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::;
Calendar
26 April 2012
E-Mail
info@payersandproviders.com with
the details of your event, or call
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California Edition
Nearly half of Californias recent nursing
graduates are without employment in the eld
18 months after graduation, raising concerns
that the recent push to stretch educational
capacity could fall by the wayside.
A study conducted last fall by the
Oakland-based California Institute for
Nursing and Health Care concluded that 43%
of nursing school graduates were unable to
obtain jobs in the eld 18 months after they
obtained their license. The numbers are
similar to a survey CINHC conducted in 2010,
when it found 42% of newly minted nurses
could not nd work for a prolonged period.
Industry observers blame a variety of
factors for the tough job market, including the
reluctance of older nurses to retire, and the
resistance among many new graduates to
relocate for jobs with providers in suburban or
rural areas.
I love the Bay Area, my family is here,
and I dont want to move. I hear that all the
time, said Suzette Cardin, assistant dean of
student affairs at the UCLA School of Nursing
who was the surveys principal investigator.
Cardin added that nurses who graduate from
community colleges with an associate degree
are also having a hard time getting hired.
Of those nurses who could not nd work,
42% said it was because they were told a
bachelors degree was preferred or required.
That was the second most-cited answer for not
getting a job, followed by a lack of
experience, at 92%.
Those nurses with far more experience are
reluctant to leave the profession. About 14%
of the total nursing workforce in California is
older than 60 years of age, according to
CINHC data. Deloras Jones, CINHCs
executive director, observed that many cannot
leave because their retirement portfolios took
big hits or they have a family member who is
out of work.
We know the unemployment of a spouse
or the need for nurses to work extra hours is
keeping a lot of them in their jobs, she said.
The data are a sobering reection of the
devastation the Great Recession has inicted
on what has long been considered a robust
job source. Five years ago, nurses were being
lured to positions with ve-gure signing
bonuses. And despite the job stagnation to
have hit Californias nursing sector in the
intervening years, demographers predict
nurses will remain in short supply for decades
to come.
April 30-May 1
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Many New Nurses Cant Get Jobs
Study Says Nearly Half Statewide Are Seeking Work
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Continued on Next Page
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In Brief
Lucile Packer
Childrens Begins Cord
Blood Donor Program
Lucile Packers Childrens Hospital in
Palo Alto has created a cord blood
donation program with the intent of
helping potential stem cell transplant
recipients.
The hospital is encouraging
parents of newborn children to
donate blood from their umbilical
cords to the international stem cell
transplant registry. Cord blood is rich
in stem cells, which can be used for a
variety of transplant purposes,
particularly to supplant bone marrow
transplants in leukemia patients,
which are highly invasive and can be
difcult to match donors.
"This is a public service project
to expand the donor pool," said Rajni
Agarwal, M.D., the clinical director
for pediatric stem cell transplantation
at Packard Children's and medical
director of the new collection
program. "It will help physicians do
more stem cell transplants and save
more lives."
The donated cord blood will be
screened by MD Anderson Cancer
Center in Houston and then entered
into the registry.
The program was started after
Stanford Law School professor
Amalia Kessler could not nd any
places to donate cord blood after she
had her rst child in 2009, even
though she and her husband had
been bombarded with solicitations
from rms that bank cord blood for
the personal use of a newborns
family.

CHLA Finds Potential
Chemotherapy
Alternative
Researchers at Childrens Hospital
Los Angeles say they may have found
Continued on Page 3
NEWS
Im not as worried about people not
wanting to choose nursing as a career as I am
about policymakers wanting to put resources
somewhere else, Jones said. She added that
California has increased the number of
nursing school slots by 63% over the past
decade, primarily through private and
government grants to expand existing
programs and the opening of new nursing
schools.
Just under 1,500 nursing graduates were
surveyed by CINHC, representing about 10%
of the 15,780 who were newly licensed in
California between April 2010 and August
2011. More than 70% were under the age of
35, and 87% were female.
A total of 57% were in their rst jobs in
nursing, and 62% were employed by acute
care hospitals.
Of those who found work, 70% found
Two medical groups serving Los Angeles and
Orange Counties have been selected by the
Centers for Medicare and Medicaid Services
to participate in the shared savings program
for accountable care organizations.
Premier ACO Physicians Network in
Lakewood and AppleCare Medical ACO in
Buena Park are expected to have about
20,000 lives combined under the three-year
program.
Altogether, 27 ACOs were selected by the
CMS nationwide to participate in the project,
which is aimed at slowing the cost of caring
for Medicare beneciaries. Late last year, it
announced 32 pioneer participants in ACO
programs.
We are excited to welcome Applecare
and Premier as partners with Medicare and
look forward to working with them to
improve care for Medicare beneciaries in Los
Angeles and Orange counties," said CMS
acting Administrator Marilyn Tavenner.
