1

Inside This Issue

Federated States Federated States Federated States Federated States

of Micronesia of Micronesia of Micronesia of Micronesia

Board of Directors

Arthy G. Nena, Chairman

National Government

Kapilly Capelle, Vice-Chairman Pohnpei State

Marcus Samo Sec-Treasurer Chuuk State

Salpasr Tilfas Member

Kosrae State

Ignatius Manglay Member Yap State

Nena S. Nena Ex-Officio

Federated

States of

Micronesia

(April-June, FY2010) The Official Newsletter of MiCare Health Plan

Tel: (691) 320-2549/5865/3415. Email: nnena@micareplan.fm Website: www.micareplan.fm

MiCare

Pension Plan TPA MOU with Guam ASC Trust Co. Page 4

Net Asset continues

to rise, Page 2.

The News & Updates

VOLUME 2, NO. 1

STEPS TO IMPROVE REFERRAL SUPPORT SERVICES IN MANILA

Arrival at Ninoy Aquino International Airport (NAIA) is a fearsome experience to a lot of referral patients, espe-cially to the first time travelers. Prior to 2000s, referral patients were escorted upon arrival and assisted through immigration and customs until picked up outside of the lobby area. Recent efforts to intensify airport security and for other unknown reasons, the escort services were no longer provided and patients had to clear them-selves through immigration and customs and are re-quired to walk further until reaching the new designated

pick-up area at the lower level of the arrival area.

A recent experience has prompted the MiCare Management to seek ways of easing the burden of going

through long lines and walk long distances and to seek op-tions to facilitate timely arrivals of patients at the receiving hospitals. On February 12, 2011, a Pohnpei based refer-ral patient was held up by the immigration officer at the NAIA for over two (2) hours due to lack of documenta-tion of return flight schedule. The patient was initially

referred for suspected heart problem and needed evaluation and possible further treatment. Once released by Immigration, by the kindness of one of the airport employees, the patient was accom-panied and guided through a bus ride until he finally arrived at the Philippine Heart Center of Asia

(PHC) after midnight and was eventually admitted.

The Management’s response to the incidence included (1) a memo to all Field Officers alerting them to provide itinerary documents to the referral patients before departure; (2) Manila Office to initiate exploration of patient’s escort assistance at the NAIA; and (3) make appointment to meet Dr. Enrique Ona, a long time MiCare Medical Coordinator at the National Kidney and Transplant Institute (NKTI), and now the new Secretary of the Department of Health, for the new

Philippine Government. (Continue on page 9)

FY2010 AUDIT REPORT: NET ASSETS HAVE GONE UP

TO ABOUT $0.806 MlLLION Deloitte and Touche has completed its independent audit report of MiCare Plan opera-tions and financial performance in FY2010, and noted an increase in net profit from 0.2 mil at end

of FY09 to over 0.8 million.

FY2009 was the turning point of the financial status of MiCare operation from that of the deficit spending to one that has possible financial solvency. In FY 2006, financial standing of MiCare plunged to over $1.5 million deficit. Recovery measures were implemented in FY2007 and gradu-ally a grip on the expenditure control and close monitoring of spending has proven how deter-mined the board of directors were to save the program coupled with consolidated dedication

from MiCare staff. (Continue on page 2)

Vice-Chairman Kapilly Capelle (L) and Secretary Enrique Ona (R). Mr. Capelle presented a Microne-sia Wall Tray with a “Nan Madol” inscription, as a token of appreciation for a long years of service as MiCare Medical Coordinator at National Kidney and Transplant Institute and to congratulate Dr. Ona for his new post as Secretary of Health on behalf of

MiCare Board of Directors and staff.

1 2 3 4 5 6

FY 2005 2006 2007 2008 2009 2010

Net Asset(Deficiency) $(1,44 $(1,55 $(782, $(313, $255,4 $860,00

-2000000

-1500000

-1000000

-500000

0

500000

1000000

Net Asset/Difficiency

Net Asset/Difficiency

Understanding Sleep

Apnea, Page 8

Radiation Update

Page 14

(October 2010-March 2011, FY2011) The Official Newsletter of MiCare Health Plan

Tel: (691) 320-2549/5865/3415. Email: info@micareplan.fm Website: www.micareplan.fm

2

FY 2010 Audit Report.. (continued from page 1)

The table at right shows the trend of Mi-Care net assets (deficit) from FY05 to FY10. The Strategic Goal 1 adopted by the Board of Directors last December 2008 calls for the elimi-nation of deficit spending by the end of FY2009. Beginning of FY2008, the deficit amount was $782,511. The Audit Report has indicated that FY10 operations carried no questioned costs, and hence issued an unqualified opinion. The ultimate goal of MiCare is to increase its Net Asset to reach $1.6 million in FY2013. With over 0.8 million in net assets reported at end of FY10, it is foreseeable that MiCare will attain its strategic goal.

By Eusebio “Bong” Mangonon

The Financial Status Report (OctoberOctoberOctoberOctober----March, FY 2011 ) March, FY 2011 ) March, FY 2011 ) March, FY 2011 )

Page 2 The News & Updates

The deficit spending reached its highest peak in FY06 at about $1.6 million. In FY07, the deficit began tapering off until it totally eliminated in FY09. With a positive net asset of over $255,000, FY10 brought in another net profit of over $0.5 million and an

accumulated net asset of over $0.8 million.

