BC Raises Costs Of Individual Health Plans in Michigan
Story from the Detroit News

As more Michigan residents flock to Blue Cross Blue Shield of Michigan to buy their own health coverage, the state's largest insurer is replacing several types of individual policies with plans that will cost up to $600 a year more -- and come with higher co-payments and other out-of-pocket costs.

The new insurance plans -- with monthly premiums ranging from $51 to $292 per a person -- are on sale now and take effect Wednesday.

On March 27, Blue Cross stopped enrolling new consumers in several older plans, including Value Blue, a catastrophic coverage policy, and its no-deductible Individual Care Blue. The changes don't affect Blue Cross members enrolled in those plans. Instead, the new rates will apply to newly unemployed residents seeking to replace workplace coverage by buying their own insurance from Blue Cross. The new plans also differ from those for which Blue Cross is seeking state permission to raise rates and would not be affected if that request is approved.

With the rollout of these new plans, Blue Cross has introduced a lengthy application that includes optional health questions and ties insurance agents' commissions to the medical condition of new enrollees.

The changes are so drastic that some insurance agents say Blue Cross is deliberately making its money-losing individual policies less attractive to slow sales. Blue Cross contends that it's simply keeping up with market trends, as well as the rates and plan offerings of its private-sector competitors.

As the state's insurer of last resort -- a responsibility tied to its tax-exempt status -- Blue Cross must cover all Michigan residents, regardless of their medical history. But that arrangement, Blue Cross officials say, leaves them with the state's sickest and costliest members. Last year, Blue Cross lost $133.2 million on individual insurance policies, dragging its bottom line to a $144.9 million loss for 2008.

Insurance agents say the new rates will make it harder to sell the plans. New members aren't going to want to pay more in premiums for higher out-of-pocket costs, especially if there are better deals offered by other insurers.

"It's not good for the consumer," said Patrick Pennefather, president of the Michigan Association of Health Underwriters, which represents health insurance agents and buyers for employer groups. The new plans, he added, are going to slow down sales for Blue Cross, a move that could help stem the rising tide of losses on individual policies.

Some agents are likely to stop selling Blue Cross' individual policies altogether because the commission structure lowers incentives for enrolling sickly customers into its individual plans, Pennefather added.

Blue Cross's new incentive structure offers a 15 percent commission to agents who sign up healthy members and only 2 percent for signing new enrollees with severe medical problems. A 2 percent commission could translate into only a couple of dollars a month on some policies, say insurance agents, and is much lower than the 8 percent commissions previously offered by Blue Cross on all policies, regardless of the applicant's health status.

Blue Cross said the tiered commissions better match incentives offered by their rivals in the individual insurance market.

"It may drive a lot of agents out of the individual insurance business. In fact, many have said they plan to get out of it," Pennefather said, noting that agents can make 20 percent with other private insurers.

Some Blue Cross critics, including Michigan Attorney General Mike Cox, have questioned why Blue Cross is collecting health information, since that is at odds with the company's mission as the state's insurer of last resort. Cox's office has said it's investigating whether the changes are lawful.

Answering the questions about health status, however, is voluntary and won't affect consumer eligibility or rates, but will help applicants qualify for lower co-payments, Blue Cross officials said.

Blue Cross also points out that it still pays at least some portion of the commission to agents for all applicants. Most other insurers pay no commission if they end up rejecting the applicant, said Helen Stojic, a Blue Cross spokeswoman.

As for the new plan prices and coverage, Stojic said Blue Cross hopes to better reflect the marketplace, where deductibles and higher out-of-pocket maximums are common.

The insurer also contends its rates are still better than most plans for people with serious medical conditions.

"Our plans are aligned more closely with those in the market, with one important difference: We still don't medically underwrite and we are still the insurer of last resort," Stojic said.

Unlike rate hikes for existing customers, state regulators don't require Blue Cross to seek public input before introducing new plans or closing new enrollment in existing policies.

Blue Cross is seeking rate hikes on its existing individual policies that cover about 400,000 members. It's asking for an average rate hike on three types of policies: a 56 percent increase on individual plans, 42 percent on group conversion coverage (which extends benefits from a former employer) and 31 percent for Medigap plans.

Users of Stopain Report Relief From Chronic Pain
Story from Market Watch

ENCINITAS, Calif., April 7, 2009 /PRNewswire via COMTEX/ -- DRJ Group Inc., the makers of all-natural Stopain(R) topical analgesics, today announced the results of an informal study conducted with chronic pain sufferers at two adult foster care facilities.

The test was conducted with residents living at two facilities owned by Leon and Paulette Hanson in Cannon Falls, Minn. The Hansons approached the DRJ Group about conducting an informal study after receiving a complimentary sample of Stopain.

"I was skeptical, but after our test I am convinced that this product works," said Leon Hanson. "I would recommend it--in fact, I have recommended it to others. I am so glad we found Stopain."

"Our business philosophy is to focus on customer feedback when it comes to managing pain," said Bob Miller, president and CEO of DRJ Group, Inc. "When Leon mentioned his residents and their ongoing struggle to manage pain, we were happy to provide Stopain and are very pleased with the results."

Residents began using Stopain in October 2008. Here are Hanson's accounts of two of his residents' experiences with Stopain:

Resident #1: One resident who tried Stopain was a woman in her 90s with shoulder pain that developed after years of manual farm labor. According to Hanson, she had tried a series of pain medications, heat wraps and ointments with no significant relief. When staff at the facility began applying Stopain to her shoulder before her daily nap, she noticed the cooling effect immediately. Hanson says by using Stopain, she was able to sustain relief without needing pain pills.

Resident #2: Another resident who reported relief from Stopain was an 89-year-old woman. Hanson says she developed severe, persistent shoulder pain following a stroke. According to doctors, the shoulder pain did not come from the stroke; the cause of the pain is unknown. After three or four applications of Stopain, she reported significant relief. Hanson explained that the woman used to wince in pain whenever staff lifted her, but the pain subsided after using Stopain.

The active ingredient in Stopain is menthol, recognized by the Food and Drug Administration as an analgesic that provides temporary relief for minor pains and stiffness of arthritis, muscle aches, strains and simple backaches. Stopain products include the top-selling spray and roll-on in the topical analgesics category.

For more information visit www.stopain.com.

SOURCE DRJ Group Inc.

Restoring Vision to Stroke Victims
Story from the Democrat and Chronicle

Patients who are partially blind after a stroke may be able to retrain their brain after doing months of eye exercises on a computer, according to a small study by University of Rochester researchers.

The study, published in the April 1 issue of the Journal of Neuroscience, found that people who did vigorous exercises every day for several months could coax the healthy regions of their brains to take in visual information, making up for other parts of the brain damaged by strokes.

Neuroscientist Dr. Krystel Huxlin, who led the study at the University of Rochester Eye Institute, said she was surprised by the research results because scientists had long believed that patients could not recover from the type of visual damage done by strokes. Many people are one-quarter to one-half blind after strokes, and though rehabilitation is common for relearning speech and movements, patients rarely receive visual training.

Huxlin studied four women and three men in their 30s to 80s, who had a stroke eight to 40 months before the experiment. All were partially blind and had substantial damage in the primary visual cortex of their brains, meaning their eyes could take in visual information that they could not consciously see.

During the study, they were told to "watch" a group of about 100 small dots move right or left across a computer screen. Though the patients were not aware they could see the dots, they would guess which direction the dots were moving and could improve their success rates over time when told when they've made a correct choice. Eventually, they became aware of the dots and their movements, as their brains relearned how to take in the visual information, the study found.

When they improved, researchers moved the dots deeper into their blind areas and could coax the brain to see more areas.

The five patients who completed the training had significantly improved vision, and several could drive again, shop and exercise after the experiment.

The University of Rochester has filed a patent on the technology.

