next Jan. 1 or risk fines.

The House will vote on two bills: one by Rep. Tim Griffin, R-Ark., to implement the president's one-year delay in the employer mandate, and another by Rep. Todd Young, R-Ind., to delay the individual mandate. Although Griffin's bill would implement a policy the Obama administration has already announced, it's part of a broader GOP attack on the health care law with the goal of repeal.

The White House said in a statement vowing a veto that "it's time for the Congress to stop fighting old political battles and join the president" in boosting the economy and helping the middle class.

In the days leading up to the vote, the National Republican Congressional Committee, which helps elect GOP candidates, has issued a flurry of news releases calling on Democratic incumbents to vote for a delay in the individual mandate and posing the question "Big business got a break from Obamacare, but what about families?"

"It was a shocking admission of defeat when the Obama administration delayed the disastrous law's employer mandate," the NRCC said in one release directed at Rep. Elizabeth Esty, D-Conn. "Though big business may be delayed from the onerous effects of Obamacare, middle-class families across Connecticut won't."

Stepping up the pressure, the House Ways and Means Committee held a hearing on the administration's delay of the employer mandate, questioning J. Mark Iwry, a Treasury Department official and top adviser on health policy.

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Health tech startup aiming for fences

Flying under the radar for much of its existence, local health tech startup hc1.com Inc. now thinks it’s ready to soar.

The company, spun out last year from Zionsville-based Bostech Corp., is on pace to generate annual revenue of $10 million by year's end. And it thinks business could triple next year.

That’s because hc1 is branching out from its focus on medical lab customers, and is now talking to radiology groups and institutional pharmacies. Signing up entire hospital systems is its ultimate goal.

Bostic

CEO Brad Bostic, who is better known for co-founding local search firm ChaCha Search Inc., said hc1’s software is key for giving doctors and health care executives the real-time data they need to meet the new demand in health care: better care at lower cost.

“You’re able to do a much better job focusing your resources,” said Bostic, 38, while drawing diagrams on a large whiteboard in his office on West 96th Street in Zionsville.

Focusing resources may well be the name of the game for health care providers in the future. They will be treating more patients as aging baby boomers require more health care and as Obamacare expands the number of non-seniors with health insurance.

At the same time, both public and private health plans are pushing health care providers into new kinds of contracts that reward them financially only when they keep patients healthier, reducing the amount of health care services they need.

The wide adoption of electronic medical record systems, spurred by incentives and penalties contained in the 2009 stimulus act, was supposed to help all health care players talk to one another. But hc1’s pitch is that few EMR systems or medical billing systems can easily produce a dashboard of key data that allows health care executives to manage their operations.

Hc1 is already being used in more than 500 health care facilities, and pulls data from more than 200 million health care transactions each year. It charges its customers a monthly fee for each person who accesses its software, which is run from cloud-based computers.

Hc1’s customers include Alere Toxicology, one of the nation’s largest operators of medical labs, and Tennessee-based HCA Inc., the nation’s largest chain of for-profit hospitals.

The company has more than 70 employees now and expects to reach 120 by the end of 2014. Bostic is optimistic in part because he bills hc1 as the first product to provide customer-relationship management specifically for health care customers. He estimates the total U.S. market for such tools at $8 billion annually.

And he thinks hc1 has a good amount of firepower to grab a bigger and bigger share of that market. The company has raised $14 million from angel investors.

“Now it’s starting to catch fire as this killer app for health care,” Bostic said.

Hc1 is working with Indianapolis-based Northwest Radiology Network to start its foray into imaging services. Northwest employs 50 physicians who read X-rays, CT scans and MRIs for 18 hospitals.

Linda Wilgus, Northwest Radiology’s chief financial officer, said she expects hc1 to give her information she needs to schedule physicians, so turnaround times on reading images don’t lengthen out, and on each physician’s speed and productivity at reading scans.

Hc1 is also setting up a system that will check all the orders Northwest Radiology receives for scans from physicians against appropriateness guidelines published by the American College of Radiology. If a doctor orders an MRI when a cheaper CT scan would work just as well, Wilgus will get a message on her computer, allowing her to call the ordering physician to see if he or she considered the lower-cost option.