The News & Updates

Net Assets FY 2005-2010 and Projected FY 2011-

2013

-2,000,000

-1,500,000

-1,000,000

-500,000

0

500,000

1,000,000

1,500,000

2,000,000

Ser ies1 -1,440,540 -1,554,304 -782,511 -313,732 255,405 806,198 871,867 1,100,000 1,400,000 1,600,000

2005 2006 2007 2008 2009 2010 Mar . 2011 Proj . 2011 Proj 2012 Pr oj . 2013

3

Collections and Payments- October-March,FY2011.

Mid-Year Financial Activities Project A Bleak End of Fiscal Year

Page 3 The News & Updates

While the end of FY10 brought hope for a brighter financial solvency by end of FY2013, as stipulated in MiCare Strategic Goal No. 2, the mid-year financial

activities project a bleak end of FY11.

The Table at the left shows a variance be-tween end of FY2010 actual costs of discharges in Manila and the projected cost at end of the FY11. The actual referral cost in Manila was $1,286,202 in FY10 and by the end of FY11 the projected costs based on the first six months (October—March)

was $1.609,472.

The projected increase in cost of Manila bound referrals are due to the increase of number of referrals to about 30 more than in FY10 as well as

increasing cost of medical care.

The major cause of the increase is seen in the March discharges which amounted to a record breaking amount of $258,868. Cost of discharges in Manila for the month of March is about 31%% of the six months in FY11. Out of the March expenditure, 50% are due to seven (17) cases of Angioplasty (stenting) and ByPass (Open-Heart) Surgeries. (See

Table on page 9).

The trend over the several months has indi-cated that there will be more and more cases of heart related operations and treatments during the coming months and perhaps more so over the com-

ing years.

Discharges in Manila (October to March, FY11)

and projected costs of Discharges.

Month BA SR SN Total Total Cost

October 21 12 5 38 $152,665

November 19 6 1 26 $141,631

December 18 11 0 29 $116,665

January 7 10 1 18 26,077

February 21 6 1 28 $134,907

March 32 11 0 43 $258,868

Total F10 98 56 8 182 $584,900

Total FY11 118 54 9 161 $830,813

6 Mo Average FY11 20 9 1 30 $138,468

6 Mo Average FY10 16 9 2 27 $97,483

End of FY11 Projected 236 112 16 364 $1,609,472

End of FY10 Actual 220 88 13 303 1,268,202

Variance -16 -24 -3 -61 ($341,270)

“Cost of Angioplasty and by-pass surgeries are increasing, claiming about 50% of the March’s record breaking cost of over $.250 million.”

Month Honolulu Guam Manila

On Is-

land

Private

On Is-

land

Hospi-

tals

AirFare

Reim-

burseme

nt

Admini-

stration

FY11

Payments

FY10

Payments Variance

FY 11

Collec-

tion

FY10

Collection Variance

FY11

Collec-

tion Vs.

Re

October 28,598 2,280 211,742 111,029 55,314 15,556 2,883 40,296 467,698 356,278 -111,420 550,849 518,691 -32,158 83,151

November 28,683 1,415 104,786 131,712 70,759 16,657 8,329 10,405 372,746 437,435 64,689 469,794 442,212 -27,582 97,048

December 22,506 2,252 253,398 194,045 48,000 22,272 10,469 13,896 566,838 321,795 -245,043 404,127 424,917 20,790 -162,711

January 4,812 0 11,308 62,693 51,826 12,192 2,675 35,958 181,464 491,407 309,943 574,994 495,091 -79,903 393,530

February 71,568 232 290,930 131,365 48,000 33,254 13,830 71,676 660,855 382,904 -277,951 366,994 357,556 -9,438 -293,861

March 61,756 2385 140760 114,472 56,898 26,938 4,122 14,097 421,428 425,036 3,608 503,315 469,933 -33382 81,887

6 MoTotal 217,923 8,564 1,012,924 745,316 330,797 126,869 42,308 186,328 2,671,029 2,414,855 -256,174 2,870,073 2,708,400 -161,673 199,044

Mo Average 36,321 1,427 168,821 124,219 55,133 21,145 7,051 31,055 445,171.5 402,475.8 -42,695.7 478,345.5 451,400 -32334.6 33174

EOY Proj 435,846 17,128 2,025,848 1490,632 661,594 253,738 84,616 372,656 5,342,058 -512348 5,740,146 -388,015 398,088

FY 10 Actu 4,829,710 5,393,255

The News & Updates

4

• Supplemental Non-Residents-

$28,958

(2) Medical Cost I can recieve?

• .

(1)Premiums I have paid

over the past 25 years? • For Basic Plan member, you have paid

$9,295.

• Supplemental Plan- $21,092.50

How

much? • 1 Year Coverage is up to $50,000.

• One Open Heart Surgery in the Philip-pines is $about $20,000.

• One Open Heart Surgery in Honolulu is about $105,000;

You may send your comments and questions regarding MiCare program policies and ac-tivities, or on any article written in the News and Updates.

