Sunday, December 30, 2007

Diane Crosier and her cronies, school attorneys

Diane Crosier, Ed Brand, Daniel Shinoff, Jack Sleeth and the infamous Bonny(Bonifacio) Garcia have been cronies for a long time.

Sweetwater Union High School District (SUHSD)
Board Adopted Minutes
August 26, 2002

President Sandoval called the closed session meeting to order at 6:10 p.m.
Board members present were Robert Griego, Pearl Quiñones, and Arlie
Ricasa. (Christopher Suber, student board member, was excluded from the
closed session meeting.) Jim Cartmill joined the closed session meeting
at 6:11 p.m.

Also attending closed session were Ed Brand, superintendent, Bonny Garcia,
legal counsel, Dan Shinoff, Jack Sleeth, and Diane Crosier, general
counsel, and Kathy Dahlen, labor negotiator.

Diane Crosier still votes at SELF board of directors meetings

downloaded 12/30/07

Committee: Claims & Coverage Committee
Phone: (858) 292-3747
Fax: (858) 279-6236
Term Expires: 00/00/0000
Affiliation: San Diego County Schools JPA
Counties: Imperial
Los Angeles
San Bernardino
San Diego
Santa Barbara

Saturday, December 29, 2007

Doctors, not insurance companies, should make healthcare decisions

Daily News--Los Angeles
Hundreds honor girl who needed liver transplant
By Dana Bartholomew, Staff Writer

...Nataline Sarkisyan, the 17-year-old Northridge girl whose death last week sparked a renewed call for health-care reform after she was twice denied a prescribed liver transplant, was buried Friday after a tear-streaked funeral.

The insurance company, which deemed the surgery experimental, stated it would pay for the procedure "in this rare and unusual case" after loud public protest.

Nataline's case drew national attention among health advocates and Armenian groups calling for reform.

"What happened here is a glaring example of what happens when you let the insurance companies decide who lives and who dies," said Geri Jenkins, co-president of the California Nurses Association, before she attended the funeral.

"We've put the insurance companies in the driver's seat - and that needs to change."

"We're here because of an insurance failure, not being able to get a patient in time," added Berdj Kasbarian, president of the Hye Riders Motorcycle Club, among two dozen Armenian bikers attending the service.

"We should change the health-care system to a European system, where everybody is covered."

...The day before Thanksgiving, her brother Bedig had donated his bone marrow. But because of her failing liver, doctors recommended a transplant.

On Dec. 11, Cigna denied a liver transplant for the girl, despite the pleadings of physicians at UCLA Medical Center where she was treated.

Friday, December 28, 2007

Schools Excess Liability Fund

Schools Excess Liability Fund
Statewide Public Education Agency, Sacramento California

The Schools Excess Liability Fund is a joint powers authority created under Title 1, Division 7, Chapter 5, Article 1 of the California Government Code. Our organization boasts participation of 85% of the school districts in the state representing 77% of the total average daily attendance. Our members include many K-12 districts, community college districts, charter schools, county offices of education and the California State University system. We have been in business since 1986.
Schools Excess Liability Fund
Our mission: SELF is a member-owned, statewide partnership of public educational agencies providing quality pooled programs for excess coverage that benefit our students.

The Schools Excess Liability Fund has a 1,000 square foot conference facility located in their administrative office in Sacramento. The facility is available from 8 to 5 Monday through Friday. Members in need of a place to hold meetings should contact our office to reserve a date. The facility will accommodate a meeting of up to 30 people, and can hold 50 people classroom style. You can e-mail Lois Gormley to reserve the room. Please include your name, organization, phone number and number of people attending the meeting.

Downloaded 12-28-07
Area 6
Diane Crosier

Committee: Claims & Coverage Committee
Phone: (858) 292-3747
Fax: (858) 279-6236
Term Expires: 00/00/0000
Affiliation: San Diego County Schools JPA
Counties: Imperial
Los Angeles
San Bernardino
San Diego
Santa Barbara

Wednesday, December 26, 2007

What do CIGNA and Kaiser have in common

What do CIGNA and Kaiser have in common, besides wrongfully allowing transplant patients to die?

Ummm, I don't know.

Ruthless insurance administrators?

Kaiser apparently works with Keenan and Associates, and Cigna seems to work with Driver Alliant.

I have first-hand experience with Keenan, and I know that they pressure public entity clients to cover up wrongdoing so the insurance company will not have to pay.

Monday, December 24, 2007

Who can you trust more on health care, unions or insurance companies?

It may be partisan to say that a 527 run by labor unions supporting health care reform isn’t the same thing as a 527 run by insurance companies opposing it. But it’s also the simple truth.


Op-Ed Columnist
State of the Unions
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Published: December 24, 2007
Once upon a time, back when America had a strong middle class, it also had a strong union movement.

Skip to next paragraph

Paul Krugman.

Go to Columnist Page »
Blog: The Conscience of a Liberal
Blogrunner: Reactions From Around the Web These two facts were connected. Unions negotiated good wages and benefits for their workers, gains that often ended up being matched even by nonunion employers. They also provided an important counterbalance to the political influence of corporations and the economic elite.

Today, however, the American union movement is a shadow of its former self, except among government workers. In 1973, almost a quarter of private-sector employees were union members, but last year the figure was down to a mere 7.4 percent.

Yet unions still matter politically. And right now they’re at the heart of a nasty political scuffle among Democrats. Before I get to that, however, let’s talk about what happened to American labor over the last 35 years.

It’s often assumed that the U.S. labor movement died a natural death, that it was made obsolete by globalization and technological change. But what really happened is that beginning in the 1970s, corporate America, which had previously had a largely cooperative relationship with unions, in effect declared war on organized labor.

Don’t take my word for it; read Business Week, which published an article in 2002 titled “How Wal-Mart Keeps Unions at Bay.” The article explained that “over the past two decades, Corporate America has perfected its ability to fend off labor groups.” It then described the tactics — some legal, some illegal, all involving a healthy dose of intimidation — that Wal-Mart and other giant firms use to block organizing drives.

These hardball tactics have been enabled by a political environment that has been deeply hostile to organized labor, both because politicians favored employers’ interests and because conservatives sought to weaken the Democratic Party. “We’re going to crush labor as a political entity,” Grover Norquist, the anti-tax activist, once declared.

But the times may be changing. A newly energized progressive movement seems to be on the ascendant, and unions are a key part of that movement. Most notably, the Service Employees International Union has played a key role in pushing for health care reform. And unions will be an important force in the Democrats’ favor in next year’s election.

Or maybe not — which brings us to the latest from Iowa.

Whoever receives the Democratic presidential nomination will receive labor’s support in the general election. Meanwhile, however, unions are supporting favored candidates. Hillary Clinton — who for a time seemed the clear front-runner — has received the most union support. John Edwards, whose populist message resonates with labor, has also received considerable labor support.

But Barack Obama, though he has a solid pro-labor voting record, has not — in part, perhaps, because his message of “a new kind of politics” that will transcend bitter partisanship doesn’t make much sense to union leaders who know, from the experience of confronting corporations and their political allies head on, that partisanship isn’t going away anytime soon.

O.K., that’s politics. But now Mr. Obama has lashed out at Mr. Edwards because two 527s — independent groups that are allowed to support candidates, but are legally forbidden from coordinating directly with their campaigns — are running ads on his rival’s behalf. They are, Mr. Obama says, representative of the kind of “special interests” that “have too much influence in Washington.”

The thing, though, is that both of these 527s represent union groups — in the case of the larger group, local branches of the S.E.I.U. who consider Mr. Edwards the strongest candidate on health reform. So Mr. Obama’s attack raises a couple of questions.

