Ehnes says she can’t cure all ills, but she wants to keep doctors fiscally healthy

The San Francisco Chronicle

As California’s HMO watchdog, Cindy Ehnes‘ job is to keep the state’s health maintenance organizations in line. Her style, she says, is to rely on mediation rather than confrontation. “I want the HMOs to feel that I’m tough on the issues but soft on the people,” said Ehnes, who was appointed by Gov. Arnold Schwarzenegger as director of the state Department of Managed Health Care in March. “I’m not adversarial. I’m a problem solver, but I am a tough-minded regulator.”

Ehnes, 53, a lawyer who served as the head of enforcement for Colorado’s Division of Insurance, takes the helm of the nation’s only stand-alone HMO regulatory agency at a time when health insurance premiums are rising by double digits, benefits are shrinking, employers are frustrated and more costs are being shifted to consumers.

In a recent interview, the new departmental chief stressed that she can’t solve the big issues plaguing the American health care system. Her focus, she said, will be to make sure that doctors’ groups are financially sound and that the HMOs pay them on time. In addition, she plans to streamline some of the licensing and paperwork requirements for the plans.

At the same time, she said, she intends to consider the needs of the consumer first and foremost.

“My background is very much about people who have the most extreme need for high quality care. The idea is when you need medical care, you need it to be responsive and you need it to be affordable and available,” Ehnes said.

The department was created by a series of HMO reforms in 1999 and opened its doors in 2000. It has been without a permanent leader since its founding director left in January 2003 for another position.

Ehnes is responsible for overseeing about 90 specialty and full-service plans on an operating budget of $36 million, which is primarily paid by HMOs through assessments.

HMOs cover more than half of insured Californians, compared with a national average of just 25 percent, according to InterStudy Publications, which tracks HMO enrollment.

The high rate of participation in HMOs, the most restrictive form of managed care, has helped keep premiums lower in California than in other comparable regions in the country. But recent studies have shown that the state is losing that edge as rates have soared and managed care has loosened its controls in the face of consumer backlash.

Ehnes has no authority over insurance rates. But she is charged with making sure the HMOs operate within the law and that the state’s medical groups are solvent. She is in charge of levying fines against plans that violate laws and of maintaining the department’s call-in consumer service, the HMO Help Center, which she considers one of the main achievements of the previous leadership.

Her predecessor, Daniel Zingale, came to the department with a strong consumer activist background, particularly in AIDS and gay rights issues. After he left the department to become former Gov. Gray Davis‘ Cabinet secretary, the department was run by acting director Jim Tucker.

Consumer advocacy groups want to make sure Ehnes carries on the spirit of consumer activism.

“When it’s a matter of life and death for patients, she has to be hard as nails,” said Jamie Court, head of the Foundation for Taxpayer and Consumer Rights. “The HMOs have to think of her only one way: as a watchdog with bite and bark, and not as a lapdog who purrs.”

Ehnes has her own advocacy background as a supporter of the rights of the disabled and the uninsured.

Born in Ohio, Ehnes was working her way through college at a fast-food restaurant when she caught her left hand in a meat grinder. Just two years ago, she was diagnosed and treated for breast cancer.

The loss of her hand when she was so young not only caused her to readjust the way she went about her daily life but also changed the way she thought about herself.

“At some point, I had to make a decision whether it was my job to take care of the outside world and how they responded, or just go live my life,” said Ehnes, who is married and has two daughters, ages 19 and 21.

Going on to live her life caused her to suspend her schooling for a couple years to become the first disabled representative for the Bonne Bell exhibition ski team and a gold-medal winner at the Winter Olympics for the Disabled.

She then returned to finish college and earn her law degree. She began her career as an attorney in private practice for several years in Colorado.

Ehnes has lived in California just two years, moving from Colorado where she was director of enforcement for its Division of Insurance. Most recently, she served as manager of self-funded plans for the California Public Employees’ Retirement System and as a director of plan and provider relations for the Department of Managed Health Care.

She was also the legislative affairs director for the Commission on Family Medicine in Colorado and helped to set up a plan for the medically uninsurable in Colorado.

The job that most relates to her current position was at the Colorado Division of Insurance.

Kirk Yeager, who worked with Ehnes at the Colorado insurance department for about four years, said Ehnes didn’t back down when it came to making sure insurers followed the laws and imposing fines when necessary.

“She will work for solutions that are practical,” said Yeager, deputy commissioner of market regulation for the division. “You can truly be aggressive and very diplomatic. Diplomacy does not mean weakness at all, especially in Cindy’s case.”

Yeager said her mediation skills were so disarming that he underestimated her abilities at one of the first negotiations he conducted with her. “But by the time she had heard everyone out, she walked away from the table with virtually everything we wanted,” he said.

Ehnes’ plan to direct her attention toward the financial health of medical groups is good news, says Steve Thompson, vice president of governmental relations for the California Medical Association.

“We’re hoping she will be a strong regulator of the entire system. We believe her predecessor (Zingale), while doing a good job on the consumer side, failed properly to regulate on the financial side,” he said. He was referring to the financial problems and dissolutions of medical groups in recent years, which he attributed in part to the lack of proper and timely reimbursements to physicians by the HMOs.

Zingale applauds her focus. “I think she has a very good sense of the unfinished business of the department. She genuinely honors our accomplishments for patients and feels rightly the next step is to address the doctors’ concerns,” he said, adding that he believes the department is in good hands.

Steve Tough, head of the California Association of Health Plans, praised Ehnes’ breadth of experience, which includes working with medical providers, health plans and consumers.

“Cindy will never lose sight of the need to keep consumers’ needs in perspective, and consumer protections are going to be paramount in her book,” said Tough, whose group represents the state’s HMOs.

Ehnes describes herself as a strong believer in managed care. “A lot of people aren’t, but I am,” she said. “I’m a strong believer in the beneficial things that managed care can provide in terms of care coordination.”

She doesn’t pretend to have all the answers to the problems in health care, but she said she will try to keep the state’s plans and providers in the best shape she can.

“Right now the only response we’re seeing is raising cost-sharing and skinnying benefits, and that is not really a good long-term solution,” she said. “I will be spending much of my time as an overseer of the health of this health care system in trying to move toward solutions.”
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Name: Lucinda “Cindy” Ehnes
Age: 53
Position: Director of the California Department of Managed Health Care
Responsibilities: Overseeing the state’s 90 health plans and protecting consumers’ rights in their dealings with HMOs
Experience: Manager of self-funded health plans, California Public Employees’ Retirement System; deputy director of plan and provider relations, California Department of Managed Health Care; interim executive officer, California Board of Optometry; director of enforcement, Colorado Division of Insurance
Education: Law degree, Catholic University School of Law (1978); bachelor’s degree, George Washington University (1975)
Claim to fame: Gold-medal winner in skiing at the Winter Olympics for the Disabled, 1974, 1980, 1982
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E-mail Victoria Colliver at [email protected]