WIS Investigates: The business of health care

COLUMBIA, SC (WIS) -

Health care in South Carolina is a $35 billion a year business, just ask an economist like Lynn Bailey.

"It is a business," said Bailey. "It is not a charity, it's not a feel good."

One of the biggest in that business: hospitals. The Kaiser Family Foundation found hospital care amounted to 40.4% of health care costs in the state.

"We now spend on average, probably, $8,500 per person in South Carolina for every man, woman, and child on health care," said Bailey. "That's the $35 billion."

The top three of the Midlands' largest employers are Palmetto Health Alliance, Blue Cross & Blue Shield of SC, and Lexington Medical Center.

Why does that matter? You're never sick, so this doesn't affect you right?

Wrong, health care costs can turn up in unexpected places, like the price of a new car.

Consider this: When G-M sells a vehicle, $1,400 of what you pay is paying for GM's employees' health insurance.

The National Institute of Medicine estimated in 2009, $2.7 trillion in the U.S. is spent on health care. But they claim $765 billion is potentially excess spending. That's right: billions on what they consider unnecessary tests or procedures.

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WIS Investigates: The business of health care

Sage Offers Health Care Reform Track at Sage Summit 2013 and Announces Premier Sponsors of the Conference

WASHINGTON DC--(Marketwired - Jun 27, 2013) - Sage North America today announced a new learning track around health care reform at Sage Summit 2013, along with the premier sponsors of the conference. Sage Summit is the annual conference for the Sage ecosystem that includes partners, customers, and employees, to be held at the Gaylord National Resort and Convention Center in Washington, D.C. July 21-26, 2013.

Learning Track Focuses on Prepping Small and Medium Businesses for Health Care Reform Provisions

The Patient Protection and Affordable Care Act (PPACA) is the most significant regulatory overhaul of the US Health Care System since the passage of Medicare and Medicaid in 1965. New regulations will undoubtedly affect nearly all small and midsized businesses, and in an effort to prepare its customers with the tools they need to understand the various impacts of the PPACA, Sage has launched a new learning track for attendees of Sage Summit 2013, breaking down the subject matter by topic.

Attendees of the all-day learning track will walk away understanding what the PPACA means for their business, how it will impact the bottom line, what responsibilities they have as business owners, executives, and HR managers, and what steps should be taken now to prepare for provisions starting in 2014. Health care expert Henry Aaron of the Brookings Institute and President and CEO of BenefitMall Bernard DiFiore will be on-site at Sage Summit to lead content-rich keynote sessions followed by breakout sessions that focus on key provisions and compliance requirements, benefit options, health insurance carriers, and what all of this means for business owners, their employees, and their bottom line.

More information on the Health Care Reform Learning Track is available at http://na.sage.com/sage-summit/sessions/health-care.

Premier Sponsors

Platinum Sponsor - Scanco (www.scanco.com) has been leading the way in mobile bar-coding applications for Sage since 1989. Scanco's products include Waterhouse Automation, Manufacturing Automation, Sales Automation, and Route Delivery. Scanco now offers seamlessly integrated solutions for Sage 100 ERP and Sage 500 ERP on iOS, AnDroid, and Windows Mobile devices.

Strategic Sponsor - Microsoft http://www.microsoft.com Founded in 1975, Microsoft (NASDAQ: MSFT) is the worldwide leader in software, services, and solutions that help people and businesses realize their full potential. Microsoft Office 365 provides anywhere access to your familiar Office applications, email, calendar, video conferencing and most up-to-date documents, across your devices -- from PCs to Macs to Windows 8 mobile devices.

Gold Sponsor - ScanForce Software (www.ScanForceSoftware.com) provides automation software for Sage 100 ERP that revolves around the use of bar-code scanning. Automation software includes: Waterhouse Automation, Thermal Label Printing, Remote Sales, and Light Manufacturing.