Letters to the Editor: LETTER TO THE EDITOR: (Submit your Letter to nnena@micareplan.fm )

ASC IS DESIGNATED AS TPA FOR MICARE PENSION PLAN

The MiCare Health Plan and the Guam base ASC Trust Company executed a Third Party Administrator (TPA) for the employees Pension (retirement) Plan. Regular and contract employees working more than one (1) year will be eligible to voluntarily enroll in the new pension plan approved by the MiCare Board of Directors last March 11,

2010.

After several communications between MiCare and the ASC Trust Company, the parties met last March 24, 2011 to finalize the terms of the TPA agreement. After the legal review by the FSM AG’s Office, and approved by the Board of Directors, the

pension plan will be implemented.

ASC Representative will be on island to conduct orientation to the MiCare employees and to enroll those who have selected to participate in the Plan. MiCare may contribute up to

10% of the premiums paid by the employees.

The News & Updates

The News and Update The News and Update The News and Update The News and Update

Managing Editor Nena S. Nena

News Editor Olivier Wortel

Layout Editor Bong E. Mangonon

Financial Reports Bong E. Mangonon & Accounting Staff Utilization Updates Dr. Jordel Maravilla & Utilization Staff Referral Updates Dr. Rowena Ocampo Shrue Joseph

Pose for photo (L-R) Comptroller Bong Mangonon, Brian A. Matanane, Investment Advisor; Jessica L. Castron, Participant

Development Manager; and Administrator Nena S. Nena

WE LOVE TO HEAR FROM YOU!

We would like to know from our members how do you find our new The News & Update and how else we can

improve our Newsletter.

Please send in your views, comments and inquiries on any articles and issues addressed in the News & Updates. Send an e-mail to nnena@micareplan.fm or info@micareplan.fm.

For those of you who want to have a copy of our past issues, please visit our website at www.micareplan.fm.

Thank you.

5

MiCare Regulations

The Board of Directors is currently reviewing at least 39 proposed changes to the MiCare Regulations. Final review and adoption of changes will be during the Board meeting sched-uled for April 15, 2011. New changes, if any, will be posted for 60 days public comments and finally submitted to the FSM President for review and approval. The News and Update will

publish the new changes when they are promulgated.

The News & Updates

Month 6 Mos Approved Referrals

FY09 FY10 FY11

October 97 87 83

November 72 86 95

December 51 57 57

January 51 52 54

February 62 72 73

March 66 44 90

6 Mo Total 399 398 452

Mo Average 67 66 75

FY09 FY10 FY11

Mo Average

67 66 75

60

65

70

75

80

Mid Year Referral

Average

Average monthly approved referrals during the first six months in FY11 was 75, compared to the same period last fiscal year of 66. If the trend continues into the next half of the fiscal year, the total num-

ber of referrals will reach a breaking 900 level, compared with the actual number in FY10 at 778.

The figures presented include Basic Referrals and Supplemental Referrals to Hawaii, Guam, Manila and elsewhere. As shown on page 3, about 33% of the referral patients in all categories were sent to Ma-nila. However, all Basic Referrals (BA) are directed to Manila Hospitals. Supplement Residents (SR) referrals and Suplemental Non-Resident (SN) Referrals are sent to all approved tertiary health facilities in Manila, Ha-waii and Guam. For SN patients they may go to any health facilities and submit medical bills for review and

reimbursement.

The SN members are those government employees who are working in foreign services offices in

Guam, Hawaii, Washington D.C, New York, Fiji, and the people’s Republic of China.

For emergency treatment, members in all three categories may go to any hospital for treatment but must submit to MiCare a medical summary and the paid billing. If the receiving hospital is not an approved facility, member should make advance payment and submit billings for reimbursement. The emergency cov-

erage is up to $2,500.

As shown in the Table above, total number of referrals during October 2010 to March 2011 was 452

compared with same period last year of 398, an increase of about 13%.

The MiCare Management and the Board of Directors will review the potential impact the increase would have on the current financial status and will continue to work to curb the increases while providing

the best member services possible.

How would you advise MiCare to curb the increasing number of referrals and associ-

ated costs.

Certainly either curbing actions or increasing sources of funding, or both should be proac-

tively implemented.

NUMBER OF REFERRALS ARE ALSO INCREASING IN FY 2011

6

Page 6 The News & Updates

Reimbursements to Local Hospital and Clinics (October-March, FY11)

With close monitoring and careful utilization review of the local reimburse-ment claims received from seven private providers and four State Hospitals, the to-tal end of year payments is estimated at $2.1 million, compared with the actual end

of FY10 payment of over $2.3million.

As shown on the table at left, a pro-jected reduced payment amount in FY2011 is based on six months payment activities during months of October 2010 to March 2011. If the level of payments continue into the next six months, the projected reduced

payment is about $143,000.