Identifying unnecessary, duplicative or just overly intensive scans will help hospitals reduce their expenses for treating patients. It also could reduce Northwest Radiology’s reimbursements, but Wilgus is convinced that providing such quality-boosting and money-saving measures will be vital for Northwest Radiology to maintain the contracts it has with its many hospital partners.

“Data is going to be key to get to the changes we’re going to need to have the health system of the future,” she said.

Hc1 is able to make these data available for Wilgus by capturing all the orders and scheduling messages that Northwest Radiology’s computer systems already receive.

An ordering physician’s office alerts Northwest Radiology that it has requested a scan. Then it sends a scheduling message when it has settled on a time with the patient.

When the scan is conducted, most scanners send a message to Northwest Radiology when the scan begins and when it is finished. Finally, they send a note to tell Northwest Radiology’s physicians there is an image waiting for them to read and interpret.

The same kind of “e-prescribing” systems are already widely used in medical labs and pharmacies, which is why hc1 is targeting those companies, too. By adding long-term-care and home-health providers, Bostic thinks hc1 can produce comprehensive profiles of each patient a health system is caring for.

“All that data is just being squandered right now,” Bostic said.

Before implementing hc1’s software, Wilgus could get some data about physicians’ productivity, turnaround times and frequency of inappropriate tests. But it all came months in arrears, and it often took significant work to pull data from the many different computer systems used by various hospitals and combine it in one database.

“Today, I have to manage my practice in the rearview mirror,” Wilgus said.

Bostic is now in discussions with Florida-based Strategic Radiology Group, a national chain of radiology practices Northwest Radiology is part of, about deploying hc1 in all 16 of its practices across the country.

Another hc1.com customer is St. Vincent Seton Specialty Hospital, a subsidiary of Indianapolis-based St. Vincent Health. The long-term-care hospital worked with hc1 to develop its software, and it now uses it to track whether physicians are ordering too many lab tests.

Troy Reiff, the executive director of St. Vincent Seton, has his hc1.com dashboard set to report two things to him: any physician who is ordering more tests than his peer physicians are, and any patients whose lab results have been normal four times in a row.

If a physician is ordering more tests than is normal, Reiff said he tries to have a discussion with the doctor to understand the circumstances of his patient to see if all those tests are justified.

And if a patient’s test results are normal four times in a row, Reiff asks physicians to stop testing the patient so frequently. Reiff said it’s common for a patient to be tested frequently when he or she first arrives. But then those tests are repeated frequently—and unnecessarily—for the next several weeks while the patient recovers.

“They were being done even the day of discharge, even though they were normal four, five, six days prior to discharge,” Reiff said.

Reiff said he couldn’t get the same kind of information from St. Vincent’s other computer systems, unless he employed a team of people to pull the data, combine it into one database, then analyze it. And even then, it would be too old to affect patients currently in the hospital.

“Your EMR systems are not capable of extracting the lab system data and analyzing it like hc1.com is,” he said.•

View the original article here

Get ready to see for-profit religious hospitals

I have to say it: the not-for-profit label worn by Indianapolis' hospitals is meaningless for just about everyone but the IRS.

Fact is, the executives leading those organizations are as profit-focused as any car dealer or street corner food vendor. If anything, they're coveting black ink more than ever.

That much was clear last month when St. Vincent Health, at the behest of its parent organization, St. Louis-based Ascension Health Alliance, laid off about 865 people.

St. Vincent’s cuts were just a small part of 4,700 jobs eliminated nationwide by Ascension, according to an executive who was laid off at St. Mary Medical Center, an Ascension subsidiary in Evansville.

Ascension, the nation’s largest chain of Catholic hospitals, wants to boost profits from its operations substantially. Any business would.

But Ascension faces extra pressure to focus on cutting costs, because both government health plans and private health insurers are holding the line on reimbursement rates. And Ascension, like all hospitals, needs to keep its profit margins healthy to satisfy its public bondholders.

Ascension’s hospital operations turned a profit of 3.7 percent in its most recently reported financial year, up from 2.7 percent the year before. That’s good but not great for a hospital system.

The 4,700 jobs eliminated represent just 4 percent of Ascension’s total work force of 122,000 people, but the cuts still could give a sizable boost to Ascension’s profit margin. A 4 percent cut to salaries and benefits would have saved Ascension about $325 million in its most recently reported fiscal year, which ended June 30, 2012. Its profit margin would have jumped up to 5.7 percent.