Silver Sponsor - ERPnGo.com and Bronze sponsors - Altec, ACS Group, Edisoft, Inc., IN-SYNCH for Sage 100 ERP, SalesFUSION, SWK Technologies, Inc., and TUG

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Sage Offers Health Care Reform Track at Sage Summit 2013 and Announces Premier Sponsors of the Conference

Health Care REIT to Acquire Venture Partner’s Stake in $173 Million Deal

By Dow Jones Business News, June 27, 2013, 05:33:00 PM EDT

By Tess Stynes

Health Care REIT Inc. ( HCN ) agreed to acquire joint-venture partner Merrill Gardens' 20% equity interest for $173 million, in a deal in which assisted-living company Emeritus Corp. ( ESC ) will operate the properties under a long-term master lease.

The deal includes pro rata mortgage debt of $82 million.

Under the agreement, Health Care REIT, a senior-housing and health-care-focused real-estate investment trust, will expand its long-time relationship with Emeritus--a provider of assisted living, memory care and home health-care services.

Health Care REIT Chairman and Chief Executive George L. Chapman said "Their strong existing footprint in the markets where this portfolio is located will allow for a seamless transition and value creation over the long-term."

Mr. Chapman also said that privately held Merrill Gardens decided to concentrate its efforts on new development projects, but will remain a strategic partner for Health Care REIT.

Emeritus will lease a total of 38 senior housing communities, representing approximately 4,400 units. The communities are concentrated primarily in Washington and California, with more than 40% of the units designated for independent living.

Rent in the first year of the 15-year lease is set at $54 million and will increase each year. Emeritus has the option to increase the lease for an additional 15-year term.

Under the deal, set to close in the third quarter, Emeritus will pay a $10 million management-contract termination fee to Merrill Gardens.

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Health Care REIT to Acquire Venture Partner's Stake in $173 Million Deal

Health Care REIT starts new leasing agreement

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Health Care REIT starts new leasing agreement

Toledo-based real estate trust Health Care REIT, Inc. said Thursday that it has entered into a leasing agreement with Emeritus Senior Living on a portfolio of 38 high-quality senior housing communities that are currently owned in an 80-20 joint venture between Health Care REIT and Merrill Gardens.

The real estate trust will acquire Merrill Gardens 20 percent equity interest in the joint venture for $173 million, which includes mortgage debt of $82 million.

The transaction is expected to close in the third quarter upon receipt of regulatory and lender consents.

This transaction reflects the flexibility of our business model and the power of our relationship investing platform, said George L. Chapman, Chairman and CEO of Health Care REIT. We are excited to grow our longtime relationship with Emeritus. Their strong existing footprint in the markets where this portfolio is located will allow for a seamless transition and value creation over the long-term.

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Health Care REIT starts new leasing agreement

Payer and Provider Organizations Gather to Discuss Opportunities in Government Sponsored Health Care

WASHINGTON, DC--(Marketwired - June 27, 2013) - More than 200 executives representing over 80 health care organizations met in Washington, D.C. for the 2ndGorman Health Group Forum on the future of government sponsored health care programs.

The exclusive event provided an intensive cross-functional examination of the state of government health care programs to support health plans and providers exploring new opportunities in the health insurance exchanges, the dually eligible expansion, and the continued growth of the Medicare Advantage and Part D markets.The cross-functional agenda brought CEOs, Chief Medical Officers, Compliance leaders, analysts, and Network management executives alike.The faculty was led by GHG's subject matter experts and also included innovative leaders from health plans and provider organizations across the country, and discussions centered on the industry's entry into an "age of austerity and accountability" and the subsequent implications on models of care, service and delivery.

"The GHG Forum is only in its second year, and the industry's tremendous response only underscores the reality that government programs are at a crossroads. We face tremendous policy and regulatory challenges, and yet the opportunities before us surpass anyone's wildest expectations.Only those organizations ready and able to act decisively and swiftly implement an integrated approach to government sponsored health care programs will succeed in this land grab," said John Gorman, Founder and Executive Chairman of Gorman Health Group.

