Susan Reda of STORES Magazine has written a great piece featuring these three companies which can be found on the STORES Website by clicking here.

From the article:

Recruiting employees to work in retail stores is the easy part; it’s convincing them to stay that can be grueling.

Turnover in the retail industry is notoriously high. For myriad reasons — everything from long hours and tedious tasks to the chance to earn a dime more per hour at the shop across the mall — retail employees suffer from a collective case of retention deficit disorder. Statistics reported earlier this year by the National Retail Federation estimate industry turnover at 58 percent for full-time associates and 114 percent for part-time employees.

Given the cost of recruiting, hiring, onboarding and training, retailers are understandably frustrated when an employee who has been with the company just a few short weeks or months decides to move on. The prospect of investing in an employee who departs before the season changes is unsettling at best, but return on investment is not the only concern: Customer service suffers when there are not enough associates to assist shoppers, process transactions or provide the knowledgeable insight that a seasoned employee can offer.

Company: BURGERVILLE
Headquarters: Vancouver, Wash.
Employees: 1,400+
Retention Strategy: Affordable Health Care

A 2005 employee survey spelled it out in black and white: The No. 1 concern of Burgerville workers was affordable health care.

“We bet that if we could find a way to make health care affordable for all our employees — most of whom are hourly employees — we could alleviate a huge concern and win their loyalty,” chief cultural officer Jack Graves says.

It was a sizeable bet — approximately $1.5 million — but it has paid off handsomely. Since it began offering an extended and improved health insurance plan, Burgerville has achieved a dramatic increase in employee retention and loyalty.

Prior to implementing the new plan, turnover rates hovered around 128 percent. In 2006, the first full year of the health care initiative, turnover dropped to 54 percent; today the rate is holding steady at 52 percent. Productivity and employee confidence are up, absenteeism is down and, by reducing turnover, Burgerville has conservatively saved more than $500,000 — capital the quick-serve chain would have had to invest in recruiting, training and onboarding.

Under Burgerville’s plan, employees who have been with the company for at least six months and work 20 hours a week are eligible for health insurance; it costs each employee $15 per month, or $90 monthly for family coverage. Burgerville’s parent company, The Holland, pays more than 90 percent of the premium for employees and their dependents.

The package, put together in partnership with Kaiser Permanente, has no deductible — a tipping point for employee acceptance, according to Graves. High school and college students, retirees and young moms working part time “are often on a tight budget,” Graves says. “What we learned, however, was that these employees were less likely to go to the doctor — even if they had some insurance — because they couldn’t afford the deductible.

“Offering affordable health care with a zero deductible was a game changer,” he says.

It didn’t happen overnight, however. “The program was so outside the box that people didn’t believe it at first,” Graves says. “We actually set up a field trip of sorts to a Kaiser clinic to demonstrate how it worked.”

Employee retention isn’t the only metric Burgerville uses to measure its return on investment. “With more skilled employees, our restaurants are running better and they look better,” Graves says. “The food is hotter and it’s served faster, too. There’s a renewed sense of pride and commitment.”

The changes are having a healthy effect on the bottom line, too; Burgerville reports a year-over-year increase in guest counts and a lift in sales.

“Being a local company, word spread quickly of our commitment to providing health care, and guests have rewarded us for that,” Graves says. The company has received substantial feedback from guests indicating that the care showed to its employees separates Burgerville from the pack.

“Many guests have written to us saying that it is this sort of program that keeps them committed to the Burgerville brand,” Graves says. “I’ve got the e-mails to prove it.”

Burgerville employees are at the forefront of what allows the company to live its values to their fullest extent. Without strong, vibrant and healthy people working in each of their restaurants, the company cannot provide the service which their guests expect.

Even more important, Burgerville has been able to live their mission “Serve with Love” and stand by their employees. Burgerville believes that thriving individuals lead to thriving families which helps build efficient and connected communities. This in turn supports a very healthy and sustainable business.

]]> http://midiguru.wordpress.com/?p=256 Wed, 01 Oct 2008 20:45:31 +0000 midiguru http://midiguru.es.wordpress.com/2008/10/01/kaiser-cement/ The story so far: Our hero is experiencing significant depression. To the point of paralysis, anger, despair, and minor mental impairment. Rather than consult his semi-regular therapist, who is not licensed to prescribe anti-depressants, he decides to try using the Kaiser Permanente system.

He is paying $600 per month for Kaiser health coverage, whether he uses it or not. And while that may seem a lot of money (it is a lot of money), his plan has a high copay. Each time he visits a Kaiser provider, he shells out $50.

Today's $50 was a colossal waste.

First he has to browbeat Kaiser to get an early appointment. They want him to show up in two or three weeks. Having managed to thrash the system into something that, to a first approximation, resembles submission, he drives over to Pleasanton, fills out a long form concerning his mental and emotional issues past and present, and then has an hour-long intake conversation with a mental health professional of some sort.

The professional goes over the answers on the form and then asks general background questions, which take up the remainder of the hour. The professional is not himself empowered to write a prescription for anti-depressant medication, but merely books an appointment two weeks from now with the psychologist who is so empowered.

More to the point, the professional provides no actual mental health services for our hero. At the end of the hour, our hero feels (a) more desperate than before, because he has just spent an hour going over the issues, (b) frustrated because he still has to wait two weeks to see someone who (in theory, at least) can actually do something, and (c) ripped off to the tune of fifty bucks. Since one of the key issues causing the depression is excessive financial outflow, this latter point is not trivial.

What I actually need is to have someone sit down and spend several hours -- or quite possibly several days -- going over the various issues with me and helping me formulate a plan of action. The so-called mental health profession is not, of course, set up to provide that type of service, not at any price. With Kaiser, you have to wait two weeks just to get a BandAid.

It is the nature of the problem that I don't know what to do. If I knew what to do, I'd be out there doing it! What I need, then, is some help figuring out what to do. Again, if I had someone to talk to, I'd be talking to them. But I don't. So I need to employ the services of a professional. But that doesn't work either, because they don't actually provide any useful insights or suggestions.

Does anyone have a glimmer of why I'm feeling a teensy bit crazy and desperate right now? Probably not. I haven't explained the underlying issues, have I? Nor will I, not in this forum. I just wanted to bash fuckin' Kaiser a little.

PREFERRED SKILLS: Experience in After Hours Care or ER. Experience with Adults, Pediatrics and Trauma Preferred. This position is for After Hours Care and will be working every Saturday, Sunday and Holidays, and 1 day during the week in Family Medicine.
JOB SUMMARY: Practices professional nursing by the performance of both independent nursing functions and delegated medical functions in accordance with accepted practice standards. Such functions include the initiation and performance of nursing care through health promotion, supportive or restorative care, disease prevention, diagnosis and treatment of human disease, ailment, pain, injury, deformity, and physical or mental condition using specialized knowledge, judgment, and skill involving the application of biological, physical, social, and behavioral science principles. CRS 12-38-103 (10).

POSITION REQUIREMENTS: Currently licensed as a Registered Nurse in the State of Colorado. Previous med/surg experience preferred. Applicant must be a graduate of a RN program that meets Colorado State Board of Nursing curriculum requirements. BLS strongly preferred. National Provider Identifier (NPI) and Taxonomy code required at time of hire.

