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KNOW HIV/AIDS (www.knowHIVAIDS.org) is a global media campaign to combat HIV/AIDS through on-air public service messages and outdoor advertisements, television and radio programming, and free print and online content. The campaign seeks to educate the general population about the impact of AIDS globally, and to promote prevention and testing among higher-risk populations, including young people, African Americans, Latinos, women, and men who have sex with men. This initiative is a partnership of Viacom Inc. and the Kaiser Family Foundation.

The Henry J. Kaiser Family Foundation

Sleuths Scope Out Benefits:

GTE Seeks Quality at the Right Price

12/24/2000

By Charles Ornstein Reprinted with permission of The Dallas Morning News

CHAMPAIGN, Ill. If George Crowling put pencil to paper, his job description would read something like this: fortune-teller, penny-pincher, paper pusher and private detective.

In short, Mr. Crowling manages health benefits. He is the person charged with finding health insurance programs for thousands of workers at GTE Corp. and the voice that soothes irate workers when they have problems with their HMOs.

Each spring, Mr. Crowling assumes the role of sleuth. The regional health-care manager travels Texas and the Great Plains, ferreting out information on the HMOs that insure GTE’s workforce. He’s looking for signs of trouble, proof of improvements and a personal commitment to the telephone company’s quality-driven focus.

Mr. Crowling and two other regional health-care managers have kept an eye on GTE’s medical spending for years. And they continue doing so despite a merger with Bell Atlantic Corp. that created Verizon Communications Inc., the nation’s largest local telephone company.

Last year, GTE spent about $1 million on salaries and travel expenses for Mr. Crowling and the two other health-care managers. That’s a fraction of the $548.7 million cost of covering health care for its employees, retirees and dependents in 1999.

Yet, their negotiating prowess and knowledge of health plans has held GTE’s increase in medical expenditures to 8 percent for 2001 at a time when competitors have seen their costs skyrocket by 15 percent or more. The savings amount to millions of dollars.

In using in-house experts instead of hired consultants to negotiate with health plans, GTE breaks ranks with most of corporate America, as it has done since the early 1990s when it aggressively sought to shift employees into HMOs.

On the road – again

Mr. Crowling logged thousands of miles in his pursuit of the right health plans. One two-day trip in May found him visiting four insurers.

The first day, he racked up frequent-flier miles from Albuquerque, N.M., to St. Louis before renting a car for a three-hour drive to Champaign, Ill. But he wasn’t done there. In the course of a two-day stay, he made two round trips between Champaign and St. Louis – a total of 900 miles.

On every site visit, Mr. Crowling carried a black binder prepared by his assistant, JoAnn Phillips, whom he credits with maintaining his sanity. Inside the notebook are directions to his meetings, HMO enrollment figures and the HMO’s responses to a standard GTE questionnaire.

At his first stop in Champaign, Mr. Crowling spent 21/2 hours at PersonalCare, an HMO that covers about 100 GTE employees. He discussed prescription drug costs and efforts to reduce medical errors.

Todd Petersen, PersonalCare’s senior vice president and chief financial officer, is more accustomed to dealing with consulting firms. GTE is one of the few national clients to visit his health plan, he said.

His health plan has benefited from GTE’s emphasis on quality. PersonalCare has won a coveted spot as one of GTE’s benchmark plans because of its high scores on national quality and satisfaction surveys. The honor means that GTE pays a greater share of the premium for employees who enroll.

“They’re probably the only company that we do business with that actually backs up what they say,” Mr. Petersen said. “Every other company gives lip service to quality. But at the end of the day, it’s really about our provider network and price, as opposed to quality.”

A veteran of the health-care business, Mr. Crowling knows what questions to ask. As a consultant, he helped stabilize financially troubled Bay Pacific Health Plan in California.

Each of his counterparts has credentials in finance or health care. On the West Coast, Tom Davies had been a senior vice president at Blue Cross of California. Jim Astuto, who handles the East Coast, worked in the finance department at H.J. Heinz Co. before coming to GTE 13 years ago.

“It’s always an advantage, in relating to vendors, to have worn their shoes, to have worked in their arena,” said Mr. Davies, who is based in San Ramon, Calif. “When it comes to developing market strategies and plan designs, having this background has been one of the keys to our success.”

Mr. Astuto, who works in the Atlanta suburbs, said he made 19 trips this season from Florida to Maine to review about 50 health plans. He is also the point man for designing prescription payment plans that make consumers aware of costs.

“If you’re dedicated to providing the best, you need to get out there,” Mr. Astuto said. “You can look at all the quantitative markers on them, but sometimes you just need to get out there and hear the speeches.”

Benefits of site visits

It’s amazing, Mr. Crowling said, what he learns just from site visits.

At PersonalCare in Champaign, for instance, he saw data illustrating how patients shifted away from specific, high-cost drugs when the HMO increased their co-payments. Those patients moved to lower-cost drugs that the HMO described as equally effective.

“People are remarkably honest with us, sometimes shockingly honest about what’s happening or what’s going to happen,” Mr. Crowling said.

