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.