First, does it make sense, in the current political and economic environment, for Democrats to lump unions in with corporate groups as examples of the special interests we need to stand up to?

Second, is Mr. Obama saying that if nominated, he’d be willing to run without support from labor 527s, which might be crucial to the Democrats? If not, how does he avoid having his own current words used against him by the Republican nominee?

Part of what happened here, I think, is that Mr. Obama, looking for a stick with which to beat an opponent who has lately acquired some momentum, either carelessly or cynically failed to think about how his rhetoric would affect the eventual ability of the Democratic nominee, whoever he or she is, to campaign effectively. In this sense, his latest gambit resembles his previous echoing of G.O.P. talking points on Social Security.

Beyond that, the episode illustrates what’s wrong with campaigning on generalities about political transformation and trying to avoid sounding partisan.

It may be partisan to say that a 527 run by labor unions supporting health care reform isn’t the same thing as a 527 run by insurance companies opposing it. But it’s also the simple truth.

Sunday, December 23, 2007

Christmas came one week early for California insurers Monday.

See full story here.


Christmas for Insurance Corporations! (+)
by: California Nurses Shum
Wed Dec 19, 2007 at 16:56:21 PM PST

(The followign commentary by Rose Ann DeMoro, executive director of the California Nurses Association/National Nurses Organizing Committee, first appeared at the Huffington Post.)

Christmas came one week early for California insurers Monday.

In a present gift wrapped by the California Assembly with Gov. Arnold Schwarzenegger playing Santa, Assembly members passed a bill mislabeled as healthcare reform that will guarantee not health care but millions of new customers for the insurance industry, with California taxpayers paying the bill.

Need more evidence. Look at the list of supporters. They include industry giants, Kaiser Permanente, Health Net, PacifiCare, Blue Shield, Cigna, and Molina Health Care --all among the biggest and most profitable health plans in the state.

California Nurses Shum :: Christmas for Insurance Corporations!
It's not hard to see why they are on board.
Under the new bill, insurers would gain millions of new customers who are either forced to buy insurance under threat of having their wages garnished or facing a lien on their property -- or signed up into private insurance plans through a public pool funded with taxpayer or employer funded subsidies.

The bill passed Monday -- the product of a backroom deal between Schwarzenegger and Assembly Speaker Fabian Nunez -- even eliminated a provision from an earlier draft that would have provided exemptions to the forced insurance for Californians whose costs would exceed 6.5 percent of their income. Now those people will still have the mandate to buy insurance, though they will be eligible for full or partial public subsidies.

It's a disgraceful day when we have our elected leaders shaking down patients and consumers to swell the profits of an industry that became incredibly rich off the pain and suffering of patients who are routinely denied care when they need it most.

Nothing in this plan changes those deplorable practices. Insurers will continue to be able to block care even when recommended by a physician when they brand it as "experimental" or "not medically necessary." They will continue to be able to reject diagnostic procedures and access to specialists.

And, they will continue to be permitted to charge whatever they want. There are absolutely no restrictions on skyrocketing premiums, deductibles, or co-pays. The inevitable result will be more Californians facing bankruptcy for medical debt when they are forced to buy junk insurance they can't afford or self-rationing care even while they continue to pay the premiums.

Proponents of the bill praise the model of a similar Massachusetts law on which the California bill is based. Well, here's what's happening in Massachusetts today. State officials has discovered that since they failed to place any limits on insurance industry price gouging, the state will not be able to continue to afford the subsidies. So they are going to have to reduce payments to doctors and hospitals or sharply increase out-of-pocket costs for patients. That's progress?

This is not health care reform. It's a hijacking of the yearning of the public for genuine overhaul of our health care system. It's Schwarzenegger as a reverse Robin Hood, picking the pockets of patients and the public coffers for the biggest insurers in the land. And it will not stand.

California's State Senate may yet put the brakes on this plan -- not even scheduled to go into effect for four more years.

If California lawmakers want to actually accomplish something today on health care, they should look elsewhere. Thousands of California children face the imminent cutoff of coverage due to the President's veto of the children's health program. Concurrently, with California facing a $14 billion and growing budget deficit, Schwarzenegger is talking about big across the board cuts, including significant reductions in existing health programs.

Let's address these immediate crises -- and then move to enact genuine, healthcare reform such as a single payer, improved Medicare for all approach embodied in HR 676 in Congress and SB 840 in California -- rather than handing out any more presents to a wealthy industry that hardly needs the help.

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Insurance companies demand that schools and other institutions deny wrongdoing (0.00 / 0)
How does the law get enforced in school districts?
It doesn't.

Insurance brokers seem to run our schools-among other institutions.

Keenan and Associates runs San Diego County Office of Education Joint Powers Authority. They also run Kaiser Permanente.>

Rick Rinear, JPA Director Diane Crosier's right-hand man at SDCOE-JPA, says all claims should be "returned as insufficient, late or rejected."

Here's a quote, followed by a more complete document to give the context. My bet is that the link at the bottom will soon be broken by SDCOE-JPA. They seem to cut off access to public records whenever I make a link to them.

Quote by Rick Rinear:

"If a claim is submitted in letter format and is sufficient (in compliance), per the Government Code, the claim should be handled as if submitted on the district's Claim Form; i.e., returned as insufficient, late or rejected."

January 22, 2004
To: JPA Representatives
From: Rick Rinear, JPA Risk Management
Subject: Tort Claim Reporting Form - Revised

We would like to clarify the Tort Claim Reporting procedure, as there has been some confusion about requiring all potential claimants to use a district-written Claim Form.

Effective April 1, 2003, Government Code Section 910.4 (a) requires public entities to provide a standardized Tort Claim Form that claimants use to file their claims for submission to districts.

The standard Claim Form (sample attached), must include information specified in Government Code Section 910 and 910.2. Districts can still consider claims "submitted" without the required form. Districts may consider a written claim without requiring the referenced claim form. The referenced claim form must be available when requested.

We are providing a sample Cover Letter for potential claimants who request the required form. Careful review of a claim is necessary for compliance or late filing.

If considered insufficient (not in compliance), the claim must be returned to claimant within 20 days from receipt. If a claim is submitted in letter format and is sufficient (in compliance), per the Government Code, the claim should be handled as if submitted on the district's Claim Form; i.e., returned as insufficient, late or rejected.

The enclosed sample letter should only be used to forward a claim form to those claimants who request a form from the district.

...Please continue to forward claims when received to San Diego County Schools Risk Management JPA,...Attention: Rodger Hartnett, Property & Liability JPA Claims Coordinator. Rodger or Lisa Adriance-Jensen will recommend what action to take.

The letter above can be found at
at least, until SDCOE breaks the link to this public record.

Should CIGNA be charged with murder?

See full story with photos here.

Article from ABC NEWS
Dec. 22, 2007

The lawyer for California teen Nataline Sarkisyan charged today that the only reason Cigna Health Care officials changed their minds and approved a liver transplant for the desperate girl was they knew it was too late and they wouldn't have to pay for it.

Sarkisyan, 17, died Thursday just hours after Cigna reversed its decision and approved the procedure it had previously described as "too experimental…and unproven." Now the Sarkisyan family hopes manslaughter or murder charges will be pressed.

Their lawyer, Mark Geragos, says he will refer the case to prosecutors for possible criminal charges against the insurer, Cigna HealthCare.

"All of the doctors there unanimously agreed that she needed and should have that liver transplant. And the only entity, if you will, who said no to that in the middle of that medical decision, was some piece of garbage who decided that making a couple of dollars, or saving them a couple of dollars, was worth more than the 65% chance over six months that she would survive," said Geragos.

"The only reason they approved it is because we had organized a protest in front of Cigna's corporate headquarters… and in the face of public pressure, they did it," he said.