AppleCare co-founder and chief medical
ofcer Surendra Jain, M.D., said the cost
savings goal for his ACO was relatively
modest: 5% over three years. Altogether, it
will care for 7,500 beneciaries under the
shared savings program.
Jain said AppleCare would use a
combination of technology and carefully
coordinated care to reduce costs. For
example, medical records will be closely
scrutinized to determine which of the
participating Medicare enrollees has diabetes,
which can lead to multiple hospitalizations if
not kept under control.
We will go after those beneciaries with
diabetes and go after controlling their blood
sugar. It will be a proactive approach as
opposed to episodic care, he said.
Additionally, resources will also be
focused on those enrollees who have the
greatest incidents of other chronic illnesses,
such as renal disease and require dialysis.
AppleCare also wants to reduce the
readmission rates within 30 days of an initial
hospitalization. Nationwide, the readmission
hovers at between 15% and 20%. AppleCares
overall readmission rate is about 13%, which
Jain believes is a realistic objective for its
shared savings population.
Although providers participating in the
project are paid directly by Medicare, Jain
hopes the project will increase revenue
sharing with AppleCare doctors.
Its all speculative, but a 5% to 10%
bonus payment would be nice, he said.
their jobs within six months of searching.
Among those without nursing work, 28% held
other positions, although most of them were
part-time or seasonal jobs, such as assisting
with the administration of u shots.
Although Cardin noted that many nurses
are not getting positions because they did not
engage in an intensive job search after
graduation, 80% of those surveyed said they
were interested in taking unpaid internships.
More of those nurses may get that wish.
Jones said that CINHC has been pushing
transition programs operated in conjunction
with hospitals and colleges. Graduates
undergo more training that provides a
transition from academia to a clinical setting,
and their critical thinking skills are better
developed.
Jones said 80% of the participants in
those programs soon obtain a nursing job.
Nurses (Continued from Page One)
ACOs Named For Shared Savings
AppleCare, Premier Get Go-Ahead From CMS
!"#$%!&'(!&)*&!+!&)*&!,-!./-0#1!2!.#34$50#1!.6,%$17$89(!::;
Page 3
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In Brief
a new way to kill cancer cells within
children who are suffering from acute
lymphoblastic leukemia (ALL) that is
an alternative to traditional
chemotherapy.
The method uses a fusion of a
toxin to a protein that is able to target
cells affected by ALL directly.
Although these are laboratory
studies, we are very encouraged by
our ndings and were actively
developing this approach to test in
the clinic, said Nora Heisterkamp,
one of the researchers on the project.
Although ALL has a relatively
high cure rate among pediatric
patients, recurrences of the disease
are primarily linked to the
development of resistance to the
drugs commonly used to treat the
cancer. ALL also accounts for about
30% of adult leukemia cases.
Healthcare Mergers Up
In First Quarter
Healthcare mergers accumulated
considerable momentum during the
rst quarter of 2012, according to a
new report by Connecticut-based
M&A tracking rm Irving Levin
Associates.
Altogether, 153 deals occurred
during the rst quarter of the year, up
14% from the rst quarter of 2011,
when 134 were consummated. Long-
term care facilities had the most
transactions with 39, although that
number was unchanged from the year-
ago quarter. A total of 23 deals were
reported in the hospital sector,
compared to 22 during the rst
quarter of 2011. Home healthcare
reported 11 deals, nearly double the
six reported during the rst quarter of
2011.
Quarter over quarter, the
volume of healthcare M&A deals
keeps increasing as both strategic and
nancial buyers invest more of their
capital in the various sectors of
healthcare, said Sanford Steever, an
Irving Levin editor. Despite rumors of
its demise in the general media, the
M&A market for healthcare is alive
and thriving.
NEWS
Researcher E. Richard Brown Dies
Co-Founded Influential UCLA Health Policy Center
E. Richard Brown, a UCLA professor who
was perhaps the most recognized healthcare
policy researcher in California, died
suddenly on April 20. He had suffered a
stroke while making a presentation in
Kentucky earlier this month, UCLA
announced.
Brown was 70, and had only
recently retired from the UCLA
Center of Health Policy Research,
which he had co-founded in 1994.
Browns intent in creating the
center was to take the volumes of
disparate health data churned out
by Californias researchers and turn
it into practical reports that the
public could easily understand, as
well as advocate for changes in
health policy in a non-partisan
manner.
The center regularly issues reports on
wide-ranging topics such as how the
economic climate impacted insurance rates
in California, how unprepared the states
residents are for paying for their healthcare
in retirement, and how caregivers for Medi-
Cal enrollees often labor in near-poverty and
hunger. They are regularly reported by state
and national media.