New Research Concerning Stress
Story from PR Web

Stressed-out people are told to exercise, meditate or eat right, but stress causes the brain to resist all of those things. A novel, proven approach to stress developed by a University of California, San Francisco researcher provides simple tools that switch the brain from stress to joy. In that brain state people feel like exercising, meditating and eating right. National meeting of researchers and clinicians on the method will be held on April 23, 2009 and sponsored by the Institute for Health Solutions; complimentary public access to web-based learning of the tools begins April 14, 2009.

San Rafael, CA (PRWEB) April 14, 2009 -- Who isn't stressed out? Neuroscience weighs in and finds that the best antidote to stress is a brain state of high-level well-being, or what most of us would call….well, joy. Brain scans show that when the part of the brain associated with joy lights up, the part of the brain associated with stress goes out. In other words, joy swamps stress.

How do you get from stress to joy? Developmental Skills Training, or DST, also known as the Solution Method, has taken what we know from three fields of scientific study - stress, attachment, and neuroplasticity - and created simple tools that enable you to identify your brain state on a 1 to 5 scale. For each state there is a tool that offers the quickest, easiest way to get from stress to joy, given that initial level of stress.

You know how when you're stuck in stress and know that you should: 1) exercise, 2) meditate, or 3) eat right -- but you just can't? Those times when all you can do is: 1) watch television, 2) numb out, or 3) crave sweets? Because of these exciting new scientific insights, now we know why: It's not you! It's your brain state, and in that state our brain is genetically programmed to warn us that hungry lions are chasing us. Something as sensible as taking a walk, relaxing in a meditative state, or getting a sound sleep, would be dangerous to someone who needs that adrenaline rush to stay vigilant and deal with hungry lions in pursuit.

But in the 21st century, there aren't many hungry lions, or many other objective reasons to justify that kind of damaging life or death body response. Yet with repeated episodes of responding as if there were, our brains become sensitized and we overreact; or even worse, we stay stuck in stress.

A national conference of Solution Method researchers and clinical providers who use the method to help people learn the tools to rewire their brain to move through stress toward well-being, will be held in Tiburon, California on April 23, 2009 and sponsored by the Institute for Health Solutions. For a limited time, starting April 14, a complimentary orientation by telephone with a health professional to learn about the method, along with complimentary 10-day membership to the website to lbegin learning the tools, will be available at www.solutionmethod.org.

According to Solution Method developer Laurel Mellin, Associate Clinical Professor of Family and Community Medicine and Pediatrics, School of Medicine, University of California, San Francisco, "The best way to beat stress is to know your number -- the brain state on a 1 to 5 scale - then use the tool that corresponds to that state to naturally switch the brain out of an emotional ditch and toward a state of well-being."

Mellin adds, "Just knowing your number, the state of your brain, can be enormously relieving. For example, when the brain is at 5, a full-blown stress response, it is reasonable to expect to have cravings for sugar and other artificial rewards. Instead of blaming yourself, you can see that it is not you, but your brain state. Then you can use the tools to switch that state so that cravings fade."

Mellin developed this method over the last 30 years, initially targeting pediatric obesity. Results were so positive for both the children in the program and their parents, that she created the adult version, the Solution Method. Stress eating was one of many symptoms that just faded naturally through use of the tools.

Amazingly, the new discoveries in neuroscience have validated how her tools work. They create "positive emotional plasticity" to rewire the brain, so that we are not triggered to go into a full-blown stress response as easily. In addition, the tools enable us to learn to change our emotional setpoint from numbness, discouragement, or irritability to a pure sense of joy more of the time. This creates resilience and reduces the physical ravaging on the body created by chronic stress.

On a societal level, since eighty percent of health problems are stress-related, rewiring the stress response could very well have an enormously positive effect on reducing health care expenditures. Recognizing that stress is at the root of so many health conditions - such as overweight, depression, anxiety, and diabetes - and teaching patients tools to deal with the underlying stress, could herald a new paradigm in health care.

For additional information on the news that is the subject of this release (or for a sample, copy or demo), contact Laurel Mellin or visit www.solutionmethod.org. The method is copyrighted and patent pending. Groups, telegroups, individual coaching, and web-based support are available at www.solutionmethod.org. Programs for childhood obesity are available at www.shapedown.com or www.childobesity.com. New book on the method, Wired for Joy: A Scientific Solution to Stress, author, Laurel Mellin, publisher Hay House will be released in Spring, 2010. Classic book on the method, The Pathway:Follow the Road to Health and Happiness (HarperCollins, Publishers, 2004).

Contact:
Laurel Mellin, Executive Director
Institute for Health Solutions
415-457-3331
http://www.solutionmethod.org

The Importance of Being Prepared
Story from the Sun Sentinel

If you help care for an elderly parent — or will do so in the future — it's smart to plan ahead for an emergency room visit.

More than 7 million emergency hospital visits each year involve patients 65 and older. A rushed visit to the hospital can be difficult and stressful, and caretakers will be called upon to answer lots of on-the-spot questions related to medical care and payment.

Fortunately, planning ahead can save a world of headache. Even simple things help a lot.

"I usually bring enough Diet Pepsi and snacks to last six hours, since that's how long I am waiting with my mom or dad until they're admitted," said Ann Blanchard, founder and president of HandiRecords.com, which sells low-priced organizer notebooks for medical information. "And some Sudoku or crossword puzzles, since I'm too stressed to concentrate on a novel."

To help, the American College of Emergency Physicians recommends:

Fill out a medical history form (ahead of time): Go to EmergencyCareForYou.org to obtain a form that you and your parent's physicians can complete. On the form you will list what medications your parent is taking, allergies, as well as past and current medical conditions. Bring this form to the emergency department and give to the emergency physician. Also keep track and make sure your parent is taking medications correctly.

Anticipate admission: Bring a change of clothes and some personal items in case your parent is admitted to the hospital. You can always leave them in the car.

Know physician contacts: Do you know all the names of the doctors your parents see? You should. Take some time now and find out their names, contact information, why your mother or father sees them and how long they have been patients. Write it down and hand it to the doctor or nurse in the emergency department. If you are traveling, have copies of the most recent doctor summary and a copy of an EKG if it is abnormal.

Convey parent's state of mind: You know your parent better than the doctor. If he or she seems confused, explain to the physician what "normal" behavior is like. If the doctor is talking to you, make sure you are talking to your parent. The doctors may have to run tests, conduct an examination or admit your parent to the hospital. Keep the conversation open with your parent.

Consider living wills: A difficult issue to discuss, but end-of-life planning is important nonetheless. Do your parents have living wills, and do you know what their wishes are if their conditions become critical? If not, find out now.

Report on recent surgeries: Keep track of surgeries, especially those involving implanted devices such as hip replacements, or pacemakers.

Simplify insurance information: Have a single sheet of paper with insurance and identification information.

Bring reading materials: Make sure you have a book, magazine or a newspaper to read while you are waiting for results or to see a physician. Bring a laptop so you can check your e-mail or do work. Having something to do that will make the time pass more quickly and help keep your stress level in check, too.

For information about elderly emergency care, go to emergencycareforyou.org.

One Man's Struggle With BCBS
Story from ZDNet.com,
by Paul Greenberg

My wife and I get our health insurance from Anthem Blue Cross & Blue Shield, here in Virginia. Because my wife is a cancer survivor our insurance rates are exorbitant. Last year, we had a $500.00 deductible (each) and were paying more than $1600 a month for coverage that at best was going to get us 80% when the deductible was covered.

Toward the end of last year we made a decision to increase our deductible to $2500.00 which would not only get us 100% coverage when the deductible was done but would lower our rate to around $1279.00.

Quite the bargain (he said entirely sarcastically). But the increase in the deductible was offset by the reduction in the monthly payment so that we were swapping more upfront costs and maybe a couple of hundred dollars more for 100% coverage. Worth it to us. This began January 1, 2009.