By the time the approval came through Nataline had been on the liver transplant list for two weeks and her condition had deteriorated so badly that it was too late to have the procedure.

"I believe, the corporation knew, powers that be knew, that at that point approving the liver transplant was a 'gimme' because her condition deteriorated to the point where she couldn't receive the liver…she didn't have any chance of either, one, getting a liver or, number two, actually being able to receive it," he says.

Nataline, who was fighting leukemia, developed liver failure after complications from a bone marrow transplant she received from her brother last month.

Despite her already fragile health, Geragos says, "all of the doctors at the University of California Medical Center unanimously agreed that she needed and should have that liver transplant."

More than 6,000 liver transplants are performed in the United States every year, making it one of the most common organ transplants, according to the United Network for Organ Sharing.

Saturday, December 22, 2007

The Association of Governmental Risk Pools


The Association of Governmental Risk Pools (AGRiP) was organized in late 1998 as a membership organization for public entity risk and benefits pools in North America. It is a successor to the Pooling Section that operated for nearly 20 years under the auspices of the Public Risk Management Association.

The AGRiP Sourcebook lists more than 420 public entity pools that are eligible for membership in the association. These pools provide a wide range of property, casualty, workers’ compensation and employee benefits programs for their members.

Pools encompass the full spectrum of public entity organizations including state agencies, higher education, public or common education, all forms of local governments (cities, towns, townships, boroughs, counties, parishes, etc.), a vast array of "governmental" special districts, including health care facilities, and not-for-profit organizations.

AGRiP was created for the following purposes:
• To promote pooling as a practical extension of local government’s obligation to be a good steward of public funds.
• To act as an advocate for the advancement of intergovernmental pooling as the most appropriate risk and employee benefits financing mechanism for most local governments.
• To provide a forum for intergovernmental issues of mutual interest in the administration and operation of self-funded and group insurance purchasing programs, and other group programs associated with the funding and operation of intergovernmental pools.
• To identify legislative and regulatory issues affecting intergovernmental pools and to provide information to assist pools in addressing such issues.
• To act as a clearinghouse for the collection and dissemination of data and resources relating to intergovernmental pools and to encourage and support new research for tomorrow’s pools.
To provide meaningful and significant education and professional support for the members, governing bodies and staffs of intergovernmental pools. The nine-member AGRiP Board of Directors operates under the Carver Policy Governance™ process. Besides addressing the process by which AGRiP operates, the board’s governance policies also set forth how the organization is to achieve its original purposes through a set of Ends statements as follows:
• VISION STATEMENT AND ORGANIZATIONAL MISSION "As the recognized authority on and resource for information on intergovernmental pools, AGRiP is the leading national association for pool management. As a result of our efforts, the pooling community is united to achieve excellence in pool governance, management and services."
• EFFECTIVE GOVERNANCE AND MANAGEMENT "As a result of our efforts, members will have information, knowledge and skills necessary to effectively govern and manage their pools."
• MEMBER SATISFACTION "As a result of our efforts, members will have confidence that their common needs are addressed and represented with dependability, reliability and professionalism."
• ADVOCACY "As a result of our efforts, members will have an effective advocate for the advancement and promotion of pooling."

Revised March 20, 2007
John Sallade, CRM, President
Managing Director of Insurance Programs
County Commissioners Association of Pennsylvania
(Term Expires: December 2009)

Cheryle Mangels, CRM, ARM, Vice President
Executive Director
Colorado School Districts Self Insurance Pool
(Term Expires: December 2011) Lester Nixon
Risk Management Director
North Carolina Association of County Commissioners
(Term Expires:December 2011)
Shawn Bubb, CPA, CIA
Director of Insurance Services
Montana Schools Group Insurance Authority
(Term Expires: December 2008)
Michael Rhyner, ARM
Executive Director
Michigan Municipal Risk Management Authority
(Term Expires: December 2008)
Ken Horner
Director of Operations
Cities and Villages Mutual Insurance Co. (WI)
(Term Expires: December 2009)
Brent A. Wilkes, CAE, ARM, CIC
Public Employer Risk Management Association, Inc.
(Term Expires: December 2007)
[Not to be confused with the infamous Brent R. Wilkes*]
Steven P. James
Deputy Executive Director
Maryland Association of Boards of Education
(Term Expires: December 2007) Donna Abersman - CAJPA Representative
Deputy Chief Executive Officer/COO
Alliance of Schools for Cooperative Insurance Programs (CA)

Member Pools
Revised 12/14/07

National | International |Pools by State: AK | AZ | AR | CA | CO | CT | FL | GA
| IA | ID | IL | IN | KS | KY | LA | MA| MD | ME | | MI | MN | MS | MO | MT | NE
| NV | NH | NJ | NM | NY | NC | ND | OH | OK | OR | PA | RI | TN | TX | UT | VT
| VA | WA | WI | WY

Alaska Municipal League Joint Insurance Association, Inc.
Alaska Public Entity Insurance

Arizona Counties Insurance Pool
Arizona School Risk Retention Trust, Inc.

Central Arkansas Risk Management Association

ABAG PLAN Corporation
Alliance of Schools for Cooperative Insurance Programs
Association of California Water Agencies/JPIA
Big Independent Cities Excess Pool
California Affiliated Risk Management Authority
California Association of Joint Powers Authorities
California Housing Authority Risk Management Agency
California Transit Insurance Pool
Contra Costa County Schools Insurance Group
CSAC Excess Insurance Authority
Independent Cities Risk Management Authority
Monterey Bay Area Self Insurance Authority
NonProfits United Vehicle Insurance Pool
North Bay Schools Insurance Authority
Northern California Cities Self-Insurance Fund
Public Agency Risk Sharing Authority of California
Redwood Empire Municipal Insurance Fund
San Diego Pooled Insurance Program Authority/SDCCRMA
Schools Insurance Authority
Schools Insurance Group
Southern Orange County Property/Liability Joint Powers Authority
Special District Risk Management Authority
Vector Control Joint Powers Agency
Ventura County Schools Self-Funding Authority
Yolo County Public Agency Risk Management Insurance Authority

Information about Brent R. Wilkes [as opposed to Brent A. Wilkes]
Web Personalized Results 1 - 10 of about 268,000 for Brent A. Wilkes. (0.13 seconds)

Brent Wilkes - Wikipedia, the free encyclopediaBrent Roger Wilkes (born May 21, 1954), an American defense contractor. Wilkes became well known for his involvement with the Duke Cunningham defense ... - 56k - Cached - Similar pages - Note this

National Executive Director | LULAC-League of United Latin ...Brent A. Wilkes is the National Executive Director for the League of United Latin American Citizens this country's largest and oldest Hispanic organization. ... - 12k - Cached - Similar pages - Note this

TPMmuckrakerBrent Wilkes has been indicted for bribing public officials, particularly former Congressman Duke Cunningham and CIA Executive Director Kyle “Dusty” Foggo. ... - 34k - Cached - Similar pages - Note this

Brent R. Wilkes - SourceWatchIn Spring 2005, Brent Wilkes was identified as president of the Wilkes Corporation: earned his bachelorâ??s degree in accounting from San Diego State ... - 40k - Cached - Similar pages - Note this > News > Politics > Randy 'Duke' Cunningham ...Brent Wilkes was convicted Monday of 13 felonies for bribing former congressman Randy “Duke” Cunningham with expensive meals, trips, a yacht and mortgage ... - 37k - Cached - Similar pages - Note this > News > Metro -- Jury finds Wilkes guiltyA federal jury convicted Poway defense contractor Brent Wilkes yesterday for his role in engineering the biggest bribery scheme in congressional history, ... - 41k - Cached - Similar pages - Note this
[ More results from ]

Brent Wilkes: Blogs, Photos, Videos and more on TechnoratiBrent Wilkes is going to spend some time in quiet contemplation. Brent Wilkes was convicted Monday of 13 felonies for bribing former congressman Randy ... - 43k - Cached - Similar pages - Note this

Brent Wilkes | Sunlight FoundationThe San Diego Union Tribune, without whom this would not have happened, is reporting that corrupt contractor Brent Wilkes was found guilty by a jury on 13 ... - 40k - Cached - Similar pages - Note this

Deal Maker Details the Art of Greasing the Palm - New York TimesA career built on “transactional lobbying” made Brent R. Wilkes rich but put him in the middle of a criminal probe. - Similar pages - Note this




TUESDAY, DECEMBER 5, 2006, 9:00 AM

Board of Supervisors North Chamber

1600 Pacific Highway, Room 310, San Diego, California



The Board of Supervisors serves as the Code Reviewing Body for any Local Government Agency, other than Cities, with jurisdiction wholly within the county per Government Code Section 82011. This letter is a result of the Biennial Review of Conflict of Interest Codes pursuant to Government Code Section 87306.5.