ESSENTIAL RESPONSIBILITIES: (Portions adopted from Colorado State Nurse Practice Act CRS 12-38-103). Evaluating health status through the collection and assessment of health data CRS 12-38-103 (10). Collects subjective and objective data. Analyzes, reports, and records data. Uses data to identify health care problems and create plan. Prioritizes patient’s needs. Triage patients either in person or via telephone and implements proper course of action in accordance with established protocol/guideline or in consultation with provider. Conducts telephone call backs to patients requiring follow-up care. Evaluates emergency situations and initiates appropriate nursing interventions.
Practices within scope of practice perimeters as inferred by licensure, standard nursing practice, knowledge, skill level, sound clinical judgment, and KP guidelines.
Accurately documents patient data, actions or interventions, responses, and plans for care/follow-up according to guidelines and/or standard nursing practice.
Health teaching and health counseling to patients and/or their families.
Executing delegated medical functions which deliver aspects of care that implement and are consistent with the medical plan as prescribed by a licensed or otherwise legally authorized physician or person acting under the physician’s delegated authority.
Administers intravenous therapy and other medications.
Providing therapy and treatment that is supportive and restorative to life and well being either directly to the patient or indirectly through consultation with, delegation to (per Colorado State Board of Nursing rules and regulations for delegation), supervision of, or teaching others.
Refers to medical or community agencies per Kaiser Permanente guidelines those patients who need further treatment, evaluation, or assistance.
Review and monitor therapy and treatment patient plans. Initiate appropriate consultations and/or actions accordingly.
Facilitates the coordination and integration of care between health care services; manages populations of patients to ensure appropriate utilization of health care resources.
Leads health care team by influence and role modeling integrated effective nursing practice, exemplary service, innovation and providing outstanding support for physician practices.
Patient advocate.

COMPLIANCE LANGUAGE: Supports compliance and Kaiser Permanent’s Code of Conduct by adhering to federal and state laws and regulations, accreditation and license requirements, by policies and procedures. Responds appropriately to observed fraud and abuse.
Functional and Environmental Factors available upon request.

SCHEDULE: Rotating schedule; Hols/wknds/nights; Floats between depts/locs/facs
STARTING SALARY RANGE : $27.20 - $32.00 (Hourly)
- Kaiser Permanente is an AA/EEO employer -

This position supports Kaiser Permanente’s code of conduct and compliance by adhering to all laws and regulations, accreditation and Licensure requirements, and internal policies and procedures. Kaiser Permanente is an AA/EEO employer.

DEPARTMENT: Operating Room
SCHEDULE: Part – Time Regular; 24 hours per week; Evening Shift, 1530 - Midnight
Week One: Thursday, Friday, Saturday
Week Two: Sunday, Thursday, Friday
EDUCATION: High School Diploma/GED. Graduate of an accredited registered nursing program and completion of the current hours required by the BRN of RN student clinical experience; OR Graduate of registered nursing program and either: 1) 2000 hours of RN experience in clinical area of specialty from a licensed acute care facility within three (3) years of graduation; or 2) graduate of an accredited licensed vocational nursing program that includes clinical student experience in acute care and has worked 2000 hours as a licensed vocational nurse within the clinical area of specialty within three (3) years before graduation or currently enrolled in an accredited entry level MSN program and has completed pre-licensure requirements to practice nursing.
CERTIFICATION/LICENSE: Current California RN License. Current BLS, Depending on the particular specialty, ACLS and or NALS and or PALS may also be required for this position. See job duties for specific requirements for specialty units.
JOB SUMMARY: The Registered Nurse (RN) II is a professional caregiver who assumes responsibility and accountability for a group of patients for a designated time frame. The RN II provides care to patients via the therapeutic use of self, the nursing process, the environment and instrumentation, and other health care team members.
QUALIFICATIONS: High School Diploma/GED. Graduate of an accredited registered nursing program and completion of the current hours required by the BRN of RN student clinical experience; OR Graduate of registered nursing program and either: 1) 2000 hours of RN experience in clinical area of specialty from a licensed acute care facility within three (3) years of graduation; or 2) graduate of an accredited licensed vocational nursing program that includes clinical student experience in acute care and has worked 2000 hours as a licensed vocational nurse within the clinical area of specialty within three (3) years before graduation or currently enrolled in an accredited entry level MSN program and has completed pre-licensure requirements to practice nursing. Current license to practice as a Registered Nurse in California
Minimum of 6 months experience. See job duties for specific experience requirements for specialty units.
Demonstrated knowledge of the RN scope of practice. Demonstrated commitment to service orientation (members, staff, providers). Demonstrated effective written and oral communication skills (in English). Good interpersonal skills. Also refer to Position Specifications outlined in the appropriate collective bargaining agreement.
DUTIES: Performs assessment/data collection in an on-going systematic manner, focusing on physiologic, psychosocial, cultural, spiritual and cognitive status; also nutrition, pain, patient/family education, family involvement and patient advocacy.
Formulates a goal-directed plan of care that is prioritized and based on determined nursing diagnosis and patient outcomes.
Implements care in a thorough, skillful, consistent, and continuous manner.
Establishes priorities or patient care based on essential patient needs and availability unit resources time, personnel, equipment, and supplies.
Identifies patient/family learning needs and implements appropriate measures.
Documents patient care and unit activities in a timely, accurate, and concise manner.
Demonstrates an awareness of and sensitivity to patient/family rights, age specific needs, cultural and ethical beliefs.
Demonstrates knowledge of and applies safety principles as identified within the institution.
Performs efficiently in emergency patient care situations following established protocols, remaining calm informing appropriate persons, and documenting evens.
Demonstrates sound knowledge base and actions in the care of a designated patient population.
Demonstrates responsibility and accountability for own professional practice.
Participates regularly in staff development activities for unit and Department of Nursing personnel.
Demonstrates knowledge of legal issues, including patient confidentiality and risk management in all aspects of patient care and unit functioning.
Participates in unit and Department Performance Improvement activities as directed.
Delegates appropriately and coordinates duties of health care team members.
Utilizes effective communication methods and skills, following lines of authority, as appropriate.
Demonstrates a service philosophy in all-interactions with patients, families, and all members of the health care team.
Establishes effective working relationships with members of the health care team, patients, and families. Acknowledges staff rights and cultural an ethical beliefs.
Provides data for staffing decisions and demonstrates flexibility in the resolution of staffing issues; demonstrates flexibility when floating to other units upon requests.
Ability to navigate in a windows environment, utilizing a mouse and the ability to learn electronic medical record system application.
Identifies and solves problems effectively.
Participates in nursing research activities as requested.
Performs other related duties as necessary.
SPECIALITY AREAS: If no qualified candidate, may be willing to train in the specialty areas listed below. Candidates in training are required to obtain appropriate certification(s) within 6 months of hire or transfer into the unit.
OR – Two years recent (within the last 3 years) experience in acute hospital OR, working on a variety of surgical procedures. The ability to take call within the hospital required response time, work variable hours, and rotate weekends.
Supervisory Responsibilities: This job has no supervisory responsibility.
Compliance Accountability: Consistently supports compliance and the Principles of Responsibility (KP’s code of conduct) by maintaining confidentiality, protecting the assets of the organization, acting with ethics and integrity, reporting non-compliance, and adhering to applicable Federal and State laws and regulations, accreditation and licensure requirements, and KP policies and procedures.

Surgery Staff Nurse II Job at Kaiser Permanente - Sacramento, CA

It is hard to say what message does Kaiser send to us. Am I also eligible to vote for myself or I am not qualified by age? Or only baby boomers are welcome to vote for themselves?