However, little did we know what was in store. We got a notice yesterday that said our monthly rates were going up to $1576.00 as of May 1, 2009 - an increase of nearly $300.00 per month. A convenient fact, they forgot to tell us when we were changing our deductible for this year.

To add insult to financial injury this paragraph was in the letter accompanying this rate increase.

“We work hard to keep your costs down

“As health care costs continue to rise, we work hard to find ways to save on the health care services you need. For example, as the largest health insurer in Virginia, we have used our negotiating power to keep local provider and national pharmacy costs as low as possible. But even with cost-cutting initiatives like these, we’re finding it necessary to increase premiums for all members enrolled in your type of plan.”

Their idea of saving us money is to increase our premium by $3500 a year? Their cynicism is breathtaking.

The Nature of the Health Insurance Beast

One would think that with the outcry over the high costs of health insurance, the general health insurance bashing that’s going on, the bad perception as cold and uncaring that they have and the discussion of universal health care, their concerns about actual living, breathing (that of course presumes they had been able to afford health insurance when they got sick) beings - sentient creatures called, drumroll please,…………customers would be paramount.

They are not concerned. Their customers aren’t even a subject of discussion.

This came abundantly clear when I called the customer service line for Anthem and spoke to a very nice representative who was clearly hamstrung by two things a. the company b. regulation. I was absolutely astounded, not just by the magnitude of the increase (around 23 percent) but by what I was told. This was a “policy wide” increase. In other words, my actual health didn’t matter, my wife’s didn’t matter, nor did our track record in any way matter. This premium was raised whether you were a category 4 (high risk) or category 3, 2, and 1 (low risk).

This was raised regardless of any individual whatever. It was a raise whether you paid $1279 per month or $450 per month. You were raised that same nearly $300.00. Why, because it was “against the law” to treat individuals as individuals, when it came to pricing policies for specific insurance programs.

So this increase was based on the performance of the policy itself - not the customers using the policy. You can imagine that, in effect, my human health concerns are reduced to the level of an actuarial table, an algorithm or two and a policy. There is NOTHING human about that. There is NO customer differentiation - actually not even recognition by Anthem that their customers are something more than a name on a policy.

Is there a law preventing this differentiation? My customer rep told me that they have been told there is.

I checked as best as I can and I couldn’t find anything that substantiated that either nationally or in Virginia. That said, that doesn’t mean it doesn’t exist. It could.

But can insurance companies treat their customers individually if they’re blocked by law? They can’t right?

Wrong.

In the 3rd edition of CRM at the Speed of Light I covered another Blue Cross Blue Shield (this would be back in 2004). That was Blue Cross of California and their My LifePlan program which was a customer friendly program that provided a large set of online tools to help you find what you needed without much bureaucracy - be it a specialist, pharmacy or a wellness program.

More germane was this:

“It is in the interest of the insurance company to see that a diabetic customer has regular checkups for blood sugar. Consequently, by institutionalizing CRM processes, the alert will show on an agent’s or other appropriate CSR’s screen that diabetic customer A should take advantage of a free test being given in his area over the next month. Aside from any humanitarian concerns that the insurance may (or may not) have, keeping that diabetic customer healthy is in the insurance company’s interest, simply because if the diabetic is healthy, no one collects and premiums are paid for a longer time. The insurance vendors can also track whether the diabetic took advantage of the free blood sugar test. The response can create the need to adjust the level of risk associated with the diabetic. This is a step better than even the thought-leadership that CRM-driven insurers can provide and is a major step to reducing risk without the cold-blooded approach characterized by State Farm.”

As of 2009, you can substitute Anthem for State Farm. No wait. Add “and Anthem.”

This approach would be aimed at preventing recurrences which benefits the insurance company that doesn’t have to pay out the dollars. Second it would make a policyholder feel like the insurance company gave a crap beyond the money we’re feeding them each month so that we don’t have a catastrophe that we can’t afford to pay for. In other words, this would be a way to treat a customer like an individual that mattered to the company.

Has Anthem ever sent us a notification of something related to preventing a recurrence of my wife’s cancer - either through an email or a direct mail piece?

Noooooo.

All we ever have gotten in the nearly a year we’ve been with them is notices of bills and notices of things that might become bills. And the monthly invoice. And now the notification of the premium increase. I mean this literally. Not metaphorically.

Sure, look, I get the fact that they are a business but if the customer in the highly sensitive area of health is nothing more than an actuarial table and a policy performance tied by an algorithm, then their business doesn’t deserve to survive, much less prosper.

Whether you believe in universal health care or not (I do), I would presume you would see that this is not just an inhumane approach, it is a cold blooded model implemented by heartless creatures who have no concern for their actual policyholders. They are concerned that a. you pay and b. you don’t use the insurance ever.

My wife and I are stuck with this company for awhile. Because of her past condition, it isn’t that easy to guarantee coverage, so the cost of moving is perilous for us. But from a CRM lesson learned here, it should be clear that not only is this a company that should never have its practices emulated, even with nice CSRs, but it should be seen as a model of what not to do when your customers are more engaged and more concerned than ever.

BCBS of Michigan Says It's Losing Money,
Seeks Bailout From Customers
Story from the Detroit News

Robert Boys is 73 years old, lives on a fixed income, and worries he'll soon have to shell out another $33.20 a month on health premiums.

His insurer, Blue Cross Blue Shield of Michigan, is seeking to raise the rates on his Medigap policy by 31 percent, to $140.29 a month, as part of a broader proposal to increase rates on its entire line of individual insurance plans -- policies for people who buy their own medical coverage. Blue Cross says it needs to raise rates to stem growing losses incurred in the individual market.

"They are hitting the people that can least afford it," said Boys, who lives in Brighton. "I'm trying to live on Social Security right now. What do I cut now?"

Boys is not alone in his worries. Many Blue Cross members are troubled by the insurer's proposed rate increases, which are now under review by state insurance regulators. They say the increases are too extreme and ill-timed with the state's unemployment rate in the double-digits -- the highest in decades.

On Monday, state regulators deemed the Blue Cross rate filing complete and will now go about notifying Blue Cross members, as well as other industry stakeholders and the state's attorney general, of the insurer's request. Once those steps are complete, members will have a chance to weigh in by requesting a rate hearing to challenge the increases.

The rate hikes are among the highest proposed by Blue Cross in the last five years and will affect about 400,000 Blue Cross members, including 209,000 seniors who buy their supplemental Medicare plans, known as Medigap.

Depending on the insurance plan, the proposed increases range from a few percentage points to as much as 72 percent for some of the insurer's age-rated plans, such as Individual Care Blue. Blue Cross's Medigap enrollees will see increases of 31 percent, but the hike won't affect Medicare Advantage members.

Blue Cross says the increases are necessary to stanch red ink flowing from its individual health plans and come as part of several cost-cutting moves announced in January by the insurer, including a work force reduction of about 1,000 positions.

As the state's insurer of last resort -- a responsibility tied to its tax-exempt status -- Blue Cross must cover all Michigan residents, regardless of their medical history. But that arrangement, Blue Cross officials say, leaves them with the state's costliest members because those customers are routinely rejected by other private insurers because of pre-existing medical conditions.

"The need for the increases is driven by a broken regulatory system in the individual insurance market that has not changed in nearly 30 years," Blue Cross spokeswoman Helen Stojic said.

Millions in losses claimed

Blue Cross has spent more than a year pushing for legislation changes to give the insurer more leeway in raising monthly rates, an effort that fizzled last December when state lawmakers let the measure die.

Blue Cross now says its losses in the individual market -- expected to increase in 2009 to $210 million -- could jeopardize the organization's long-term financial health.

Some Blue Cross critics, including the Michigan Attorney General Mike Cox, aren't so sure and have questioned the way the insurer is calculating those losses, saying they aren't as large as Blue Cross claims.

Lidia Abate of Farmington Hills is one Blue Cross subscriber eager to voice her opposition.