Additionally, new agencies, the Helix Charter High School and Albert Einstein Academies have recently adopted their Conflict of Interest Code, and request your approval.

Approve the Conflict of Interest Code adopted by the:

Albert Einstein Academies

Carlsbad Unified School District

Chula Vista Elementary School District

Del Mar Union School District

Encina Wastewater Authority

Escondido Union School District

Fallbrook Public Utility District

First 5 Commission of San Diego

Grossmont-Cuyamaca Community College District

Helix Charter High School

Helix Water District

Lemon Grove School District

Leucadia Wastewater District

Mountain Empire Unified School District

North County Cemetery District

North County Fire Protection District

North County Transit District

Olivenhain Municipal Water District

Padre Dam Municipal Water District

Pine Valley Fire Protection District

Rainbow Municipal Water District


San Diego Community College District

San Diego County Office of Education

San Diego County Regional Airport Authority

San Diego County Water Authority

San Diego Educational Facilities Authority No. 2

San Diego Pooled Insurance Program Authority

San Diego Unified Port District

San Dieguito Water District

San Elijo Joint Powers Authority

Santee School District

San Ysidro School District

Solana Beach School District

Southwestern Community District

Sweetwater Union High School District

Vista Irrigation District

Warner Unified School District

Water Conservation Garden Authority

Job Description

Printable Version
Job Class Title Senior Risk Management Specialist
Job Class ID 3383
General Description Lead and perform highly independent specialized duties in one or more of the City's Risk Management programs; may be assigned to one or more of the following areas: safety, public liability, insurance and disability management; and to perform other related duties as assigned. This is the advanced journey level of the Risk Management Specialist Series. Incumbents perform the full range of duties and work independently to complete more complex assignments and projects. Employees in this class are distinguished from the Risk Management Specialist class in that they are responsible for all phases of policy development and implementation in addition to planning and assuming full responsibility for the program's budget.

Essential Functions Functions may include, but are not limited to, the following: participate in the development, coordination and implementation of various risk management activities in the Risk Management Program for the city; oversee professional staff in performing and conducting studies, special projects, and administrative and technical functions; perform liaison function between administrators, employees, attorneys, management staff, service providers and members of the public; plan, prioritize, assign and review the work of subordinate staff; compile and develop information for special studies and reports from a variety of resources; make recommendations for corrective actions where applicable and prepare written reports; conduct training presentations for City staff at various levels and locations; formulate, write and disseminate policies and procedures; prepare and monitor program budget; establish and maintain effective working relationships with those contacted in the course of work; perform independent managerial and technical duties in the administration of assigned risk management program; make program specific recommendations to various levels of management; perform other duties as assigned. WHEN ASSIGNED TO SAFETY: develop and present employee safety-training materials; provide relevant safety information to departments; compile data, maintain safety database and analyze illness, accident and injury data for trends; implement special projects, including coordination, research and development of safety initiatives to solve hazards; interpret, analyze and determine general occupational health and safety and industrial hygiene compliance in all City departments; ensure City operations comply with OSHA laws and regulations; spearhead the Citywide Safety Committee. WHEN ASSIGNED TO LOSS CONTROL SERVICES (Public Liability and Insurance): Ensure appropriate risk transfer techniques are being employed and documented; review contracts and proposed activities to recommend appropriate insurance and indemnification provisions; serve as the City's alternate representative to the San Diego Pooled Insurance Program Authority; administer the City's self-insured liability program; collect from third parties for damages to city property; prepare and present or defend small claims court actions; coordinate and conduct investigations into public liability claims; interview claimants and employees; work closely with City Attorney and outside counsel in claims management; prepare insurance applications; maintain records of losses, accidents, insurance certificates and other risk management related information. WHEN ASSIGNED TO DISABILITY MANAGMENT: administer the City's self-insured Workers' Compensation and disability management programs; serve as a liaison between the injured employees, third party administrators and departmental management; ensure payroll is being reported accurately for employees out on disability related leaves; maintain OSHA injury logs; work with the other risk management programs to ensure recovery from third parties; employees receive all disability benefits which they are entitled and identify injury trends and conduct accident investigations; ensure City's disability management programs meet Federal, State and local laws and regulations; facilitate return to work efforts; coordinate the delivery of the short and long term disability programs, FMLA, CFRA, SDI, workers compensation and union disability programs.

Knowlege, Skills and Abilities Knowledge of: basic principles and practices of Occupational Health and Safety Rules; Industrial Hygiene; principles and practices of safety program management; research methods and techniques; OSHA laws and regulations; Government Code as it relates to tort claims; Labor Code as it relates to Worker's Compensation; claims processing in all areas of risk management. Ability to: use computer software, including word processing, database, spreadsheet and Power Point; apply statistics and statistical methodology; apply proper English usage, spelling, grammar, and punctuation; work independently and manage a large volume of work; solve problems with speed and accuracy and diplomacy; communicate clearly and concisely, both orally and in writing; identify and interpret complex regulations, laws and codes, and explain policies and procedures to employees and others; perform independent research; collect, compile, analyze and present a variety of data in a meaningful way to various groups, agencies and management staff; develop and implement various data collection and reporting systems; establish and maintain effective working relationships with those contacted in the course of work, including irate citizens and employees suffering from illnesses or injuries; make presentations to small and large groups.
Minimum Qualifications Any combination of experience and training that would likely provide the required knowledge and abilities is qualifying. A typical way to obtain the knowledge and abilities would be three years of responsible journey level work experience in a risk management related program and training equivalent to a Bachelor's degree in Public Administration, Occupational Health and Safety, Industrial Hygiene, Business Administration or a related field. License or Certificate: ARM, CEBS, CIH, CPCU, CSP or WCCP are highly desirable. Possession of a valid California driver's license at time of appointment or the ability to arrange for transportation.
Physical Demands and Working Conditions On an intermittent basis, sit at desk or computer workstation for long periods of time; intermittently walk (on uneven terrain under varying weather conditions) be exposed to dust, dirt, noise, insects, changes in temperature; stand, bend, squat, twist, crawl and reach to observe site conditions, enter confined spaces to assess safety; use a telephone or a radio to respond to calls and inquiries; use a keyboard to communicate through written means, review information and enter/retrieve data; see and read characters on a computer screen; lift light weight up to twenty pounds; drive a vehicle to various city locations, or that ability to arrange for transportation; attend meetings at various locations. Work is performed in both outdoor and indoor settings under varying weather and temperature conditions. There is movement required from the office to other city worksites and offices. There is exposure to traffic in the external environment when going to outlying offices, meetings, or performing field inspections. Work is frequently disrupted by the need to respond to in-person and telephone inquires and may work varying hours.