One way to effectively monitor and control the medical costs at the local pro-viders is amending various provisions in the MiCare enabling legislations to include, but

not limited to the following:

(1) Authorizing and implementing annual Claim Audit on all fee-for service facilities; (2) Certification of physicians pro-viding services to MiCare patients with au-thority to decertify physicians who are not

following standard expectations and rules and regulations; (3) Review and renewal of contract with local providers every three years with option to terminate contract with any abusive or fraudulent providers; (4) Establishment of formulary with established prices of all covered medications and Relative Unit Value (RUV) schedule for all ser-vices covered by MiCare Health

Insurance Coverage;

The above proposed changes along with other propos-als are to be reviewed by Board of Directors during its next

meeting.

In addition, there are 39 proposed changes to the regula-tions also to be reviewed by the BOD. Any changes approved by the Board will be shared in the

Hospital/Clinic 2011 (Oct-Mar 11)

1. Genesis Clinic & Hospital $412,076.00 38%

2. Pohnpei Family Health Clinic $88,087.00 8%

3. MedPharm Clinic/Optical $92,129.00 9%

4. Bersysin Comm Health Clinic $39,606.00 4%

5. Sefin Health Clinic $14,677.00 1%

6. The Family Clinic $3,418.00 0%

7. Kasehlelia Dental Clinic $92,324.00 9%

8. Pohnpei State Hospital $204,000.00 19%

9 Chuuk State Hospital $36,000.00 3%

10. Kosrae State Hospital $48,000.00 4%

11. Yap State Hospital $42,796.00 4%

TOTAL $1,073,113.00 100%

Monthly Average $178,852.17

EOY Projection $2,146,226.00

EOY FY10 Actual $ 2,288,963.00

Variance ($142,737.00)

1. Genesis Clinic & Hospital

40%

2. Pohnpei Family Health

Clinic

9%

3. MedPharm Clinic/Opt ical

9%

4. Bersysin Comm Health Clinic

4%

5. Sefin Health Clinic

1%

6. The Family Clinic0%

7. Kasehlelia Dental Clinic9%

8. Pohnpei State Hospital

20%

9 Chuuk State Hospital3%

10. Kosrae State Hospital5%

1. Genesis Clinic & Hospital

2. Pohnpei Family Health

Clinic

3. MedPharm

Clinic/Opt ical

The News & Updates

7

Strategic Goals Baseline/Target Last Report Update Remarks

SG 2: : Increase Capital Investment Fund to $1.6 million in 2013.

FY09 Baseline: $5

FY2010: $1,000,000

FY2011: $1,200,000

FY2012:$1,400,000

FY2013 $1,600,000

$1,017,277

(63% attainment rate as

of end of FY10)

$1,217,277 76% Attainment Rate

April, 2011

SG 3: Increase membership sub-scribers by 25% in FY2013 from FY2008 Baseline.

Baseline: 20,735 in FY2008 FY09 LEVEL: 18,880 , less 1,935. New Target for FY10: 2,000 FY11 Target: 1,000 FY12 Target : 1,000 FY13 Target: 1,000

18,880

Pohnpei -12,939 Kosrae - 2,711 Yap—1,857 Chuuk—1,206 TOTAL—18,880

.FSM Students and stu-dents abroad are being

considered for eligibility.

SG 4: Reduce costs of claims and opera-tional expenditures by 25% in FY2013.

Baseline: $5.5 mil Overall Target: $1,375,000 Annual Target:: $275,000

.

SG 5: Increase fi-nancial supports to Hospitals in FSM to improve diagnostic and treatment ser-vices in order to re-

Baseline FY2009 ( $512,466) : Pohnpei: $278,009 Chuuk: $$78,000 Yap: $66,457 Kosrae: $90,000

FY2010: ( $911,190)

Pohnpei: $557,190 Chuuk: $72,000 Yap: $192,000 Kosrae: $90,000

6 Mos in FY11: $331,796 Pohnpei: $204,000 Chuuk: $36,000 Yap: $42,796 Kosrae, $49,000

SG 6: By 2013, Con-struct a new MiCare Building

No Activity Grant Proposal is being implemented by the new Public Relations Special-

ist.

SG 7: By FY2009 Develop and Imple-ment a Human Re-sources Develop-ment Plan

$35,000 approved by the Board of Directors for Human Resources Devel-opment Training program in FY2011.

Continue training sup-port to the on-line de-gree courses and the Billing and Coding in-

service trainings.

Strategic Goals Updates

Page 7 The News & Updates The News & Updates

8

Dr. Jordel Maravilla

Doctor’s Advice

The News & Updates

UNDERSTANDING SLEEP APNEA

What is sleep apnea?

It’s the brief pauses in breathing during sleep. Apnea is a Greek word than means “want of breath”. This temporary cessation of breathing during the sleep cycle often results to sleepiness in the day time. It could last from a few sec-

onds to minutes and may occur 5-30 times or more an hour.

What are the types? Central Sleep Apnea (CSA) .4% of cases Breathing is interrupted by a lack of respiratory effort Obstructive Sleep Apnea (OSA) 84% of cases Breathing is interrupted by physical block to airflow despite

respiratory effort Complex/Mixed Sleep Apnea 15% of cases Combination of central and obstructive sleep apnea

What are the symptoms?

loud snoring abnormal pattern of snoring with pauses and gasps excessive daytime sleepiness memory changes depression irritability restless sleep sexual dysfunction abrupt awakenings accompanied by shortness of

breath Awakening with dry mouth or sore throat Morning headache Difficulty staying asleep (Insomia)

Risk factors for sleep apnea Obesity alcohol, sleeping pills and tranquilizers at bedtime elderly – over 65 y.o. men – 2x at risk Diabetes – 3x at risk Short, Thick neck enlarged tonsils elongated soft palate small chin, maxilla and mandible Large tongue Narrow throat Menopause Chronic nasal congestion Family history of sleep apnea Hypertension Smoking – 3x at risk

How to diagnose?