When trouble is brewing, he and his colleagues said, insurers in their regions call to prepare them before flare-ups prompt employee questions. Mr. Astuto, for example, learned of contract stalemates between hospitals and HMOs in Massachusetts, Florida and Kentucky long before the providers made the information public.

In Kentucky, Mr. Astuto encouraged the health plan to stand its ground and avoid paying the higher reimbursements requested by the physicians.

Three years ago, Mr. Davies helped facilitate an agreement between an HMO in Washington state and a large medical group. “[The two sides] painted themselves in a corner,” he said. “There was no way to get out without breaking the relationship.”

Because GTE provided insurance to 2,600 HMO members who used those doctors, Mr. Davies said he felt obligated to intervene.

“We were able to talk to both sides in very direct ways,” he said. “The top management of both the medical group and the company got together and hammered out an approach.”

First to the table

When GTE started offering HMOs to workers in 1988, it was part of the first wave of employers to embrace programs that offered $5 doctor visits, no claim forms and rules governing access to medical services.

But the company did not fully embrace the managed-care concept until four years later, when it hired its regional health-care managers to find quality HMO choices.

Since then, GTE has been a leader in transferring employees to managed care. In 1997, it was one of the first employers to increase patient co-payments for physician office visits to $10 from $5. A year later, it began charging varying co-payments for prescription drugs, separating medications into generic or one of two brand-name categories.

The moves gave employees a feel for the rising health-care costs that the company was paying and came on top of the monthly contributions that employees made to insurance premiums.

Unlike GTE, most companies hire consulting firms to manage health insurance benefits – or at least assist with managing it. In fact, GTE’s merger partner, Bell Atlantic, does so, leaving Verizon with something of a hybrid system for the 2001 benefit year.

Some employers prefer consultants because of their expertise, tools and relationships with health plans, said Erich Blumberg, a consultant for Hewitt Associates, which administers GTE’s benefits program.

“The process of selecting and managing plans has become very complex,” said Mr. Blumberg, who’s in Hewitt’s Dallas office. “For more employers than not, it’s a once-a-year event. … You just don’t want to have the staff.”

GTE’s use of regional health-care managers – almost unheard of today – began in 1992.

“Virtually nobody was doing this,” Mr. Crowling said. “The concept that we would actually bring on a crew of people that would do nothing but evaluate health plans full time, … we were speaking Greek to them.”

Holding costs steady

He, Mr. Davies and Mr. Astuto have tried to earn their keep by managing costs in an arena that seems ungovernable, and they have achieved success. The amount of money GTE spends per person was exactly the same – to the dollar – in 1999 as it was in 1994.

Today, the chief threat to their success lies no further away than the corner drugstore. Like other corporations around the nation, GTE has sought ways to cut the cost of prescription drugs.

In 2001, GTE will take over the prescription programs of 25 HMOs in a pilot program that sets different co-payments for the same drug. Working with its pharmacy-benefit manager, GTE will allow patients to pay $15 co-payments for certain drugs – such as Prozac for depression or Zocor for high cholesterol – after meeting certain requirements. Otherwise, they would pay a $25 co-payment.

To qualify for the lower co-payment on Prozac, for instance, a GTE employee must show treatment from a mental-health professional. (The information would not be shared with the company.)

“When the product is more appropriate and absolutely required for your good health, it’s covered, and it’s covered at a lower amount,” said Patricia Wilson, a pharmacy consultant who has worked with GTE for more than a decade.

The goal, officials say, is to get high-cost drugs in the hands of people who really need it while discouraging their use among those who don’t meet the criteria.

“If people are using a drug because their doctor wrote it and doesn’t know any better, that’s not going to fly,” Mr. Astuto said. “This area has to be managed. It’s eating us up.”

Although the cost of prescription drugs has grabbed the spotlight, the health-care managers perennially focus on containing increases in premiums.

No state has been more conducive for cost-cutting in this area than California.

There, HMOs abound, and Mr. Davies has called the shots for the last two years. He has specified what GTE is willing to pay and told HMOs to take it or leave it.

“They all gave us proposals, and we came back and said, ‘We’ve read your proposals. They’re all over the map,'” Mr. Davies said. “None of them are adequately justified and this is what we’re willing to pay.

“It’s a free market, free world and they can withdraw. And several did.”

But don’t confuse Mr. Davies with a bully. “It’s a close working relationship. It’s not a bully thing,” he said. “We have a good deal of mutual respect and trust.”

GTE, for instance, provides its California HMOs with a detailed breakdown describing to which plans they lost members and from which plans they gained enrollees.

The firm also provides the HMOs with copies of all complaints and compliments. And it shows the HMOs where their premiums rank in relation to their peers.

Although Mr. Davies can virtually name his price in California, he and his colleagues say they’ve learned that the lowest price doesn’t always mean the best deal.

GTE is one of the few companies that turns down health premiums that are too low. Designed to recruit new members, such premiums often last for only one year, company officials said, and the subsequent increase will wipe out any gain.

One Texas health plan offered to reduce GTE’s rate by 3 percent for 2001. Instead of accepting, Mr. Crowling proposed a 3 percent increase. He said paying more now ensures stability later.