Keenan outreach

Press Kit - About Keenan
Go to >> Background . Executive Team . Code of Ethics
Advisory Board

Code of Ethics
In the conduct of our business, we are and will continue to be guided by the following principles:

We will be fair and truthful in our relations with our clients, our coworkers and our carriers.

We will conduct our business in a manner which will enable us to take pride in our efforts and in the products and services that we provide.

We will be flexible and responsive to the changing world in which we live.

We will constantly strive to improve upon all we do.

We will act in a manner that will earn the respect and esteem of others.

We will be exemplary citizens in the communities in which we live.

We will achieve all financial success and growth as a result of adhering to these principles.

Community Involvement

Keenan is dedicated to making a difference in the lives of those less fortunate. At Keenan, we seek out opportunities to give to those communities where the company has business and employee presence.

Corporate Giving - Contributing to the creation of a stronger and better community is the responsibility of every corporation. Keenan strives to make a difference in its community through donations, sponsorships and employee volunteerism.

Community Enrichment - Keenan fosters personal growth in the lives of individuals and groups through its participation in education, arts and cultural programs.

Outreach - Keenan employees have an opportunity to directly impact their community by giving of their time, talents and resources.

Fair Use Notice

This site contains copyrighted material the use of which has not always been specifically authorized by the copyright owner. We are making such material available in our efforts to advance understanding of education issues vital to a democracy. We believe this constitutes a 'fair use' of any such copyrighted material as provided for in section 107 of the US Copyright Law. In accordance with Title 17 U.S.C. Section 107, the material on this site is distributed without profit to those who have expressed a prior interest in receiving the included information for research and educational purposes. If you wish to use copyrighted material from this site for purposes of your own that go beyond 'fair use', you must obtain permission from the copyright owner.

Keenan code of ethics

Code of Ethics

In the conduct of our business, we are and will continue to be guided by the following principles:

We will be fair and truthful in our relations with our clients, our coworkers and our carriers.

We will conduct our business in a manner which will enable us to take pride in our efforts and in the products and services that we provide. [What exactly makes these people proud? To make a lot of money?]

We will be flexible and responsive to the changing world in which we live.

We will constantly strive to improve upon all we do.

We will act in a manner that will earn the respect and esteem of others. [Which others? The ones who think obtaining money and power deserves respect, even if you have to violate the law to do it?]

We will be exemplary citizens in the communities in which we live. [Money, again. Keenan will appear to act in the public interest on some occasions if it gets a good photo opportunity and the chance to impress customers.]

We will achieve all financial success and growth as a result of adhering to these principles. [So far, so good.]

Keenan and public entities

Founded in 1972, Keenan currently provides insurance, consulting and financial services to over 800 public agencies and over 120 healthcare providers in California. Keenan & Associates' Public Agencies division focuses exclusively on providing innovative solutions for municipalities, counties, local water and transportation authorities and other governing districts. This focus brings a unique understanding of the diverse challenges and risks facing our clients and solid, trusted expertise in protecting and enhancing your human and capital resources. Keenan has a network of offices strategically located throughout California.

Friday, December 21, 2007

Dec. 18, 2007 Julia Rosen on California Health Care proposal

See full story here.

Health Care Proposal Moves Forward

Working Californians
posted by Julia Rosen | 12.18.07
One could call this a deal, or a breakthrough, but with so little time for people to figure out what is really in this thing, there is a decent amount of confusion. The Assembly has passed a health care reform bill that is supported by Arnold. It is massive and if passed would be one of the most significant changes to our health care system ever. The details are emerging, but what is clear is that the huge coalition of groups working to get reform enacted is split and that is partially due to the speed at which this proposal moved forward.

So while Andy Stern, the president of SEIU international is featured in this picture accompanying the article in the LAT, Art Pulaski and the California Labor Federation has not taken a position.

The state Assembly on Monday approved the first phase of a $14.4-billion plan to extend medical insurance to nearly all residents, giving Gov. Arnold Schwarzenegger and his Democratic allies their first victory in a risky yearlong campaign to overhaul California's healthcare system.

The measure, negotiated by Schwarzenegger and Assembly Speaker Fabian Nuñez (D-Los Angeles), would require almost everyone in California to have insurance starting in 2010. It would provide subsidies and tax credits for those who would have trouble paying their share of the premiums.

The authors estimate that it would bring medical coverage to 3.6 million Californians, including 800,000 children, who currently don't have it. But the plan cannot go into effect unless it passes the state Senate and voters approve a companion initiative that Schwarzenegger and Nuñez are planning to place on the November ballot to finance it.

See Dave more on a few significant issues with the funding. The initiative to fund the program, if they can manage to get it on the ballot faces an uncertain future without a united front behind it.

I know I am sounding really cynical now about the prospects of this plan, but I am a pretty pragmatic observer. The Senate refuses to come back to consider this before the end of the year. We don't know what they will determines once they have a chance to really thoroughly examine the proposal. It is unclear if they have gone far enough on affordability and there is a huge concern that there has not been enough headway on reforming the health care system itself. The labor community is split. The state has serious budget issues. We have no clue what the climate will look like in November 2008, if this makes it on the ballot.

There are a lot of reasons not to be excited about this development. However, there have been significant improvements made as negotiations progressed. This bill would drastically improve health care access for hundreds of thousands of Californians. The question is will it do a lot of harm to thousands more? Who benefits the most, Californians or the insurance industry? And does this have a real shot at passage?

Hopefully we will find out some more answers in the coming weeks. This too big of an issue to ram through without careful examination.

Blue Shield Illegally Canceling Policies

Blue Shield Illegally Canceling Policies

Working Californians
The WC Blog
posted by Julia Rosen | 12.13.07
Illegally canceling health care policies is stock and trade for the industry. Their competitor Blue Cross was already fined $1 million by the state in March and Health Net faced a massive court case for doing the same thing. There are lots of reasons why our health care system is a mess and this is one of them. LAT:

California's top insurance regulator has accused Blue Shield, one of the state's largest health plans, of 1,262 violations of claims-handling laws and regulations that resulted in more than 200 people losing their medical coverage.

Calling the allegations "serious violations that completely undermine the public's trust in our healthcare delivery system and are potentially devastating to patients," Insurance Commissioner Steve Poizner said he would announce today that he would seek a $12.6-million fine.
Each one of those cases is a person who had insurance and got sick. They filed for payments authorized by their coverage and Blue Shield said no and attempted to cancel their policies. These sick people then had to fight tooth and nail to get the payment to their doctors so they would not be liable for the bill. In over 200 of those cases they lost and the companies dropped them completely from coverage. Of course that means that they then have a pre-existing condition and thus would have a next to impossible time getting coverage from another company.

It is a disgusting practice that is all about trying to squeeze out a few more dollars in profits. It is illegal and I am glad to see the state launching the investigation and moving to fine them. It sure would be nice if that dissuaded the companies from trying this in the first place, but I don't hold out that much hope that it will.

Keenan is tops for public entities and health care

Keenan is a full service broker, dedicated to providing superior insurance products and services. Our exceptional growth is directly related to our concentration on meeting the risk management, employee benefits, workers' compensation and property & liability consulting and brokerage objectives of public entities, health care systems and high-tech firms. For more information, call 1.800.654.8102, or email Visit our web site at

Keenan & Associates, the largest privately held brokerage and consulting firm in California

TORRANCE CA, June 12, 2007 -- This week, Keenan & Associates was named the top insurance broker in San Francisco’s East Bay by the East Bay Business Times. Keenan’s Oakland office of employee benefit, property and casualty and workers’ compensation consultants, serves clients throughout the East Bay area generating a premium volume of $866 million dollars.

