Arbitration Panel Finds Blue Shield of CA Breached Contracts and Engaged in Unlawful Business Practice

Posted on Oct 21, 2016 in Expanding Access

An arbitration award filed this week in Sacramento Superior Court found that Blue Shield of California engaged in an unlawful business practice against the not-for-profit Sutter Health network of doctors and hospitals, and breached its contracts with Sutter.

The arbitration stems from a finding in San Francisco Superior Court that Blue Shield failed to obtain the agreement of one of its self-insured clients to be bound by the contract between Blue Shield and Sutter, as required by the contract.

In self-insured/self-funded plans, employers pay for doctor visits and hospitalizations for their employees. This type of plan differs from more traditional health insurance plans where employers agree to a pay a premium for each employee, and the health insurance plan pays for the medical costs the patient incurs.

“Self-funded employers should have ready access to the agreements we negotiate with health plans so they understand and agree with the contract terms that govern the health care providers in the networks their employees access,” said Sutter Health spokesperson Bill Gleeson. “Sutter Health allows and encourages health plans to share the contract with their self-insured customers.”

The arbitration panel, which issued its findings October 4, concluded that:

• Blue Shield not only failed to obtain the self-insured client’s agreement to be bound to the contract, but the health plan refused to provide the agreement to the client when asked.

• “Blue Shield’s actions constitute an unlawful, unfair and fraudulent business practice,” which violated the California Business and Professions Code section 17200.

• Blue Shield breached its contract with Sutter Health and breached the covenant of good faith and fair dealing by its actions which hampered transparency and resulted in harm to Sutter.

The panel also concluded that the arbitration provisions in Sutter Health’s contract with Blue Shield over many years covered all disputes, including allegations of antitrust—despite Blue Shield’s protestations to the contrary in 2014 and 2015.

Blue Shield was ordered to pay Sutter Health damages as a result of the breach.

“This is good news for consumers and employers,” said Gleeson. “We hope this decision inspires more health plans to proactively share their provider contract terms with their self-funded employer customers, and also encourages employers to proactively understand these agreements which are so important to their employees.”

Sutter Health, Validic Lead Pilot Demonstration to Capture, Share and Use Patient-Generated Health Data

Posted on Oct 19, 2016 in Research

Not-for-profit Sutter Health, recognized as an innovator in digital patient engagement, and Validic have begun a pilot demonstration to determine how patient-generated health data can best be delivered to care teams and researchers to improve the care and outcomes. The results of this work will inform federal government policy and help determine how the healthcare industry implements remotely-collected patient health data across the nation.

In health care today, many mobile applications, wearables and clinical in-home devices can collect patient data remotely. These devices help patients live with and manage chronic diseases. However, what is missing is a single, secure pipeline to deliver protected health data into the electronic health record or clinical dashboard so care teams can use the remote information effectively.

“We’re excited that Sutter Health is playing a leading role in a project that we expect to have a profound impact in how care teams use patient-generated health data. Creating a secure, effective pipeline for this data to the electronic health record establishes a connection between patients and clinicians like never before,” said Albert Chan, M.D., vice president and chief of digital patient experience.
The joint pilot began targeting Sutter Health patients with Type II diabetes in September. Participating patients receive Sutter’s Mpower (Motivating Patients Online with Enhanced Resources) app on their smartphone. Using Validic’s digital health platform for data connectivity, the Mpower app has the capability to securely connect to various devices that measure blood glucose, blood pressure, level of activity and weight—important metrics in caring for patients with diabetes. The system then interprets the information and provides visual feedback and motivational incentives to keep patients on track with their care program, while also alerting care teams when attention is required.

The federal Office of the National Coordinator (ONC), a division of the Department of Health and Human Services, contracted with Accenture Federal Services, which selected Sutter Health and Validic to guide the pilot demonstration. Results from the study will help ONC to develop a research paper that identifies barriers to wider use of patient-generated data in clinical care and recommend how these barriers can be removed.

California Ballot Measures Address Medi-Cal Underfunding, Enhance Health Care

Posted on Oct 19, 2016 in Expanding Access

Among initiatives on the November ballot are three measures affecting health care and the future of Medi-Cal.

With the passage of the Affordable Care Act, access to care has improved, uninsured rates have declined dramatically and nearly one in three Californians are covered by Medi-Cal. But continued success is threatened.

Government reimbursement for services has not increased. In fact, among all 50 states, California ranks nearly last for reimbursing health care providers for their services. With reimbursement woefully inadequate and a growing number of people insured by Medi-Cal, all Californians are impacted—employers, patients and health care providers.

Along with hospitals, doctors, teachers, community clinics and others, Sutter Health supports a yes vote on three measures that address the underfunding of Medi-Cal and enhance health care in our state.