“We try to manage for the long term, and a one-year dip followed by a second-year increase is not what we have in mind,” he said. “We think we’re better off paying a reasonable amount for what we anticipate getting.”

Mr. Crowling’s job is to know what’s reasonable across a broad swath of the central United States that extends from his home base in Irving up to Champaign, Ill. That’s where his site visits pay off, he said.

The Henry J. Kaiser Family Foundation

Behind-scenes Look Shows How Firm Chose Health Plans

Fourth in an occasional series

12/24/2000

By Charles Ornstein Reprinted with permission of The Dallas Morning News

“Health insurance is obviously an important decision,” said Mr. Gilmore, 56, a vendor training coordinator for Verizon Communications Inc. “But it’s taken on a little bit less importance because we’ve been satisfied with Cigna, and my kids are older now and they’re both married and I don’t cover them with insurance anymore.”

Mr. Gilmore and many of his fellow employees took little more than a day to make decisions about health coverage, but three regional health-care managers spent eight months vetting health plans and negotiating contracts that will take effect Jan. 1.

The trio’s choices would have to satisfy the demands of 284,000 employees, retirees and their dependents of the former GTE Corp. while fitting within a whopping half-billion-dollar budget eventually approved by chairman and chief executive Charles R. Lee. This particular line item consumed nearly 8 percent of GTE’s operating income in 1999.

Along the way, the three managers encountered steep increases in medical and prescription drug costs, financially unstable HMOs and renewed efforts to reduce medical errors in hospitals.

Typically, employees don’t get to peek behind the veil of secrecy associated with benefits selection, receiving little information besides an enrollment kit each fall. But for this article, GTE provided exclusive and unprecedented access – and candidly discussed the factors that affected decision-making. That included access to internal meetings, visits with health insurers, company documents and employee interviews.

In the midst of an already complicated process, GTE underwent dramatic corporate changes. In one year, it divested itself of two units, spun off its wireless operations into a joint venture with Vodafone Group PLC, and merged with Bell Atlantic Corp. to form Verizon.

Privately, GTE’s benefits staff questioned whether they would even have jobs after the merger. Like many corporations, its partner Bell Atlantic relied heavily on consultants to select insurance programs.

A bad year

From the get-go, regional health-care manager George Crowling and his two colleagues at GTE knew this year would bring cost increases unseen during the mid- and late 1990s.

On a visit to mideastern Illinois, where GTE provides local phone service and employs about 400 people, Mr. Crowling was faced with a 60 percent premium increase for retirees by a local HMO called Health Alliance Medical Plans. That was on top of a 13 percent increase for active employees.

In St. Louis, industry colossus UnitedHealthcare demanded an increase of 29 percent to cover GTE employees across Missouri.

Mr. Crowling and his two co-workers logged nearly 100 visits with health plans this year, developing a strategy that responded to trends they saw across the country.

“They’re atypical in the way they do things,” said Larry Atkins, president of Health Policy Analysts Inc., a Washington-based benefits policy and consulting firm. “There probably are not a lot of companies out there really scouring these HMOs, turning them upside down, shaking them and then making decisions about which one they want to contract with.

“Most companies say: ‘We really don’t want to go to those lengths. If there’s an off-the-shelf product that somebody else is vetting that will meet our requirements, let’s do that.'”

In the 1999 benefit year, the company spent $548.7 million, or $3,653 for every employee and retiree – the same per capita amount paid in 1994. For this calendar year, the company expects costs to increase by about 5 percent.

As for 2001, the benefits year observed for this article, the company expects a net increase of 8 percent, on top of premium increases absorbed by salaried employees.

In the overall scheme of things, GTE’s medical spending will still look pretty good, compared with other large companies, said Mr. Crowling, regional health-care manager for Texas and 13 other states. But that doesn’t mean he and other executives aren’t worried by the trend.

Bruce Taylor, director of employee benefit policy and plans at the newly minted Verizon, brought home the magnitude of the cost increases during a September speech in Toronto.

Verizon, he said, will spend nearly $500 million per year on prescription drugs, including the amount spent by its HMOs. Conservatively, drug spending is increasing at 15 percent annually – or $75 million a year.

“That means … every time you go by a phone booth, a Verizon phone booth, I need to have 300 million more phone calls at 25 cents each just to pay for the increased costs for prescription drugs,” Mr. Taylor said. “If you let me take the price of the phone call up to 35 cents, then it goes down” to 214 million extra phone calls.

‘Wet cement’

On a rainy, unseasonably warm day in February, a team of 26 people crammed into a small, windowless conference room in Coppell to begin the selection process and set key dates in “wet cement.”

The group was divided between representatives of GTE and Hewitt Associates, the firm hired to administer GTE’s behind-the-scenes benefits process. Hewitt, based in Lincolnshire, Ill., processes paperwork, runs GTE’s customer service center, calculates its premium payments to HMOs and helps new employees enroll in the system.

The marching orders from the executive suite largely paralleled those of years past: Hold cost increases to less than 75 percent of the national average; improve employee satisfaction through external measurable means; and prevent labor disruptions over health care.

But the merger with Bell Atlantic prompted two new directives: Don’t make any major changes; and begin aligning plans with Bell Atlantic.

