Best's rating changes.(Ratings)(Company rankings) - Best's Review

This edition of Best's Rating Changes reflects all rating changes--assignments, changes or placed under review--that occurred for life, health and property/casualty insurers domiciled in North America, as well as international insurance companies, since this section last appeared in the July 2007 edition of Best's Review.

Rating actions.(Ratings)(Statistical table) - Best's Review

This edition reflects all financial strength rating changes--assignments, changes or placed under review--that occurred for life, health and property/casualty insurers domiciled in North America, as well as non-U.S. insurance companies, since this section last appeared in the September 2009 edition of Best's Review.

Hospital claims Premier is stifling competition ; Physician-owned center claims large health system put pressure on insurers. - Dayton Daily News (Dayton, OH)

DAYTON -- A small, physician-owned hospital claims in federalcourt that southwest Ohio's largest health system has colludedillegally to drive competition from the Dayton market.

The Medical Center at Eliza-beth Place, located in the former St.Elizabeth's Hospital, filed the antitrust lawsuit against PremierHealth Partners.

'The lawsuit seeks to remove the illegal barriers erected by thedefendants and return the playing field to level-set,' Alex Rintoul,the Medical Center's CEO, said Friday.

Insurers listed in the complaint represent more than 70 percentof insured people in the Dayton area, the complaint states.

The complaint claims that Premier and other defendants --Catholic Health Initiatives, MedAmerica Health Systems Corporation,Atrium Health System, Samaritan Health Partners and UVMC -- colludedby 'coercing, compelling or co-opting commercial health insurers ormanaged care providers' to cut off access to the medical center fortheir networks.

Anthem, UnitedHealthcare, Private Healthcare Systems, Humana,Cigna and Medical Mutual of Ohio are listed in the complaint but arenot defendants in the lawsuit.

In addition to pressuring insurers, the complaint states, thedefendants threatened punitive financial consequences againstphysicians who affiliated with the hospital and offered payments todoctors who agreed not to work with the center.

'We strongly deny the allegations that were made in the lawsuit,and we'll be defending against that,' said Diane Ewing, vicepresident of marketing and communications for Premier HealthPartners. She said she was speaking on behalf of all of thedefendants.

Antitrust lawsuits are not uncommon, and physician-ownedhospitals have taken aim at larger hospitals in other markets, saidHarry Gerla, a former U.S. Securities and Exchange attorney whoteaches antitrust law at the University of Dayton School of Law. Butprivate entities who file those lawsuits lose more than 97 percentof the time, he said.

'In general plaintiffs are heavy, heavy underdogs,' Gerla said.'They've got a tough task. I'm not saying they can't do it.'

Premier is a nonprofit corporation formed in 1995 that existsbecause of a joint operating agreement involving the otherdefendants:

- Catholic Health Initiatives is a Colorado-based nonprofitcorporation and the sole corporate member of Samaritan HealthPartners, the parent company of Good Samaritan Hospital.

- MedAmerica, an Ohio nonprofit, operates Miami Valley Hospitaland some subsidiaries.

- Atrium, an Ohio nonprofit, was previously known as Middle-townRegional Health System and operates the Atrium Medical Center inMiddletown.

- UVMC, an Ohio nonprofit, controls and operates Upper ValleyMedical Center in Troy.

Spokespeople for some of the insurers stated that those companiesdon't comment on pending litigation.

'We are unaware of the lawsuit between the Medical Center atElizabeth Place and Premier and are unaware of the allegations inthat lawsuit,' said Kim Ash-ley, public relations director forAnthem. 'I can tell you the Medical Center at Elizabeth Place iscurrently contracted with Anthem and has been for several years.'

In 2010, Rintoul and Dr. John Fleishman, chairman of MCEP'sboard, told the Dayton Daily News that less generous contracts withAnthem and UnitedHealthcare have hurt financial performance, revenuegrowth and profit margins.

The Medical Center at Eliza-beth Place is a for-profit companyand opened in 2006 inside the former St. Elizabeth's Hospital withfour operating suites. It has 26 beds and the space to expand to atleast 50, the complaint states. The effects of Premier's actionsforced the center to sell an ownership interest to Kettering HealthNetwork, the only other hospital system in the Dayton area, in 2009,the complaint states. Kettering Health Network is not a defendant inthe lawsuit.