Profit-focused management is hardly unique to St. Vincent and Ascension. Indiana University Health, for example, tried to boost its profit margins over the past decade with aggressive building and marketing campaigns. It even, for a time, started new hospitals using for-profit structures and investment capital from physicians.

Some find this business-minded approach to medicine morally reprehensible. Hospitals, however, see themselves as using business practices to help them advance a worthwhile cause—human health. In this view, profits are not the purpose of the organization, but rather a necessary ingredient for sustaining that mission over the long-term.

“No margin, no mission” is the phrase often used by health care executives, particularly those leading religious, not-for-profit hospitals.

With exactly this mindset, Ascension launched in 2011 the Ascension Health Care Network as a for-profit joint venture with Oak Hill Capital Partners, a Wall Street private equity firm. The network’s goal is to use some of Oak Hill’s $30 billion asset chest to acquire struggling Catholic hospitals in order to keep them alive.

“Of course, the reason this issue is on the table at all is that there are Catholic hospitals across the country that are facing the question of whether they are going to be able to continue to survive, to thrive in the long run,” explained Leo Brideau, CEO of the Ascension Health Care Network. He noted that “in many cases we’re talking about whether they will even survive over the next five years or so.”

Brideau made those comments during a March 2012 conference at Seton Hall University in New Jersey. The proceedings of that conference were published this year as a book titled, “Is a For-Profit Structure a Viable Alternative for Catholic Health Care Ministry?” You can read the book here.

Ascension’s executives clearly think they can meld their Catholic mission and a for-profit status.

“The point is, ‘for-profit’ describes our tax status; it doesn’t describe our purpose. Our purpose is continuing the healing ministry of Jesus—that is our purpose,” Brideau said. “And so, whether not-for-profit or for-profit, we use our capital in very much the same ways; but in either case we have to provide a return on investment to our bondholders and to our shareholders.”

One thing Brideau did not address in his speech was whether a for-profit structure would affect the amount of free care provided. A 2006 analysis by the Congressional Budget Office, using data from Indiana and four other states, not-for-profit hospitals provide a tick more uncompensated care than their for-profit peers—4.7 percent of their operating expenses, compared with 4.2 percent at for-profit hospitals.

That said, I suspect we'll see other not-for-profit hospitals, perhaps even some here in Indianapolis, turn to a for-profit strategy to deal with financial pressures. Sensing exactly that kind of trend, the Catholic Health Association passed a rule in 2011 that allowed Catholic hospitals to keep their membership after converting to a for-profit organization, pending a study of the issue by a task force. And that's certainly what Ascension's Brideau expects.

“I believe that there is no question that for-profit tax status can be entirely consistent with maintaining the Catholic health ministry," he said. "In fact, I would argue that in today’s world it is necessary, beyond simply being appropriate.”

View the original article here

Franciscan doubles down on accountable care

Franciscan St. Francis Health earned a $6.6 million bonus from the Medicare program for its success at keeping central Indiana patients out of the hospital and the emergency room. So the hospital system will expand its participation in so-called accountable care programs to all its Indiana territories.

That performance ranked Franciscan in the top five out of 32 groups of health care providers participating in the Medicare Pioneer ACO program—one of the Obama administration’s earliest tests of a key Affordable Care Act strategy for controlling future increases in health care costs.

Franciscan actually reduced spending—a rarity in health care—on 20,000 Medicare patients in 2012 compared with the cost of care those same patients received annually in the three previous years.

The federal Medicare program, the largest health plan for seniors, projected it would spend $230 million last year to care for the 20,000 patients, based on their health status and claims experience. That number represented a 4.8-percent increase over the average annual amount Medicare had paid to care for those same patients in 2009 through 2011.

Franciscan’s efforts to keep the patients healthier and out of the hospital led to spending $216.7 million on them—a 6-percent reduction from Medicare’s projected amount. The federal Medicare program will pay Franciscan a bonus of $6.6 million—its half of the $13.3 million Franciscan saved.

Franciscan executive Jay Brehm said accountable care is a key strategy for Franciscan’s future success.

“There is a lot of support throughout the organization,” said Brehm, senior vice president of strategic planning and business development for Franciscan Alliance, the Mishawaka-based parent Franciscan St. Francis Health. “We think it helps Franciscan improve its service offerings and value to the payers and the beneficiaries that seek our services.”