At age 59, Abate said she pays $286 a month for her Flexible Blue PPO. Her 89-year-old mother also spends another $107.09 a month for her Blue Cross Medigap policy. Under the proposed rate increase, her monthly premiums will rise only 3 percent but her mother's will go up 31 percent to about $140 a month.

"Luckily, she has us lending her a hand with her rent. Can you imagine how many older people will be in trouble if this happens?" said Abate, who lost her job at a physical therapy firm last year. Any increase to her policy will also strain the family's budget, Abate said. "We do have a mortgage and cars and bills and the 401(k) is in the toilet," she added.

Rate increase OK'd in 2008

Blue Cross received state approval last year to raise rates on about 20,000 members enrolled in individual plans, a hike that ranged from 40.6 percent for the high option to 22.49 percent or the moderate-level plans. The final increases approved by the insurance commission were lower than Blue Cross had requested, but still too high for member Ghada Abraham, who challenged the rate hikes before their approval by the insurance commissioner and continues to fight them on appeal.

"Blue Cross was created to make coverage affordable, yet the opposite is happening," said Joseph Aoun, an Ann Arbor attorney representing Abraham, who has the moderate option of Blue Basic and saw her monthly rates increase from $459 to $562 last year. Now, Blue Cross's request could send their premiums up another 63 percent to $917 a month.

"These increases, on top of the large increase they have received in years past, put coverage beyond the reach of the average resident," Aoun said.

Blue Cross said it sympathizes with its individual members, particularly those on fixed incomes or who have lost their jobs.

"Blue Cross wants to continue providing coverage to the vulnerable. But we need a regulatory system that works," Stojic said, adding that the market for individual policies has grown rapidly, saddling the Blues with a greater financial burden than their private-sector competitors.

Blue Cross expects to add another 76,000 individual members in 2009 and its actuaries project losses of up to $1 billion on its individual policies over the next three years. Financial information released in March by Blue Cross shows the insurer lost about $133.2 million on its individual policies in 2008 -- a slight improvement from the previous year's losses of $134 million. Still, Blue Cross says, the losses incurred on individual insurance dragged down the insurer's bottom line last year, contributing to a net loss of $144.9 million for 2008.

Subsidies For Private Medicare Plans
On The Chopping Block
Story from the Wall Street Journal

The government late Monday is expected to set in stone the 2010 rates it will pay health insurers to run private Medicare plans. Most signs suggest that cuts are coming in the subsidies that the industry got during the Bush administration.

Stocks of health insurers were sucked into a surprise tailspin in February after Medicare officials signaled they planned an effective 5% cut in those payments after formula adjustments. Insurers, medical societies and others have had six weeks to give regulators their arguments before the payment rates become final for next year.

Their arguments, plus an effort by 17 senators from both parties who on Friday urged Medicare to reconsider the way it calculated the effective cuts, could sway the Centers for Medicare and Medicaid Services to compromise on the new payment rates, as the federal agency has in previous years. But its new management hasn't given any hint of letting up on efforts to rein in federal subsidies for the private-sector Medicare plans.

More than 10 million beneficiaries get their medical and drug coverage through so-called Medicare Advantage plans, which the Bush administration promoted with extra benefits for seniors and by providing subsidies to insurers that offer them. President Barack Obama wants to finance a good chunk of his health-care agenda by cutting those payments over time to the level of traditional Medicare's per-patient outlays. But the rates signaled in February by the new administration caught insurers -- and Wall Street -- off guard by cutting payments so soon.

The stock performance of big Medicare Advantage players on Friday suggested that many investors "don't believe it will be a positive surprise," said Matthew Borsch, analyst at Goldman Sachs. Humana Inc., already down 30% for the year, shed $1.54, or 5.7%, to $25.46 on Friday.

If the payment cuts remain or change little from those proposed, insurers may raise premiums or cost-sharing amounts, such as copayments The Blue Cross Blue Shield Association argues that the cuts could translate into premium increases or benefit reductions of between $50 and $80 a month for seniors. That could slow enrollment in a business that has been critical to many health insurers' profit growth in recent years.

Medicare Advantage wraps physician and hospital services in one. Unlike traditional Medicare, the government doesn't pay providers directly but instead pays insurance plans to manage care.

The Obama administration argues it wants to make sure the plans aren't overpaid while not providing value or better care. Last week, it took steps to tighten screws on the private plans on another front, setting new caps on what insurers can charge sick seniors and ordering them to be more upfront about what they cover.

Governor Doyle of Wisconsin Discusses Health Care Leadership
Story from NBC26 WGBA

Governor Jim Doyle will discuss his leadership in health care and moderate the first Regional White House Forum on Health Reform on Thursday, March 12, 2009 at 2:00 EDT at the Ford Conference and Event Center in Dearborn, Michigan. Governor Doyle will join Michigan Governor Jennifer Granholm and Melody Barnes, director of the White House Domestic Policy Council.

Governor Doyle has made Wisconsin a national leader in providing access to affordable health care. In a time when many states are cutting back on health care programs, Governor Doyle is moving forward on a bold plan to insure 98 percent of Wisconsin residents through simple, accessible, and affordable plans. Since February 2008, all kids in Wisconsin have been able to get the health care they need at a price their families can afford through BadgerCare Plus. Nearly 70,000 children have enrolled in the program since 2008.

Governor Doyle is also moving forward the state's efforts to provide low-costs prescription drugs to Wisconsin seniors through SeniorCare. SeniorCare is cheaper, easier to apply for and provides better drug coverage than Medicare Part D. The program saves taxpayers and the federal government over $90 million a year, and provides prescriptions to 90,000 Wisconsin seniors.

Wisconsin is making strides in many areas of health care, including long-term care. The state's pilot program, Family Care, serves elders and people with disabilities with a need for a nursing home level of care with a flexible, community-based approach. It saves the Wisconsin Medicaid program an average of $450 per month per person.

Forum participants will include doctors, patients, providers, insurers, policy experts and health care advocates of all kinds - both Democrats and Republicans - who will discuss the urgent need to curb skyrocketing health care costs that are draining our federal and state budgets, devastating families and small businesses and undermining our long-term economic prosperity. People across the country can also visit www.healthreform.gov to submit their questions and ideas and join the debate.

There is Job Security - If You Enjoy Working With the Elderly
Story from KansasCity.com

Do you want almost slam-dunk-guaranteed job security over the next 10 years?

Take a look at job projections from the U.S. Bureau of Labor Statistics and demographic trends which show — no surprise here — that the big baby boom generation is getting old.

People who provide care for seniors, especially those who require extended care, will be needed in droves.

Look especially for growth in demand for in-home care providers.

Because the cost of nursing home or life-care facilities is comparatively high, many Americans are opting for in-home care, sometimes round-the-clock.

Nationally, that means the personal and home care aide category is expected to grow by more than 50 percent — from 767,000 in 2006 to 1.15 million in 2016.

In Missouri, projections are for a 28 percent growth in the demand for home care aides, from 21,000 jobs in 2006 to 26,920 in 2016. A separate projection calls for demand in Kansas to grow by 35 percent, from 11,400 jobs in 2004 to 15,340 by 2014.

One supplier of such workers, Home Instead Senior Care, says the demand for senior care givers will outplace supply. It expects to have to double its workforce in just three years to handle incoming business.

Now here’s an important note of caution for anyone thinking of jumping into the growing, nearly recession-proof occupation:

Caring for seniors is not for everyone.

To help find out if you have the interest, aptitude or attitude for the profession, you can take a career self-assessment test.

In-home caregivers may be trained nurses, nurse assistants, physical therapists, cooks, housekeepers, errand-runners and companions.

Doug Kisgen, owner of Home Instead, points out that in-home care giving can be a mid-life career change as well as a part-time job opportunity.

If you like old people, if you have some experience as a care giver, or if you have a giving personality, you might consider the field.