There is more. "You are under arrest. Step away from the vehicle, turn around and put your hands on top of your head":

Impression I got after observing these billboards after a week:

Design Fail factor: 4 (out of 10).

Update: 7macaw's suggestion:

Checking into my daily news on the net. I have come across yet again another ugly situation involving children. I feel the need to blog about it to get the word out and maybe someone can offer more assistance for these children in need.

Kaiser Permanente has just released a report that over 960 San Franciscan maternity ward children and their mothers may have been exposed to a diagnosed worker in that maternity ward that has active tuberculosis.

The worker no longer works for Kaiser and Kaiser has been contacting and informing all patients that may have been exposed. This worker was employed with Kaiser from March to Aug 08.

See the full story here.

Although this makes my blood boil that this was not caught before hand especially in a vital area as a maternity ward when babies are more susceptible to all sorts of issues, Kaiser is responding and will give the necessary antibiotics to the mothers and children. You would think that in a hospital certain extraordinary precautions would be taken especially in a maternity ward.

Thank goodness if one could make that statement that this is a common strain of the infectious diseases that antibiotics will respond well to it. What gets me here also is the statement common strain of the infectious disease, yeah I am aware of what they mean but really this is a infectious disease there is nothing common about it! Let's not try to minimize the scare and the importance of getting help to these children and their mothers for Pete's sake! If you know or have family from this area tell them about this. Done with my rant now, lol!

]]> http://ikeslife.wordpress.com/?p=65 Thu, 21 Aug 2008 16:32:26 +0000 ikeusa http://ikeslife.es.wordpress.com/2008/08/21/haircut-new-office-look/ I drove Kristie to her volunteer position today, which was a change.  Afterwards I had my blood tested at Kaiser Permanente, Sunset office; and then over to the barber to have my hair cut.  It was high time.  I had it clipped on the sides with a number 2 guard, and trimmed elsewhere.  I think my hair looks funny right after its clipped - it sorta makes me look like a football jock from the 1950's, or something.

At work, Mindy and I reorganized the admin office furniture.  We consolidated all of our old office equipment down to one table, and threw out an old credenza and a bunch of junk.  The office, which has traditionally been as wasteland of clutter, is now halfway "inviting".    The rest of my day consisted of catching up on paperwork and corresponding with in-kind donors.  One donor wanted to contribute some new scrap booking materials and another wanted to give an old mattress.  I said yes to the scrapbook stuff and referred the mattress person to the Community Warehouse.

The drive home was uneventful.  The weather was sunny and cool.  Absolutely perfect.  I drove back to Kristie's office and picked her up around 5:45 or so.  She was waiting in the office, and I was unable to contact her since the switchboard operator said the intercom was down.  A meaningless detail of this day, but one that was notable at the moment.

Dinner consisted of veggie lasagna (leftovers at this point), salad, cherry/pear cobbler, and pineapple bread (much sweeter than banana bread).  I've been operating with a substantial sleep deficit (must be this sorry blog keeping me up) and crashed out for about an hour. We watched the Olympics, and part of a concert on OPB with Rob Thomas and the members of Matchbox 20.

News:  Congresswoman Stephanie Tubbs Jones of Ohio, passed away from a brain hemorrhage. Obama has decided who his running mate will be, but will not say who it is, at this point.

Just as I was approaching my office, I spotted none other than Steve Novick. I am 98% sure of this. He was just leaving a store and sped away in his car, the back of which was covered in political pumper stickers, evidence enough that I had witnessed the genuine article.

Work today involved picking up some clothing for a client, rearranging a storage room, installing a closet rod at the emergency shelter, and picking up supplies at Lowe's (yes, lowly Lowes).

In the mid-afternoon I had a doctors appointment at Kaiser Permanente. KP has some great commercials on television, but actually working within their system can be arduous and time consuming. I can't complain however, since my employer foots the bill, minus co-pay. I had a unit of blood withdrawn from my person for the 4th straight week...my treatment for haemochromatosis. I'm a human magnet!

Kristie made waffles for dinner tonight, she is so great! This was a nice treat, but also evidence that we need to do some serious grocery shopping! Tonight I worked on a script for an up-coming public access television project (more on this later), and started watching the Bucket List film with Kristie. We didn't finish it before starting to fall asleep, despite the evening heat and humidity.

So on my job search "job". My days start early. Trying my best to get a one up on the competition. I receive a lot of email alerts from different job sites, like Kaiser Permanente. As soon as I get them I put my application in. I almost feel crazy submitting resume after resume. Never getting any responses or call backs. Well not to be a liar like that, I do get those automated responses saying the company I applied for has received my resume. It goes something like this.

Dear Kizze:

We have received your application for the position of Administrative Clerk.

If you have not done so already, click https://portal.ebmud.com/vra/sigma5/login.aspx. to log in and include your education and experience history.  All applications must include contact, education, and any experience information to be considered further.

We will contact you once we have reviewed your application materials to apprise you of your status in the selection process.

Sincerely,
EBMUD Recruitment and Classification

So on a daily, I will get a couple of the above confirmations in my inbox. Somewhere in those lines and words common to all who apply is a hope that I will be picked for the job, in which, I have given my time and effort too. Filling out job applications, day after day can be tedious, time consuming, overwhelming,  but I do it. Knowing that my continuing worthiness will lead to booming opportunities.

So I wonder if getting tips on how to improve my application will work. There are many help site on applications, giving you tips on how to better your application for a call back. Job Scribble has a few tips, there are more to be found all around the net. At this point trying anything to better my chances sounds good.

The study involved 49,000 pregnant women in Kaiser Permanente's prenatal care program. Reasearchers looked at the use of multiple substances among this population including cigarettes, alcohol, marijuana, methamphetamines, cocaine and heroin. Of the population, 2,073 women were enrolled in Kaiser Permanente's prenatal substance abuse treatment program called Early Start.

The study's findings showed that the outcomes for addicted women who received substance abuse treatment in conjunction with prenatal care were very similar to those women who did not use such substances. These positive outcomes were shown for mom and baby. The risk of complications normally attributed to substance use in pregnancy, such as low birth weight, preterm labor or delivery and stillbirth, were virtually the same in the non-addicted women and the women in the substance abuse treatment program.

This research shows that with early prenatal care and substance abuse treatment, pregnant women can have the same results as a women who doesn't smoke, drink or use drugs in pregnancy. It also shows that addicted women who become pregnant need to reach out for help as soon as they find out about their pregnancy. While not many doctors offices have a program that includes both prenatal care and substance abuse treatment, many treatment agencies, like Crossroads for Women, will work in conjunction with a pregnant woman's doctor, to ensure the healthiest pregnancy possible.

Read more

From WebMD: Kick Addictions for a Healthy Pregnancy

From Newswise: Treatment for Cigarette, Alcohol & Drug Use During Pregnancy Dramatically Improves Outcomes for Mom and Baby

technorati tags: pregnant, women, addiction, prenatal care, substance abuse treatment

So, from the CA Department of Managed Health Care, I bring you the statistics on California health plans and the numbers of complaints they got from health care providers in 2007 (doctors, paramedics, physical therapists, OB/GYNs, etc.).

In first place for worst relationship with providers is Blue Cross with 603 complaints -- a whopping 19.7% of the total complaints for the year!

In second place, Blue shield with 305 complaints!