The overall results of the Pioneer ACO were mixed. Franciscan was one of just 13 participants that saved money compared with their expected spending. Four spent more than their target and 15 spent the same. Nine organizations left the program after the first year.

But combined, the 32 organizations spent $87.6 million less than projected by Medicare’s actuaries. In order to be eligible for bonus payments, they also had to report quality data in 15 areas.

Among all the Pioneer ACO participants, spending still went up—0.3 percent compared with the average over the previous three years. But that was less than the 0.8-percent increase in the cost of care for similar Medicare beneficiaries, according to an analysis by the Centers for Medicare & Medicaid Services, the federal agency that administers the Medicare program.

Franciscan’s care actually cost Medicare less than it had been paying—about $2.8 million less than the annual average in the three prior years. That represented a 1.3-percent spending reduction.

Franciscan achieved savings by reducing the number of patients coming back to the hospital a second time for the same condition, reducing patients’ use of the emergency room, and by working with long-term care providers to shorten patients stays by improving their health faster.

Franciscan identified about 2,000 patients it deemed in need of in-home visits and other interventions from its team of complex care nurses and social workers.

Franciscan identified those patients by running their past Medicare claims through predictive modeling software, which essentially identified patients suffering from or were at high-risk of developing three chronic diseases: diabetes, congestive heart failure or chronic obstructive pulmonary disease—or in many cases, all three.

“Most of those people were hitting the ER a lot. Most of those people had readmissions. Most of those people had 15 to 20 medications,” said Jenny Westfall, regional vice president for Franciscan ACO.

These high-need patients also had transportation and income issues that frequently prevented them from getting the care they needed.

“We’ve used a lot of social workers to help these patients," Westfall said. "They don’t have a lot of support at home. Oftentimes, they have no transportation. They don’t have the money to buy the prescriptions that we prescribe for them when we send them home. So we just did a lot of hand-holding.”

Franciscan also identified patients in need by surveying the roughly 700 physicians who are part of its Pioneer ACO organization. Those doctors will get a chunk of the $6.6 million bonus, Brehm said, but the size of their take has yet to be decided by Franciscan executives.

The rest of the bonus, he said, would be reinvested in Franciscan’s in-house systems and personnel that support its ACO programs.

In addition to the 2,000 patients who received home visits and coaching, Franciscan placed telephone calls to about 75 percent of its 20,000 patients. And all patients received written materials about the Franciscan ACO, which included educational materials about various health conditions.

Franciscan is trying to keep those efforts going this year. It also has to step up its game on its quality metrics. To qualify for another bonus, it has to hit goals set by Medicare.

But Franciscan is committed to making it work. The system plans to start two new ACOs by year end. One, in the Lafayette area, will likely include 10,000 Medicare patients. Another, in northwest Indiana, will include 10,000 to 12,000 patients.

Franciscan is also operating two other accountable care organizations. One is a partnership with Indianapolis-based physician group American Health Network. That organization includes about 28,000 Medicare patients. The other is a partnership with Union Hospital of Terre Haute, which includes about 14,000 Medicare patients.

So by year’s end, Franciscan will be serving at least 82,000 patients in its accountable care organizations.

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Expect deja vu: Obamacare won't fix health care

In this post I predict that Obamacare will be a non-event in Indiana. Two previous posts argued for why Obamacare will succeed and why it will fail. No single post should be read as my personal view on Obamacare, but rather as my best attempt to analyze the available evidence for three potential outcomes of the law.