The complaint, filed Jan. 30, states that under the jointoperating agreement, the defendants are owned, controlled andoperated independently, and 'Premier has stated that the JOA is nota merger of assets, but a consolidation of revenue streams.'

The complaint also quotes an unnamed Premier vice president assaying that specialty hospitals should be precluded in most cases,and physician-owned speciality hospitals are 'particularly damaging'because they 'attract away an important segment of an existinghospital's specialists,' resulting in revenue declines.

Enforcement of Federal Smog Standard Could Change Texas Power Plant Balance. - Knight Ridder/Tribune Business News

By Randy Lee Loftis, The Dallas Morning News Knight Ridder/Tribune Business News

Nov. 25--Stand in southernmost Dallas County and you're breathing dirty air. Take one step south into Ellis County, which has North Texas' biggest industrial polluters, and suddenly the air is clean u at least in the eyes of the law.

That kind of legalistic line-drawing, which has irked environmentalists for years, will be on center stage as state and federal officials scramble to put a long-delayed tougher federal smog standard into play.

The action comes under a proposed legal settlement between the U.S. Environmental Protection Agency and health and environmental groups. The groups sued to make the EPA implement the tougher standard, which has been on the books but not enforced since 1997.

By April, officials in Texas and other states must tell the EPA which areas have illegally dirty air under the new rules; a year later, the EPA must finalize the list. If regulators go by past practice, they'll list all or part of particular metropolitan areas u Dallas-Fort Worth and Houston, for example u as violators.

Inside such areas, limits on industries and other pollution sources are tighter than outside u even just a few yards outside. That's why new power plants serving the four-county area of Dallas, Tarrant, Collin and Denton u the zone that officially violates the current smog standard u are going up in Ellis County, just outside the violation zone.

But that violation zone is likely to expand under the newer, tougher standard to include Ellis as well as Dallas, Tarrant, Collin, Denton, Parker and Rockwall counties, state air-pollution figures show.

Officials at the Texas Commission on Environmental Quality wouldn't discuss how they would choose the areas to go on the list. EPA officials haven't yet told the states how to compile those lists.

The new and old standards are often called the one-hour and eight-hour standards, reflecting changes in how the government measures smog. Industries challenged the new eight-hour standard in court, but the Supreme Court backed the new standard in 2001. Environmentalists sued to force the EPA to implement the standard.

Because the new standard allows less smog or ozone in the air than the current one, more areas will violate it. But even with more counties included, officials still face the same challenge of trying to control local smog with mostly local measures u something many experts say can't be done.

Only much broader controls by states and the federal government on major pollution sources such as power plants and cars will guarantee clean air, they say. But some worry that the regulators aren't willing to tackle those topics. They cite federal and state reluctance to tighten controls on coal-burning plants and automobile emissions and fuel efficiency, plus other sources.

'That basically leaves the decisions to [utilities],' said Jim Marston, head of the Texas office of Environmental Defense, one of the groups that sued to implement the new standard.

Federal officials acknowledge that smog isn't just a local phenomenon. They say they're working with the states to put more regional controls in place.

'We're seeing a lot of regional controls that will bring a lot of marginal ... [violators] into attainment,' said Tom Diggs, regional air planning chief for the EPA. Texas' most recent smog plans, he noted, include tighter limits on power plants and vehicle fuels for the eastern third of Texas, a step meant to improve Dallas-Fort Worth air quality.

The EPA won't regulate a broader area than necessary, Mr. Diggs said. 'We anticipate the areas will be large, but not a whole state,' he said.

But Mr. Marston said Texas and federal planners had missed previous opportunities to expand pollution controls, jeopardizing North Texas' chance for cleaner air.

In early September, people in North Texas and across the entire eastern United States found out how completely smog ignores county or state lines.

A gigantic blob of dirty air rose in the upper Ohio Valley u home to many big, coal-burning power plants u and moved east and south.

Within days, tens of millions of Americans from Vermont to Arkansas were breathing smoggy air. The cloud's southern end moved into North Texas before the cloud started breaking up.

Computer-generated tracking maps for Sept. 10 show an unbroken cloud of smog covering all or parts of 20 states and part of Canada.