“We are proud to be recognized as the East Bay’s number one insurance brokerage,” said John Scatterday, Senior Vice President at Keenan’s Oakland office. “Keenan’s dedication to developing new products to better serve our clients has driven the momentum of our continued growth. This customer focused approach has been the catalyst in obtaining this lofty recognition.”

Founded in 1972, Keenan has grown to be the 18th largest insurance broker in the United States. With a network of 10 offices located throughout California and a staff of more than 600 insurance specialists, Keenan provides unparalleled service and customized solutions to over 800 clients throughout the state.

Keenan is a full service broker, dedicated to providing superior insurance products and services. The services provided by Keenan include risk management, employee benefits, workers' compensation and property & liability consulting and brokerage objectives of public entities, health care systems and high-tech firms.

Other accolades awarded to Keenan & Associates include ranking eighteen on the nationwide Business Insurance list, number eight on the Insurance Journal list of independent insurance brokers, as well as appearing on the East Bay Business Times list the past two years.

About Keenan
Keenan & Associates, headquartered in Torrance, CA, was founded in 1972. Keenan has grown to the 18th largest insurance broker in the United States. With a network of offices located throughout California and a staff of more than 600 insurance specialists, Keenan continuously provides unparalleled service and customized solutions to our clients.

Keenan is a full service broker, dedicated to providing superior insurance products and services. Our exceptional growth is directly related to our concentration on meeting the risk management, employee benefits, workers' compensation and property & liability consulting and brokerage objectives of public entities, health care systems and high-tech firms. For more information, call 1.800.654.8102, or email Visit our web site at

Keenan & Associates Presents Fourth Annual Summit The State of Change: Perspectives on Reform and Accountability in California
Educational events address critical issues including universal health care, health reform, employer liabilities and pharmaceutical trends

TORRANCE CA, November 12, 2007 -- Keenan & Associates, the largest privately held brokerage and consulting firm in California, presented their fourth annual Keenan Summit, featuring notable California thought leaders addressing topics critical to employers such as health care reform legislation and public employer liabilities for retiree health care costs. This year’s theme was “The State of Change: Perspectives on Reform and Accountability in California.” The program was held in Long Beach on November 7, 2007 and in Oakland on November 8, 2007.

The Keynote Panel on health care reform and universal health care spoke to an audience of almost 400 attendees representing public agencies, school districts, hospitals and labor organizations. The panel included Cindy Ehnes, Director of the California Department of Managed Health Care, Don Crane, President and CEO, California Association of Physician Groups, , Anne Eowan, Vice President-Government Affairs of the Association of California Life and Health Insurance Companies, and Chris Ohman, President and CEO of the California Association of Health Plans.

Those presenting additional topics at the Summit were Ed Weisbart, MD, Chief Medical Officer, Express Scripts, Inc.; Ron Bennett, President and CEO of School Services of California; Joe Aguilar, Partner from accounting firm Vavrinek, Trine and Day; and Louis Leone and Andrea Ritigstein of the law firm Stubbs & Leone. Among the subjects discussed, attendees expressed particular interest in issues related to funding retiree health care costs, fiduciary liabilities and trends in the pharmaceutical industry.
“Public agencies are facing a crisis situation, said Henry Loubet, Senior Vice President/Chief Strategy Officer at Keenan & Associates.” As it became clear at the summit, they have promised retiree health care benefits - which are becoming increasingly costly – without the funding in place to pay for them. Experts in this field agree, pre-funding these expenses is crucial to the financial future of California.” Loubet added, “A pay-as-you-go approach is no longer a viable long-term strategy. With careful planning, schools can fund health benefits for both current and retired workers.”

“Keenan has brought together today’s most influential thought leaders in the area of health care and employer liability,” said California Association of Physician Groups’ Don Crane. “California will likely lead the nation in health care reform, especially in the next two years, and this summit provided a forum for state leadership to discuss and identify solutions to the changing landscape of health care.”

The Keenan Summit was made possible by the generous contributions of these sponsors: Blue Shield of California, Health Net, Valley Oak Systems, MuniFinancial, United Healthcare PacificCare, Blue Cross of California, Express Scripts, Bay Actuarial Consultants, Aetna, Unum, Delta Dental, Kaiser Permanente, Wachovia Securities, Vision Service Plan, Maximus, and Johnson Rooney Welch.

About Keenan
Keenan & Associates, headquartered in Torrance, CA, was founded in 1972. Keenan has grown to the 17th largest insurance broker in the United States. With a network of offices located throughout California and a staff of more than 600 insurance specialists, Keenan continuously provides unparalleled service and customized solutions to our clients.

Keenan is a full service broker, dedicated to providing superior insurance products and services. Our exceptional growth is directly related to our concentration on meeting the risk management, employee benefits, workers' compensation and property & liability consulting and brokerage objectives of public entities, health care systems and high-tech firms. For more information, call 1.800.654.8102, or email Visit our web site at

Kaiser and Keenan

Keenan HealthCare

What Makes Keenan HealthCare Different?

As specialists in serving hospitals and healthcare organizations, Keenan HealthCare understands your unique needs as both a utilizer and a provider of healthcare services.

We can provide you with normative data very rapidly and more cost effectively than a general practitioner.

Due to the number of clients we serve and the resulting large volume of insurance, we can deliver cost effective programs designed exclusively to meet your special needs.

We are one of the largest privately held consulting/ brokerage/ administrative firms in California... and have been one of the top 20 in the nation for many years.

We differentiate ourselves from our competitors by:

Developing unique programs
Using the volume of business from our client base to negotiate competitive pricing
Developing a database of claims information to use in carrier negotiations and trend analysis
Providing unequaled service through our dedicated Customer Service Departments
Offering risk pooling to stabilize rates for the long-term
Distributing updates on legislative matters that affect the healthcare industry
Keenan HealthCare, as a specialist in the field, is better prepared than a general practitioner to offer cost effective, attractive alternatives to healthcare organizations. Our staff are experts in this niche market because of internal training programs, experience and emphasis on continuing education. We routinely monitor trends and issues that impact healthcare organizations to enable us to design programs that better meet the needs of our clients.

As an organization with a well defined niche, Keenan HealthCare understands the healthcare community's issues and operations, and more importantly, the unique problems and constraints faced by healthcare organizations and their employees in today's complex and changing environment.

© Keenan HealthCare
License No. 0451271

Keenan & Associates

Keenan & Associates
2355 Crenshaw Boulevard
Suite 200
Torrance, CA 90501
United States
Tel: 310-212-3344
Primary Industry:


Department of Industrial Relations December 2007
2007/2008 Self-Insured Assessment Rates

The Department of Industrial Relations Self-Insurance Plans (DSIP) has started to send out invoices for the
2007/2008 self-insured assessments. The invoices are dated December 12, 2007 with payment due no later
than January 11, 2008.
Assessments are 100% employer funded and are used to support the Department of Workers’
Compensation (DWC) budget, fund the Department of Insurance and the local District Attorney anti-fraud
efforts, pay for injured workers’ whose employers were uninsured and provide benefits for injured workers’
who qualify under the Subsequent Injury Fund. The total assessment amount required each year is
dependent upon budgets needed to run each of the four programs outlined and the available fund balance
for each program.
The 2007/2008 assessments represent an increase over last year’s due to a smaller carry over balance than
expected, a loan made to the Division of Occupational Safety & Health (OSHA), an increase in the DWC’s
operating expenses, as well as, a one time investment in the DWC’s Electronic Adjudication Management
2004 2005 2006 2007 2008
Total Assessment $165 million $209 million $195 million $281 million
$329 million
User Funding Assessment
(DWC and DIR)
.012656 .021993 .017982 .019662
Uninsured Employers Benefit
Trust Fund Assessment
.004923 .002696 .003572 .001785
Subsequent Injuries Benefit Trust
Fund Assessment
.001121 .001099 .001586 .002727 .000814
Anti-Fraud Surcharge .004712 .003662 .003772 .005451 .006031
Each self-insured employer’s actual assessment amount is contingent upon indemnity paid as reported on
your most recent Self-Insured Annual Report (fiscal year 2006-2007 for public entities and the 2006 calendar
year for private employers).
For those customers who, for budgeting purposes, need to estimate their 2008/2009 Self-Insured
Assessments, please contact your Claims Analyst who can provide with this information.
If you have any questions regarding the information contained in this Briefing, please feel free to contact your
Account Executive, Claims Analyst or Christine Gerbasi at 310-212-0363 x3760 or