“We make sure that our employees are focused on beating our competitors as opposed to being distracted by hassles of health-care needs or delivery systems,” said Ezra Singer, Verizon’s executive vice president for human resources. “If they’re able to keep their eye on the competitive issue, that’s what we want.”

The job of keeping the benefits selection team on track fell to John Large, project manager for annual enrollment. “The process starts rolling,” he exhorted. “Everybody knows what they have to do.”

For the most part, Mr. Large was correct, and his team met most of the 115 key deadlines, 46 of them considered critical milestones. Among them: Complete a communications plan by the end of April. Identify health plans to drop by the end of June. Determine the company’s share of insurance premiums by the end of July.

All of this, of course, was designed to launch open enrollment for active employees on Oct. 6 and give the team time to notify employees whether they were required to change plans. The selection process ended Nov. 10.

Everybody at the meeting was conscious of the impending merger with Bell Atlantic, the big telephone provider on the East Coast. The deal would create the largest local phone company and move GTE headquarters from Irving to New York.

“We have a lot going on this year that we didn’t have going on last year,” one participant said.

Once the dust settled, members of the health-plan team received preliminary indications that their jobs were safe. Yet Verizon’s health-care strategy remains under development.

“What I want to do going forward is really take the best aspects of Bell Atlantic and GTE, and at the same time, look at what other companies are doing,” Mr. Singer said. “Whatever we do, I want to make sure that it’s sustainable and that it can last for a long while.”

‘An endless pit’

After the introductory meeting in February, the situation was largely quiet for the next couple of months, with teams working behind the scenes. Beginning in May, though, the health benefits managers began holding meetings with health plans, securing bids for 2001 premiums and making changes.

They also spent a good deal of time discussing prescription drug prices, which Verizon’s Mr. Taylor called an endless pit.

“There’s no such thing as too much resources dedicated to managing prescription drugs,” he said.

At their visits to the health plans, the regional health-care managers employed shortcuts to trim costs without sacrificing benefits. Mr. Crowling slightly lowered the premium increase for Health Alliance in Illinois by increasing the patients’ $10 co-payment for physician-office visits to $15. He also raised the price of some brand-name drugs to $15 from $10.

Mr. Crowling reduced the premium increase for United’s Missouri health plan by proposing to self-insure it. That means GTE, not United, would assume the risk for all of its employees’ medical claims. As a result, United reduced its increase to 19 percent, and it remained an insured product.

Using these methods and others, GTE officials said, they lowered its overall 2001 cost increase from an anticipated 11 percent to 8 percent.

The zipper

After Mr. Crowling and the other regional managers collect the data on the cost of the health plans, Mr. Taylor and GTE’s executives determine how much money the corporation will allocate for medical costs. Employees pay the remainder, under a complicated formula known as “the zipper.”

GTE assigns each health plan to one of 14 slots, based on quality and cost, and consumers pay a different amount – or nothing at all – based on where their health plan is assigned.

Employee contributions at GTE have increased slightly with time. The average employee and retiree paid $298 toward medical premiums in 1999, compared with $257 in 1994. The average includes union members, who represent about half of GTE’s workforce, even though they do not contribute to premiums.

Even excluding union members, however, GTE officials said their employees pay lower premiums than employees at most national corporations.

In late August, the curtain rose on the selection process when GTE distributed its first reminders about open enrollment and a wallet-size card with a personal access number for the Internet and automated telephone systems. The benefits staff followed up with an e-mail reminder to all employees.

But several steps remained. Hewitt arranged for the printing, collating and mailing of millions of pages of information. The material went out in three cycles, with about 50,000 people in each wave.

Union workers came first and received a full enrollment kit, complete with descriptions of available health plans. Retirees received a similar package.

Salaried workers got a two-page letter directing them to one of three routes: the Internet, the automated phone system or a request for a full enrollment kit. Of the 42,000 people who received the letter, only 2,000 requested a hard-copy kit.

Any employee or retiree who changed plans had to be sent a subsequent letter confirming any changes. GTE officials say 85 percent of active employees made no changes at all. Of the rest, 58 percent made changes online.

Gail Morgan was one of the employees who decided against making any changes, sticking with Cigna.

“I guess if I had problems with them – if it took me a week to get in to see my doctor every time I called – then I’d probably be looking at the other plans,” said Ms. Morgan, 51, who works on the company’s regulatory filings. “As long as I’m happy with them and don’t have any problems, I don’t even compare the other plans.”

Even though they don’t know the intricacies of the process, employees said they can imagine that the benefits selection process takes a while.

“It wouldn’t surprise me if they’re already working on next year’s,” Ms. Morgan said.

Health care, without question

09/06/2001

By Robert DavisReprinted with permission of USA Today

LAREDO, Texas Hector Salino waits patiently as his wife sees a nurse at their local medical clinic.

But he is in no ordinary waiting room, and she is in no ordinary clinic. He stands in the sweltering heat by his dusty pickup, not far from his home, as his wife gets her health care inside a specially equipped, air-conditioned truck. The medical visit is free, and no questions are asked especially the question most dreaded by millions of Hispanics living illegally on this side of the border. In health circles here, few people care if any patient who enters the door is a legal U.S. resident.