After 10 months of acrimonious debate, 2,000 pages of legislation, 20,000 pages of regulations, and nine years before full implementation, Obamacare is going to bring us back to where we started.
Oh, it will fix a few issues along the way—and it will create some new ones.
But by and large, Obamacare will leave in place the same major problems in the health care system that existed before the law was passed—in both Indiana and across the nation.
- Costs, of both health care and health insurance, will remain high and will proceed on their faster-than-inflation march.
- Those costs will still be borne by employers and their workers, as hospital systems shift the burden of under-payment by publicly financed health insurance onto employers.
- The third-party insurance system will be permanently entrenched as the beneficiary of both a $300 billion per year tax break for employers but also now a $150 billion per year flow of subsidy payments for individuals buying in the exchanges.
- And yet, there will still be a large number of uninsured Hoosiers (and Americans).
- Significant inequities will continue to exist in the American health care system. They will not all be the same inequities as before, but they will be there.
- The gradual rise of consumerism—by exposing families to more of the costs of their care—will go on, in spite of the dislike President Obama and many health care providers have toward health savings accounts. But now, HSAs will be a reality for more Hoosiers than ever.
This is why I say Obamacare will be a “non-event.”
Obamacare requires health insurance policies purchased by employers with more than 50 workers to adhere to various new rules and pay new taxes. But there is a way to get around some of those rules and taxes, and more employers are taking advantage of it.
Rather than buying insurance from a health insurer like Indianapolis-based WellPoint Inc., an employer can act as its own insurer. So it simply hires WellPoint or a third-party administrator to process its workers’ medical claims, but not to take on the financial risk of those claims.
Then an employer buys a different kind of insurance called stop-loss, when medical claims exceed $50,000 or $100,000 for one worker or a predetermined amount for the employer's entire workforce. This is called “spec and agg” coverage. It’s like a high-deductible health plan for an entire company.
Self-insurance rates were already higher in Indiana than in other states. Getting precise data is difficult, but local insurance professionals say a good rule-of-thumb estimate is two-thirds of Hoosiers with employer-sponsored health benefits get them from a self-insured employer. The rate is 58 percent nationally, according to a Rand Corp. study, and has been rising.
Dr. Ben Park, the CEO of American Health Network, expects those the rate of self-insurance among employers to shoot up to 90 percent in Indiana. That’s because the companies that offer stop-loss insurance have revamped their products to appeal to smaller and smaller employers. Some stop-loss insurers are signing up employers with as few as 10 employees, according to local benefits brokers.
If nine out of every 10 workers at Indiana employers is covered by a self-funded insurance plan, that means those employers are not bound by Obamacare’s mandates on essential health benefits. It also means they can avoid the community rating risk pool that small employers buying a health insurance will be part of. That’s an advantage for any employer with a generally younger or healthier workforce.
Also, self-funded employer and stop-loss insurers will not be subject to the new tax Obamacare will assess on actual health insurance policies sold by insurers. In Indiana, WellPoint expects such taxes to add 2.7 percent to overall premiums.
Still costs for employers are expected to rise even a bit faster than they had been for the past decade. Health care spending has moderated during the economic downturn but has hardly budged from the double-the-rate-of-inflation pace at which health care and health insurance have risen for the past 40 years.
Employers were hoping that hospital systems wouldn’t shift as many costs onto employers as they have in the past, because Obamacare’s expansion of insurance coverage would give the hospitals more paying customers.
But with Indiana not expanding its Medicaid program (so far) and with the newly insured that will flow into Obamacare’s exchanges landing in plans that pay as much as 30 percent less than employer health plans, the new patients won’t improve finances at hospitals much—if at all.
But hospitals have improved their bargaining power by scooping thousands of formerly independent physicians and by consolidating into larger chains. (This consolidation has been justified as helping produce coordinated care that saves money, but don’t hold your breath on that. Most of the organizations that have tried it so far have either not saved money and some have just given up after trying it for a eyar or two.)
So hospitals will have the clout to make cost-shifting, which averages about $1,000 per commercially insured person, continue.
With costs still rising, the number of Hoosiers paying thousands of dollars out of their own pocket each year will go up. That's because employers, trying to duck Obamacare’s 2018 “Cadillac” tax, are turning in higher numbers to high-deductible plans. Also, the majority of customers on Obamacare’s exchanges are expected to opt for low-cost bronze and silver plans—which will also come with high deductibles.