We currently accept the following insurances:

- Aetna
- Beech Street
- Blue Cross
- Blue Shield
- Department of Labor (Federal W/C)
- First Health/CCN
- Keenan and Associates
- Medicare
- PacifiCare
- State Fund (SCIF)
- United HealthCare

We also accept many more Private and PPO Insurances and we are providers for most of the Workers' Compensation Medical Provider Networks (MPN's).

The Shor Group of ComaniesAlburger Basso deGrosz (insurance brokerage); Keenan & Associates and Keenan Healthcare (insurance brokerage); CIGNA Property & Casualty (underwriter) ... - 7k - Cached - Similar pages - Note this

Cigna Insurance TexasCIGNA Corp., Philadelphia, Pa. Harvard Pilgrim Health Care Inc., Wellesley, Mass. .... Keenan & Associates Named Top Insurance Brokerage in San Francisco . ... - 39k - Cached - Similar pages - Note this

It's you that Keenan, Kaiser and Cigna care about

Upcoming Events:
April 6-9th, 2008 2008 Annual Forum
Four Cornerstones: The Future of HealthCare?
Key West, Florida

Past Events:
March 2007 Annual Forum
Strategies for Consumer Health Engagement: “It’s All About the Consumer”

Presentation: Member Connections – Building Quality into the Member Experience
Presented by: Ann F. Carson, MPH, Assistant Vice President, Product Development, National Committee for Quality Assurance

Presentation: The Role of the Consumer in Health Care: A Health Plan Perspective
Presented by: Mary Wilkins, Senior Vice President
Cigna HealthCare’s National Accounts Segment

Presentation: Making Innovation Count in Healthcare
Presented by: Mohan Nair, Executive Vice President and Chief Marketing
Executive The Regence Group

Panel Discussion: The Plan Perspective

Presentation: Engaging Members Incentives for Change
Presented by: Sandra Brower-Stenger, Senior Director Corporate QI/HEDIS, AvMed Health Plans

Presentation: Consumer Engagement
Presented by: Amy Chambers, Senior Legal Counsel, Business Development, Priority Health

Presentation: It’s All About the Consumer
Presented by: Martin E. Hickey, M.D., Senior Vice President, Health Care Affairs, Excellus

Presentaion by: Mohan Nair, Executive Vice President and Chief Marketing Executive, The Regence Group

Panel Discussion: The Vendor Perspective

Presentation: Improving Member Engagement for Health and Care Management
Presented by: Dogu Celebi, Executive Vice President, IHCIS, Ingenix

Presentation: Engaging the Member, Part II, The Vendor Perspective
Presented by: John Harris, M.Ed., FAWHP, Senior Vice President, Healthways

Presentation: Help people make better health decisions
Presented by: Molly Mettler, MSW, Senior Vice President, Healthwise

Presentation: Web-Enabled Consumer-Centric Rx Benefit Information System
Presented by: Robert S. Oscar, R.Ph., President – Founder, RxEOB

Presentation: Professional Development: The Five Dysfunctions of a Team
Presented by: Skip Everitt, Founder, Chief Executive Officer,
Everitt & Associates

February 8, 2007 MCEG Top 10 Issue #2:

Investment in real-time infrastructure. Innovation in business process continues to yield returns in customer satisfaction and increased revenue. CIOs know that business process fusion requires a robust and scalable real-time infrastructure, and are investing accordingly.

Co-Sponsored by: HP and Covisint
Presentation: Investment in real-time infrastructure

December 12 MCEG Top 10 Issue #5:

Nimble, speed-to-market solutions. Fast, focused and results-driven projects will be required to address the rapidly changing product portfolios and changing demands of the market. These IT projects will need to fit within overall standards and architectures to avoid rework and too-early replacement later.

Presentation: Automation of Paper Based Work-Flows
Presentation by: Terry Boch and Roger McKinney Sponsored by: Covisint

November MCEG Top 10 Issue # 6: Retention and Use of Clinical Information as it Impacts:
Predictive Modeling
Diseases Management
Health Outcomes
The New Frontier of Predictive Knowledge Management
Presenter: Dr. Kevin Fickenscher, Perot Systems
Sponsored by: Perot Systems

October 10th MCEG Top 10 Issue #9:

Rapid Product Development to Meet the Changing Demands of Members
Presenter: Mark Olson
Sponsored by: TriZetto

May 24 Tools Consumers Really Want
Dan Levin, Intuit; Bill Whitely, Ingenix
March 27, 28, 29 2006 Annual Forum
"The Quest for Intelligence Based Healthcare"

Information Transparency: The Cost of Not Knowing Charley Baker, President, CEO, Harvard Pilgrim Health Care
Panel Discussion: Clinical Integration/Interoperability to Improve Quality Michael Cropp , MD, MBA, CEO, Independent HealthDavid Kibbe, MD, MBA, Director, Center for Health Information Technology, AAFP Henry Loubet , Chief Strategy Officer, Keenan Andrew Webber , President, CEO, NBCH
Pay For Performance: The Road Ahead Geoff Baker, MBA, CEO Med-Vantage
Digital Nation: Business Realities of Innovation Joseph Batista, Director, Chief Creatologist, Hewlett Packard
Leadership Development: The Path from CIO to CEO Elyse Sutherland, PhD, President
Sutherland Leadership Strategies
February 23 RHIO Initiatives & Requirements Jim Jones, Healthcare Solutions Manager, Hewlett Packard
December 6th MCEG Top 10 Issues - #7 "Impacts and movement to services oriented architecture" Presenter:Eric Brown, VP, Research Director, Forrester HealthcareSponsored by: Perot Systems
October 18th MCEG Top 10 Issues - #9: Impact of Medicare Reform Legislation "Medicare/Medicaid Reform: Competitive Impact - What it means"
Presenter: Greg Maguire, Sr. VP, Operations, Keystone Mercy Health PlanSponsored by: TMI | a daou company

August 5th MCEG Top 10 Issues - #2: Collaboration with Providers "Using Web Collaboration to Improve Health Plan/Provider Relationships"
Presented by: NavimedixSponsored by: Sybase
June 28th Pay for Performance Presented by: Geof Baker of MedVantage Inc.
Sponsored by: Trizetto
April 25, 26, 27 2005 Annual Forum
"Innovation: In With the New"

Healthcare Market Outlook Thomas Main, Chaperhouse

Innovation at Humana: CDHP JacqueSokolov, MD of Sokolov, Sokolov, Burgess

Leveraging Innovation and Technology Larry Leisure of Kaiser Foundation Health Plan, Inc.

National and Regional eHI Janet Marchibroda

Technology Vision and Impact Charles Nebolsky of Accenture Technology Labs

March 17th CDHP: Lessons Learned in Developing a Custom Web Portal Henry Loubet, Keenan and Associates

Keenan & Associates and Cigna Heathcare really care about you

The following article is from MANAGED HEALTHCARE EXECUTIVE.