The medical mantra here is just treat; don’t ask.

As President Bush and Mexican President Vicente Fox meet this week to negotiate key immigration issues, health officials across the nation are paying more attention to preventive-care visits like the one the Salinos recently made to the mobile clinic. Immigrants, most of them from Mexico, are settling in surprising numbers across the nation’s midsection.

While California, Florida, Illinois, New York, New Jersey and Texas have the highest number of legal and illegal immigrants, the states in between from Oregon to the Carolinas have seen the fastest growth in immigrant populations, the latest Census found.

“These places are not used to dealing with immigration,” says Jeffrey Passel of the Urban Institute, a think tank on public policy. “Their health care systems may not be set up to deal with these populations.”

Hospitals, already facing financial difficulties, face many challenges, from figuring out ways to unclog emergency rooms to translating Spanish to English.

“Texas, California and Florida have managed this for a long time,” says the American Hospital Association’s Rick Wade. Now, “some of our members who were not dealing with it are now having to deal with it.”

Law sometimes forbids treating illegals

The number of Hispanics living in the USA soared in the past 10 years, according to the 2000 Census. Today, the number of Hispanics roughly equals that of black Americans.

The immigrants who enter illegally have changed the look of many American homes. Ten percent of children now live in a house with an illegal immigrant, the Urban Institute says.

The illegal residents are coming in droves, numbering as many as half a million a year, and the last thing they want to do is make their presence known.

“As an undocumented immigrant, you are extremely hesitant to receive services and help,” says Clarissa Martinez De Castro, director of state and local public policy for the National Council of La Raza, a Hispanic advocacy group. “You just want to work, support your family and keep a low profile.”

One concern is that any health worker could feel compelled to report the illegal immigrant.

“We have to be careful, because what we are doing is technically illegal,” says Steve Saldana of Catholic Charities in San Antonio, which helps poor Hispanic families get free medical care. “If you know where an illegal alien is, you are supposed to report them.”

But some immigrants also fear that accepting help will hurt later attempts to become a legal resident. Legal residency is bestowed upon immigrants who show, among other things, they don’t need federal aid.

In 1996, a federal law put restrictions on which immigrants could get Medicaid. At the same time, some immigrants were asked in widely reported cases to repay Medicaid benefits or risk their residency status.

Use of public benefits by immigrants dropped more than 30% from 1994 to 1997.

Recently, the push has been in the opposite direction. Last month, the Bush administration announced changes in Medicaid aimed at making it easier for states to provide insurance for children, including illegal immigrants. But confusion and fear remain.

A legal fight is ongoing in Houston, where the hospital district has been told to stop using public money to treat illegal immigrants. Texas Attorney General John Cornyn says the 1996 federal law prohibits states from offering non-emergency health care to illegal immigrants. The case is being watched by hospitals across the nation.

Health officials want to treat the new residents.

“The kind of treatment they get here is vital,” says David Lauricella, spokesman for the Laredo Health Department. “If we don’t treat them here now, they’ll end up in the emergency room later.”

But they’ve found here that simply offering care isn’t enough. Coaxing immigrants out of their homes and into the health system takes a lot of effort.

Key to success: Being nice

Beside the truck-turned-clinic near the Salinos’ home along the Rio Grande, Sister Rosemary Welsh of Mercy Regional Medical Center has taken to the streets of immigrant towns along the border colonias to make a difference in the hospital.

“We’re trying to train them not to use the emergency room as a clinic,” she says. In the process, she has perfected one solution to the immigration health problem a key tip that she shares with colleagues looking for help.

Be nice. “We were the barriers,” Welsh says. “We were not nice, and we made people feel stupid. That was our biggest barrier.”

As Salino’s wife finishes in the tractor-trailer clinic, he smiles with gratitude.

“Mercy, they are good people,” he says. “That’s great for people here.”

The Henry J. Kaiser Family Foundation

2001/02 Kaiser Media Fellowships Program

Kaiser Media Fellowships program sitevisit to Seattle, WA and Vancouver, British Columbia, Canada Sunday, August 4–Friday, August 9, 2002

Accommodations :

Sunday, August 4-Wednesday, August 7/Seattle: W Seattle Hotel, 1112 Fourth Avenue, Seattle, WA 98101 Wednesday, August 7-Friday, August 9/Vancouver: Metropolitan Hotel, 645 Howe Street, Vancouver, British Columbia, Canada V6C 2Y9

Sunday, August 4-Seattle, WA 6:15pm: Drinks 7:00pm: Dinner–Studio 3, 2nd floor, W Seattle Hotel Monday, August 5-Seattle, WABriefings at Studio 6, 3rd floor, W Hotel 8:30 am: Buffet breakfast 9:00 – 12:00am: Bob Putsch, Cross-Cultural Health Care Program and other invited speakers -Interpretation and language services: current issues/problems caring for immigrant populations -Infant mortality -Outreach to underinsured/uninsured women and children 12:00- 2:00pm: Working lunch 2:30 – 4:00pm: Treating asthma in the home, Lung Association of Seattle 4:15 pm: Maren Grainger-Monsen, M.D., Filmmaker-in-Residence; Senior Research Scholar, Stanford University Center for Biomedical Ethics-Multicultural training of doctors -Melanie Tervalon, MD, University of California San Francisco School of Medicine-The Multicultural Health Program, Children’s Hospital, Oakland, CA 6:30pm: Meet in hotel lobby and walk to restaurant 7:00pm: Dinner, Wild Ginger, 1401 Third Avenue, Seattle

