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Category Archives: Health Care Recruiter

Could This Century-Old Law Be Used To Curb Drug Prices? Democrats Think So

The law could allow HHS to use a patented invention â in this case hep C drugs — and the drugmaker wouldn’t be able to do anything about it other than to demand “reasonable” compensation. Democrats want HHS to take this step in hopes that a lower-cost generic could be manufactured. Meanwhile, HHS Secretary Alex Azar says the administration is exploring more actions on cutting high drug costs.

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Medicaid Changes May Just Shift Spending From Families To Administrative Bureaucracy, Experts Warn

Implementing and monitoring the work requirements and other new regulations isn’t going to be cheap. Outlets report on Medicaid news out of Alaska, Virginia, Kansas, Iowa and Missouri.

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First Edition: February 22, 2018

Today’s early morning highlights from the major news organizations.

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After Shooting, ‘Honor How Kids Want To Deal With Their Feelings’

With so much coverage of last week’s grisly school shooting in Parkland, Fla., students, parents and others are struggling to cope.

Christine Sylvest, a child psychologist in Rockville, Md., has a unique perspective. She grew up in Coral Springs, Fla., and attended Marjory Stoneman Douglas High School, the site of the shooting that left 17 people dead. She moved with her family to Ashburn, Va., before her senior year in 1995.

“For me, this was my high school,” she said in an interview with Kaiser Health News on Wednesday. “I can image being in that hallway, and I can only imagine the horror.€

Sylvest talked about how the teenagers at Stoneman Douglas and elsewhere can work through their feelings and how parents and educators should respond. Her comments have been edited for length and clarity.

Q: Weâ€ve seen students at Stoneman Douglas and others around the country march in protests. Is this therapeutic for them?

Yes, absolutely. It is really a healthy way for these teens who have been traumatized to do something with the initial reaction of anger and disbelief and shock. And this is a way for other teens to also deal with their feelings of anger and hopelessness.

Maryland child psychologist Christine Sylvest, who spent three years as a student at Stoneman Douglas High School in Parkland, Fla., says, “For me this was my high school. I can image being in that hallway and I can imagine the horror.” (Aiste Ray/Bee Me Photo)

Q: How can parents help their teenage children deal with their feelings following the shooting?

Parents need not to be afraid to broach the subject with their kids and to ask them what they have seen about it. Kids have seen a lot of information in traditional and social media about the shooting. Parents need to just listen and then validate their child’s feeling by telling them that it is understandable to feel anger, fear and anxiety.

Q: What should parents tell kids who are worried about going to school?

Parents need to emphasize that schools are actually pretty safe places. The school shooting is getting a lot of coverage because it happens so rarely. Emphasize the specific things that their child’s school does to keep them safe, such as fire or intruder drills. And tell them that if they see something [suspicious], they can tell a teacher, administrator or guidance counselor. You can tell kids that anything is possible, but few things like this attack are probable. Give your child concrete information about what  their school is doing to keep them safe.

Q: What are the long-term implications for the mental health and well-being for the kids at Stoneman Douglas?

There are concerns about them developing post-traumatic stress disorder symptoms. Not everyone who went through it will, but some may have symptoms. This includes nightmares and flashbacks and intrusively reliving elements of the trauma. Such things as fire alarms or loud noises can trigger reminders of gunshots. Processing this experience is more of a marathon for some people, and it absolutely could take community and family support and therapy.

Q: Are the children in Parkland, a relatively upscale community, affected differently from the shooting than teens growing up in Chicago or other places where they may be closer to gun violence?

Other areas of the country where gun violence is more common and where children have more experience with it in some ways can make this event even more traumatizing for them to witness. Kids who have not been through a trauma before and generally do not fear for their safety — these are protective factors. So in that community sense, kids in Parkland are more protected from developing symptoms of trauma than kids who are not in safe areas.

Q: How can parents and schools help teens in Parkland try to recover?

Routines are very important to help kids feel normal, but it’s important to honor how kids want to deal with their feelings, and anything within reason should be supported. It is important that kids get back to school, but it may be an individual thing when kids are ready. At Stoneman Douglas, teachers and administrators are really going to have to pay attention to the emotional status of kids and ease them back in. No kid can learn when their feelings are in the way.

Q: Having gone to school at Stoneman, you have a close connection to the shooting. Can you talk about that?

I don’t have family down there anymore. So, for me personally, my memories begin in that high school. I just know it’s affected the whole community.