And in third place, Kaiser Permanente with 288 complaints!

Numbers to keep in mind when shopping for health insurance. If the plan doesn't keep your doctor happy, how happy do you think your doctor is going to make you? Also, for those interested, Kaiser had a total of 6,793,480 enrollees in 2007. Blue Cross had 4,162,214 enrollees -- fewer members, more doctor complaints.

Want to see the complete rankings? Check out the PDF from the DMHC

The FT picks up on todays BMA meeting in Edinburgh.

"NHS URGED TO SHED MARKET SYSTEMS"

Doctors for Reform don't want to shed the NHS market.

But Chris Ham does - he seems to have changed his mind.

"Chris Ham, professor of health services management at Birmingham University and a former head of strategy at the English health department who helped shape England’s policy of competition, has since developed reservations, sharing Scotland’s concern that competition in England could lead to service fragmentation. He has urged adoption of the model employed by Kaiser Permanente, a not-for-profit health group, in the US, which integrates primary and secondary care, appearing to produce better results than the English NHS at similar or lower cost.

The integrated Kaiser Permanente model is also praised in a background paper the BMA prepared for this week’s debates."

Kaiser Permanente.......

Not-for-profit......

Hmmmm..........

Wonder what The Witch Doctor and Her Black Cat are thinking..........

Analysis: Mark Twain said the only two sure things in life were death and taxes.  So it's no surprise that the two presidential campaigns are focusing on healthcare and the economy, since people are universally affected in personal ways.  Forget taxes for today, I'm interested in technology's role in healthcare, which is growing, and there's no more potentially game-changing facet of that than the role of data. 

That Los Angeles Times story has a number of examples where the data just pop out at you, bonking you on the head.  And there's prescriptive (no pun) value when you find and understand good data; an example in the story is "A 1996 study in the American Journal of Epidemiology found that the incidence of disease in the workplace is reduced when workers have paid sick days."  That's evidence for a policy change with demonstrable ROI.

By the way, I wonder if James Carville gets residual credit for the newcomer cliche based loosely on his famous line from 1992.  The phrase, "It's the data, stupid," including the quotation marks for precision, now gets 1,900 hits on Google, and more than 4,400 on Live Search.  (Hey, notice that disparity?)

Data has to be aggregated and maintained as records, and I intend to write more about the subject of health records in future.  One area I'm particularly interested in is personal health records (often abbreviated as PHRs).  There's a good story today on TMCnet ("Work Remains in Creating Access to Online Health Records") giving a quick overview of two major partnering efforts - one by Kaiser Permanente using Microsoft's HealthVault, the other by the Massachusetts state Blue Cross Blue Shield using Google Health. 

Most insurers can't offer portable records to members unless they partner with a Microsoft or a Google," according to Carlton Doty, a senior analyst with Forrester Research, quoted in TMCnet story.

I've been listening to an interesting podcast series by Perot Systems on "Healthcare Tech and the World," and the most recent is a good interview with Dr. William Stead, Associate Vice Chancellor for Strategy/Transformation and the Chief Information Officer at Vanderbilt University Medical Center.  He makes some incontrovertible points:

• "First, we're actually going to shift from expert-based care to system-supported practice."
• "Second, we're going to shift from medicine that is appropriate for mass delivery...we're going to really shift to individualized medicine."
• "The third component is... that we... will embed support for health into a person's living environment."

We've got Microsoft efforts (some using current technologies, some in the R&D labs) which are addressing all three areas.  One of the most exciting new things we have going is called Amalga, as in amalgamating data streams from multiple mutually-incoherent sources into coherency.  We call it "a unified approach to healthcare intelligence," and long before I joined Microsoft my group at DIA looked at the precursor prototype system (then known as Azyxxi, before Microsoft acquired the company) for use in the intelligence community.  That hasn't happened yet, but the technology is impressively flexible and I think it could be used in almost any domain. 

And a final point back on the data front: a British National Health Service (NHS) doctor writes today in The Guardian defending the practice of data-mining in the healthcare arena ("All Patients Can Benefit from Our Collecting of Statistics").  I recommend that article, as his point is valid across any measurable discipline:

You can measure outcomes in all branches of medicine, using various methodologies depending on the patient and the condition being treated. In surgery you might monitor how quickly a patient walks again after a hip replacement, or the number of avoidable errors a particular surgical team makes. In psychiatry you can measure the extreme and distressing outcomes like self-harm and suicide.  But you can also measure the number of patients who successfully return to work, or the number of addicted patients who live free of their dependency for a defined period or time. In recording and analysing those outcomes you can look for the commonalities that point to either success or failure and use this information to improve the quality and safety of the care you provide."

It's an exciting time if you like data, data-mining, and the unpredictable insights and value they bring to medicine and improved healthcare.  And, since I'm getting older like the rest of us, I'll be paying more attention to healthcare anyway :-)

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This is one of those things that makes you sad to have to talk about, but it is what it is, I suppose. This post should give you pause if you, like me, are a California Anthem Blue Cross (marketed as Tonik to Gen X, Y, and Z) individual member and are expecting Anthem to pay up should you ever have a catastrophic medical issue.

In short, Blue Cross is the worst offender in the state in terms of "rescission." What does that mean? It means Blue Cross has been canceling people's insurance policies when they filed claims that appeared too expensive (i.e. not profitable to Blue Cross). Imagine how you would feel if, after a $30,000 trip to the emergency room, Blue Cross told you they were no longer willing to pay as agreed in the contract despite your having paid their exorbitant premiums month after month? I know I'd be pretty angry, assuming I was healthy enough to handle such news.

There are regulatory agencies out there that are supposed to monitor this kind of insurance abuse, but Anthem Blue Cross has managed to get around ponying up to its responsibilities to its paying members. According to this article in the San Francisco Chronicle, "Anthem Blue Cross (of California) has the highest number of alleged illegal rescissions, it may face the least regulatory consequence simply because of its sheer size and its skill in legal intimidation."

"California regulators admitted Thursday that for more than a year they didn't even try to enforce a million-dollar fine against health insurer Anthem Blue Cross because they knew they would be outgunned in court."

It's one thing to pull people's coverage when they need it most. It's another thing to underhandedly duke it out in court with high-priced lawyers just so you can get away with such selfishness. First thing this week, I plan on getting insurance elsewhere. Right now, Kaiser Permanente seems like the best option as they have not practiced rescission since 2006 and, I've heard, either accept you or reject you without the pricing games that Anthem Blue Cross plays by raising your rates for every extra health issue you may have.***

For more on Anthem Blue Cross' dirty tricks:
California Doctors and Hospitals Join Blue Cross Rescission - Cancellation Class Actions

***Update: CA's Department of Managed Health Care has a website where you can take a look at the fines insurance companies have had to pay for their wrongdoings. Here are the links for Kaiser and Blue Cross. Most important to note is that Kaiser "reserves its right to pursue rescission of KPIF membership agreements of enrollees who enroll after May 15, 2008, in accordance with California law." While Kaiser has publicly said they no longer pursue rescission since 2006, you should note that they have reserved their right to reinstate rescission in the future. Sorta feels like you're gambling rather than getting peace of mind sometimes, doesn't it?

SANTA ANA, Calif.—California has sued one of the state's largest hospital operators to stop the company from billing privately insured patients for balances on medical services not paid by the insurer.The practice—known as "balance billing—is becoming increasingly common in California. The Department of Managed Health Care has banned balance billing, but regulations aren't expected to take effect until the fall, at the earliest.

