How Yale‘s Jon Soderstrom became a technology-transfer superstar

 

 

Jon Soderstrom once thought he would become a minister. Instead, his career path led to Yale University, where he became managing director of the Office of Cooperative Research (OCR), overseeing the commercialization of inventions stemming from faculty research.

“It’s a rather improbable journey,” acknowledges Soderstrom, who is widely recognized as heading one of the most successful university technology-transfer initiatives in the country.

 Along the way he has had a hand in the creation of more than two dozen ventures, including Molecular Staging, Genomic Systems, Achillion Pharmaceuticals, Protometrix, Iconic Therapeutics, Applied Spine Technologies, HistoRx, Affomix and Kolltan Pharmaceuticals.

 And done his best to start and keep those companies in New Haven.

 Soderstrom’s journey began far from Yale, in Sparta, Mich., a tiny town 17 miles north of Grand Rapids.

 “It’s Lake Wobegon [Garrison Keillor’s fictional Minnesota town] and I’m not kidding,” he says, “with three Lutheran churches — one for the Swedes, one for the Germans and one for everybody else.” Soderstrom’s grandfather arrived there in 1882, fleeing the potato famine in his native Sweden.

 Soderstrom adored his father Edward, a bomber pilot during World War II, who received the Distinguished Flying Cross and saved fellow pilot George McGovern [later a U.S. senator and 1972 Democratic presidential nominee], when both were shot down on a mission.

 After the war his father, an engineer, helped run the family hardware business until the late 1960s, then designed warehouse systems for a firm with clients including Federal Express and Wal-Mart.

 “He was my hero because he could design anything and make it work, and traveled all over the world solving problems,” Soderstrom says. “That’s what I’ve tried to emulate.”

 While growing up, Soderstrom baled hay, trimmed trees and picked apples and peaches at local farms. He graduated from Hope College, a Christian liberal arts school in Holland, Mich., in 1976 with an undergraduate degree in psychology.

 “Originally I thought I would be was a minister.” Soderstrom says. “God was calling me. He’s still there, at the center of my life, but had a different plan for me and how I was going to serve.”

 Soderstrom went to graduate school at Northwestern, where he studied operations research and focused on the management of innovation and productivity. He earned a Ph.D. in 1980, the same year the Bayh-Dole Act was enacted, allowing universities and small businesses to own inventions created using federal funding and to commercialize those inventions.

 “That’s what opened the floodgates,” says Soderstrom, who had spent a semester at Oak Ridge National Laboratory in Tennessee and was hired there following graduation.

 “I started with social impact analysis — how you define the impact of technology on society,” he explains. “It was exactly the same stuff  I’d been doing at Northwestern but funded by the Department of Energy. One of the programs, an energy-related inventions program, gave small grants to inventors for proof of principle and proof of prototype, to try to commercial them and see what worked and what didn’t.”

 He later became director of technology licensing and director of program development at Oak Ridge, which was operated by Union Carbide until 1984, when Martin Marietta Energy Systems took over.

 In the mid-1990s, Martin Marietta merged with Lockheed Corp.

 “I was starting to feel restless and antsy,” Soderstrom says. “Then the phone rang and there was a recruiter asking about the tech-transfer program at Yale.”

 His first reaction was lukewarm. But he changed his mind after meeting Gregory Gardiner, who then headed OCR, which had opened in 1982 with one person and few resources.

 The situation radically changed, Soderstrom says, when Richard C. Levin became Yale president in 1993.

 “What they wanted to do was transformative,” he says. “They really wanted to leverage the intellectual capital, to transform it and to change the world.

 “Rick also wanted to use the office to build the economy of New Haven,” Soderstrom adds. “Who wouldn’t want to do that?”

 He joined the office in 1996.

 “Greg and I set ourselves a goal of six ideas that could be funded,” Soderstrom recalls. “Of those, three got financed. One became Molecular Staging, another Qiagen, and the third polyGenomics. Each one raised around $5 million in Series A funding, and it got to a point where we had the money. ‘What are we going to do with these things?’ One of the conditions was we had to do them in New Haven.”

 Finding suitable real estate, however, was not Soderstrom’s forte.

 It was familiar territory for Bruce Alexander, then a Yale alumnus working with Levin on economic-development issues. Soon he and Soderstrom were collaborating.

 “When I first came to New Haven, a company, Gene Logic, was going to Gaitherburg, Md. and taking jobs,” says Alexander, now Yale’s vice president for New Haven and state affairs and campus development. “Jon and I figured out there was no wet lab space available in New Haven. The two of us worked together to get Winstanley [Enterprises] involved. They were in Connecticut and when they expressed some interest in 300 George Street [the former SNET headquarters]. The university agreed to take about 50,000 square feet [ten percent of the building’s total] in order to provide them with some cash flow if they purchased it. They also had a relationship with one of our endowment managers. That gave the developer some comfort.”

 

In 2000 Winstanley acquired 300 George from Matthews Ventures for $27.5 million and retrofitted it for bioscience use.

 

“Molecular Staging became the first biotech tenant, closely followed by a bunch of others,” Soderstrom says.

 

Winstanley went on to manage a lab and office building at 25 Science Park and renovate part of the former Winchester firearms building for Higher One, a financial services company for colleges and universities founded by Yale students. The developer currently is working on plans for 100 College Street, a new 400,000-square-foot mixed-use building to which Alexion Pharmaceuticals will relocate. The building is a centerpiece of the Downtown Crossing project, which aims to convert part of Route 34 into an urban boulevard.