Across the country, health care organizations are facing a transition in their business model. The hallmark of this paradigm shift is a proactive approach to member management. To ensure long-term survival, plans must master a new approach to their service model, become data-driven in compliance and develop performance targets and learn to manage to them.To support health plans in this effort, GHG has launched both the annual GHG Forum and the Point, a unique information-distribution platform that collects and summarizes regulations, provides extensive analysis of timely topics, and gives members priority access to GHG Forum materials, recorded webinars, white papers and memos from GHG subject matter experts and more.

"Our friends and clients have a challenging road before them," said Gorman."Our goal is to provide the timely and meaningful information they need to empower decision making and support the actual implementation of health reform."

About Gorman Health Group | http://www.gormanhealthgroup.com

Gorman Health Group is a national health care professional services and software company staffed by subject-matter experts, former health plan executives and seasoned regulators. For over 16 years, hundreds of clients serving millions of beneficiaries have leveraged the strategic counsel and technology solutions of GHG to maintain compliant operations, improve market position, and advance growth objectives. Learn more at gormanhealthgroup.com.

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Payer and Provider Organizations Gather to Discuss Opportunities in Government Sponsored Health Care

Health care research collaboration between NZ and Canada

27 June 2013

Community-based primary health care research collaboration between New Zealand and Canadian researchers

The Health Research Council of New Zealand (HRC) has announced funding for a research collaboration in which New Zealand and Canadian researchers will work together to explore ways to better care for older people with high health needs in the community.

This joint research project is being led by Professor Toni Ashton at The University of Auckland in New Zealand and by Dr Walter Wodchis at the University of Toronto in Canada. The research will be carried out over five years and will seek to identify and implement innovative integrated community-based primary health care models that address the health and social needs of older adults with complex care needs.

The HRC and the Canadian Institutes of Health Research (CIHR) will jointly fund the research project, with the HRC investing $1.2 million and the CIHR investing $2.5 million. This joint funding partnership builds on the existing history of partnering and collaborative work between the two organisations.

The overall objective of this funding initiative is to develop innovative solutions to improve the delivery of community-based primary health care, with a focus on key areas such as chronic disease prevention and management, and access issues for vulnerable populations.

The HRC component of this research partnership is funded through the HRC Partnership Programme. The Canadian component of this research partnership is part of the CIHRs wider transformative community-based primary health care initiative, which seeks to fund community-based primary health care with a range of external partners, both within Canada and internationally.

Go to http://www.cihr-irsc.gc.ca/e/47018.html to view the Canadian Institutes of Health Research media announcement about this collaboration.

Implementing models of primary health care for older adults with complex needs

60 months, $1,199,925

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Health care research collaboration between NZ and Canada

Health Care REIT Enters Into Triple Net Lease With Emeritus Senior Living on Seniors Housing Portfolio

TOLEDO, Ohio--(BUSINESS WIRE)--

Health Care REIT, Inc. (HCN) announced today that the company has agreed to enter into a triple net lease with Emeritus Senior Living (ESC) on a portfolio of 38 high-quality seniors housing communities currently owned in an 80%/20% joint venture between Health Care REIT and Merrill Gardens. Health Care REIT will acquire Merrill Gardens 20% equity interest in the joint venture for $173 million, which includes pro rata mortgage debt of $82 million. The transaction is expected to close in the third quarter upon receipt of regulatory and lender consents.

This transaction reflects the flexibility of our business model and the power of our relationship investing platform, said George L. Chapman, Chairman and CEO of Health Care REIT. We are excited to grow our long-time relationship with Emeritus. Their strong existing footprint in the markets where this portfolio is located will allow for a seamless transition and value creation over the long-term. Merrill Gardens has made the decision to concentrate its efforts on new development projects. Merrill Gardens will continue to be a strategic partner for Health Care REIT.

Transaction Highlights

Predictable, Attractive Rent Growth with Upside Potential

This high quality, well-located portfolio broadens and strengthens our service offerings in key markets, allowing us to create significant long-term value, said Granger Cobb, CEO and President of Emeritus. We are very pleased to welcome these Merrill Gardens communities to our family and to expand our relationship with Health Care REIT.