Sleep laboratories

Clinical symptoms

What are the complications?

Apnea could contribute to high blood pressure, heart failure,

stroke and heart attack

What are the treatment?

Losing excessive weight

avoid alcohol and sedatives

Sleeping on one side

medications to relieve nasal congestion

CPAP – continuous positive airway pressure

ENT surgery

Mouthpiece

When to see a doctor:

Snoring loud enough to disturb your sleep or that of others

Shortness of breath that awakens you from sleep

Intermittent pauses in your breathing during sleep

Excessive daytime drowsiness which may cause you to fall asleep while you’re working, watching television or

even driving a vehicle

DO YOU EXPERIENCE ONE OR MORE OF THE

FOLLOWING? SEE YOUR DOCTOR!

Snoring loud enough to disturb your sleep or that of

others

Shortness of breath that awakens you from sleep

Intermittent pauses in your breathing during sleep

Excessive daytime drowsiness which may cause you to fall asleep while you’re working, watching televi-

sion or even driving a vehicle

DOCTOR’s ADVICE

9

The News & Updates

Referral Services in Manila…(Continued from page 1)

Beginning March 5, 2011, MiCare referral patients are being picked up outside the lobby area, instead of walk-ing down to the designated area at the lower level. Such arrangement is an improvement for patients, but the assess-

ment team seeks revitalization of escort support that was done during 2000s.

The Vice-Chairman and the Administrator were accorded a courtesy call on the Secretary last March 10, 2011. Prior to meeting with the Secretary, they were met by Dr. Aleli P. Sudiacal, the Bureau of International Health Coop-eration for the Department of Health, to review the proposed agenda for discussion with the Secretary. The subject of special escort services to medical referral patients from Micronesia was cleared by Dr. Sudiacal for presentation to

the Secretary.

During the brief courtesy meeting with Secretary Ona, Dr. Sudiacal and one other staff, the Vice-Chairman and the Administrator were assured of the Department of Health’s proactive actions to facilitate the revitalization of refer-ral patients escort services at the NAIA through consultations with the Airport Authority, Hospitals in the Philippines

and other relevant Government agencies.

According to the MiCare Manila Office, the Airport Support Assistance to the referral patients has been rein-stated. The require procedures included faxing the names and itinerary of the referral patients to the Airport Assis-tance Office. The Office will then assign a staff to accompany each patient through the immigration and custom check

points up to the lobby area where our patients will meet up with MiCare driver .

HEART OPERATIONS HAVE CAUSED MICARE FINANCIAL STRESS

The first six months in fiscal year 2011 painted a less optimistic end of the fiscal year with a 36 referral cases related to heart problems. The month of March, 2011 has marked the highest number of heart cases, numbering to

a record breaking 14 cases with a total cost of $154, 780 , averaging about $11,056 per case.

During the six months, ten (10) Angioplasty/Stendting (PTCA) operations were performed gar-nering a total costs of $136,430 or an average about $13,643 per op-eration. Likewise, By-Pass Surgeries (CABG) numbering seven at a total cost of $136,785

or average of $19,541 per case.

The table at the left shows a total of 36 patients undergoing heart operations and related procedures during October 2010 to March 2011. The accumulated total cost of these heart related treatments went up to $336,575 for

the six months period, an average of $56,096 per month.

The Management of MiCare Health Plan have re-viewed options to either curb the escalating cost due to referral treatments in general and/or to adjust premium

contributions from the members.

The proposed recommendations will be forwarded

to the Board of Directors for final adoption.

Summary of Basic Referral Patients (Heart Cases)

From October 2010 to March 2011

Months No. of Patients Utilization Cost

October 2010 2 $ 16,414.91

November 201 4 53,486.67

December 2010 4 22,959.82

January 2011 1 1,441.20

February 2011 11 87,492.88

March 2011 14 154,779.62

36 $ 336,575.10

No. of Patients underwent Procedures for the period Oct.2010 to Mar. 2011

Operation Done No. of Patients Total Cost

Angioplasty/Stenting (PTCA)

10 $ 136,429.67

ByPass Surgery (CABG)

7 136,785.03

Pacemaker 1 8,891.58

Evaluation w/out special procedures

18 54,468.82

36 $ 336,575.10 Read Article on Heart Cases Seen in the FSM Hospi-

tals, 2004-2010, page 10.