Any connection we have to something that is happening puts us in the shoes of the victims. Anytime you have a path to empathy — whether it’s being a parent or a high school kid or a band parent or a kid in the junior ROTC — has a powerful point of view that can make these things more upsetting, more traumatic and cause more grief and sadness. That is absolutely normal to feel, and human. And it can be used as a way to not only deepen your understanding and caring for other people, but you can use that closer connection to better talk to your kids or spur you to action such as contributing to a victims’ fund or make sure your kids’ school has an intruder drill.

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Couple Makes Millions Off Medicaid Managed Care As Oversight Lags

CHULA VISTA, Calif. — Norma Diaz and her husband, Joseph Garcia, have dedicated their careers to running a nonprofit health insurer that covers some of California’s neediest residents.

For three decades, they have worked for a Medicaid managed-care plan, Community Health Group, serving nearly 300,000 poor and disabled patients in San Diego County under a state contract funded entirely by taxpayers. They’ve earned above-average ratings for patient care.

And in the process, they’ve made millions of dollars.

Together, Diaz and Garcia made $1.1 million in 2016 and received more than $5 million since 2012, according to the health plan’s tax returns and company data. Diaz€™s compensation as CEO exceeded the pay of several peers at bigger plans in 2016.

Garcia, married to Diaz since 1997, is an outside consultant who serves as chief operating officer. Their health plan, with $1.2 billion in annual revenue, had a profit margin of 19 percent in 2016, the highest of any Medicaid insurer in California and more than six times the industry average.

“This is not only a conflict of interest but egregious overpayments,” Frank Glassner, chief executive of Veritas Executive Compensation Consultants in San Francisco, said after hearing of the payments from a reporter and reviewing the tax returns. “It€™s the family-and-friends plan.”

The arrangement at this midsize California health plan raises broader questions about government oversight as states award billions of dollars in public money to private plans to cover patients on Medicaid, the federal-state insurance program for the poor.

Evidence is mounting that Medicaid’s rapid expansion under the Affordable Care Act has far outstripped the government’s ability to monitor the taxpayer money it turns over to insurers. In California, for instance, some health plans have reaped outsize profits, so large the state is now trying to claw back billions in overpayments, a recent Kaiser Health News investigation found.

Medicaid enrollment has soared to 74 million Americans, from 58 million before the ACA rollout. About 75 percent of them are assigned to plans like Community Health

Group, which receive a flat monthly fee per person to handle their medical care.

Increasingly, states have embraced managed care in hopes of controlling Medicaid costs. Insurers could see further growth as the Trump administration and Congress seek to cut federal spending on Medicaid and shift more of the fiscal burden onto states.

These managed-care contracts can be highly lucrative for the companies involved and their executives, like Diaz and Garcia. Any money left over after spending on medical care and administration is profit or “surplus,” depending on whether the plan is nonprofit.

Federal auditors have warned for years about lax oversight of Medicaid money, a task that primarily falls to states. A 2017 report found that even as managed care has grown in importance, states have fallen behind in collecting essential data from plans.

In the past year alone, government auditors and consultants criticized Illinois, Kansas and Mississippi for poor supervision of Medicaid insurers. Illinois auditors said the state didn’t properly monitor $7.1 billion paid to Medicaid plans in fiscal year 2016, leaving the program unable to determine what percentage of money went to medical care as opposed to administrative costs or profit.

An examination of Community Health Group in California points to systemic flaws in oversight.

For instance, California officials said they do not examine the companies’ public tax filings. As a social welfare nonprofit, Community Health does not pay taxes, but it is required to file returns with the federal government, known as 990s, which provide basic information about operations and finances.

In a review of Community Health’s recent returns, KHN discovered that the company falsely denied — on the񎧟 and 2016 forms — that it was doing business with a family member.

In response, the insurer immediately said that was an error and it was amending the returns to reflect its relationship with Garcia. The company had disclosed the relationship in earlier years.

California’s Medicaid agency, in a statement, said insurers are allowed to set their own conflict-of-interest policies. Asked specifically about Community Health Group, it referred further questions back to the health plan.

Likewise, the state’s chief insurance regulators at the Department of Managed Health Care said in a statement that insurers are not required to submit information on executive compensation and the state does not set standards for that. They do review the pay of outside contractors.

Diaz and Garcia, sitting together at a conference table in the CEO€™s office on a recent weekday, said they were proud of their long record of helping disadvantaged people. The couple insists there’s nothing wrong with mixing work and family.