This higher exposure on health plans was not President Obama's goal when this process started back in 2009, but it’s the one of the only ways now to keep health care affordable.
Proponents of Obamacare also hoped it would end the “job lock” that now keeps workers stuck at employers with good health benefits, because the current individual markets are so unattractive. But I expect employer-provided benefits to remain the preferred option for just about everyone, and therefore, “job lock” will continue.
I see this happening because, after the employers with relatively healthy workers move to self-insure, they will steal away healthy patients that would otherwise have been factored into the risk pool for the individual markets, pushing up rates there.
That’s not to say that life won’t improve in the individual markets. It will, in quite substantial ways, as I discussed in my post predicting that Obamacare will work.
But expect Obamacare’s exchanges and individual markets to have a second-class status that Hoosiers will avoid, if they can. The exchanges will be the province of low-wage workers, who are the ones that will benefit most from Obamacare’s subsidies.
But for anyone who gets no subsidy or only a small one, health coverage in the exchanges will be expensive and will come with limited choices on doctors and hospitals.
Add to that the fact that Indiana Gov. Mike Pence is unlikely to expand eligibility for the Indiana Medicaid program up above the poverty limit—as called for by Obamacare—and you get a whole lot of Hoosiers still uninsured. Based on estimates from the actuarial firm Milliman Inc., there will still be about 400,000 Hoosiers uninsured, without a Medicaid expansion. Most of those folks will actually have lower incomes than those getting subsidies for health insurance in the exchanges. But there will be no help for them.
So, as I said, there will still be huge inequities in Hoosier health care—just like there were before the drive to pass Obamacare.
“I am not the first president to take up this cause,” Obama declared in a speech about health care reform to Congress on Sept. 9, 2009, “but I am determined to be the last.”
The president's determination, unfortunately, will not be enough.

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Dow AgroSciences posts record second-quarter sales

Strong sales of new crop-protection products helped Dow AgroSciences LLC report record second-quarter revenue of nearly $1.9 billion, an increase of 10 percent from the same period a year earlier.

The Indianapolis-based maker of agricultural products, a unit of Michigan-based Dow Chemical Co., said Thursday that profit totaled $290 million before accounting for interest, taxes, depreciation and amortization—down from last year’s second-quarter record of $307 million.

Sales of crop-protection products rose 12 percent, driven by large gains in Latin America, where sales of new crop-protection products grew 14 percent.
Parent Dow Chemical said its second-quarter profit more than tripled, boosted by a $2.16 billion payment related to a scrapped joint venture, and its adjusted results beat Wall Street predictions.

The company earned $2.34 billion, or $1.87 per share. That was up from $649 million, or 55 cents per share, in the same quarter of 2012. Excluding the payment from Petrochemical Industries Co. of Kuwait and other one-time items, Dow posted an adjusted profit of 64 cents per share.

Revenue was essentially flat at $14.6 billion, compared with $14.5 billion a year earlier.

Analysts, on average, expected adjusted profit of 62 cents per share on $14.5 billion in revenue, according to FactSet.

Overall sales increased 2 percent, with Latin American volume jumping 12 percent and Asia Pacific volume rising 7 percent. Overall pricing fell 2 percent.

Dow Chemical shares traded late Thursday morning at $34.92, up 53 cents each.

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Judge ends Indiana-Planned Parenthood battle

A judge on Tuesday made permanent her order barring Indiana from denying Medicaid funds to Planned Parenthood clinics, ending the state's two-year legal fight.

U.S. District Judge Tanya Walton Pratt issued his permanent injunction after the U.S. Supreme Court in May refused to hear Indiana's appeal in the case. Days later, the Centers for Medicare and Medicaid Services issued an administrative ruling siding with Planned Parenthood.

Indiana had sought to prevent Medicaid enrollees from accessing health care at clinics operated by Planned Parenthood of Indiana and Kentucky because the organization provides abortions.

Planned Parenthood, represented by the American Civil Liberties Union, had argued that a 2011 Indiana law targeting the organization should be blocked because it probably conflicted with a federal Medicaid statute that protects patients' rights to make their own decisions about health care providers.

"This decision recognizes the rights and liberties of health care providers and the women they serve," said ACLU of Indiana Executive Director Jane Henegar. "We hope lawmakers will now see where federal law and the Constitution draw the line to protect individuals against government intrusion."

Indiana Attorney General Greg Zoeller issued a statement saying "it was important and necessary to defend the policy decision of the people's elected representatives in the Legislature that Medicaid dollars should not indirectly subsidize the payroll and overhead expenses of abortion providers. "

"If legal challenges to similar statutes in other states eventually reach the United States Supreme Court, then Indiana would have another opportunity through an amicus brief to assert this legal argument," Zoeller said.

Tuesday's ruling made permanent the judge's June 2011 preliminary injunction. It came a day after the two sides filed an agreement with the court stipulating that the state cannot violate Medicaid's "freedom of choice" provision.