10

PREMIUM COLLECTIONS REACHES PROJECTED 50% FOR SIX MONTHS Private Businesses Contribute 16%

The premium collections during the first six months in fiscal year 2011 (October 2010 to March 20, 2011) reached $2.9 million, meeting 50% of the projected total premium collection for the same period. About 33% of the total collections came from the FSM National Government, followed by Pohnpei State Government and Agencies at 28% (See Chart at right). As in the previous years, the Private Sector has signifi-cantly contributed to the premium collections during the last six months, contributing about 16% in the amount of $472,615. Although, Yap State Government is not participating in MiCare health plan, its employees and dependents contrib-uted 5% or $105,587 to the six months premium collections. All enrollees from Yap State and their dependents are enrolled under Individual enrollment arrangement whereby they pay 100% of the established premiums. Chuuk State contributions has decreased to 4% allegedly due to the recent passage of mandatory requirements for em-ployees there to participate in the Chuuk State Health Plan. The total projected collections by end of the fiscal year is about $5.7 million.

70% of Referable Heart Conditions Seen in FSM Hospitals are related to Heart Attack (Myocardial Infarction)

According to the FSM Health Statistical Report, over 110,000 heart related conditions are seen in the FSM Hospitals between 2004—2010. Based on MiCare’s own review of the statistics, a total of 3,366 heart related visits to the Hospitals are clearly referable conditions. Among the identified referable heart conditions 70% are due to Myocardial Infarction (MI), and 26% are due to Valvular Heart Diseases. There has not been any confirmation as to how many of these two types of referable heart conditions were referred during the past 7 years. However, during the first six months in FY11, there were 36 heart related operations and procedures per-formed in Manila alone, costing MiCare over $336,000 (See story on page 9). Each operation cost is averaging about $9,333 per case. Out of 36 heart related operations and procedures during the six month period, 35 are related to heart at-tack (myocardial infarction) and Valvular Heart Diseases. The types of operations performed for these two types of referable heart conditions include (1) Angioplasty/Stenting (PTCA), ByPass Surgery (CABG) and Evaluation without special procedures (See Table on page 9). ByPass Surgery (CABG) costs MiCare about $19,540 per operation and for Stenting operation, the cost of each operation is averaging at $13,643. The heart attack related conditions was totaled to 337 per year in all hospitals in the FSM, according to Mi-Care own analysis on the data provided by the FSM Department of Health, including those MiCare referable cases. If all the estimated cases of Myocardial Infarction are referred, a yearly costs to the Nation is about $6.6 million. Heart conditions have become a serious health conditions for the entire Nation and begin to cause financial stress to MiCare during the first six months in Fiscal Year 2011.

The News & Updates

Participating Accounts Collections %

FSM National Govt. & Agencies $ 937,655.01 33%

Pohnpei State Govt. & Agencies $ 812,710.08 28%

Kosrae State Govt. & Agencies $ 209,816.62 7%

Chuuk State Govt. & Agencies $ 105,586.95 4%

Yap State Govt. & Agencies $ 139,971.72 5%

Private Businesses $ 472,615.42 16%

Individual Accounts $ 78,986.11 3%

Others ** $ 112,730.17 4%

Total $ 2,870,072.08 100%

11

A TOTAL OF $2.5 MILLION WAS DISBURSED DURING THE

FIRST SIX MONTHS OF FY 2011: 34% PAID TO MANILA HOSPITALS AND FOR PROFESSIONAL FEES

Referral costs in Manila remain dominant as anticipated, garnering about $850,580 (34%) of the total disburse-ment during the first six months in FY11 (October-March). The total disbursement amount was $2,505,570 (about 45% of projected collection at end of the fiscal year). Out of the total amount to Manila Hospitals, about 36% paid for

professional fees.

Private Hospital & Clinics collectively received about $742,315 or 30% of the total six months disburse-ment. Out of this total, Genesis Hospital and Clinics

was paid $412,076 or 56%.

The four Main Hospi-tals in the FSM were paid

about $330,796.

Hawaii based tertiary Hospitals and clinics received about $217,952, while Guam Hospitals were paid a smaller

amount of $8,564.

Most of the amount paid to Hawaii Hospitals went to Straub Hospital and

Clinics.

If the reimbursement trend continues into the next six months, the projected end of fiscal year total reim-

bursement will reach over $5.0 million. However, considering ever increasing cost of referrals, the total disburse-

ment may surpass the projected total collections at end of the fiscal year.

Page 11 The News & Updates

1. “ He who does not know food, how can he understand the diseases of man”?”

Hippocrates, the father of medicines (460-350 B.C.)

2. “Water is the most neglected nutrient in your diet, but one of the most vital”

~ Julia Child

3. “Processed foods not only extend the shelf life, but they extend the waistline as

well.” ~ Karen Sessions

4. SPC: “Taro root (tuber) is an excellent source of energy, which the body needs to stay active. It also provides fiber, which is needed to make the intestines and bowels work properly. When eaten regularly, as it usually is in most rural areas in the Pacific, taro root is also a good source of calcium and iron. Calcium helps to make strong bones

and teeth, and iron helps keep blood healthy. Women and young children need lots of iron in their diet.”

0100,000200,000300,000400,000500,000600,000700,000800,000900,000

Hawaii Guam Manila FSM Priv Clinics

FSM Hospitals

Air Fare (Continen

tal)

Administration

Reimbursement

Disbursement 217,952 8,564 850,580 742,315 330,796 126,868 186,328 42,307

Mid-Year Disbursement

The News & Updates

12

1. Health Promotions— MiCare will sponsor a Fun-Run early next fiscal year, possibly between Octo-ber-December, 2011. The Fun Run will be coordi-nated with the FSM National Olympic Committee and other agencies as co-sponsors. There will be other health prevention activities directed at the school ages, including essay contests and other health prevention subjects.