In their corner: Health coaches support consumer efforts toalter behavior

The interest in health coaching is driven by purchasers' desire to lower medical benefit costthrough wellness and disease management, according to Steve Richter, senior vice presidentat Keenan & Associates, Keenan HealthCare division. "This means facilitating behaviorchange in consumers who know what lifestyle or other behavior changes they need to make,but have not followed through," Richter says.

Health coaching can include disease management, case management, utilization review andgenerally applying evidence-based medicine guidelines to care delivery, according toMicali.Because of the strong imperative to provide behavior modification interventions, healthcoaching recently has gained great popularity because of the ability to address multiplebehaviors, health risks and self-management of illness in a cost-effective manner,Butterworth says."If we can encourage people to make healthier lifestyle choices and adhere to theirtreatment plans by facilitating self-care competencies, the outcomes include reduced healthrisks and better self-management of chronic conditions," she says.

OHSU HMS offers health coaching through a multidisciplinary group, including nurses,dietitians and other health promotion specialists, who spend time with individuals primarilyby telephone.

"During these interactions, the health coach focuses on identifying both the physical and mental obstacles that prevent members from taking charge of their health and bettermanaging their chronic conditions," says Jay Krueger, senior vice president of businessstrategy, APS Healthcare, a specialty healthcare company based in Silver Spring, Md.,which bundles health coaching into its disease management program.The number of health coaching sessions may vary on the program being pursued, Micalisays. "Someone who wants to significantly change diet and exercise to address obesity mayrequire a high frequency of sessions and a long duration, given that eating habits can bevery slow to combat," he says.

Health coaching is fairly intensive and not necessary for every member, according toButterworth. "The most cost-effective way to administer all health promotion and disease management interventions is to identify members/employees at greatest risk and stratifythem by need for varying the intensity of services," she says.

Candidates for health coaching tend to respond positively because health coaches act as anadvocate, according to Krueger. "Health coaches provide a supportive environment to helpmembers obtain positive healthcare results that are sustainable over time," he says."Individuals who are involved in their care make better decisions and are more able toengage their physicians and other support resources in managing their care."In addition, many health coaching programs offer consumers financial incentives toparticipate, Micali says.

CIGNA has found that the majority of individuals respond positively to outreach from a health coach, according to Daniel L. Ober, DO, medical senior director, health advocacyand information at CIGNA. "Some may not be aware of their health risks or haveinformation to help them incorporate changes or follow a doctor's recommendations," Dr.Ober says. "Others find it helpful in setting goals and like the accountability of knowing their health coach will be calling them."CIGNA has formed CareAllies Health Coach program that targets those who are at higherrisk for future healthcare problems, based on their responses to a health risk assessment."We are focusing on consumers as the end-users of our clinical management and healthadvocacy services," Dr. Ober says.

When a CIGNA HealthCare medical plan is offered by a plan sponsor, CIGNA provides clinical management and health coaching programs, which include disease management programs, a 24-hour health information line and a healthcoaching program."CareAllies provides plan sponsors with these programs when an employer wants to offer aconsistent set of clinical management and health coaching programs across their entireworkforce, whether or not they have an underlying CIGNA medical plan," Dr. Oberexplains.
Page 4
The CareAllies team averages about two health coaches per 1,000 members, along with a team of health advisors, level-of-care nurses, nutritionists, lifestyle management specialists,a dedicated health coach medical director, multiple specialty physicians and a pharmacist.The number of health coaches may be adjusted to meet volumes and utilization and demand, says Dr. Ober. "Our health coach program is individualized, dependent on the member's need," Dr. Obersays. "Attempting to make dietary or physical activity changes, for many individuals,requires a series of small steps over several months."Aetna offers a Wellness Counseling service that looks at health risk assessment data and risk-stratifies members, according to Anthony Rubino, product specialist for the MemberAdvantage Programs, and subject matter expert for the Aetna Healthy Body, HealthyWeight, and Wellness Counseling. The Wellness Counseling service costs 60 cents per-member per-month (PMPM) and the Aetna Healthy Body, Healthy Weight program costs$1 PMPM. "The Wellness Counseling services lower modifiable risk factors, identifycandidates for disease and case management programs earlier, educate about Aetna consumerism tools and support positive health-related behavior change," Rubino says.Wellness Counseling nurses provide outreach to members if they are at risk for a number ofconditions. "This type of early intervention has been shown to identify at-risk membersearly and to manage a condition early before the condition becomes chronic or severe,"Rubino says.

CareFirst BlueCross BlueShield is launching a health risk assessment tool"MyHealthProfile" this month and a "Healthy Lifestyle Coaching" health coaching service for smoking cessation, exercise participation, as well as weight and stress management fromHealthways this October, according to Dr. Safeer. "Our health coaches will not be spending time telling participants that smoking is bad for you or for your lungs–which offers a lowerprobability of being effective. Instead, we will partner with the participant to take intoaccount their individual situation when approaching their unhealthy behavior," he says.

Tracey Walker is senior editor for MANAGED HEALTHCARE EXECUTIVE.

Cigna HealthCare refused to pay for a 17-year-old leukemia patient's liver transplant

Family blames HMO for teen's death

Cigna refused to pay for a 17-year-old leukemia patient's liver transplant until the family staged a protest Thursday, but Nataline Sarkisyan died shortly after the reversal.

By Molly Hennessy-Fiske, Los Angeles Times Staff Writer

December 21, 2007
A grieving family is blaming an insurance company for the death Thursday of a 17-year-old leukemia patient, who died hours after the company reversed course and agreed to pay for her to receive a liver transplant.

Nataline Sarkisyan was being treated at UCLA Medical Center, where she had been unresponsive in intensive care for about three weeks, her mother said.

"She had a 65% chance of survival if she had gotten the liver," Hilda Sarkisyan said from her home this morning.

The Sarkisyans' insurer, Philadelphia-based Cigna HealthCare, denied the transplant earlier this month.

Doctors at UCLA sent a letter Dec. 11 to Cigna emphasizing that Nataline was eligible for a transplant, Hilda Sarkisyan said. But Cigna refused to pay, citing a lack of medical evidence the procedure would help.

Hilda Sarkisyan said the company was trying to save money. "They just like to collect. They don't want to deliver," she said.

On Thursday, the family rallied supporters online and staged a protest at Cigna's Glendale office with about 150 people, including many members of the local Armenian community and the California Nurses Assn., which had released statements supporting the family's cause.

Later in the day, Cigna released a statement approving the transplant payment.

"Although it is outside the scope of the plan's coverage, and despite the lack of medical evidence regarding the effectiveness of such treatment," spokesman Wendell Potter wrote, "Cigna HealthCare has decided to make an exception in this rare and unusual case, and we will provide coverage should she proceed with the requested liver transplant. Our thoughts and payers are with Nataline and her family at this time."

Nataline died about 6 p.m.

Cigna spokesmen did not respond to e-mail and telephone requests for comment this morning.

The family's lawyer planned a news conference later today to discuss the situation.

Charles Idelson, spokesman for the Oakland-based California Nurses Assns., called Cigna's handling of the Sarkisyan's case "outrageous."

"If Cigna could approve the transplant yesterday in response to hundreds of phone calls and people pounding on their door in Glendale, why couldn't they have done it eight days earlier?" Idelson said this morning.

He said his group, which represents 75,000 nursing professionals, the majority in California, has recently rallied around a number of patients who have been denied care.

While it isn't clear that Cigna could have saved Nataline by approving the transplant earlier, Idelson said, the insurer should have trusted her doctors.

"The transplant was recommended by the medical professionals at the bedside," Idelson said. "They should have been listened to."