That agency's director, Cindy Ehnes, said Prime Healthcare Services Inc. is "the largest example of this egregious practice we've seen to date, and it must be stopped."

Ehnes' agency filed a lawsuit Friday in Orange County Superior Court against Prime Healthcare. The suit seeks to prohibit the Victorville-based company from billing patients for unpaid medical bills Prime contends insurers owe.

"Consumers who have purchased health coverage in good faith deserve to know that it will cover them in a medical emergency and not result in crushing medical debt," Ehnes told the Los Angeles Times.

Prime acknowledged it has been billing thousands of patients the unpaid portions of their bills. The company contends it can legally do so—and that it wouldn't have to if insurers paid their full portion of medical claims.

Prime has 12 hospitals in Southern California and has acquired all but one of its properties in the past four years.

The Times reported that when Prime takes over a hospital, it often cancels insurance contracts, allowing it to charge higher rates. Insurers contend they had begun sending Prime only partial payments on members' bills.This spring, Kaiser Permanente sued Prime to prohibit the company from billing more than 5,000 of its members for unpaid bills. A temporary injunction prevents Prime from such billing until the case is resolved.

From the Technical Track:

Quite a bit of information provided, most of it designed to update the audience on progress the HealthVault team has made since the initial launch last October. There is a lot of repetition in the various technical decks, so if you are going to choose one to download, go with the HealthVault Architecture Overview as it really has all you need to know, with one minor exception.

As for key messages in the technical track, they are as follows:

• Greatly simplifying the sign-in/sign-up process for the consumer (I tested it and it really is a substantial improvement). Also making more general improvements to the UI (user interface).
• Build-out of data types with 20 new ones since launch and 12 more pending. This is quite important for developers of personal health applications (PHAs) that will sit a on top of HealthVault. Still, looking at those data types that they have today, it is hard for me to understand the logic of the choices made. Comes across as somewhat of a free-for-all. Most likely driven by existing partner needs.
• Ability to directly connect to clinical data. This is through their work with such partners as AllScripts, KRIPTIQ, and Eclipsys. Still no Cerner, GE, McKesson and most importantly, Epic, who did not even send a representative. Remember, its Epic's My Chart that powers the Kaiser patient portal My Health Manager that Kaiser and Microsoft will be working on together to link My Health Manager to HealthVault.
• Restatement of basic design principles: Inclusive of standards, Commitment to "Openness" (they have signed on to the Open Specification Promise (OSP)) and CodePlex support (supporting both Java and Ruby).

The most interesting slide in all the technical session slides was the following one (it is not in the Architecture Overview slide deck, but one titled: Platform Adoption) that lays out their overall platform strategy. This gives an extremely clear picture of their thinking and where they are headed.

For example, Consumers are put one target market of six shown, though one may argue that the "Employer" column may share much in common with the Consumer. And what is quite puzzling is: Where are the payers? It oul seem to this analyst that if you are targeting employers, the leap to supporting payers is not that big as employers and payers have very similar needs, particularly when it comes to managing population health and encouraging healthy behaviors.

From the Business Track:

While I found the technical slides to have some real nuggets of information, was quite surprised at the dearth of information found in the business session slides. Most of the information was very simplistic. With all the marketing muscle at Microsoft, I expected something better.

But in and amongst the weeds, I did come across some very interesting information in the presentation entitled: "How We Make Money".

This slide deck begins with a shot of the MSN.com Health & Fitness site, with a HealthVault widget from the American Heart Association embedded on the site demonstrating personalization, how they intend to leverage existing Microsoft properties and sell Web property "real estate" to partners. This theme was extended to the HealthVault search engine.  In this case it looks like Microsoft intends to re-brand HealthVault Search as a subset of the Microsoft existing search engine,  live.com

It appears that Microsoft intends to have HealthVault be subsumed into these existing properties, which see far more traffic then HealthVault does today. I did a quick Alexa analysis comparing first three health-centric websites, HealthVault, RevolutionHealth and WebMD. HealthVault doesn't even show-up in the rankings.

Did another Alexa analysis, this time adding live.com and msn.com (couldn't get a read on the sub-site health.msn.com) and as one would expect, these two properties see lots of eyeballs, which could give far greater exposure to the HealthVault property/brand.

Remains to be seen if that will ultimately be the case, but HealthVault clearly is not getting much traffic today, so it certainly can't hurt. But then again it may have the affect of diluting the HealthVault brand.

But this is where all those partners come in (there are 36 software partners and 9 device partners up and running today). In a somewhat brazen and even arrogant manner, the HealthVault folks are adopting a marketing strategy that they refer to as an "ingredient branding strategy" Think Dolby, Intel Inside, etc. What they are looking to do with the ingredient strategy is have all their partners put the HealthVault label (web tile for websites, logo on device packaging) and let the partners push the HeathVault brand.

This is ludicrous.

In a market as small, immature and nascent as this one, with so many challenges ahead, it is hard to believe that Microsoft is depending so strongly on its partners to take the HealthVault brand to market. Really quite bizarre and something they should rethink.

Tomorrow, will have see the last post on this event and will have highlights from interviews wth several who attended this event.

Lately, I have been feeling more like a philosopher than a producer...or writer for that matter. I have been analyzing my need to thrive instead of just striving. Throughout the majority of my life, I have gained an enormous amount of survival skills that have ensured my preservation. However, I realize that somehow I have been creeping back into the comforts of what is familiar. You know, the scraping of money from your piggy bank between pay checks. The dilemma of what to eat given the price of gas.

And speaking of which, isn't the price of gas enormous! It is outrageous to think that our lawmakers saw this coming and chose not to do anything about it. Who stands to gain in this type of economy?

The rich who have stocks in these oil companies, that's who. I think the smartest people in the bunch right now are those ducking from the financial blows and those riding the waves until something drastic changes.

I am hoping like many that the new President will have a huge impact on these gas prices and the cost of food. Who knew that the poor would be the middle class? Well, my instructors tried to warn us over 10 years ago. With all of this education and technology flipping about, who really listens anyways?

What's the true cost of education, if we choose to remain ignorant? Not sure about the answer to that one. I have yet to payback my student loans. I am in graduate school! LOL! (Pursuing my passion nonetheless).

So back to question in my mind...how do I start to thrive in this economy? Well, for one, after putting out a plethora of resumes, I realized looking for a job, IS a fulltime job! I am very comfortable working for myself. Then, I think, well what does thriving really look like for me?

Well, first of all, I have to make more than just enough. I must ENJOY what I am doing and get paid for it. I love flexibility with time and travel. I truly love writing and expressing my opinion. I am not sure how many corporations want to know what I am truly thinking. LOL!

And then there is the whole quality of life component of the thriving. You know Kaiser Permanente loves to talk about thriving all of the time in their ad campaigns. I used to work under contract as a Project Manager for Kaiser. They were known by insiders and patients nationwide for actually killing people and working their employees to death. Read all about it here: http://www.kaiserthrive.org/. BTW all of this is true.

Marketing is powerful. Deception is lethal, especially in the healthcare industry. So "Kaiser-thriving" (at least the reality of Kaiser Thriving) is NOT what I am interested in.