Tuesday, August 6-Seattle, WA 8:30 am: Depart hotel by van Visit to Group Health Cooperative 521 Wall Street [corner of 6th Ave. and Wall St.], Seattle, WA 98121 9:00 am: Buffet breakfast -Welcome by Cheryl Scott, CEO, Group Health; Gary Feldbau, MD, medical director 10:00 – 11:15 am: Panel 1: A behind the scenes look at a “high performing plan”: Ted Eytan, MD; Matt Handly, MD; Karen Merrikin, JD; Hugh Stradley, MD 11:15-11:30 am: Break 11:30 am-12:45 pm: Panel 2: Pharmaceuticals-evaluating drug safety and efficacy: Jim Carlson, PharmD; Matt Handley, MD; Brian Harris, MPH; Marc Mora, MD 12:45pm-1:45 pm: Working lunch Panel 3: Providing culturally competent care-research, outreach and implementation: Bill Beery , MPH; Ted Eytan, MD; Paula Lazano, PhD; Ed Wagner, MD 2:00 pm: Depart by van Visit to Harborview Medical Center 325 9th Avenue, Seattle, WA 98104 2:30-5:00 pm: –Community House Calls program –Multicultural diabetes project –Cancer prevention, focused on Asian-Americans (Contact: Bria Chakofsky, Community House Calls program) 5:15 pm: Depart by van for hotel 6:30 pm: Meet in hotel lobby, walk to restaurant 7:00 pm: Dinner, Dahlia Lounge, 2001 Fourth Avenue (at Virginia Street) Seattle

Wednesday, August 7-Seattle, WA/Vancouver, Canada 7:00 am-8:00 am: Pick up boxed breakfast, Earth & Ocean restaurant, W Seattle Hotel 8:00 am: Depart hotel by van-bring overnight bag 10:00 am-12:00 pm: Visit to Lummi Tribal Health Center, 2592 Kwina Road, Bellingham, WA 98226 -Barbara Finkbonner, Director, Lummi Tribal Health Center; 2001 Kaiser Native American Health Policy Fellow -Darrell Hillaire, Chairman, Lummi Tribe -Aaron Thomas, Communications Director, Lummi Tribal Health Center 12:00 pm-1:30 pm: Working lunch 2:00 pm: Depart by van for Vancouver, Canada 4:00 pm: Arrive/check in, Metropolitan Hotel, Vancouver 7:30 pm: Meet in hotel lobby 8:00 pm: Dinner, Connaught Room, Metropolitan Hotel

Thursday, August 8-Vancouver, CanadaConnaught Room, Metropolitan Hotel

8:30 am: Buffet breakfast 9:00 am-12:15 pm: Briefings on the Canadian healthcare system; pharmaceutical drug policies; health issues for aboriginal peoples –Steve Morgan, PhD, Canadian Institutes of Health Research Postdoctoral Fellow, Centre for Health Services and Policy Research, University of British Columbia –Jeff Reading MSc, PhD, Scientific Director, Canadian Institutes of Health Research, Institute of Aboriginal Peoples Health; Associate Professor & Research Chair, Department of Public Health Sciences, University of Toronto 12:15 pm: Working lunch–2002 Kaiser Media Fellows discuss their projects 3:00 pm-5:00 pm: Visit to Multicultural Family Centre, REACH Community Health Centre –Carole Christensen, program director, Multicultural Family Centre –Jessica Chenery, program coordinator, Healthy Eating Active Living Diabetes Prevention Program 6:30 pm: Meet in hotel lobby, walk to waterfront restaurant 7:00 pm: Dinner, Five Sails, 300-999 Canada Place

Friday, August 9 am: Fellows depart

Participants

2001 Kaiser Media Fellows:

• Raney Aronson, producer, Frontline, New York City
• Bob Davis, medical and science writer, USA Today
• Don Finley, science, medicine, and environment editor, The San Antonio Express-News
• Merrill Goozner, freelance journalist and associate professor of journalism, New York University
• Andrew Julien, health/medical writer, The Hartford Courant
• Andy Miller, health care business reporter, The Atlanta Journal-Constitution

2002 Kaiser Media Fellows:

• Jonathan Cohn, senior editor, The New Republic
• Jon Palfreman, senior producer, FRONTLINE
• Marc Shaffer, independent television producer

Invited reporters:

• Wendy Lawton, health reporter, The Oregonian

Kaiser Foundation staff:

• Penny Duckham, executive director, Kaiser Media Fellowships Program
• Priya Helweg, program manager, Native American Health Policy Fellowship Program
• Jinhee Pai Kim, program associate, Kaiser Media Fellowships Program
• Sonia E. Ruiz, policy analyst, Minority Health and HIV/AIDS

