by Leesa Tori

I just returned from two intense days in Scottsdale, Arizona, where I attended – and was a panel judge for! – The Care Continuum Alliance’s annual conference. It was a whirlwind of opinions, plans and programs from expert thinkers committed to improving population health. The attendees included those from wellness and health promotion, prevention, care coordination and patient advocacy, condition management and complex case management, and folks who are generally passionate about wellness matters and have something to contribute to the conversation.

I was honored to have been invited to judge presentations at the Forum’s track on “Improving the Health and Productivity of Our Workforce.” The presenters I watched were quite impressive, offering their insights into innovative wellness and care management programs, providing clear takeaways to help attendees implement, evaluate and improve their own programs. Different population health models and strategies from development to delivery were covered in order that stakeholders could take home new tools for their work towards improving outcomes, demonstrating value and increasing quality of care and services. 

One of the presentations I especially enjoyed was “Workplace Wellness Study: Employer Insights on Incentives, Programs and Success Strategies.” Beena Thomas and Seth Serxner from Optum, a global health services firm focusing on population health, presented their findings on the approaches human resources professionals are taking to administer health and wellness solutions at their companies. The good news they shared is that not only are more companies joining the ranks in offering wellness programs in the workplace, but their efforts are showing great success. One of the most important takeaways from this presentation was the significant value employers accrue when their wellness strategy is driven by an approach emphasizing “health ownership,” resulting in higher perceived levels of employee well-being and increased employee participation.

As you know, I have been thrilled that with the launch of the Affordable Care Act has come a newly engaged focus on population wellness, as the health care community shifts from incentivizing high volumes of health care services, to rewarding the quality of what’s provided instead. This is not an easy undertaking and could take years to provide measurable results. But I am happy every day that folks in the health policy community have identified the big elephant in the room, and are willing to do something about it.

Like I said, changing the priorities of health care delivery from treating sickness to keeping consumers healthy won’t be simple, as the stakeholders are many: employers, payers, providers, and last but not least, consumers. Payment and delivery systems are mind-bogglingly complex and won’t easily evolve. But there’s not doubt in my mind we’re moving in the right direction.

Administration officials say about 476,000 health insurance applications have been filed through federal and state exchanges, the most detailed measure yet of the problem-plagued rollout of President Barack Obama's signature legislation.

However, the officials continue to refuse to say how many people have actually enrolled in the insurance markets. Without enrollment figures, it's unclear whether the program is on track to reach the 7 million people projecting by the Congressional Budget Office to gain coverage during the six-month sign-up period. Read more here...

WASHINGTON — Robyn J. Skrebes of Minneapolis said she was able to sign up for health insurance in about two hours on Monday using the Web site of the state-run insurance exchange in Minnesota, known as MNsure. Ms. Skrebes, who is 32 and uninsured, said she had selected a policy costing $179 a month, before tax credit subsidies, and also had obtained Medicaid coverage for her 2-year-old daughter, Emma. Read more....

 

Law of the Land: Bumpy Start to Health Care Exchanges No Surprise, but Some Opponents' Tactics Outrageous
On one matter, supporters and opponents of the Patient Protection and Affordable Care Act agreed—the days and months immediately after Oct. 1, when the new health exchanges open for business, would be bumpy. No law as complicated as the ACA has ever started without glitches and missteps. Read more...

On October 7, The Tori Group was thrilled to welcome Kathleen Solorio as Principal and Chief Operating Officer. Kathleen brings over 20 years of extensive and diverse operations experience in the health insurance industry. Most recently, Kathleen served as a Senior Director at Blue Shield of California, where she created a global learning strategy supporting the enrollment, claims, and call center service centers. In this capacity, she was a strategic partner to each of the functional units, driving performance optimization locally and off-shore.

As a business architect, Kathleen created efficiencies as Director of Large Group enrollment and billing operations. Managing the enrollment for Blue Shield's largest clients, including CalPERS, Kathleen's teams assured that large scale, custom benefit groups were implemented successfully.Prior to Blue Shield, Kathleen held several C-level positions, including COO for Benefit Partners (third party administrator for health insurance purchasing pool PacAdvantage), General Manager at Interplan (provider network), and CEO at Staff Builders (healthcare provider).

Kathleen earned her Bachelor of Science in Business from CSU Sacramento. She is an active supporter of community causes and currently serves as Board President of Big Brothers Big Sisters of El Dorado County. 

Tori Group founder Leesa Tori said, "I've worked with Kathleen for many years and am thrilled she's joined our growing team. Her contribution will be invaluable, and I welcome her."

We want to congratulate those in the health insurance community today, especially Covered California, on making health care available and affordable to so many Americans.

As open enrollment for our nation’s Affordable Care Act begins today, access to health care is no longer an abstraction for uninsured and underinsured Americans. Millions will be looking to their new state Health Insurance Exchange marketplaces for affordable, comprehensive health insurance coverage. In fact, by the end of 2014, Covered California aims to have insured more than one million Californians newly enrolled in Medi-Cal, and up to 1.2 million who qualify for assistance with paying for their health insurance plans.

These health care exchanges have worked tirelessly, within tight timeframes, to develop highly complex programs. And while their work continues, they deserve high praise for what they have accomplished. Here at The Tori Group we are honored to call these people our colleagues.

And we know our work is not over. Rather, we continue to have weeks and years of work ahead of us – work that requires dedication and passion. As Peter Lee, Covered California Executive Director said, “…this is not the finish line, it’s the starting line. Stand and be proud!”