I am in the process of defining what thriving looks like for me with particular focus on the financial portion because throughout all of my wonderful education, I never learned how to make an abundance of money. The over $100,000 in debt for student loans does not cover a single class in real life money management nor hands-on financial abundance (how to implement in your life so you can pay off your student loans...) wait a minute...that's a great title for a class. "How to Implement Financial Abundance in Your Life So That You Can Pay Off Your Student Loans and Eat and Clothe Yourselves Regularly!"

I am copyrighting as we speak! This is ground breaking! Maybe I can charge per page! As I learn, I can teach! Fabulous! My thriving plan is unfolding in front of my eyes! THIS IS WONDERFUL!!!!

(This is why this section is called "Psycho Babble"- I feel a bit loopy right now! LOL!)

Stay Tuned to this unfolding workof art...or entertainment for that matter. Most people die before paying back their loans.

LOL! And they say that the housing market is the horrible bubble that bursted and disrupted the economy. Wait until these student loans hit the fan...if they haven't already! I wonder if the government is counting on the repayment of that money. DON't HOLD YOUR BREATH UNCLE SAM!!!

FYI: I plan to be in repayment in 2010. SO I will be repaying back my loans with the help of abundant passive income that will overflow from the rafters into my bank accounts.

Pray for me, as you can see, I need help! LOL!

Your Thoughts?

JSC

State officials, hospitals and doctors are locked in a dispute over whether some patients can be charged if they are taken to an emergency room outside of their health care network. For some, that bill can be a couple of hundred dollars, but for others it can reach into the thousands.

The ban proposed by the California Department of Managed Health Care would affect members of HMOs, such as Kaiser Permanente, not members of other kinds of insurance plans. The department only regulates HMOs. Administrators and hospital-based doctors say the state should be targeting insurance companies.

Statewide, thousands of people get pressed for payment by doctors and hospitals, typically after they are taken to an emergency room outside their insurance plan. Doctors and hospitals that think health care plans and insurance companies have shortchanged them on payment for treatment then try to make up the difference by going after patients who already paid their share. It's called balance billing.

Karla and William Gledhill, of Chino Hills, understand the practice well.

The couple got hit with a $53,000 bill from Arrowhead Regional Medical Center in Colton after their insurance company, Anthem Blue Cross, paid about $25,000. Their 16-year-old son, Ryan, was flown to the hospital after a serious dirt bike crash in Lucerne Valley.

Karla Gledhill said she racked up late-payment fees and bill-collection threats as she repeatedly wrote letters and made telephone calls to the hospital and insurance company. Last week, the insurance company agreed to pay the bill.

Gledhill said she thought she would have to hire an attorney, which sometimes is a patient's only recourse, hospital officials say.

The hospital and insurance company said privacy laws prevented them from commenting on the family's claim.

"You don't know anything about balance billing until you're stuck in the middle, trying to hammer out what's right," Gledhill said.

Balance Billing

More than 1.75 million insured Californians who visited emergency rooms in the past two years were asked to pay more, even after their co-payments and deductibles, according to the California Association of Health Plans. The professional organization represents 40 health care plans that cover an estimated 21 million Californians.

The average balance bill was $300, which added up to about $528 million that patients spent in addition to their co-payments and deductibles, the association said. More than half of the patients who were balance billed paid.

"The practice needs to be banned, period," said association spokeswoman Nicole Kasabian Evans. "The patient shouldn't be placed in the middle. That's what the insurance companies and health care providers are doing."

In July 2006, Gov. Schwarzenegger ordered an end to balance billing after he realized many residents were being charged for medical expenses they didn't owe, said Cindy Ehnes, director of the state Managed Health Care Department. But the department couldn't come up with a suitable solution to HMOs and providers, she said. So, the department decided to merely ban the practice.

"We have tried many other approaches to solve this problem," Ehnes said. "We have decided to go back to our first job, which is to protect consumers."

Ehnes said she had hoped lawmakers would have passed legislation regulating balance billing. At least seven states have balance billing laws, including Colorado and Florida. Meanwhile, state Sens. Don Perata, D-Oakland, and Leland Yee, D-San Francisco, have introduced balance billing legislation.

HMO Vs. Hospital

The ban comes as Kaiser, the state's largest HMO, got a temporary restraining order earlier this month from Los Angeles County Superior Court against Prime Healthcare Services Inc., of Victorville, to stop it from collecting money from thousands of Kaiser patients or reporting them to credit agencies. A hearing is set for Thursday.

"This has been an ongoing dispute for a year or year and a half," said Dr. Ben Chu, president of Kaiser's Southern California region. "... They threatened to trash their credit ratings if they didn't pay."

Earlier this year, Prime Healthcare sued Kaiser, claiming that Kaiser owes $25 million for its patients who were treated at eight of Prime Healthcare's hospitals, including Desert Valley Hospital in Victorville, Chino Valley Medical Center and Montclair Medical Center.

Prime Healthcare attorney Michael Sarrao couldn't be reached for comment.

Prime Healthcare has accused Kaiser of delaying payments by repeatedly demanding patient medical records, claiming that care provided was unnecessary and requiring transfer of members to Kaiser hospitals.

Chu disputed the claims.

"It's not about delaying payment," he said. "It's about substantiating claims."

Calculating Health Cost

Dr. Richard Frankenstein, president of the California Medical Association, said the organization, which represents 35,000 doctors, will fight the state Managed Health Care Department's ban.

"They ought to be regulating the insurance companies, not the doctors, which it does not have the authority to do," he said. "We see this as a $500 million transfer from patients to insurance companies, and the insurance companies aren't paying the bill."

On average, Frankenstein said, insurance companies pay all but about $30 of a doctor's bill.

"If that doctor sees 50 to 60 patients, that $30 does add up," he said.

Some specialists may not work on-call emergencies if insurance companies refuse to pay and they can't bill patients, Frankenstein said.

Frank Arambula, Arrowhead Regional Medical Center's chief financial officer, said the hospital compares its costs to those of other facilities, which are reported to the California Office of Statewide Health Planning and Development. The data are posted on the agency's Web site.

"We set our rates based on market-driven prices," he said. "We think it's a fair assignment and the payer is going to pay those charges."

Conversely, insurance companies rarely show patients and health care providers how they determine what to pay for service, Arambula said.

In a written statement, Anthem Blue Cross spokeswoman Peggy Hinz said the company reimburses out-of-network hospitals for what it considers reasonable and customary costs. It is changing its reimbursement policy to protect members who require emergency care, she wrote.

"It was not the intent of our reimbursement policy to increase out of pocket expenses for our members, who do not have a choice in selecting the place where health care services are performed, such as in the case of an emergency," Hinz wrote.

Anthem Blue Cross bases its reimbursement rates on factors including submitted charges for payment, comparisons of charges for services offered at other hospitals, and service costs that are reported to the state, Hinz wrote.

Fighting the Bill

The Gledhills didn't care whether Arrowhead Regional Medical Center was in their Anthem Blue Cross preferred provider organization network. Their son needed surgery on his pancreas.

"Worst case, we thought we would owe $6,000," said Karla Gledhill, whose husband owns a small Anaheim business.

Anthem Blue Cross first determined the Gledhills owed the hospital $53,273.17 after it paid $25,121.28, according to a claim recap. It paid another $12,606.15 after Karla Gledhill complained to the California Department of Insurance.

The Gledhills still faced a $40,667.12 bill and no explanation of how Anthem Blue Cross determined what it would pay.

"How could I fight a fair fight if I didn't have all the information?" Karla Gledhill asked. "I didn't think Arrowhead's charges were exorbitant for the care my son received."