Emeritus has an excellent reputation for quality and a proven track record of success that will benefit our residents, said Bill Pettit, CEO of Merrill Gardens. We are proud to have created such a strong portfolio of communities and will assist Emeritus to ensure a smooth transition. We are focused on our development strategy and continuing our nearly 20-year partnership with Health Care REIT.

About Health Care REIT, Inc. Health Care REIT, Inc., an S&P 500 company with headquarters in Toledo, Ohio, is a real estate investment trust that invests across the full spectrum of seniors housing and health care real estate. The company also provides an extensive array of property management and development services. As of March 31, 2013, the companys broadly diversified portfolio consisted of 1,133 properties in 46 states, the United Kingdom, and Canada.

About Emeritus Senior Living. Emeritus Senior Living, based in Seattle, Washington, is the nations largest assisted living and memory care provider, with the ability to serve nearly 50,000 residents. More than 30,000 employees support nearly 480 communities throughout 45 states. Emeritus offers the spectrum of senior residential choices, care options and life enrichment programs that fulfill individual needs and promote purposeful living throughout the aging process. Its experts provide insights on senior living, care, wellness, brain health, caregiving and family topics.

Forward-Looking Statements. This document may contain forward-looking statements as defined in the Private Securities Litigation Reform Act of 1995. When the company uses words such as may, will, intend, should, believe, expect, anticipate, project, estimate or similar expressions, it is making forward-looking statements. Forward-looking statements are not guarantees of future performance and involve risks and uncertainties. The companys expected results may not be achieved, and actual results may differ materially from expectations. This may be a result of various factors, including, but not limited to, the satisfaction of closing conditions to the transaction, including, among other things, the obtainment of certain lender consents; the parties performance of their obligations under the transaction agreements; the receipt of applicable healthcare licenses and governmental approvals; unanticipated difficulties and/or expenditures relating to the transaction; the companys ability to enter into new joint venture agreements and management contracts; the cooperation of joint venture partners; the status of capital markets, including availability and cost of capital; changes in financing terms; competition within the health care and senior housing industries; negative developments in the operating results or financial condition of the operator/tenant, including, but not limited to, its ability to pay rent; operator/tenant bankruptcies and insolvencies; governmental regulations affecting Medicare and Medicaid reimbursement rates and operational requirements; liability or contract claims by or against the operator/tenant; issues facing the health care industry, including compliance with, and changes to, regulations and payment policies, responding to government investigations and punitive settlements and the operator/tenants difficulties in cost-effectively obtaining and maintaining adequate liability and other insurance; and changes in rules or practices governing the companys financial reporting. Additional factors are discussed in the companys Annual Report on Form 10-K and in its other reports filed from time to time with the Securities and Exchange Commission. The company assumes no obligation to update or revise any forward-looking statements or to update the reasons why actual results could differ from those projected in any forward-looking statements.

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Health Care REIT Enters Into Triple Net Lease With Emeritus Senior Living on Seniors Housing Portfolio

Highmark health plans meet medical loss ratio requirements under health care reform for second consecutive year

PITTSBURGH, June 25, 2013 /PRNewswire/ --Highmark Health Services announced today that for the second consecutive year, its insured health plans in all of its markets met the medical loss ratio (MLR) requirements of the Affordable Care Act, and it will not be required to issue rebates.

MLR is the share of premium revenues that an insurer spends on patient care and quality improvement activities as opposed to administration and profits. Under reform, insurers in the large group market must meet an MLR standard of 85 percent annually, and insurers in the small group and individual markets must meet an MLR standard of 80 percent annually, or issue rebates.

Highmark Health Services has now met the MLR requirements for both of the years 2011 and 2012 that MLR reporting has been required by the U.S. Department of Health and Human Services. The company met the requirements for its large group (51 or more employees), small group (2 to 50 employees) and individual health insurance plans offered through each of its health insurer affiliates, including Highmark Blue Cross Blue Shield in western Pennsylvania, Highmark Blue Shield in central Pennsylvania and the Lehigh Valley, Highmark Blue Cross Blue Shield West Virginia and Highmark Blue Cross Blue Shield Delaware.