Proposition 52, the Medi-Cal Funding and Accountability Act of 2016, protects a partnership created in 2009 between the state and California’s hospitals resulting in approximately $18 billion in new federal funds to help pay for hospital care for Medi-Cal patients, with no increase in California taxes. For details see Keep a Good Idea Working.

Proposition 55, California Children’s Education and Health Care Protection Act of 2016, will extend for 12 years the current tax rates on single taxpayers earning more than $250,000 and couples making more than $500,000 a year. It will bring up to $2 billion annually to hospitals and doctors in the form of new Medi-Cal funding. Click on Help Our Children Thrive for more information.

Proposition 56, California Healthcare, Research and Prevention Tobacco Tax Act of 2016, will increase California’s cigarette tax by $2 per pack, with an equivalent increase on products containing nicotine derived from tobacco, including e-cigarettes. The majority of funds generated by Proposition 56 will be used to improve existing health care programs, prevent smoking and fund research into cancer and other tobacco-related diseases. For information go to Since When Has Tobacco Cared About Our Kids?

Sutter Health CMO Honored with Prestigious Award

Posted on Oct 12, 2016 in We're Awesome

Arra G. Yerganian

Arra Yerganian, chief marketing & branding officer for Sutter Health, received the 2016 CMO Officers Award.

The CMO Officers Award, presented by the CMO Club, is based on a marketing executive’s demonstrated ability to democratize the brand beyond the marketing department and/or to lead the growth agenda for the company across functional areas.

The CMO Awards recognize top senior marketing executives across 10 categories, selected by their peers for their innovative, creative and collaborative work throughout 2016. Learn more about the awards from the CMO Club.

Sutter Health Gives Gift of Surgery to People in Need

Posted on Oct 4, 2016 in Community Benefit

Eighty-nine people in need received life-changing surgeries through Sutter Health’s annual Gift of Surgery program this summer. Physicians and medical teams from 20 Sutter Health surgery centers volunteered their time and expertise to provide outpatient elective procedures including cataract and gallbladder removal, as well as hernia and knee ligament repairs. The surgeries, whether they helped patients walk pain-free or regain their sight, dramatically impacted patients’ quality of life. In some cases, these surgeries helped individuals return to work or experience the simple joys of playing with their grandchildren.

As part of its not-for-profit mission, Sutter Health gives millions every year to provide care to people in need—regardless of their income, insurance or immigration status. The surgeries provided through the Gift of Surgery program this summer have an estimated value of over half a million dollars. Sutter Health’s total community benefit investment increased 25 percent to $957 million last year. These funds supported traditional charity care, unreimbursed Medi-Cal costs, health education programs and community clinics.

Annually, Sutter Health partners with community health organizations that select appropriate candidates in advance for the Gift of Surgery program from among the patients they serve. Sutter collaborated this year with community organizations from across Northern California including Ravenswood Family Health Center, RotaCare, Samaritan House, Axis Community Health, School Health Clinic of Santa Clara, Operation Access, Tri-City Health Center, Community Health Center Network, Santa Clara Family Health Plan (Alameda County), Sacramento Physicians’ Initiative to Reach Out, Innovate and Teach (SPIRIT) and Healthy Partners.

Sutter Health Helps Develop Comprehensive Diabetes Management Platform

Posted on Sep 12, 2016 in Quality, Transformation

Sutter Health is among the first healthcare networks to partner with Onduo—a joint venture between Verily Life Sciences LLC, (formerly Google Life Sciences) and Sanofi—to support and simplify care for those with type 2 diabetes.

“This collaboration with Onduo further advances our work to develop engaging and incredibly personal care options for those with type 2 diabetes—and for their families—so they may live their very best lives,” said Chris Waugh, Sutter Health’s chief innovation officer. “Because our integrated network focuses on Northern California, where we care for one of the most diverse populations in the world, we offer partners like Onduo the unique opportunity to work with us to test treatments and tools in various care settings that can influence the care for people of all races and ethnicities.” Read More

Sutter Health Scholarship Program Helps 235 Students Pursue College Dreams

Posted on Sep 6, 2016 in Uncategorized

college studentCongratulations to the 235 students who earned college scholarships from Sutter Health for the 2016-2017 school year through our Van R. Johnson Sutter Scholars program.

For more than a decade, Sutter Health has proudly supported the continuing education of tomorrow’s leaders by offering these scholarships—named in honor of former longtime Sutter Health CEO Van Johnson— exclusively to college-age children and grandchildren of employees within the Sutter Health network. Sutter has awarded more than 4,600 scholarships, totaling $7.6 million, since 2002. Read More