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2001 Kaiser Media Fellowships Program

Kaiser Media Fellowships program sitevisit to San Antonio and Laredo, TX:Sunday, July 29-Friday, August 3, 2001

Accommodations: The Menger Hotel, 204 Alamo Plaza, San Antonio, TX 78205 (Tel: 210-223-4361; fax: 210-228-0022)

Sunday, July 29

Meet in Miami airport6:30pm: Meet in hotel lobby

7:00pm: Dinner, The Grant Room, The Menger Hotel, with Bibi Lobo, vice president, National Latino Children’s Institute

Monday, July 30-San Antonio

The Grant Room, The Menger Hotel8:30am: Buffet breakfast

9:00am-12:00pm: Overview briefings on national and regional immigration trends, issues; immigrant health policy and financing issues; medical interpretation services –Jeff Passel, The Urban Institute: Overview briefing on national and regional immigration trends, Census data –Leighton Ku, Center on Budget and Policy Priorities: Immigrants’ utilization of health services; impact on safety net providers

12:00pm: Working/buffet lunch

12:30-3:30pm: –Mara Youdelman, staff attorney, National Health Law Program: Medical interpretation services and related policy issues –Josh Bernstein, National Immigration Law Center: Overview of current national/regional immigration legal, welfare and policy issues

3:45pm: The AVANCE program Promotora and Health Initiatives: –Marisa Chapa, Maria Hudson, and Mercedes Perez de Colon

4:30pm/4:45pm: (Optional) Walk from hotel two blocks to the San Antonio Express-News

5:00pm: Visit the San Antonio Express-News

6:00pm: Return to hotel

6:45pm: Meet in hotel lobby, drive to restaurant

7:00pm: Dinner, Pico de Gallo, 111 S. Leona Street

Tuesday, July 31-San Antonio

The Grant Room, The Menger Hotel

8:30am: Buffet breakfast

9:00am-10:30am: Clarissa Martinez, director of state and local public policies, the National Council of La Raza: U.S./Mexico bi-national perspective on border issues and migration

10:45am-12:00pm: Anne Dunkelberg, Center on Public Policy Priorities, Austin:Texas state immigration and health policy legal issues:

12:00pm: Working lunch at hotel

12:50pm: Depart hotel by van

1:15pm: Arrive, Texas Diabetes Institute/University Health SystemUniversity Center for Community Health–Briefings and visit to the University Health System/Texas Diabetes Institute-financing indigent care; the CareLink program (insurance for county residents under 200% of federal poverty); financing trauma care; diabetes-contact: Ms. Leni Kirkman, public affairs department, University Health System

5:00pm: Depart Texas Diabetes Institute; return to hotel

6:45pm: Meet in hotel lobby

7:00pm: Dinner with Tom Ferguson, M.D., editor and publisher, The Ferguson Report, Paesano’s Ristorante, 111 West Crocket

Wednesday, August 1-am: San Antonio; pm: Laredo

8:30am: Depart hotel by van-bring overnight bag

9:00am-11:00am: Meeting at Catholic Charities–Theresa Coles Davila, Center for Legal and Social Justice–Steve Saldana, executive director, Catholic Charities

11:00am: Depart Catholic Charities by van

11:30am: Arrive The Guenther House, 205 East Guenther Street

11:30am: Working lunch, followed by visit to The Texas Center for Infectious Disease-TB, Hansen’s Disease, etc. Visit/Working lunch with hospital Director, Mr. Jim Elkins; colleagues; and potentially Texas health department staff

3:15/3:30m: Depart Texas Center for Infectious Disease by van for Laredo

6:00pm/6:30pm: Arrive/check in, La Posada hotel, 1000 Zaragoza Street, Laredo, TX 78040

7:30pm: Meet in hotel lobby

8:00pm: Dinner, El Rancho restaurant, 2134 Avenida Guerrero, Nuevo Laredo, with health and border health officials, and local health groups

Thursday, August 2-Visit to Laredo

7:30am: Depart hotel by van-border area issues: –Visit to Gateway clinic and El Cenizo colonias (c. 10 miles from Laredo)–Visit to Laredo port of entry, border patrol facility

Contacts: David Lauricella, public affairs department, Laredo Health Department; Jacque Crouse, public affairs department, INS regional office

12:15pm: Working lunch

4:00pm: Depart Laredo for San Antonio

7:00pm: Arrive The Menger Hotel

7:40pm: Meet in hotel lobby, walk to restaurant

8:00pm: Dinner, Boudro’s, 421 East Commerce

Friday, August 3

am: Fellows depart

Search the entire kff.org site or review a list of publications in a specific topic area:

This paper provides an overview of Medicaid spending growth in 1996. It updates earlier analyses conducted by the Kaiser Commission on Medicaid and the Uninsured.

• Issue Paper
• Issue Paper

The Henry J. Kaiser Family Foundation

Alcon Receives Warning from FDA

Problems Involving Test Batches are Fixed, Drug Manufacturer Says

12/09/2000

By Sarah LundayReprinted with permission of The Dallas Morning News

Alcon Laboratories Inc. has received a warning letter from federal regulators, saying the drug maker failed to meet several quality and safety standards during a recent inspection.

