The "death panels" are already here

Is our current system "downright evil"?

The "death panels" are already here

Sorry, Sarah Palin -- rationing of care? Private companies are already doing it, with sometimes fatal results
Salon.com
By Mike Madden
Aug. 11, 2009

The future of healthcare in America, according to Sarah Palin, might look something like this: A sick 17-year-old girl needs a liver transplant. Doctors find an available organ, and they're ready to operate, but the bureaucracy -- or as Palin would put it, the "death panel" -- steps in and says it won't pay for the surgery. Despite protests from the girl's family and her doctors, the heartless hacks hold their ground for a critical 10 days. Eventually, under massive public pressure, they relent -- but the patient dies before the operation can proceed.

It certainly sounds scary enough to make you want to go show up at a town hall meeting and yell about how misguided President Obama's healthcare reform plans are. Except that's not the future of healthcare -- it's the present. Long before anyone started talking about government "death panels" or warning that Obama would have the government ration care, 17-year-old Nataline Sarkisyan, a leukemia patient from Glendale, Calif., died in December 2007, after her parents battled their insurance company, Cigna, over the surgery. Cigna initially refused to pay for it because the company's analysis showed Sarkisyan was already too sick from her leukemia; the liver transplant wouldn't have saved her life.

That kind of utilitarian rationing, of course, is exactly what Palin and other opponents of the healthcare reform proposals pending before Congress say they want to protect the country from. "Such a system is downright evil," Palin wrote, in the same message posted on Facebook where she raised the "death panel" specter. "Health care by definition involves life and death decisions."

Coverage of Palin's remarks, and former House Speaker Newt Gingrich's defense of them, over the weekend did point out that the idea that the reform plans would encourage government-sponsored euthanasia is one of a handful of deliberate falsehoods being peddled by opponents of the legislation. But the idea that only if reform passes would the government start setting up rationing and interfering with care goes beyond just the bogus euthanasia claim.

Opponents of reform often seem to skip right past any problems with the current system -- but it's rife with them. A study by the American Medical Association found the biggest insurance companies in the country denied between 2 and 5 percent of claims put in by doctors last year (though the AMA noted that not all the denials were improper). There is no national database of insurance claim denials, though, because private insurance companies aren't required to disclose such stats. Meanwhile, a House Energy and Commerce Committee report in June found that just three insurance companies kicked at least 20,000 people off their rolls between 2003 and 2007 for such reasons as typos on their application paperwork, a preexisting condition or a family member's medical history. People who buy insurance under individual policies, about 6 percent of adults, may be especially vulnerable, but the 63 percent of adults covered by employer-provided insurance aren't immune to difficulty...

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.


http://abcnews.go.com/GMA/story?id=4043101&page=1

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

http://www.mceg.net/?article=events

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.
http://www.ohsu.edu/hms/pdf/ManagedHealthcareExecutive.pdf.

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."

molly.hennessy-fiske@latimes.com