Within that cloud, levels of ozone u the part of smog that hurts people's lungs u were high enough over eight-hour periods to make breathing difficult for sensitive people. The new smog standard seeks to lower that risk.

That and other incidents point out the futility of trying to cut smog with little more than ozone-action days, restrictions on hometown businesses and other strictly local measures, environmentalist say.

'You might not have to designate all of northeast Texas [as a violation area], but certainly you've got to look far beyond the four-county area,' said Mr. Marston of Environmental Defense. 'That would take care of building all those power plants in Ellis County.'

The EPA's Mr. Diggs said the agency would help the states craft solutions that combine local and regional controls.

The Ellis example Ellis County might be a small-scale illustration of the need for regional controls. Texas officials successfully argued in the early 1990s for limiting the Dallas-Fort Worth smog violation area u and therefore the tightest regulations u to Dallas, Tarrant, Collin and Denton counties.

Ellis County, the next county south, is home to cement and power plants whose emissions drift north. The state has ordered pollution cuts from cement plants, but rules on industrial pollution, especially on new sources, are looser there than in the four-county area. That's contributed to an industrial building boom there.

Although its air is legally clean, Ellis County has recorded ozone violations repeatedly in recent years, giving Gov. Rick Perry the option of asking the EPA to extend mandatory smog controls there. State officials have refused to take that step, saying existing control is adequate.

That leaves environmentalists hoping that the new smog standard changes things.

'Ellis County violates the one-hour standard, and it will violate the eight-hour standard,' said Katy Hubener of the Blue Skies Alliance, a North Texas clean-air advocacy group.

'It should have been included in the first place.'

To see more of The Dallas Morning News, or to subscribe to the newspaper, go to http://www.dallasnews.com.

Generation Next: 40 Under 40: David H. McKinley - The State Journal

On his first paying job: 'I worked at Oglebay Park as a teenager, a job I got pretty much as soon as I could ... because it came with a free pass to do everything at the park.'

DAVID H. McKINLEY

Owner, McKinnley Investment Group, Wheeling, 35

His/Her story: A Wheeling native, McKinley's company is one of the largest, if not the largest, independent investment groups in West Virginia. McKinley started his company in 2001 as a subsidiary of Wachovia Corp. It became an independent corporation in September 2005 and since then has grown to $120 million in assets under his management.

McKinley and his six full-time associates have clients in 10 states. The company develops retirement plans for institutions and individuals, provides money management consulting services for endowments and foundations and designs tax-sensitive wealth management strategies for high-net-worth individuals.

'Failure is not an option. Either you go after something all the way or just bag it,' McKinley said. 'I believe you need to surround yourself with trustworthy and loyal people, ideally brighter than you.'

McKinley earned his bachelor's degree in business administration from West Liberty State College. He also has completed investment training through the Center for Fiduciary Studies at the University of Pittsburgh's Katz Graduate School of Business and the Investment Management Consultants Association at The Wharton School at the University of Pennsylvania.

David is a member of the Wheeling Area and West Virginia Chambers of Commerce, Wheeling Rotary Club, St. Matthew's Episcopal Church, United Way of the Upper Ohio Valley, Regional Economic Development Partnership, Northern West Virginia Rural Health Education Center and the Business Advisory Council at West Liberty State College.

Higher deductibles not enough to control PEIA costs, panel told - The Charleston Gazette (Charleston, WV)

STAFF WRITER

Two managed-care executives said Monday that higher deductiblesand co-pays for public employees won't be enough to control costsforthe state Public Employees Insurance Agency.

