In the market for a cataract removal?


In the Los Angeles area, if you're a member of a Cigna Healthcare preferred provider organization the procedure could cost anywhere from $890 and $3,370 out of pocket, depending on the provider and the specifics of your employer-negotiated plan.


The information, not readily available to insured patients, is newly available online from the Broomfield, Conn.-based Cigna Corp. It's hoping that by providing its 170,000 Los Angeles area members the information needed to do real comparison shopping, it will lower costs for patients and attract additional workers to sign up during its fall enrollment.


For the first time, members will be able to compare the cost of procedures such as colonoscopies, endoscopies, and cardiac catherizations, plus a full range medical imaging services among facilities in their area. They'll also be able to gauge a facility's experience and success in performing certain procedures via a variety of quality markers.


"We have been promoting transparency because part of our philosophy has been the active engagement of consumers in their health care," said Chris De Rosa, president of Cigna's Glendale-based Southern California region. "In order to do that you really have to have (detailed) information for them about costs and quality. That way members can make the decision about how much they want to spend."


That's important because employers have increasingly opted for health plans that keep their costs lower by shifting more costs to employees via tiered co-payments and variable co-insurance payments.


Bridging the Divide
Sensitivity to the ethnic diversity of your clients is just good business in California, where 53 percent of the population are people of color, 25 percent were born outside the U.S. and 40 percent speak a language other than English at home.


So when a respected national group promoting health care quality held a competition to see which managed care plans offered the most innovative programs for bridging cultural and linguistic divides, it wasn't a surprise that six of the 10 winners had roots in the Los Angeles area and other parts of Golden State.


"It really demonstrates that California is in the lead when it comes to providing culturally appropriate health care services," said John Friedman, spokesman for the Washington D.C.-based National Committee for Quality Assurance.


Los Angeles-based L.A. Care Health Plan, Thousand Oaks-based Blue Cross of California Partnership Plan Inc., Woodland Hills-based Health Net of California, and the Michigan affiliate of Long Beach-based Molina Healthcare Inc. were honored this month at NCQA's annual conference in Redondo Beach. Also honored were two Bay Area plans.


The Blue Cross program focused out better outreach to MediCal and Healthy Families clients who were ethnic minorities, especially Spanish-speakers, and weren't getting the proper training in how to use their asthma inhalers. The program involved special outreach to pharmacists to let them know these patients were eligible for an extended consultation, for which the pharmacist would receive higher reimbursement.


Dr. Dawn Wood, vice president and medical director for Blue Cross parent WellPoint Inc.'s state sponsored businesses, said her division was able to document increased utilization of inhalers among its target group, and the gaps in compliance among different ethnic groups narrowed.


At L.A. Care Health Plan, whose 750,000 members make it the nation's largest Medicare-Medicaid managed care provider, the emphasis was on promoting pediatric weight management programs among ethnic groups, especially those in which chubby children are often considered healthy.


Long Beach CEO
Long Beach Memorial Medical Center has recruited veteran healthcare executive Terry Belmont to serve as chief executive of the hospital and its affiliated Miller Children's Hospital, a combined 743-bed hospital campus.


Since 1999, Belmont has been a senior vice president at Kaiser Permanente, most recently in its Inland Empire region. He earlier had held top positions at several other California facilities, including St. Joseph Hospital of Orange and California Hospital Medical Center in Los Angeles. A former director at recently acquired managed care provider PacifiCare, Belmont also served on the California Healthcare Association board and executive committee.


Belmont replaces interim chief executive Tammie Brailsford, who will return to her position as senior vice president of MemorialCare Medical Centers when Belmont starts in early November.


White Gets Certified
East Los Angeles' White Memorial Medical Center has become the second hospital in the county, and among only a handful in the state, to have its cardiac rehabilitation program certified by the respected American Association of Cardiovascular and Pulmonary Rehabilitation.


The process required White Memorial rehab staff to upgrade information technology systems and clinical practices so they could provide detailed data on patient outcomes; at the clinic, where patients who have undergone by-pass surgery and similar cardiac procedures are taught how to exercise, eat, and change behaviors to rebuild their health.


The program's medical director, Dr. Ranier Manzanilla, says the investment was worth it because the process not only provided evidence of its program's effectiveness, but also enables his medium-size 350-bed hospital to stand out from competing programs at the county's higher profile hospitals.


"It legitimizes our program," said Manzanilla, who credits program coordinator Jennifer Lee with shepherding the unit through the process. "We'd like to serve a lot more patients if we can."


Staff Reporter Deborah Crowe can be reached at (323) 549-5255, ext. 232, or at dcrowe@labusinessjournal.com .

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