The legal battle dating to May 2011 was marked by a temporary interruption in Planned Parenthood's ability to receive reimbursement for seeing Medicaid patients for routine care such as Pap smears, breast exams and pregnancy tests.

The interruption, however, led 1,600 donors in 48 states and on three continents to provide about $500,000 allowing Medicaid recipients to continue to receive at Planned Parenthood's more than 20 clinics across Indiana, said Betty Cockrum, president and CEO of Planned Parenthood of Indiana and Kentucky.

"We've been encouraged at every step along the way, but two years is a long time, and it certainly did introduce some confusion out there for our patients," Cockrum said in a telephone interview. "That's unfortunate anytime when Indiana is seeing a lot of economic duress. We're seeing the number of Hoosiers living in poverty increase. It's a bad time for people to have confusion about their health care."

The 2011 law would have made Indiana the first to deny the organization Medicaid funds for general health services. The state argued that Medicaid funds intended to help groups such as Planned Parenthood provide general health care would indirectly subsidize abortions. Planned Parenthood performs more than 5,000 abortions each year in Indiana.

The Hyde Amendment, a 1976 provision named after the late Rep. Henry Hyde, R-Ill., bans federal funding for abortions except in cases of rape, incest or when the life of the mother is at risk.

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Life sciences venture capital dips again

Life sciences venture capital dips again | 2013-08-03 | Indianapolis Business Journal | IBJ.com@import url("/css/shared/default.css");/* START: Codes for all IE6+ browsers */#menu {font-size: 12px;position: absolute;z-index: 99;top: 142px;left: 0px;height: 35px;margin: 0px;padding: 0px;display: block} #menu ul.level-1 {display: inline-block;margin: 0;padding: 0;list-style: none;zoom: 100%;height: 42px;background-repeat: no-repeat;}#menu ul.level-1 div.sub-menu {position: absolute;left: -9999px;display: none;white-space: nowrap;}.new {background-color:#000099;}#menu ul.level-1 .left div.sub-menu {position: absolute;right: auto;left: -9999px;display: none;}#menu ul.level-1 .right div.sub-menu {position: absolute;left: auto;right: -9999px;display: none;}#menu ul.level-1 li.level-1-li {float: left;display: block;position: relative;padding-top: 0;height: 42px;}#menu TABLE a {font-size:12px;} #menu ul.level-1 li.left {float: left;display: block;position: relative;padding-top: 0;margin: 0;}#menu ul.level-1 li.right {float: left;display: block;position: relative;padding-top: 0;margin: 0;} #menu ul.level-1 li.level-1-li a.level-1-a {color: #FFFFFF;font-weight: bold;float: left;display: block;height: 35px;line-height: 35px;text-decoration: none;padding: 0 15px 0 15px;text-align: center;background-image: url(/images/global/nav_bg.jpg);background-repeat: repeat-x;border-right: 1px solid #2a5290;}#menu ul.level-1 li.level-1-li.hover a.level-1-a,#menu ul.level-1 li.level-1-li.active a.level-1-a{color:#69AAf1;}#menu ul.level-1 li.left a.level-1-a {float: left;display: block;height: 35px;line-height: 35px;text-decoration: none;padding: 0 15px 0 15px;text-align: center;}#menu ul.level-1 li.right a.level-1-a {float: left;display: block;height: 35px;line-height: 35px;text-decoration: none;font-weight: bold;padding: 0 15px 0px 15px;border-right: 0px none;} #menu ul.level-1 li.first a.level-1-a {background-image: url(/images/global/nav_bg_left.jpg);background-repeat: no-repeat;}#menu ul.level-1 li.last a.level-1-a {background-image: url(/images/global/nav_right.jpg);background-repeat: no-repeat;background-position: top right;}#menu ul.level-2 li.first, #menu ul.level-2 li.last {background-image: none;} /* END: Codes for all IE6+ browsers */ /* START: This block of CSS is only used by post-IE6 browsers */ #menu ul.level-2 {display: inline-block;margin: 0;padding: 0;list-style: none; 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Print & Online Subscriptions   IBJ Daily & Other eNews Alerts   Trial Subscriptions   Subscription Renewals & Address Changes   Subscription Services Q & A     Life sciences venture capital dips again Venture capital surged in the first half of 2012, to $51.6 million in Indiana. But the pace of activity here fell off sharply in the second half of last year, and remained sluggish into 2013.