NOAA Weather-Alert Radios Available Free to
Day Care, Adult Foster Care Homes In Ludington Area
Story from Ludington Daily News

Tuesday, March 31, 2009

This week is Severe Weather Awareness Week and a good time to remind state licensed day cares and adult foster care facilities they may receive a free NOAA weather-alert radio.

“It provides a good warning for people who may not have their TVs or radios on,” Elizabeth Reimink, Mason County Emergency Management coordinator, said about the radios.

They are small, about the size of a hand, Reimink said, but loud and are designed to wake people if a warning comes at night.

“They’re programmed to receive alerts from the National Weather Service,” she said, adding that the warnings will start with a tone and then relay messages about potential storms to affected areas. Those messages will include information about the storm, the area that may be affected and the storm’s duration.

Reimink said she received grant money and bought several of the radios and has tried to contact area day care and adult foster care facilities.

“But I want to make sure no one’s missed,” she said, adding they can contact her at 408 Resseguie St., Suite 100, 845-5911.

Key Choices For Seniors
Story from Ohio.com

While Trying to Save Money, Ohio Seeks to Bridge Gap Between Nursing-Home Care and Assisted Living Care

As a former businessman and member of President Richard Nixon's administration, Fred Rouse is used to being in charge.

But when the 82-year-old lived in the nursing-home section of St. Luke Lutheran Community in North Canton, he couldn't even set his own thermostat.

Thanks to a special state program that lets some low-income seniors use Medicaid to pay for assisted living, Rouse recently moved into the assisted-living portion of St. Luke's after recovering from intestinal surgery and completing therapy.

Now he can set his own schedule — and his own thermostat — while saving the government money.

Assisted-living costs an average of $2,106 per month, compared with $4,231 for nursing-home care, according to the Ohio Department of Aging.

''I'm a conservative, and I don't like wasting money,'' Rouse said. ''And I don't see wasting people's talents to come in and blow my nose.''

Faced with an aging population and rising costs to provide care, the state is trying to expand the options between home care and nursing homes for Ohio's seniors.

The Ohio Department of Aging has been working to enhance its existing community-based programs and develop new options for long-term care, Director Barbara Riley said.

Among the choices that could be added or expanded in the coming years:

• Enhanced community-living programs, which would allow Medicaid recipients in subsidized senior houses to get on-site help 24 hours if needed, similar to assisted-living facilities.

• Adult foster care, which would bring together a small number of seniors who need help with the tasks of daily living to live in a home with 24-hour care available.

• The ''Choices'' waiver program, which allows Medicaid recipients to hire their home-care providers, who could be trained relatives. The program is only available on a limited basis in central and southern Ohio.

• PACE (Program of All-Inclusive Care for the Elderly), which allows one provider to coordinate a recipient's medical care, home care and, if needed, adult day care. There are two approved sites statewide, in Cleveland Heights and Cincinnati.

''We haven't done what we're doing now, which is make a full-force public education effort to help people understand what choices are available and to make sure we have the choices available that people want,'' Riley said.

Burden on Medicaid

Most of the burden for providing long-term care to the state's elderly and disabled population falls on Medicaid, a state-run health insurance program for the poor and disabled that is supported with state and federal tax dollars.

About 74 percent of Ohio residents who received long-term care through Medicaid in 2004 lived in nursing facilities, compared with 61 percent nationwide, according to the most recent estimates available.

Ohio's population is graying — and that's expected to cost the state a lot more green. Each month, about 12,000 Ohio residents turn 60, according to the Ohio Department of Aging.

''The big picture is there's a huge problem and it's getting worse,'' said Joseph L. Ruby, president and chief executive of the Greater Akron-Canton Area Agency on Aging.

The agency coordinates Medicaid long-term care services for residents of Summit, Stark, Portage and Wayne counties.

''The best way to address the long-term care issue is to provide long-term care options,'' he said.

Oregon, for example, has developed a system that provides seniors and disabled residents covered by Medicaid a variety of options outside nursing homes for care, said Barry Donenfeld, executive director of the NorthWest Senior Area Agency on Aging in Oregon.

Donenfeld was among several state and national speakers during a recent seminar in Fairlawn organized by the Greater Akron-Canton Area Agency on Aging.

Oregon residents can get care while living in assisted-living facilities, their own homes, foster-care homes and even with relatives, who can get paid to provide the care, Donenfeld said.

As a result, Oregon ranked second in the nation in 2007 for the percentage of Medicaid dollars spent on community-based services (almost 73 percent) compared with nursing homes, according to data from the U.S. Centers for Medicare & Medicaid Services.

Levels of care

''What Ohio would need to do is make a commitment to developing this middle of the continuum,'' Donenfeld said. ''Just because you leave home doesn't necessarily mean that the next stop is the nursing home. There are other levels of care that allow someone a much more home-like setting.''

Ohio could save about $900 million a year in Medicaid costs if the state could achieve the average balance seen nationally between patients in nursing homes versus home and community settings for long-term care, according to estimates by the Ohio Business Roundtable.

Ohio's skilled nursing facilities ''are supportive of the continuum of long-term care and the ability of consumers to make choices from different settings of care, depending on what their needs are,'' said Peter Van Runkle, executive director of the Ohio Health Care Association, which represents nursing homes and assisted-living facilities statewide.

However, he said, nursing homes need to be appropriately funded, because they will continue to be the right choice for many consumers.

Riley said the state already is taking steps to provide more options beyond nursing homes.

In recent years, the state has eliminated waiting lists for PASSPORT, a program that lets Medicaid recipients who otherwise would require nursing-home care to get services in their homes.

In addition, Ohio is making efforts to sign up more facilities for the assisted-living Medicaid waiver program, Riley said.

In Rouse's case, the former chairman of the Great Lakes Basin Commission under President Nixon got strong enough to move out of the nursing home but still needs help.

He said he has been very satisfied with the care he received in the nursing-home section when needed and now in the assisted-living area.

''I'm in good health, but I need help,'' he said from his new assisted-living room, which soon will be equipped with a recliner chair and personal-sized refrigerator and freezer.

His wife of 58 years, Barbara, has Alzheimer's disease and lives in the nursing-home portion of the facility.

''I want to stay here,'' he said. ''This is where I want to be.''

By later this year, the state also might approve more PACE sites. Participating programs get a set amount of money from Medicare and Medicaid each month to provide and coordinate all the medical care and home assistance that enrollees need.

Summa Health System in Akron is considering establishing a PACE program, possibly tied to its adult day-care program at Cuyahoga Falls General Hospital, said Patricia L. Troyer, Summa's executive director of post acute and senior services.

''Clearly,'' she said, ''people like to get services at home.''

Service in Escanaba Aids Michigan Residents With Long-Term Care
Story from DailyPress.net

ESCANABA - Trying to find the best and most affordable long-term care for a loved one can be a frustrating and complicated search. That's why the Escanaba-based Upper Peninsula Commission on Area Progress (UPCAP) began its U.P. Long-Term Care Connections (UPLTCC) service - a single point of entry process that assists people in making the decision of how they or their family member will be taken care of.

When it comes to long-term care, there are many options, some affordable, and some costly. There is also the difficult choice between placing a loved one in a nursing home or adult foster care home, or trying to find the proper care for them at home.

In 2006, Michigan funded four pilot programs to demonstrate the effectiveness of the Single Point of Entry concept. UPCAP Services Inc., was selected as one of these pilots and has provided long-term care information, assistance and counseling to people in all 15 counties of the U.P. since January 2007.

The U.P. Long-Term Care Connection utilizes UPCAP's toll-free 2-1-1 Call Center as a starting point for people wanting information about long-term care.

If the person needs further assistance after speaking with an informed call specialist, they can meet with an options counselor. Bomberg said these counselors specialize in knowing as much about long-term care as possible.