On May 21, Anthem agreed to pay the rest of Ryan Gledhill's hospital bill after the company "made a one time administrative decision to remit payment," according to the letter the Gledhills received.

The letter did not include further explanation, and Hinz said privacy laws prevented her from offering one.

Reach Lora Hines at 951-368-9444 or lhines@PE.com

As with any such event, we'll be seeing a lot of press releases come out of Microsoft and to a lesser extent, various partners.  The biggest one today is the announcement that Kaiser-Permanente will do a trial with HealthVault.  Microsoft issued a similar press release.

Why this is Important

HealthVault, Google and to a lesser extent (or at least quieter) Dossia, are all looking to create an ecosystem around which other applications and services will be built.

An ecosystem/platform model is a bit of a chicken and egg scenario. First, there is the strategy to get as many developers as possible building applications on a given platform/system. This creates a critical mass of features that will in-turn attract consumers to the ecosystem accelerating growth, presence and ultimately revenue. But before dedicating precious development resources, smaller software companies want to see if the ecosystem provider can deliver customers that may want to use their application(s), subscribing to their service and delivering revenue.  If there are few consumers, what's the point in spending those precious resources?

To date, 3rd party PHAs have gone as much on faith as anything else assuming that Microsoft's HealthVault group (and Google Health) would be successful in attracting consumers. After a pretty poor, at least from the consumer's perspective, launch of HealthVault last October, it was much to that team's credit that they were able to attract so many development partners. In a conversation I had with the HealthVault team a couple of months ago, they stated that they were in discussion with over 100 potential PHA partners and I'm sure that list has only grown. Today, they announced that there are now over 40 PHAs up and running on HealthVault. Then there is also Microsoft's seed funding, Be Well Fund, which was oversubscribed to the point where they actually increased funding by 50% as there were so many good proposals. Microsoft is being very aggressive in developing that ecosystem.

Now it just needs to bring in the consumers, and that's where Kaiser comes in.

Kaiser-Permanente is partnering with Microsoft HealthVault to potentially provide Kaiser's 8.7 million plus members the opportunity to port their Kaiser records to HealthVault. While there may be 8.7 million Kaiser  members, today roughly a third, 3 million, are active users of Kaiser's PHR, but that is still a huge number and arguably the most PHR users under any one umbrella in North America. (Note: Kaiser has done a spectacular job with their tethered PHR, My Health Manager, which is based on the EPIC MyChart patient portal. What really impresses me with the Kaiser PHR is that they continually are measuring and assessing consumer use fine tuning features to best serve both consumers and physicians. They really are setting the standard in the provider space.)

Kaiser will, like Cleveland Clinic did with Google, begin with a trial (beta) enlisting Kaiser's 156,000 employees to opt-in to use HealthVault. It will be interesting to see just how many opt-in as in the Cleveland Clinic-Google beta, only about 16% of those presented with the opportunity opted-in.

The initial trial will run through the summer providing Kaiser an opportunity to test the platform's ability to securely transfer records and populate a HealthVault account. Once the beta program is completed, provided its successful and there is no obvious reason why it won't be, Kaiser will allow its 8.7 million members the opportunity to transfer their records from My Health Manager to HealthVault.

In the conference call today, which oddly enough only had two people asking questions, myself and another, I asked two questions, which were answered by Anna Lisa Silvestre, VP Online Services, Kaiser-Permanente. Note, these are not direct, verbatim responses, but basically the gist of what she communicated.

Ques: Will you be testing the transfer of complete records?

Ans: No, we will test the system by transferring an employee's health summary that will include immunizations, allergies, medications and conditions.  We will use the Continuity of Care Document (CCD) standard to facilitate transfer of these records.

Ques: Will you consider other platforms in the future (this was my roundabout way of asking, is Google in the cards)?

Ans: Yes, we will consider other platforms in the future as this is not exclusive.  Such choices will depend on value that can be ultimately delivered to the end consumer/member.  That being said, we will not partner with every PHR company in the market but will look at a number of factors including security and privacy policies foremost among them.

Bottom-Line:

Now if I'm a developer at the HealthVault event this week, I sure would be excited hearing this news as it offers the potential for 3 million plus consumers coming on-board by the end of the year.  But is that not the Big Question - if we build it will they come?

In the Cleveland Clinic-Google beta, it appears that the majority of consumers sat back and were not willing (or didn't see enough value) to move their records to Google Health. Sure, it may have been security and privacy issues that held them back but my bet is that it was just indifference.

It remains to be seen just how many of Kaiser's employees and later, members will do likewise, which brings us back to the beginning: Which comes first, the chicken or the egg?  Will these PHSs and their development partners provide enough value (features) to bring in the consumer?  Will developers continue investing in creating enough interesting apps to attract the consumer and hopefully justify their investment?  We are a long ways from finding out the answers to these questions but what is clear is that some very significant players, representing large pools of consumers, Cleveland Clinic, Beth Israel and now Kaiser, are willing to offer consumers the opportunity to take direct control of their records and try these platforms for themselves. That is a start in the right direction.

".. Health Insurance, uses actuarial studies but doesn't actually deliver Insurance."

This article is going to be a look at the transformation of what was an obvious and proven approach to health care and how, lobbyists, financial companies and politicians forced the public discussion in a different direction and convinced many Americans to cheer for a system that steals from them.   While this article is an overview - its focus is on how the discussion changed and why.

There are a few quick terms that need to be clarified:

1. Patient: A patient is someone that is suffering illness and requires, medical counsel, education or medical treatment.  For the purposes of this discussion, there is no illness associated with breast augmentation, lypo-suction, or any of the the other cosmetic procedures delivered through health care professionals.

2. Finance Co.: This is a company that refers to itself as Health Insurance, uses actuarial studies but doesn't acutally deliver Insurance.  What the Finance Co. provides is the equivalent of a pre-paid telephone card - however, they have the right to increase the connection charge - on the fly, with little recourse to the patient.

3.  Medical Professionals:  Doctors, Nurses, Scientists, Medical Admin, Services and Support; including public health services (gov't)

4.  Non-medical Professionals: Massage therapists, teachers, instructors, social service representatives, other public health services (gov't)

5.  Non-Insurance Medical Providers: Kaiser-Permanente is the perfect example. We will refer to it in subsequent installments of this article.

How DId the Discussion Change from Health Care to Health Insurance?

"... drama in the waiting room, eerie reminders of pre-Civil Rights days in the deep South."

Fifteen years ago, there was a National discussion about health care, and 20 years before that, there were similar discussions.  The hiatus was supplied by the Vietnam war, Richard Nixon's struggle with the rules, the warm-up energy crisis and Oliver North's homegrown foreign diplomacy. Scores of other distractions were spawned by America's financial boom, a nice way to describe the national addiction to investing and exponential profits that we'll further refer to as financial crack cocaine.

When the discussions re-started, they included everything from expanding the public health service to providing basic health care for Americans.  Not only basic health care but health education and preventive medicine.  As it is, there is no incentive for delivering preventative medicine in the insurance company dominated health system - yet there are numerous financial incentives for treating more and more illness.  In short, the system, as is, becomes more profitable for investors if the number of sick people rises.  The system by design is flawed.  Consider a private police department whose investors privately hope for higher crime or less public safety in order to increase profits.