He understood that good-quality
information was the engine that powered all
the things he cared most passionately about,
from expanding health insurance coverage
to feeding and caring for the state's poorest
and most marginalized residents, said
Robert K. Ross, M.D., chief executive ofcer
of the California Endowment in Los Angeles.
Much of the data for these studies came
from the California Health Interview Survey,
which Brown helped create more than a
decade ago. The survey gleans data from
extensive interviews conducted with the
occupants of more than 50,000 households
statewide. Its ndings were used by
Californias lawmakers in attempts to create
healthcare reform late in the prior decade.
Brown himself co-wrote Californias rst
stab at single-payer healthcare legislation in
the early 1990s, and served as an
advisor to both the Clinton and
Obama administrations.
Brown was raised by his mother
in New Jersey after his parents
divorced when he was 12, and had
been traumatized by the experience
she went through after his brother
was injured in a bicycle accident.
"My mother always remembered
the stigma she felt when the
eligibility workers at the county
hospital grilled her about her income
and were very demeaning to her
because she couldn't pay the medical bills,"
Brown had recalled.
He earned a doctorate in sociology from
the University of California at Berkeley, and
eventually appointment to the UCLA faculty
as a health services and community health
sciences professor.
In recent years, Brown served a term as a
president of the American Public Health
Association.
"Rick was a passionate teacher, an
innovative and acclaimed scholar, and a
formidable advocate for health. The creation
of CHIS stands out among his many
professional accomplishments, said Linda
Rosenstock, dean of the UCLA Fielding School
of Public Health. It is without question the
leading source of self-reported health data in
California."
Brown is survived by his wife Marianne,
two daughters, a granddaughter and brother
Julian Horowitz.
HEALTHCARES BEST ADVERTISING VALUE
]
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prot executives statewide. There is no better venue for marketing
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CALL (877) 248-2360, ext. 2
OR CLICK HERE
E. Richard Brown
!"#$%!&'(!&)*&!+!&)*&!,-!./-0#1!2!.#34$50#1!.6,%$17$89(!::;
Payers & Providers Page 4
OPINION
Negotiating The Maze Of Networks
Looking For Signs to Partner Up Regionally or Nationally
Teresa Koenig, M.D. and Jay Warden are
sensenior vice presidents with The Camden
Group.
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Health plans around the country have slowly
but steadily been reintroducing tiered and
narrow networks to their product offerings as
they search for ways to differentiate themselves
and offer employers lower-cost products
without signicantly reducing benet levels.
Tiered networks allow beneciaries to
choose from different levels or tiers of
providers based on a cost/quality value
equation. Participants can lower their cost
sharing by choosing tier one providers who
offer the best value according to the
health plan.
Narrow networks are networks
that offer a limited choice of
providers. In many cases, only those
facilities and providers afliated with a
particular hospital, medical group, or health
system. Health plans have been aggressively
introducing narrow network plans across the
country.
In some cases, such as PepsiCo with Johns
Hopkins and Lowes with the Cleveland Clinic,
employers are contracting directly with
nationally known health systems for high-cost
and complex procedures and services.
As these arrangements become more
commonplace, providers need to understand
the driving forces behind such arrangements
and better prepare themselves for success
where such plans are being offered.
There are three primary driving forces for the
proliferation of successful tiered or narrow
networks in any given market.
First, in addition to publicly available
government data, most large payers have a
substantial amount of cost and quality data that
can be used to index the value provided by
individual providers. It is increasingly difcult
for providers to dispute whether they are being
excluded or placed in a lower tier unfairly.
Secondly, in most large markets, there has
been enough consolidation of facilities and
physicians that managing tiered networks is not
as onerous. Single organizations are able to
offer enough geographic and comprehensive
services coverage to be considered for a
narrow or exclusive network.
Lastly, many larger, proactive and
sophisticated provider organizations have not
only developed the geographic and service
offering diversity to be considered for a narrow
network, but they have successfully worked
with their physicians to demonstrate value
through their own cost and quality data.
For those provider organizations considering
partnering with providers, there are three key
critical success factors.
First, understand your current value
proposition. If you have not invested in the data
systems, decision tools, or analytical expertise to
fully understand how your cost and quality data
compare to others, consider outsourcing these
capabilities. In addition, many health plans
would like to offer alternatives to other provider/
payer products and are willing to partner with,
and even fund, efforts by competing
providers to develop competing narrow
or tier one networks.
Second, develop critical mass. If
your organization and its physician
partners cannot cover a substantial portion of
your service area alone, it is time to partner.
Even if you are not ready to move toward further
consolidation discussions with crosstown
competitors, developing an alternative network
to a major aggressor in your market can show
your physicians that partnership with you is not
a dead end.
Third, cover all bases from a service-line
perspective. Some large and sophisticated health
systems have recognized that they may not be
able to compete with local academic systems or
nationally known organizations in certain
specialties such as high-end cancer or
cardiovascular care, so they have developed
national relationships with the likes of M.D.