"Our responsibilities are two-fold," said Bomberg. "We're there to help the individual or family make an informed choice of where to have long-term care provided, and also to ensure people who are looking to the state for money, that they understand the eligibility criteria. We work with everyone regardless of income."

Bomberg said the counselor's job is to spend time with the person and family client to help them make informed decisions.

Options counselors also address the delicate issue of financing long-term care.

"They meet face-to-face with the client and are very straight forward

about costs," he said. "That really wasn't happening before. There weren't intensive discussions about cost and no talk of less-costly alternatives... how much is it to stay home, or that an adult foster care home may have different pricing packages that may suit a person better..."

There are 20 options counselors working in the UPLTCC program who serve the entire Upper Peninsula. UPLTCC Options Counselor Mary Ross said she received intensive training to become a counselor, and continues her training as new information and situations arise.

"We're trained on anything and everything from the technical Medicaid policies to how to deal with grief and death," she said. "(UPCAP) has pulled counselors from all walks of social work and gives them very intensive training. The counselors all have something to offer and can offer different perspectives."

Salary Up 26% For Blue Cross CEO
Story from the Boston Globe

Salary, Bonus Totals $3.5 Million as Insurer's Net Income Slides 49%

The salary and bonus paid to Cleve L. Killingsworth, chairman and chief executive of Blue Cross and Blue Shield of Massachusetts, increased 26 percent last year, to $3.5 million, even though the health insurer's membership declined and its net income fell 49 percent.

Based on previous years' retirement benefits - which Blue Cross-Blue Shield did not report for 2008 - Killingsworth's total pay package was likely about $4.3 million, making him by far the highest paid healthcare executive in Massachusetts.

The jump came during a tough year in which Blue Cross-Blue Shield's business was affected by the stock market decline, the recession, and the increasing cost of medical care.

Membership at the state's largest health plan declined about 40,000 to just over 3 million.

"The decline in membership had an impact on results," said chief financial officer Allen Maltz. "In addition, many of our customers changed their benefits plans to products that have much lower margins."

Blue Cross-Blue Shield insures employees of national companies that have locations outside Massachusetts, Maltz said, and those customers accounted for some of the drop-off in membership.

Maltz said Blue Cross-Blue Shield aims for a profit margin of between 1.5 and 2 percent. Last year's margin was almost zero. The firm had operating income from its medical claims business of just $1.6 million.

A new state assessment on reserves lowered income by $21 million, Maltz said. Revenue was flat at $6.7 billion, and medical claims were also unchanged at $6 billion.

Like most health insurers, Blue Cross-Blue Shield also relies on investment income, which fell 28 percent to $111 million. Maltz said the firm managed to avoid losses in the market by investing primarily in bonds and avoiding derivative securities that have declined precipitously in value.

"We made money in one of the toughest economic environments in the last 75 years," he said. "The company seeks to maintain strength to weather just this kind of situation."

Salaries at Blue Cross-Blue Shield were inflated by a complex executive bonus plan in which senior officials get bonuses based on a rolling average of the previous three years.

"These executives and the company performed and exceeded our expectations," said Jay McQuaide, a Blue Cross-Blue Shield spokesman. "They earned these incentives." The key metrics in the incentive plan are membership and net profit, he said.

The insurer's board members also received a 33 percent increase in base pay, from $30,000 a year to $40,000. Most earn far more because of payments for attending meetings and serving on committees.

The insurer recently said it was eliminating executive bonuses for 2009. Senior executives will still participate in a companywide bonus plan.

The company said the cutbacks would reduce cash compensation to senior executives about 30 percent and payments to Killingsworth about 50 percent, exclusive of retirement benefits.

At Harvard Pilgrim Health Care, the state's second-largest health plan, chief executive Charles D. Baker's total compensation, including retirement benefits, rose 24.5 percent to $1.7 million.

Net income for 2008 increased to $48.1 million from $45.6 million in the previous year, and membership grew 38,000 to 1.07 million.

"We did a great job of managing expenses," said James DuCharme, chief financial officer, in a statement. "Our overall administrative spending in 2008 was $15 million lower than it was in 2007."

Tufts Health Plan earned net income of $18.8 million in 2008 despite suffering investment losses of $6.2 million in 2008. In the fourth quarter alone, Tufts lost $27.3 million because of investment losses and an operating loss of $1.3 million. In 2007, Tufts posted net income of $110 million.

Enrollment increased to 698,000 at year-end compared with 678,000 in the first quarter.

"During such a challenging period, we are pleased to end the year with a positive net income," said Umesh Kurpad, chief financial officer, in a statement.

Chief executive James Roosevelt Jr. earned compensation of $1.06 million, excluding contributions to an executive savings plan, down slightly from $1.19 million in 2007.

The state's health plans are among the best nationwide, as ranked by the National Committee for Quality Assurance, a respected nonprofit. Harvard Pilgrim has been ranked best commercial health plan in the nation for four consecutive years. Tufts' plans, excluding its Medicare Advantage plan for seniors, were ranked second nationally last year, and Blue Cross and Blue Shield of Massachusetts ranked ninth.

Costs For Individual Health Plans Soar
Story from USA Today

At a time when more people are forced to buy their own health insurance because of job losses, costs for many individual policies are soaring.

Advocates say the 17 million Americans who buy their own coverage can't negotiate lower rates the way employers or other large group plans can.

COBRA SUBSIDY NEARS: Employers fear rising health costs

"These folks have their back against the wall," says Jerry Flanagan, a health advocate with Consumer Watchdog, a California-based group.

More people are shopping for coverage: The Golden Rule Insurance Company, a part of UnitedHealth Group, says sales of individual policies are up 24% in the past two months. A website that links people with insurers, eHealthInsurance, says applications are up 18% in the fourth quarter, compared with a year ago.

Among this year's large rate increases on the individual market:

• Anthem Blue Cross in California has notified about 80% of its 800,000 individual policyholders of double-digit increases, many above 30%. Spokesman Ben Singer says rising medical costs are prompting the increases.

• Blue Cross of Michigan is seeking state approval for a 56% increase in individual premiums. Spokesman Andy Hetzel says the company needs to offset losses stemming from state rules making it the sole insurer required to take all applicants.

• Regence Blue Cross Blue Shield of Oregon will raise rates for approximately 10,000 Washington state customers by 27.1% on March 1.

Another Washington insurer, LifeWise, raised rates 17.6% on Jan. 1, according to the Office of the Insurance Commissioner in Washington state.

By comparison, group health insurance premiums paid by employers rose about 5% in 2008, says a survey by the Kaiser Family Foundation.

Some insurers say increases this year for individual policies aren't out of the ordinary. Aetna, for example, says individual policy increases nationwide range from 8% to 22%.

Still, such hikes can cause "sticker shock" for people used to smaller increases under employer plans, says Robert Laszewski, who heads Health Policy and Strategy Associates, a consulting firm.

Premium rates for individual policies vary widely, depending on state rules, the type of coverage and the applicant's age and health. Unlike group coverage, in which all applicants are accepted, insurers can reject applicants for individual coverage in most states if they have medical problems.

A sample of 227,000 individual policies sold by eHealthInsurance found average monthly premiums for single people ranged from $107 to $301 in 2007, the latest data available. The average deductible, the amount paid before coverage begins, was nearly $2,000.

Family coverage ranged from $219 to $494 a month with an average $2,600 deductible.

Insurers face shrinking enrollment in group plans because employers are shedding jobs. They also have deflated investment portfolios and higher costs as patients use more health services, says a report out last week from ratings agency A.M. Best.

Those problems could lead to "higher rate increases than in the past," says Sally Rosen, a managing senior financial analyst at Best.