The problems could alter the purity of the company’s products, according to the Nov. 17 letter from the Food and Drug Administration.

Alcon, a subsidiary of Swiss-based Nestle SA, produces eye-care products and technologies, including surgical instruments, prescription drugs and contact lens care products. It employs 2,600 people at its Fort Worth facility.

Company spokeswoman Mary Dulle said the problems found during the inspection involved test batches of products that would not have been distributed to consumers. She also said that Alcon has since remedied those problems.

“We absolutely believe that there is no possibility of contamination of our product,” Ms. Dulle said.

FDA investigators who visited Alcon’s drug and device manufacturing plant in October documented “serious deviations” from the agency’s regulations governing manufacturing quality, according to the letter.

Michael Chappell, Dallas district director for the FDA, said the Alcon case continues as an open investigation until regulators review the company’s corrections.

“We don’t necessarily consider the matter closed until we go back and check that they follow the criteria they said they would and that it would actually solve the problem,” Mr. Chappell said Friday – the date specified in the letter as the deadline for Alcon to fix the defects.

Ms. Dulle declined to discuss the products involved in the testing cited by FDA inspectors.

The warning letter cited several areas of concern, including:

•Failing to clean, maintain and sanitize equipment to prevent malfunctions or contamination.

•Failing to establish appropriate written procedures to prevent microbial contamination in drug products.

•Failing to assure and document that automated equipment used in manufacturing, processing, packaging and holding of drug products will perform its intended function.

Ms. Dulle said any problems investigators found were related to manufacturing lines that were being used for testing at the time of the inspection. Still, Alcon acted quickly to fix problems, Ms. Dulle said.

“It’s a warning letter, so they’re trying to bring something to your attention in a big way,” Ms. Dulle said. “We’re really trying to work with FDA so we don’t get these letters.”

The company has received two other warning letters since 1998 on separate incidents. In both cases, Alcon responded quickly and the cases were closed satisfactorily, Ms. Dulle said.

Prior to 2003, travel and research grants were awarded to print and broadcast journalists and editors to report on health policy and public health issues for publication/broadcast. For details of the mini-fellowship awards for 1997-2001, see below.

The Henry J. Kaiser Family Foundation: Recent Mini-Fellows’ Work

Recent Mini-Fellows’ Work:

• Jenni Bergal, reporter, The Sun-Sentinel, Fort Lauderdale, FL
• Karen Brown, health and general assignment reporter, WFCR-FM public radio
• Dan Collison, independent radio and television documentary producer
• Elena de la Cruz, features writer, La Opinion, Los Angeles
• Liz Doup, reporter, The Sun-Sentinel, Fort Lauderdale, FL
• Susan Leffler, independent special projects producer, West Virginia Public Radio Network
• Sharon Lerner, reporter and columnist, The Village Voice
• Bill Zeeble, reporter, KERA-FM Radio, Dallas

Jenni Bergal, reporter, The Sun-Sentinel, Fort Lauderdale, FL Project: The Broward County mental health court-a model way to address cases involving mentally ill defendants?

New voluntary court system helps mentally ill inmates get their lives back on track, Sun Sentinel, November 24, 2002

Karen Brown, health and general assignment reporter, WFCR-FM public radio Project: Mental health problems and options among immigrant communities, especially war refugees.

Reports on mental health among refugees in Western Massachusetts, February 2001 onwards

Dan Collison, independent radio and television documentary producer Project: Mentally ill ex-offenders-making the transition back to the community.

DC Productions:

• Life on the Outside, National Public Radio, May 30-31, 2000
• Mom’s Good Move, National Public Radio, October 24-26, 2000

Elena de la Cruz, features writer, La Opinion, Los AngelesProject: Asthma and air contamination–chronic asthma among Latino children, the effects of air pollution, and prevention efforts.

• El peligro ambiental, La Opinion, August 11, 2002
• Respirar malos aires, La Opinion, August 11, 2002

Liz Doup, reporter, The Sun-Sentinel, Fort Lauderdale, FL Project: AIDS in South Florida. AIDS in South Florida, Sun Sentinel, June 8, 2003.

Susan Leffler, independent special projects producer, West Virginia Public Radio Network Project: The impact of welfare reform on access to health care for the working poor in West Virginia.

Transportation and Health Care, Transitional Medicaid, Inadequate Health Insurance, CHIP Frustrations (.pdf)The news features were broadcast over the ten station WestVirginia Public Radio Network. Each story was broadcast three times during peakdrive time news programs. Stories were produced by Susan Leffler.

Sharon Lerner, reporter and columnist, The Village Voice Project: Sex education in schools, and federal funding for abstinence-only education programs.

The Sex-Ed Divide, The American Prospect vol. 12 no. 17, September 24, 2001 – October 8, 2001

Bill Zeeble, reporter, KERA-FM Radio, Dallas Project: Diabetes, with particular focus on minority communities at highest risk.

Diabetes: A Ticking Time Bomb, October 2- November 17, 2000Thanks to KERA 90.1 FM for producing and broadcasting the series, and to Public NewsRoom for developing the website.