Anderson, The Cleveland Clinic, or Duke Health
to brand their programs and give employers
considering a narrow network the condence
that the local health system can deliver
nationally known specialists and programs.
Now is the time to begin discussions with
payer partners, if you have not already started. It
is likely that your competitors are already
moving in that direction, and you will be
surprised how ready and willing payers in your
market are to consider alternatives and discuss
these network approaches if you can clearly
demonstrate your value proposition.
By
Teresa Koenig, M.D.
and Jay Warden
Op-ed submissions of up to 600 words are
welcomed. Please e-mail proposals to
editor@payersandproviders.com
!"#$%!&'(!&)*&!+!&)*&!,-!./-0#1!2!.#34$50#1!.6,%$17$89(!::;
MARKETPLACE/EMPLOYMENT
Payers & Providers Page 5
!
MarinSonoma !PA is a heallhcare nelwork represenling our
local physician members. It is the network providing health
care and administering benefits for HMO members in Marin
and Sonoma Counlies. MarinSonoma !PA is made up oI experl
medical and administrative staff dedicated to ensuring that you
receive the highest quality health care available.
UTILIZATION REVIEW NURSE SUPERVISOR
Novato, CA
Job Summary: This position supervises U/R and Case
Management activities for commercial and Medicare enroll-
ees. Candidate must be knowledgeable about Nurse Practice
Act, JCAHO, NCQA, HMO and Medicare rules, pertinent state/
federal regulations, and hold a current, unrestricted California
Registered Nurse license.
Principal Accountabilities: Plans, organizes, and oversees
UR Nurses to provide day-to-day oversight for UR activities.
Evaluates accuracy, productivity, timeliness and ensures customer
satisfaction. Demonstrates a comprehensive understanding of
contracts, including division of financial responsibility regarding
making UR determinations. Possesses ability to research medical
necessity criteria and maintain current knowledge of UR, Medical
and Risk Management Policies. Ensures collaboration between
Benefits Coordinators and UR RNs. Ensures organizational adher-
ence to ICE, NCQA and health plan regulatory requirements, and
maintains clinical skill and knowledge necessary to set standards.
Assists with identifying patterns and trends, and develops and
implements corrective actions when necessary. Reviews referral/
service requests on assigned patients in accordance with NCQA
timeliness standards and health plan benefit structure. Educates
and supports members in accessing care using their HMO ben-
efits. Identifies and refers patients to disease management and
Wellness Programs when relevant. Assesses members physical,
psychological, social, environmental, financial and functional sta-
tus, and informs treating physician of clinically relevant findings.
Provides complex case management to patients consistent with
Marin IPA Case Management Policy 029.
Qualifications: Current California RN License. Bachelor Science
Degree, Nursing. Minimum 5 years of supervisory and 7 years
of clinical experience. Experience required in one or more of
the following: Utilization Management, Health plan, Medicare,
Case Management. Certification in Case Management, pre-
ferred. Bilingual, Spanish, preferred. Knowledge of health care
and medical procedures. Interpersonal/human relations skills.
Attentiveness to detail. Supervisory skills including timely
feedback. Ability to prioritize duties and delegate responsibili-
ties. Good clinical judgment and critical thinking skills. Ability to
organize and prioritize workload. Computer literacy.
To apply, please send your resume in text, .doc or .pdf
format to wseeley@marinsonomaipa.com
Please reference job posting: IPA2012-5
Please visit www.LaSalleMedical.com for
further details and to submit resume
LaSalle Medical Associates is one of the largest
Independent Practice Association (IPA) groups in the
Inland Empire and operates four (4) primary care clin-
ics. We are hiring three (3) compassionate, mission-
oriented, board eligible physicians in Family Medicine,
Internal Medicine, and Pediatrics. Candidates must be
committed to serving a diverse population with cour-
tesy and respect. Our clinics are positive work environ-
ments with a fully staffed support team. Join us to
share your passion for patient care and diversity.
Job Location for positions: San Bernardino, CA and/
or Hesperia CA.
Our benefit package includes:
Competitive Base Salary
Malpractice coverage (provided by CAP-
Cooperative of American Physicians)
9 Paid Holidays
Medical/Dental/Life coverage
401(k) Retirement Plan
Interested candidates may fax their CV to (909)380-8026,
or email a.canton@lasallemedicalassociates.com
PRIMARY CARE PHYSICIAN
INLAND EMPIRE
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Payers & Providers
MARKETPLACE/EMPLOYMENT
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It costs up to $27,000 to fill a healthcare job*
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Employment listings begin at just $1.65 a word
Call (877) 248-2360, ext. 2
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Or visit: www.payersandproviders.com
*New England Journal of Medicine, 2004.
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