Now consider that the cost of detectives is driven by market conditions, and the amount of attention they can dedicate to particular cases is based on the overall profit of those cases, determined by the Financial Co-op.  Public safety, no longer driving the results, the highest profit is realized when more and more cases are opened and crime is elevated, since the crime victim must pay, or pay through a Finance Co., for services.

So as you can see, for the purposes of Part One - we propose that Health Care is essentially the same as Public Safety, Public Water and Sewer, Public Works.  There is only one answer to how the discussion was altered and thereby further dividing classes of American citizens.  The most obvious being Insured and Uninsured.  While many may not see this as a 'Class' distinction - visit  Medical Professional company in your area and observe the drama in the waiting room, eerie reminders of pre-Civil Rights days in the deep South.

Pay Attention to Small Stuff

"... the payment was spread among the entire school population."

For the purposes of this section of the article - we're going to have to stick to practices and not specific people or companies.  While we have some excellent examples of specific people and companies that benefited greatly by redirecting the national discussion, we'll save that for later chapters, with footnotes and research material.

Clearly, the changes were motivated by a new approach to economics.  After being indoctrinated with 'free-market' platitudes, even High School football teams were looking for revenue far beyond what booster clubs and community fund-drives could yield.  So the answer is appetite.  The American appetite for opportunity and great return.

When Junior High schools were selling real-estate to Coke and Pepsi so that they could line the halls with machines selling high fructose corn syrup laden carbonated drinks to children; we were trading public health for corporate finance.  While it paid for the illuminated scoreboard on the football field and much more updated uniforms and equipment, the payment was spread among the entire school population.

While on the surface it seems to be logical, there was a serious breech of both public health and the loco parentis care of our children of which public schools are charged.  But 'the Beat goes on' seemed more enticing than pedantic pleas of health professionals about force-feeding our youth sugary water.  And anyone that doesn't believe that Soda dispensing machines strategically located throughout a public school isn't force-feeding than we beckon a more suitable word.

Courting Independence

"... then you were going to get credit - big and fast."

The financial appetite for return on investment permeated the atmosphere.  IRA's abounded benefiting investors with deferred income tax and lower base taxes by lowering their taxable income.  It was all the talk at the supermarket, at the beauty parlor, at the VFW and at the golf course.  An entire generation of tax planners were armed with Texas Instruments printing calculators in order to show investors, just how many millions they would have at early '80s interest rates of 12%.

These opportunities were not curtailed simply by the sudden drop in interest rates as the stock market began its first surge - because the SEC swung open the doors at the behest of the Reagan Administration to permit individuals to personally direct their retirement money into the risky equity markets.  Penny stocks abounded with the lucre of  Mom's and Pop's, although, much of it evaporated by the late 80's as the equity markets - adjusted.  That's what they call crashes because of uncontrolled financial growth - "adjustments".  On the way up ... they don't call them anything, because no one can hear over the cheering.

Pick a Card - Any Card

".. create a highly lucrative financial turbine of the insurance company."

During this period of time, gasoline rose in price, food rose in price and health care rose in price.  A society stuck for a  ready cash with appetites further whetted by buying stocks and bonds on margin; they started abandoning the sound financial tenets of their roots and willingly accepted credit cards in the simple recruitment terms of the credit card companies.  Buying on credit was easy. It was certainly an analgesic to financial pain -moreover - the new American voracious appetite for  acquiring  more "stuff" wouldn't be derailed because the disposable cash dried up.  Not for a second.  If you could prove that you were stupid enough to load up your retirement portfolio with Penny Stock get rich quick schemes and would be 'market averaging' for the next 100 years in order to get your principle back - then you were going to get credit - big and fast.

The Finance companies were watching and in the game.  They were buying up medical services companies and even hospitals through holding companies and even real estate trusts.  After all, if you are going to expand a business that collects money , shouldn't you also own the companies that you ultimately pay.  In this way you can add the power of the check book while containing costs. Further,  by leveraging the assets of the holding company by selling it off to investors - the Finance Co. in actuality, creates a highly lucrative financial turbine from what appears to be an insurance company.  Ultimately, taking more in than it pays out,  the Finance company maintains high profitability by delivering less health care to the insureds.  In effect, they create a layer that in conclusion, does nothing but convert the massive buying power of an organized group, and convert it into investor profit instead of an actual comprehensive medical plan.  It's very much like the new Electronic Scoreboard and the Soda machines.

To be continued ......  part Two next week.

Doctors and hospital officials will square off with health insurers Monday in San Diego over a state plan to ban medical providers from billing emergency room patients for charges not covered by insurance companies.

The proposal, by the Department of Managed Health Care, is the agency's third attempt in two years to outlaw so-called balance billing, which turns patients into pawns in payment disputes. The earlier proposals were scrubbed after regulators failed to build consensus among various health care parties.

What remains is a stripped-down version that lacks provisions for an independent dispute-resolution process and a method for calculating fair charges for hospital and doctor services.

The San Diego hearing comes about two weeks after several medical centers owned by Prime Healthcare, including Paradise Valley Hospital in National City, sent thousands of collection letters to Kaiser Permanente members. They demanded payment for outstanding emergency room bills.

Prime's hospitals had sued Kaiser, the state's largest health plan, in February. They contended that Kaiser refused to pay for more than $25 million worth of services after concluding that the conditions of some patients didn't constitute true emergencies.

Kaiser officials said as many as 6,000 of their members received the bills from Prime. A Prime spokeswoman said a relatively small number of bills were sent to patients treated at Paradise Valley, but she didn't know the exact figure.

Cindy Ehnes, director of the managed care agency, said Prime's widespread balance billing “put a face” on a practice that receives little public attention despite being controversial.

A final version of the agency's proposal is expected to be published by fall.

Balance billing surfaces most often when emergency room patients receive care outside of their insurance company's network of contracted providers. State law requires health plans to pay fair amounts for emergency room services, but the exact price is often disputed and insurers wind up paying a lower amount than what they are charged.

Some physicians and hospitals offset the reduced payments by sending bills to patients that cover the difference, an amount that can run from as little as $25 to thousands of dollars.

Balance bills average about $300, according to the California Association of Health Plans, a trade group that lobbies for its 40 members.

The practice can leave patients confused and afraid of being reported to collection agencies if they ignore the bills. While some people lodge complaints with their insurers or state regulators, many pay the charges.

Medical providers who engage in balance billing said the practice is intended to pressure insurers to pay for services in full. They also said it's their most effective alternative to taking health plans to court, an expensive option given the huge legal resources that most health plans have.

The managed care agency's latest proposal will give insurance companies a bigger advantage in payment disputes with out-of-network providers, said Dr. Ted Mazer, past president of the San Diego County Medical Society.

“The department is telling the health plans that they can tell the physicians what their services are worth,” he said.

Instead, Mazer said, the agency should require insurers to pay some portion of disputed bills upfront and use historical data to determine what constitutes appropriate charges.

Supporters of the proposed regulations said a ban on balance billing is long overdue.

“What this does is take the first step: saying it is wrong to have patients in the middle,” said Chris Ohman, president and CEO of the California Association of Health Plans. “The health plan industry is committed to the next step, which is designing a process that will be fair to both plans and providers.”

Insurers, doctors and hospitals must resolve their disagreements without involving patients, said Michael Russo of the nonprofit California Public Interest Research Group in Los Angeles.

“It's ridiculous to hold consumers hostage,” he said. “The patients aren't doing anything wrong.”