Community Health Group, with $1.2 billion in annual revenue, had a profit margin of 19 percent in 2016, the highest of any Medicaid insurer in California and more than six times the industry average. (Chad Terhune/California Healthline)

Diaz, 56, said her husband reports not to her but to a fellow executive, the associate CEO, and his consultant’s role was approved by the health plan€™s board. “I don’t feel for me it’s a conflict of interest because he was here for many years long before we ever got married, so we got used to a working relationship,” she said.

Garcia, 66, served as the company’s on-staff chief operating officer for about 15 years and then switched in 2011 to the role of consultant (acting as COO), which ultimately raised his pay. He said the couple has never tried to hide their personal relationship from the state or anyone else.

“I understand from the outside someone might say ‘Oh my God. That’s a conflict.’ But it’s not. It’s irrelevant that I’m her husband,” he said. “I don’t see how it’s a misuse of public funds. The expense for a chief operating officer would be made no matter what, and my compensation is fair.â€

His total compensation reached $487,386 in 2016, according to the insurer. From 2012 to 2016, the health plan paid him a total $2.3 million.

Under his consulting agreement, Garcia is paid $275 an hour and can make as much as $572,000 annually, according to documents obtained by KHN through a public records request. The health plan had requested the information be kept confidential, but the state released it.

In September, regulators at the managed-care department asked Community Health Group how Garcia’s pay was determined. The company submitted a pay range for chief operating officers that it said was drawn from industry surveys.

Community Health said it picked the maximum figure in the range, $442,863, to reflect Garcia’s many years of experience in health plan operations.” It then increased his pay range by 30 percent because it said Garcia doesn’t receive benefits. The plan called his current salary — which in 2016 fell below the maximum allowed — “both fair and competitive.

An agency spokesman said the state’s review of the matter is closed.

In early 2012, the insurer hired a new executive as COO, but he left the following year. Garcia stayed on as a consultant during that time at roughly $400,000 annually, then resumed his COO duties. His current consulting agreement runs through 2021.

“We don’t want to lose Joseph. He has a tremendous amount of knowledge,” said Albert Vitela, a retired San Diego police detective who is the plan’s co-founder and chairman.

As for Diaz, she has received $2.8 million in salary, benefits and other compensation over the five years ending in 2016. Her 2016 pay of $604,502 exceeded that of the CEO of the Inland Empire Health Plan in Southern California, which has four times the enrollment.

(Story continues below.)

Last year, federal auditors examined compensation for the 133 top paid executives at managed-care organizations in seven states, focused on health plans that get more than half of their revenue from Medicaid.

For 2015, the top executives earned $314,278, on average — more than double what state Medicaid directors earned, according to the report. Auditors didn’t find major differences in pay between for-profit and nonprofit Medicaid plans.

Executive compensation has risen as Community Health Group recorded hefty profits.

State officials had raised the rates paid to Medicaid plans in anticipation of the Affordable Care Act rollout in 2014, but the costs for newly insured patients weren’t as high as predicted. After the KHN investigation into insurer profits published in November, California’s Medicaid director, Jennifer Kent, vowed to recoup billions of dollars in excessive payments from insurers in coming months.

From 2014 to 2016, Community Health Group recorded profits of $344.2 million, according to state data obtained and analyzed by Kaiser Health News. Diaz said her insurer expects to return more than $100 million to the Medicaid program.

Robert Stern, a government ethics expert and former general counsel of California’s Fair Political Practices Commission, welcomed the scrutiny of Medicaid profits. But he said the business practices at Community Health Group suggest there is much more to be done.

“Taxpayer money should be spent as wisely as possible,” Stern said. “It’s not their money. It’s our money.”

Do you have a Medicaid managed care story? Contact Senior Correspondent Chad Terhune at cterhune@kff.org or via Signal at 657-226-0625

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Viewpoints: ACA’s Future? Pros And Cons Of Limited-Care Insurance; Amazon Can’t Remedy Health Care

Editorial pages highlight these and other health stories.

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Drug Prices Bill May Put Maryland On Direct Collision Course With Pharma Industry

News outlets report on stories related to pharmaceutical pricing.

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Perspectives: We Need Less Government And More Transparency To Curb High Drug Costs

Read recent commentaries about drug-cost issues.

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State Highlights: Md. Lawmakers Consider State Mandate For Insurance; $850M Agreement Reached In Minn. Water Contamination Lawsuit

Media outlets report on news from Maryland, Minnesota, New York, Louisiana, Georgia, Missouri, Iowa and California.

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It Turns Out, Knowing Your Genetic Risk Data Doesn’t Actually Help You Lose Weight

Previous research has suggested that analyzing a person’s genes could help determine which weight loss strategy would work best for them. But that doesn’t seem to be the case.

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