Growing Old Far From Home
Story from the Irish Times

The lonely death of an elderly Irish immigrant in New York illustrates the often sad fate of a generation of Irish who moved to the US in the 1950s and 1960s, and who now need support

‘He died alone” was the sad headline in the Irish Voice newspaper. Tony Gallagher, a 72-year-old Irish immigrant from Bellacorick, Co Mayo, was found dead in his apartment in Sunnyside, Queens in New York in late December. It is thought his body was lying there for a week before it was discovered by firefighters after they were alerted by the apartment superintendent who had not seen him for several days.

The New York Irish Center

Gallagher, a carpenter, arrived in the US in 1970. His wife, Josephine, now suffers from Alzheimer’s and has been living in a nursing home for the past three years in Kingston, New York. The couple had no children. Gallagher’s brother Eddie, lives in Holyoke, Massachusetts, and last saw him at Thanksgiving.

Ambrose Gurhy, the owner of an Irish bar in Queens, says Gallagher came in every so often. “You might see him two times a month and you might not see him again for four or five months. He wasn’t a bar person really. It was more for the company rather than a big session.”

The case of Gallagher’s lonely death has focused attention on the plight of elderly Irish immigrants in New York, and the problems of isolation that many of them face.

Ciarán Staunton, a well-known figure in the Irish community and vice-chairman of the Irish Lobby of Immigration Reform, says the death of Tony Gallagher underlines the need for a census of elderly Irish to identify those living in isolated conditions. The census could be done through a volunteer network run with the help of the Church, he says, noting that many elderly Irish in New York attend Mass daily.

According to Staunton, there are probably “a couple of thousand” Irish over the age of 65 living in the city, and many have little contact with each other.

“We need to know where are they? Who are they? We need to get the names, get their numbers and get co-ordinated.”

The New York Irish Center on Jackson Avenue in Queens has become a hugely important social centre for elderly Irish in the borough. The founder of the centre, 73-year-old Fr Colm Campbell, chaplain to the Irish community in the US, points out that the Irish in Queens are more dispersed than they are in the Bronx.

“The Irish who moved to the Bronx mainly tend to live all closely together in a tight little area in Woodlawn,” says Fr Campbell, originially from Belfast and who came to the US in 1992. “In Queens, there is no Irish neighbourhood any more. There was Woodside and Sunnyside, but they have gone.”

Because Fr Campbell lives alone and suffers from ill health, he wears a bracelet on his wrist which will sound an alarm should anything happen to him. At a Mass last weekend at the New York Irish Center in Queens he stressed to the elderly congregation the importance of looking out for each other.

Returning to Ireland is simply not an option for most seniors, says Fr Campbell, because “the Ireland they left is not the Ireland they would return to”. Indeed, one of the regulars at the centre, Pat Sheehy from Woodlawn, who left Glasnevin in Dublin in 1956, tried to relocate to Ireland three times. “It just never worked out,” she explains.

Fr Campbell says there is a great deal of loneliness. “One woman in Woodside, Queens, said to me, ‘My daughter rings me every day. But that’s just 20 minutes.’ The apartment block she lives in used to be entirely Irish but now it’s almost entirely Polish. She says they are lovely people – but she can’t understand a word that they are saying.

Fr Campbell says one of the problems with elderly Irish immigrants is their reluctance to ask for help. “There’s a thing in the Irish that just doesn’t want to admit to being in need.”

CIARÁN STAUNTON AGREES, saying that the generation that came to America in the 1940s and 1950s are “a proud people”. “No one is going to say, ‘I have spent 20 years sending back money and parcels when things were tight and now no one calls me.’”

Every Wednesday the New York Irish Center holds a lunch which is attended by 40 to 50 senior citizens. As they tuck in to their meals donated by a local Irish restaurant, Sidetracks, accordion music plays in the background. When people introduce themselves, they follow their name with the part of Ireland they came from. When I tell them I come from Nenagh, Co Tipperary, they ask if I know various Nenagh families, despite the fact that they had left Ireland in the 1950s. Many have less of an American accent than you would find in the average teenager in south Co Dublin.

Peggy Cooney, 78, originally from Dunshaughlin, Co Meath, and now living in Astoria in Queens, has been coming to the weekly lunch for four years. “I have made a lot of friends here,” she explains. “But it’s only one day a week.” Cooney came to the US in 1960, sponsored by a Jewish family in Riverdale, the Bronx to take care of their children. Later she worked for a nursing agency. She was “very happy living here” in the 1960s and 1970s. There was a lot of dancing in those days, she says and she was also active in Northern Ireland Aid. She retired at the age of 70. She never married and has a brother in Missouri.

“I’m not lacking for a social life,” she says. However, in her apartment block, no one talks to each other. “Everyone goes to work apart from me and an elderly couple. There’s no communication in the block.”

Most of the senior citizens say that the New York Irish Center is a very important part of their social life. There are other activities such as plays and Irish language classes, and the lunches on Wednesday are followed by a game of cards in the basement. One of the women advises that if I want to talk to the men, I should do so before the card game begins, “because there’ll be no talking to them after that”.

Seán Finn (73) from Ballyhaunis, Co Mayo, says the centre, along with the Irish centre in Mineola on Long Island, forms the basis of his social life. He lives alone and says that on some days, when the weather is very cold, he doesn’t leave his apartment at all.

IN WOODLAWN IN THE Bronx, the main organisation caring for the elderly Irish is the Aisling Irish Community Center. Orla Kelleher, its executive director, agrees that the Tony Gallagher case, although an extreme example, does prove that in a city of more than eight million people, “loneliness and isolation do exist, particularly for seniors.

“We have a very active group of over 80 seniors at the centre. However, they are the lucky ones who are physically able to come to the centre for the weekly meetings and events. We have attempted to expand our senior outreach programme over the past three to four years by contacting churches, hospitals, nursing homes, and so on to ensure that the older Irish are being looked after. However, our efforts have been thwarted by a serious lack of financial and human resources.”

The Tony Gallagher case would be unlikely to happen in Woodlawn because it is such a close-knit community, says Martin O’Malley, a retired bus driver from Ballycastle, Co Mayo. He lives in Woodlawn and is active in the Aisling Center and was speaking at the centre on a Saturday as Irish dancing classes took place. “I had heard he was a bit of loner,” he adds.

Hugh McMorrow (72), from Dromahair, Co Leitrim, says “Woodlawn is an area where everyone knows everyone. The people in good shape look out for the people in bad shape.”

The Irish consulate in New York says that dealing with problems of an ageing Irish community in New York is a top priority. It is unable to say how many Irish over the age of 60 are in New York, which underlines the need for a census of Irish seniors, according to Ciarán Staunton.

The consulate agrees there is a need for more information but says the most practicable way to quantify and assess needs of elderly Irish immigrants is through the establishment of a well-resourced outreach programme for seniors and points out that a new service – to include a senior helpline – will be up and running in March and training for volunteers has already begun.

Immigrant voices: lives lived abroad

TOM and MARGARET BEGLEY

Tom was born in Brooklyn to Irish parents from Roscommon and Mayo, who returned to Ireland during the Great Depression. They came back to the US in the late 1940s. Tom’s wife Margaret is from Co Down. She says they have returned to Down regularly over the years, even during the Troubles. Tom worked in the circulation department in The New York Times. The Brooklyn neighbourhood they live in, Midwood, used to be mainly Irish and Italian; today it is largely Jewish and Pakistani.

The Begley’s have three sons: one who lives in Rockland County, New York, and two who live on Staten Island. They come to the New York Irish Center regularly. “You get to hear the news and the craic,” says Tom, with a strong Brooklyn accent.

MARTIN OMALLEY

“I wouldnt leave Woodlawn for the world,” says Martin O’Malley, speaking about the Bronx neighborhood. Originally from Ballycastle, Co Mayo, he left for the US on January 27th, 1957. He had previously worked in London. “It was tough being Irish back in those days in England. ‘There goes Pat,’ they used to say to you as you walked by.”