2. MiCare Seeks More Autonomous Status —The Board of Directors have endorsed certain changes to the current MiCare legislation. One of the pro-posed changes is to allow MiCare to have its own Financial Management Regulations and Personnel Management Regulations. MiCare is collaborating with the FSM AG’s Office for the introduction and passage of the new changes in Congress during the next Congress Session.

3. Off-Island Students to Participate in MiCare - The Board of Directors endorsed a new definition of “students” who are eligible to enroll in MiCare cover-age. If the new definition is endorsed by Congress, FSM students at all levels who are studying abroad will become eligible to enroll as Supplemental Non-Resident members.

4. New Pubic Relations Specialist- Mr. Olivier Wor-tel has been accepted to fill in the Public Relations Specialist position effective May 1, 2011. Asides from his public relations activities (public education, publications, press releases, revisions of Members Manual, etc.) he will perform grant writing works to support major projects approved by the Board of Directors in the MiCare 5-Year Development Plan. One of the approved project is the MiCare Building with the estimated construction costs of more than $800,000.

5. Investment Fund- During a recent meeting of the Board of Directors, an amount of $200,000 was ap-proved to be transferred to the MiCare Investment Fund. The Fund is established by law and should be invested only on low risk investment portfolio. The total amount in the Fund is about $1.2 million, and can be used only during emergency and if au-thorized by the Board of Directors.

Page 12 The News & Updates

6. SBOC Discusses LTFF with MICARE— Suzanne Lowe Gallen and Mathew Chigiyal, both from the FSM Office of SBOC, discussed with BOD Vice-Chairman, Kapilly Capelle, and Administrative Staff of MiCare the Long Term Fiscal Framework (LTFF) “to help us better man-age limited resources….”, most particularly ways to contain costs of referrals and to encourage more people to enroll in MiCare. Possible pro-grams to be considered under the LTFF are (1) Unification of FSM Health Insurance program, and (2) Centralize Diagnostic Facilities for the FSM.

7. Humanitarian Trust Fund- The Management is reviewing the possibility of establishing the so called “Humanitarian Trust Fund” to advance payment for services not covered or partially covered when MiCare members are already ap-proved for referrals. Some steps are required to implement such concept and they include; (1) BOD’s approval, (2) Funding sources should be identified outside of MiCare general fund; (3) Level of Capital to reach at least $3.0 million, (4) Policy to utilize only the interest incurred from the trust fund each year for advance payments, and (5) the Re-imbursement mechanism.

8. Renewals of MOU with Private Providers- All-contracts with the local affiliated providers espe-cially in Pohnpei and Chuuk states will be re-viewed and renewed. After a memo is sent out to the local providers, a new draft contract will be discussed with each provider to include new expectations, requirements and relationships between MiCare and the respective providers. The review of the new contracts will commence May 1, 2011.

9. Referral Manual under Revision- The booklet that contains helpful hints for Manila bound re-ferral patients is undergoing revision to reflect most current information and expectations. By end of May, the revision should be completed and distributed to referral patients.

The News & Updates

Bits and Pieces!!

13

OVER 12,400 REIMBURSEMENT CLAIMS RECIEVED IN SIX MONTHS

Page 13 The News & Updates

Provider October November December January February March Total %

Berysin's Clinic 0 80 69 67 67 90 373 3%

Family Health Clinic 0 0 23 0 27 0 50 0%

Genesis Inpatient 64 36 145 86 78 95 504 4%

Genesis Outpatient 662 723 764 1,347 588 733 4,817 39%

Kashelelia Dental 169 194 194 88 199 197 1,041 8%

MedPharm Clinic 267 254 222 214 213 213 1,383 11%

MedPharm Optical 34 36 37 0 71 23 201 2%

Off Island 48 196 0 0 460 156 860 7%

Pohnpei Family Health Clinic 117 338 277 313 245 349 1,639 13%

Reimbursement 8 13 0 0 24 0 45 0%

Sefin Clinic 88 92 54 70 61 61 426 3%

Yap State Hospital 0 287 0 0 858 0 1,145 9%

TOTAL 1,457 2,249 1,785 2,185 2,891 1,917 12,484 100%

Valvular Heart Disease26%

Myocardial Infarction70%

Aneursym1%

Thrombosis and embolism

2% Cardiomyopathy1%Others0%

Referable Cardiac Cases, 2004-2010

Source: FSM Health Services

Analysis: MiCare

Note: Please read related article on pages 9 and 10.

Myocardial Infarction is Heart Attack Related Conditions.