"Highmark Health Services continues to serve as a trusted steward of our members' investments in their health," said Vik Mangalmurti, vice president, Highmark Health Services, Office of Health Care Reform. "Meeting the MLRs reflects our sustained efforts to ensure our members receive health coverage they can count on to be of high quality and high value."

Highmark Health Services has historically operated its business very efficiently. In Pennsylvania, its largest market, the company has typically spent nearly 90 percent of the premium dollars it collects to pay for the medical care its members receive and to improve the quality of medical care its members receive through programs such pay-for-performance incentives for hospitals and doctors, clinical initiatives to reduce health disparities and chronic disease management.

"Still, we remain very concerned about the rising cost of medical care, and we are taking bold, proactive steps to transform health care delivery and financing in ways that will help to make health care more affordable in the future," said Mangalmurti.

About Highmark Health ServicesHighmark Health Services is among the largest health insurers in the United States and the fourth-largest Blue Cross and Blue Shield-affiliated company. Highmark Health Services operates health insurance plans in Pennsylvania, Delaware and West Virginia that serve 5.3 million members. Its diversified health businesses serve group customer and individual health needs across the United States through dental insurance, vision care and other related health businesses. Highmark Health Services is an independent licensee of the Blue Cross and Blue Shield Association, an association of independent Blue Cross and Blue Shield companies. For more information, visit http://www.highmark.com.

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Highmark health plans meet medical loss ratio requirements under health care reform for second consecutive year

KORT Home Health Care Helping Patients Recover More Quickly

Louisville, Kentucky (PRWEB) June 26, 2013

For Corydon resident Jim Elliott, the new KORT Home Health Care service made his recovery from shoulder surgery easier and faster.

I was in quite a bit of pain when I came home from the hospital. KORT Home Health came to my house following my discharge from the hospital. The nurses were very courteous, attentive and extremely knowledgeable. It was a very positive experience for me, said Elliott.

The KORT Home Health Care nurse worked with Elliott on pain management and the physical therapist began an exercise treatment program, according to Elliott.

My home health care services continued for a few weeks, until I felt comfortable traveling in my car, then I continued physical therapy at a KORT outpatient clinic near my home, he said. Because of the quality of care and professionalism of the home health staff, I felt comfortable and confident continuing treatment with KORT.

KORT Home Health Care is unique in their ability to provide a continuum of care from home to KORT outpatient care, said KORT Home Health Executive Shauneen Bouthilette, RN, MSN.

The transition from home care to care at the KORT clinic was basically seamless. When I arrived at the outpatient clinic, the therapist knew how much progress I had made with KORT Home Health. Everyone was prepared to continue my road to recovery. With KORT, I knew I would be back where I needed to be. Everyone at KORT was really wonderful. They were sincere and genuinely invested in my recovery, said Elliott.

About KORT Home Health Care

According to Bouthilette, patients like Elliott truly benefit from the expertise KORT can provide.

We believe we are leaders in our industry for nursing and physical therapy. Our highly trained therapists are board certified in conditions related to orthopedic surgeries, but their knowledge doesnt stop there. KORT nurses and physical therapists provide comprehensive health care and education in the areas of diabetic management, cardiac and pulmonary rehab, oncology care, and medication management. KORTs disease management encompasses the entire well being of the patient, said Bouthilette.

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KORT Home Health Care Helping Patients Recover More Quickly

Kaiser mental health care lacking, state says; HMO hit with $4 million fine

Imposing the second-largest fine in its history, the California Department of Managed Health Care on Tuesday slapped Kaiser health plans with a $4 million penalty for failing to provide mental health treatment in a timely manner.

The department also issued a cease and desist order to Kaiser, forbidding the health plan from continuing practices in violation of state law, which ensures equal care for mental and physical health.

An investigation that started in 2012 found that Kaiser's written description of its mental health services was so complicated and misleading that it "could dissuade an enrollee from pursuing medically necessary care."