Meanwhile, Senate Finance Chairman Oshel Craigo wants tostabilizePEIA by letting small businesses into the agency's insurance pool.PEIA officials have projected next fiscal year's deficit at $48.5million.Gov. Cecil Underwood included $10.7 million in his proposedbudget. As for the rest, the PEIA Finance Board has adopted a planthat raises deductibles and co-pays to discourage public employeesfrom using PEIA services as often.Paul Holdren, president and chief executive officer of Prime One,told a joint House-Senate PEIA subcommittee that the higherdeductibles and co-pays don't go far enough.'We have a situation where it has become very convenient forpeople to use the emergency room,' Holdren said.He said the national average for emergency room visits was 380visits per 1,000 people, but West Virginia's was 579.4 visits per1,000.Information distributed by PEIA Director Bob Ayers showedMonongalia County had 273 emergency room visits per 1,000 PEIAenrollees and Harrison County had 238.Usually, rural counties are expected to have a higher emergencyroom utilization rate, but the two urban counties ranked amongcounties with the highest rates.Prime One has lost $15 million on its PEIA business the last threeyears, Holdren said. PEIA is 48 percent of Prime One's business.'In reality we have people using health care inappropriately,' hesaid. 'The system needs an overhauling.'Both Holdren and Phil Wright, president and chief executiveofficer of The Health Plan in the Upper Ohio Valley, said PEIAneededto continue to have both managed care and an indemnity or fee-for-service plan.The higher deductibles and co-pays will apply to public employeeswho are enrolled in PEIA's indemnity or fee-for-service plan. Mostof the employees are in the indemnity plan.Ayers said PEIA needs to have a steady funding source that willincrease year to year.He said premiums are going to have to increase gradually for bothemployees and employers. A 7 percent premium increase would raisecurrent premiums by $2.80 a month, he said.The PEIA Finance Board would have to approve the premium increase.Craigo, D-Putnam, said high utilization and prescription drugcosts are the two biggest PEIA cost items. One way to reduceunnecessary emergency room utilization, he said, would be to levy apenalty if patients went to the emergency room in a non-emergencysituation.Craigo also suggested allowing small businesses to join the PEIA'sinsurance pool. 'It's clear to me we need to expand the base,' hesaid after the subcommittee's meeting.He said small businesses would pay 100 percent of their costs.Many small businesses are owned by young people, he said, who can'tafford insurance.A similar suggestion was made several years ago, but was rejectedby the Legislature.Ayers cautioned the subcommittee that any proposal to bring insmall businesses would have to be carefully structured.To contact staff writer Fanny Seiler call 348-5198.

Claim costs rising at PEIA - The Charleston Gazette (Charleston, WV)

fanny@wvgazette.com

The Public Employees Insurance Agency may have to startnegotiating fees with physicians, Director Tom Susman said Wednesdayin response to a significant increase in claims paid by PEIA.

From July 1 through April, PEIA-paid claims totaled $28.8million, a $5.8 million jump over the same period the prior year.

'We may have to look at physicians' contracts,' Susman said.

Last year, PEIA went to a 'facility-nonfacility' fee schedulethat attempted to reimburse costs incurred by doctors in hospitalsand by doctors with a higher overhead cost for their privateoffices.

But Susman said PEIA didn't accurately predict the cost of thechanges, and how they would change billings from physicians andother health-care providers after the changes. PEIA didn't domonthly tracking, he added.

'I don't think anyone costed it out enough to know what they weredoing.'

PEIA has five categories of fees, depending on the level ofservices. Susman said utilization has gone up to the highest code.

Staff believes some of the increased utilization resulted frompatients having to get periodic tests when they were taking newprescription drugs.

PEIA is the best payer of any large insurance group, the directorsaid. PEIA's fees were compared with Mountain State Blue Cross andBlue Shield's preferred provider organization, Carelink HealthPlans, and Health Care of the Upper Ohio Valley.

Claims paid to hospitals for in-patient services increased from$46 million to $48 million, and the outpatient claims went from $27million to $28 million during the same 10-month period.

Susman said PEIA currently has an evaluation committee that isreviewing bids received from private vendors to review bills fromphysicians and other providers to see if they are appropriate.

By the end of the fiscal year June 30, PEIA is projected to pay$47 million more for enrollees in its indemnity, or fee-for-service, plan. Susman said the estimated total is $299.18 million,compared with $253.77 million last fiscal year. 'It probably will be$50 million more by the time it's all said and done,' he said.

The pharmacy costs are projected to be $85 million, compared with$60 million the previous fiscal year.

Susman said 10,000 of the 200,000 people PEIA covers are comingback to the indemnity plan from managed-care programs, partlybecause Carelink offered a plan with less coverage.

The director is going to speak with representatives of the WestVirginia State Medical Association to see if the organization hasany suggestions. He said the association can help PEIA hold downprescription drug costs by telling the doctors to prescribe lower-cost drugs that will be just as effective as higher priced ones.