He fell in love with the US as soon as he came out here. There was dancing “seven times a week.” He met a Galway girl, they married and had six children. He drove a bus for a living and says he would never want one of his sons “doing that crap.” One of his children is a medical doctor, while two others have PhDs. An active member of the Aisling Center, he volunteers each week making sandwiches which are given to the homeless around Manhattan.

BCBS of Michigan to Cut Up to 1000 Jobs
AP Story Posted to MLive.com

LANSING -- Blue Cross Blue Shield of Michigan said Friday it plans to eliminate up to 1,000 jobs and make other budget cuts this year in another blow to the state's economy.

The nonprofit health insurance giant said the moves are necessary to preserve its financial health. Blue Cross had hinted at possible layoffs last year after the Michigan Legislature did not pass changes to insurance rules sought by the company.

The job eliminations could affect more than 10 percent of the Blue Cross system's roughly 9,000 Michigan employees, including its subsidiaries.

Blue Cross Blue Shield employs 250 in its downtown Grand Rapids office.

Blue Cross has said it wants law changes because it is losing millions of dollars each year on health insurance policies that cover individuals.

Blue Cross customers also could feel the brunt of the company's actions. Blue Cross plans to request average rate increases of 55 percent for individual plans, 42 percent for group conversion plans and 32 percent for Medicare supplemental plans.

"We should not ask our individual subscribers to pay more without first demanding sacrifices from ourselves," Blue Cross Blue Shield of Michigan President and CEO Daniel Loepp said in a statement. "Our goal is to move forward as a strong and financially stable nonprofit company, committed to fulfilling our mission and delivering the best value in health insurance products and services to our customers."

Loepp said the company faces losses of $1 billion through 2011.

Blue Cross plans to trim 400 jobs from its core business and its Blue Care Network HMO subsidiary within the next 60 days. The other job cuts would come later in the year.

Some senior executives will face a salary reduction, the company said, while other executive pay will be frozen. Salaries of non-union employees will be frozen, and the United Auto Workers will be asked to delay a 3 percent pay increase planned for the Blue Cross employees it represents.

The company plans to reduce advertising and lobbying by 25 percent. Discretionary spending such as travel also will be cut by 25 percent.

Blue Cross is a nonprofit organization playing a unique role in the state's health care system. It can't deny any customer health insurance as long as the customer pays for it, making it the state's insurer of last resort.

In exchange for a mission of improving access to health care coverage, the nonprofit company is exempt from many state taxes.

The company's annual revenues were about $19 billion in 2007.

Crain's 2008 Newsmaker of the Year:
Daniel Loepp, CEO Of BCBS Michigan
Story from Crain's Detroit Business

As a former Lansing insider, Daniel Loepp, now CEO of Blue Cross Blue Shield of Michigan, must have been disappointed that a handful of Republican state legislators stymied Blue Cross’ 14-month effort to pass two bills to reform the individual health insurance market.

After a session that began Dec. 18 and lasted into the wee hours of Dec. 19, legislators failed to come up with a compromise on a controversial set of bills to reform the individual market.

The two bills, substitute House Bills 5282 and 5283, died. Legislative leaders promised to address what many consider to be a broken individual market in the 2009 session, which begins this month.

It was a bitter defeat for Loepp, Blue Cross’ CEO since July 2005, when he succeeded Richard Whitmer, who retired after leading the company for 18 years.

Earlier in his career, Loepp served as chief of staff for Michigan Speaker of the House Curtis Hertel and director of communication for Michigan Attorney General Frank Kelley.

Detroit native and Wayne State University-educated Loepp, who went to Blue Cross in 2000 as vice president of governmental affairs, passionately believes that Blue Cross stands alone against a herd of hungry, for-profit health insurers.

He charges these insurers are “cherry-picking” healthy people for coverage while sending the sickest and costliest people to Blue Cross. As a result, he says, Blue Cross is losing millions of dollars.

Loepp also has argued that Michigan needs a wide range of consumer protections that will benefit thousands of individuals, especially the sick, women and the elderly. He also believes Blue Cross needs regulatory reform to shorten the time it now takes for proposed rate increases to take effect.

Commercial carriers and other nonprofit health insurers, such as Health Alliance Plan or Priority Health, do not have to go through a public process as the Blues does to increase rates.

Look for the Blues to take another crack at the legislative process this year.

Test Assesses Effectiveness of Alzheimer's Drugs
Story from Science Daily

A test developed by physician-scientists at Washington University School of Medicine in St. Louis may help assess more quickly the ability of Alzheimer's drugs to affect one of the possible underlying causes of Alzheimer's disease in humans, accelerating the development of new treatments.

Scientists used the test to show that an Alzheimer's drug given to healthy volunteers reduced production of a substance known as amyloid beta (A-beta), a normal byproduct of human metabolism that builds to unhealthy levels forming brain plaques in Alzheimer's patients. The drug candidate, LY450139, which is also known as semagacestat, is being studied in clinical trials by Eli Lilly and Company.

Ongoing clinical trials are studying the effect that semagacestat may have on cognitive function and biochemical and brain imaging biomarkers in patients with Alzheimer's disease. Washington University researchers wanted to see whether the new measurement technique, stable isotope-linked kinetics (SILK), could detect the study drug's impact on A-beta synthesis in healthy volunteers.

"Bringing an Alzheimer's disease drug into clinical trials from tests in animal models has always been challenging," says study director Randall Bateman, M.D., a Washington University neurologist who treats patients at Barnes-Jewish Hospital. "We haven't had a way to quickly and accurately assess a drug's effects, and that meant there always had to be some degree of educated guesswork when it came to setting the optimal dosage for humans. SILK may help to eliminate much of that guesswork."

Scientists are unsure whether increased A-beta production, reduced clearance or a combination of the two lead to the A-beta buildup in the brain, a process that many believe triggers Alzheimer's disease. Bateman and his colleagues are currently using SILK to try to answer this question.

Until SILK, there has not been a way to directly measure the production or clearance of A-beta. The efficacy of potential new Alzheimer's drug candidates has been assessed by monitoring the cognitive functions of patients with the disease for extended periods of time, which require large, lengthy and expensive studies.

In their double-blind study, scientists gave 20 healthy volunteers varying doses of either a study drug or a placebo. At the start of the SILK test, volunteers were connected to an intravenous drip that gave them a slightly altered form of the amino acid leucine, which is a component of A-beta.

Over the course of several hours, cells in the brain picked up the labeled leucine and incorporated it into the new copies made of A-beta and other proteins. The scientists took periodic samples of the subjects' cerebrospinal fluid to determine how much of the A-beta included altered leucine.

Tracking the rise of the percentage of labeled A-beta over time reveals the A-beta production rate. Scientists then stop the leucine labeling but continue analyzing spinal fluid samples. As the body removed old A-beta and made new A-beta, the percentage of A-beta containing altered leucine dropped, revealing the A-beta clearance rate.

The results suggest a dose-dependent drop in A-beta production, with an 84 percent reduction in A-beta production being measured with the highest study drug dose.

The SILK procedure takes 36 hours, but provides scientists a more detailed assessment of amyloid beta production and clearance levels than they can obtain through conventional methods.

"You could use a spinal tap to look directly at the amount of A-beta present in the cerebrospinal fluid, but we've shown that natural processes cause A-beta levels to change dynamically," says Bateman. "Such changes make it more difficult to assess the effects of a drug in that fashion."

The study was funded through a Lilly grant from a funding program that allowed Bateman to propose the research and retain control of it. Five of the paper's 12 authors are Eli Lilly employees.

Washington University in St. Louis licensed its pending patents on SILK to C2N Diagnostics, LLC, a St. Louis diagnostics company started by Bateman and senior author David Holtzman, M.D., the Andrew and Gretchen Jones Professor and Chair of Neurology. Bateman and Holtzman's financial interests in the company are governed by the university's conflict-of-interest policies.

Funding from Eli Lilly and Company supported this research.