 

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Most Read Most E-mailed Recent Comments Snooty Fox restaurant closes after 29 years Weatherman Wright feels wronged, leaving WTHR, report says Meteorologist Buchman leaves WISH-TV, as expected FBI searches City-County Building, makes multiple arrests in Land Bank probe WTHR meteorologist leaving for position in Texas Most Read Most E-mailed Recent Comments Group eyes vacant Illinois Street building for charter school A2SO4 architectural firm reopens after temporary closure Anthem tries new 'narrow network' strategy Chrysler confirms state investment of $374 million IU, Marian set to launch wave of docs Most Read Most E-mailed Recent Comments Jake's creepy obsession with every word I type aside, Carter also makes some giant leaps of stereotype. "Disciple, are you basically saying no one is in control at IMS?" No. Mark Miles is the latest guy in charge. "Whenever something you seemingly do not like occurs, you always start blaming it on things like 'the same self interested fools that have been trying to kill the sport for thirty years.' Who is in control at IMS? I thought it was the George family." Uh, the George family OWNS the track (and ultimately the series). The day-to-day management falls to Mark Miles and his team. "Wasn't one of the whole ideas behind Tony Jr's move to control the sport was to actually control the sport? Amazing, they run the show and they still can't control it. What does that say?" It says Mark Miles is allowing himself to be unduly influenced by Euro-centric road racing enthusiasts without regard for history and the approaches that have failed multiple times. "Sorry, you can keep trying to pass the buck to 'cart' and 'champcar' owners. 17 years since the second split, 8 years of total control after the merger. The buck stops with IMS and the Georges. They allowed Junior to run it, they put Bernard in, they brought Miles as the Sports Marketing Savior. It's theirs." One hallmark of those who are militantly pro-cart and whose only frame of reference post-dates 1979 is knee-jerk defensiveness whenever anything that could even remotely be construed as a slam on two of the series that did, in actual fact, die is uttered anywhere. The issues with which we must deal today have little to do with cart. They have been dead and gone for a long time. My big problem is a giant imbalance in scheduling in favor of non-ovals. I want a true balance. I do not want another futile attempt to try and make a form of racing popular in this country that has never been accepted by the mainstream long term. As long as people like Dan Anderson are going to be allowed to purge ovals to please road racers, and owners hire formula specialists from abroad, and the venue imbalance continues being top heavy with twisties I will continue urging common sense and respect for history. It may not do any good, but someone needs to speak up. There are plenty of great choices to allow ten ovals, five natural terrain road courses and five festivals o' speed. 50/50. That makes IndyCar more unique and versatile than anything else, could be an inspired marketing theme and would attract a great cross section of casual fans. IMHO it is high time for IndyCar to quit screwing around and kowtowing to owners who have a proven history of failure where running a series is concerned. Chris was fine. He is professional and polite- but his presentation -especially during dangerous weather-was nothing special while Angie's broadcasts were engaging and very helpful. The best weather person in Indy is Chuck Loftus -love idea of flat Chuck! Welcome Angie to a great team. Thank you Chris time for something new also. Greg, your comments in regards to renters are absurd. Lumping all renters into the category of 'frat boys' is very ignorant. In addition, you do realize that people can rent houses in Broad Ripple. Why aren't you up in arms about people that decide to rent their house out? Greg, renters can and do have an interest in their communities. The younger generation (read: me) doesn't feel the need to buy a permanent location for the long-term, and we've seen what "property values" are good for. But that doesn't mean we want to live in a pit. Renters want nice furnishings, good parks, proximity to necessities, and safe neighborhoods just like homeowners do. To say that all renters are frat boys is extremely ownist of you. The ignorance on display in some of these posts is astounding! This project is absolutely justified. I would assume from the comments here that several of you rarely, if ever, actually make it to downtown and have very little clue about an urban environment. To "The Burbs": Please, stay there! Or, you might want to actually check out Georgia St. on any Friday night during the summer, whenever there is Pacers game or tournament in town... its hardly the forlorn place you make it out to be. To "Fuzzy": Nevermind..... The circle, even if not the largest public space in the city, is certainly the most high profile. In fact, Monument Circle was recently named one of the great public spaces of the entire country. Anyone who would dismiss the need for this investment is simply out of touch. 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