Kaiser Permanente officials responded Tuesday by saying improvements are under way, and they plan to challenge the fine as too stiff.

Only one other fine in the history of the department exceeded Kaiser's.

That was in 2008 when Anthem Blue Cross was hit with a $10 million penalty for wrongfully rescinding consumers' health insurance coverage.

"The amount of the proposed penalty is unwarranted and excessive, and is unnecessary to ensure our corrective actions," said John Nelson, vice president for Kaiser Permanente. "We will review this with the DMHC."

Three months ago, the department released a detailed report saying Kaiser needed to see mental health patients more quickly and improve its public disclosures or face penalties.

It provided Kaiser with a laundry list of deficiencies to correct, including these examples:

A FAQ sheet for Kaiser in Northern California says: "We offer brief, problem solution-focused individual counseling. Research shows many people improve in a single visit. We do not offer long-term individual psychotherapy at Kaiser."

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Kaiser mental health care lacking, state says; HMO hit with $4 million fine

New health care facility for sick inmates opens in Stockton

The California Department of Corrections and Rehabilitation dedicated its new health care facility Tuesday in Stockton.

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The $839 million facility is designed to care for the state's sickest inmates.

"This health care facility is an example of the state's dedication to providing inmates with mental health and medical treatment that rivals any prison health care in the country," Secretary of Corrections Jeff Beard told KCRA 3.

The facility will begin accepting inmate-patients in mid-July.

The faculty holds 1,722 patients.

"By providing acute care to the state's most seriously ill inmates, the new Stockton facility increases the capacity of medical and mental health units to meet the less-serious health needs of inmates in each prison," Beard said.

About 2,500 doctors, nurses, technicians and other support staff will be employed at the facility.

Photos: Tour new Stockton prison health facility

Melinda Meza/KCRA

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New health care facility for sick inmates opens in Stockton

Report: Slowdown in health care costs to continue

WASHINGTON (AP) There's good news for most companies that provide health benefits for their employees: America's slowdown in medical costs may be turning into a trend, rather than a mere pause.

A report Tuesday from accounting and consulting giant PwC projects lower overall growth in medical costs for next year, even as the economy gains strength and millions of uninsured people receive coverage under President Barack Obama's health care law.

If the calculations are correct, cost spikes because of the new health care law should be contained within a relatively narrow market segment. That would come as a relief for Democrats in an election year during which Republicans plan to use criticism of "Obamacare" as one of their main political weapons.

"There are some underlying changes to the system that are having an impact, and we can expect lower increases as we come out of the recession," said Mike Thompson of PwC's Health Research Institute, which produced the study. Cost "is still going up, but not as much as it used to."

The report comes with a caveat that sounds counterintuitive at first: Self-employed people and others who buy coverage individually could well see an increase in premiums in 2014.

The reasons have to do with requirements in the health care law. For example, starting next year insurers must accept patients with pre-existing medical problems, who cost more to cover. Also, new policies have to provide a basic level of benefits more generous in some cases than what's currently offered to individual consumers.

About 160 million workers and family members now have job-based coverage and are less likely to be affected. The individual market is much smaller, fewer than 20 million people. Still, it's expected to grow significantly over the next few years as a result of the health care law, which will also provide tax credits to help many people afford their premiums.

The U.S. spends more than $2.7 trillion a year on health care, well above any other developed country. But quality is uneven, there's widespread waste and fraud, and the system still leaves about 45 million people uninsured.

For years U.S. health care spending has grown much faster than the overall economy and workers' wages, but since the recession those annual increases have slowed dramatically. The debate now is whether that's a continuing trend. The answer will be vitally important, not only for companies and their employees, but for taxpayers who foot the bill for government programs such as Medicare, Medicaid and Obama's coverage expansion.

PwC's report forecasts that direct medical care costs will increase by 6.5 percent next year, one percentage point lower than its previous projection. The cost of care is the biggest component of premiums, followed by administrative expenses and overhead.

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Report: Slowdown in health care costs to continue