The News & Updates

14

Page 14 The News & Updates

Joint Press Release of the FSM Department of Health and Social Affairs (DHSA) and World Health Organization (WHO) Country Liaison Office for Northern Micronesia Statement about Japan Nuclear Crisis

Palikir, Pohnpei (FSM Information Services): March 24, 2011 - Following the 9.0 magnitude earthquake that occurred in Japan on 11 March 2011, a number of problems have been reported at three Japanese nuclear power plants (Onagawa, Fukushima Daiichi and Fukushima Daini). Despite the efforts of the Japanese authorities, several explosions have oc-curred at these plants, resulting in the release of small amounts of radioactive material into the surrounding area. Fur-ther leaks may occur. Residents in a 20 km area surrounding the nuclear facility have been evacuated and people living between 20 and 30 km of the facility have now been advised to stay indoors. Rumors have been circulating by text messaging and other means of a radiation cloud spreading across Asia and beyond from the damaged nuclear facilities in Japan. There is no evidence at this time of any significant international spread from the nuclear site. Members of the public are encouraged to take steps to halt these rumors which are harmful to public morale. The World Health Organization (WHO), which is mandated to assess public health risks and provide health advice in radiation events, is working closely with the government of Japan and the International Atomic Energy Agency. At this time it seems unlikely that significant amounts of radiation will affect areas outside of Japan. Therefore, at this time, there is no indication of any risk to FSM or any other Pacific Island areas. The FSM Department of Health and Social Affairs is working closely with the World Health Organization and other pub-lic health authorities. At this time, we are not recommending any safety precautions. Please note that "potassium iodide" pills, which are used in certain cases of radiation poisoning, are only recommended for people with very high exposure to radiation and should not be taken unless advised by authorities. The recommen-dation to stay indoors applies only to those people living within 30 km of the affected facility in Japan. We will continue to provide updates as the situation evolves.

WHO & DHS: “...at this time, there is no indication of any (radiation) risk to FSM or any other Pacific Island areas.”

Radio Australia: “Japan's nuclear disaster is continuing to have an adverse effect on the

Pacific Ocean”.

The Article below was published by the Pacific Island Report, (May 5, 2011)

JAPAN NUCLEAR EFFECTS ON PACIFIC OCEAN INCREASING

Radiation levels 600 times higher than previously detected

MELBOURNE, Australia (Radio Australia, May 4, 2011) - Japan's nuclear disaster is continuing to have an adverse effect on the Pacific Ocean. The operator of the damaged Fukushima Daiichi nuclear plant says levels of radioactive substances in the Pacific seabed near the reactor have increased. Tokyo Electric Power says new seabed samples collected some 15 kilometers from the coast contain radioactive caesium-137. The level is more than 600 times higher than previously detected off the coast of the northeastern prefecture of Fukushima. The Fukushima plant has leaked radiation into air, soil and ocean since it was severely damaged by the devas-

tating earthquake and tsunami in March.

RADIATION UPDATE

The News & Updates

15

MiCare and Continental’s Pohnpei Office Agree to Improve Services to

Referral Patients

In a recent meeting between Continental’s Pohnpei Office and MiCare Management, leverage of efforts have

been agreed to in improving services and coordination needed to support Basic Referral Patients to the Philippines.

In a letter sent to the Regional Manager, Mr. Art Day, after the meeting the MiCare Administrator extends appreciation and noted some of the key actions that are expected to facilitate mutual goals of moving forward. The

specified key actions stemming from the discussions include:

1. Designation of Mrs. Sylvia Cruz as the MiCare Referral Coordinator

2. Request to United-Continental technology division to include a “Medifare” option on the Continental.com

website for e-booking of MiCare members;

3. Assistance in establishing a MiCare OnePass account;

4. Possibility of eliminating rebooking fees for MiCare re-

ferral patients due to unforeseen physician decision in Ma-

nila

The Administrator added, “For our part, we will

continue to work in good faith with Continental. We also

look forward to assisting in communicating the special

needs and circumstances to upper management of the

evolving United-Continental company policy structure, to

move toward e-based communication and transaction sys-

tems to further streamline efforts and ease staff workloads,

and to ensure that MiCare members understand the vari-

ous Continental rules and regulations prior to travel.”

He concluded in saying that “As a Corporate Ac-

count/Customer, we continue to look forward to a mutu-

ally beneficial relationship and remain available to discuss

these and any other emerging issues in the future.”

Annually, MiCare has disbursed an average of

$300,000 to pay for Basic Referrals travel costs to the Phil-

ippines. The total amount disbursed to Continental during

FY2010 was $279,156, not counting those other self-

referred patients to the Philippines, Guam and Hawaii un-

der the auspices and coordination of MiCare Health Plan.

After the meeting between the two parties, satis-

faction was expressed by both sides and overall as a step

forward in improving working relations to support medical

referral services in the FSM.

MiCare sends referral patients from all the four States in

collaborations and coordination with the respective Field Offices

Those attending the recent meeting were Art Day, Brian Mori,

and Sylvia Cruz from Continental Pohnpei Office. From MiCare,

Administrator Nena S. Nena, Comptroller Eusebio Mangonon,

and the Public Relations Specialist, Olivier Wortel.

Page 15 The News & Updates

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16

Page 16 The News & Updates

The News & Updates MiCare Ground Floor, Suite #6 Town Plaza Bldg P.O. Box 2156 Kolonia, Pohnpei State FM 96941 T O : ____________________________________________________ ____________________________________________________ ____________________________________________________

The News & Updates