 

“I think with Downtown Crossing and Alexion coming back into town [the company started at 25 Science Park before moving to Cheshire], it’s going to spark a whole lot of stuff,” Soderstrom says. “We’ve got a bunch of companies that are positioned to transform New Haven into a biotech hub. Venture capital funding is just really hard right now, but we’re exploring new financial approaches that are project-based, instead of doing companies.

 

“We’re never going to be that big,” he allows. “We never aspired to be the new Cambridge.”

 

Alexander calls Soderstrom “a great colleague with respect to efforts to partner with and strengthen New Haven.

 

“In the university community he is regarded as absolutely tops in his field,” Alexander says. “He’s also very civic-minded.”

 In 1990, President George H.W. Bush honored Soderstrom as the 87th “Point of Light” for his volunteer work building and rehabilitating low-income housing in Tennessee. He had been organizing churches in Appalachia to address problems of the poor. Aid to Distressed Families of Appalachian Counties [ADFAC] grew out of the effort, and Soderstrom was board president in its early years.

 “I think the most important thing about Jon is what you see is what you get,” says Mike Sherman, a serial entrepreneur and partner at Elm Street Ventures who started five companies based on Yale research and who has known Soderstrom for more than two decades. “He’s a very down-to-earth individual, trustworthy, has a lot of integrity and he is experienced enough and good enough at his job that he knows how to make things happen.

 “One of the interesting things is that what Jon and his predecessor Greg Gardiner did, collectively, was to create a real spirit of entrepreneurship among Yale faculty,” Sherman adds. “When I started in this game, the pharmaceutical industry was a dirty word to a lot of academic investigators, and it was very difficult to get academics engaged. What Jon and Greg did, among others at Harvard and MIT, was helped the faculties to appreciate, not necessarily the financial aspects of developing their discoveries, but how important they could be at helping their discoveries be translated to real-life applications to help real people. That’s one of the reasons why Yale was always a good place to go to find technology. The academic personalities were really enthusiastic.”

 Sherman describes his relationship with Soderstrom as “more of a partnership” than mere licensee/licensor.

 “And that’s one of the things that makes Yale’s technology-transfer [office] stand out,” Sherman says. “They really do look it at as a cooperative venture to try to make the technologies successful. When you set up a company, you need to work out a business plan to translate something that’s done at the bench level in a commercial mode. You need to have to the scientists, and Jon is good at facilitating that.

 

“And then, of course, there’s the onerous task of raising money,” continues Sherman. “Jon was always helpful putting me in touch with investors. I would run companies for a time, then move on and find another opportunity. He often sat on the board of these companies, was helpful in finding permanent members and in a number of ways of providing extra benefits, other than just someone to look to as a source of acquiring rights to intellectual property.”

 Soderstrom “is widely recognized by his peers to be a thought leader in the technology space,” says Todd Sherer, director of technology transfer at Emory University and president of the Association of University Technology Managers.

 “He’s broadly regarded as an expert in the business and has always been viewed as being more progressive in the ways to think about tech transfer and the laws and issues that direct it.”

 Sherer also says Soderstrom is “one of the few experts in the country, and probably the world, people will turn to [for advice].”

 Soderstrom also is a leader in fostering new sources of innovation.

 In 2007, he became instrumental in founding the Yale Entrepreneurial Institute [YEI] after noticing Yale students were moving elsewhere to start new companies.

 “We’re trying to build an entrepreneurial ecosystem around New Haven,” Soderstrom says. “That’s what Greg Gardiner and I talked about in 1996.”

 Recently some eight percent of new Yale ventures were in the life sciences. “Nowadays, because of the students, we’re starting to see things growing up in other areas, particularly clean technology and computer sciences,” Soderstrom says. “I suspect that the students will always be a more diverse portfolio of opportunities than research.”

 Soderstrom credits Yale President Levin with setting the stage for the university’s entrepreneurial growth. “It all started at the very top with Rick. He has never wavered in his support, and has been one of the biggest cheerleaders.”

 Soderstrom expects the support to continue and “grow even further” under Yale’s incoming president, Peter Salovey.

 “The stronger New Haven is, the easier it is for us to retain the brightest and best faculty and students,” he says. “And the stronger Yale is the more opportunities we have to build the economy. It’s a very virtuous cycle.”

 

 In 1905 St. Vincent’s was founded by the Daughters of Charity — which has remained its watchword ever since

 

St. Vincent’s Medical Center’s mission to improve its hospital safety undertaken a few yeas ago is an illustrative indicator of the kind of service-oriented management style in which it drapes itself. For precedent, the hospital consulted the rigorously precise nuclear power industry.

 “Health care needs to learn some lessons from other industries that have significantly improved safety” says medical center CEO Susan Davis. When Davis arrived at the Bridgeport hospital ten years ago, one of the primary attractions for her was the dedication to providing service to indigent populations while continuing to strive for improvement.

 “What was great was the hospital’s commitment and incredible caring for the poor and vulnerable,” says Davis. “There were opportunities I saw to improve the patient experience, and strengthen safety and quality of care.”

 That stress on compassionate and quality patient attention is what has earned St. Vincent’s a solid reputation as a leader in health care. Consumer Reports has recognized it as being among the top three Connecticut hospitals for safety, Professional Research Consultants named it a National Excellence in Healthcare GOLD Award recipient in 2010, and in 2012 the Connecticut Hospital Association gave the center its John D. Thompson Award for safety, among other accolades.

 St. Vincent’s is a member of Ascension Health, the country’s most expansive Catholic non-profit health-care system. It opened in 1905 after the Daughters of Charity, a women’s religious group, conducted a needs-assessment.

 With 473 beds in its Bridgeport hospital and 76 beds at a Westport inpatient psychiatric facility, St. Vincent’s also maintains specialty and satellite offerings that include urgent care/walk-in centers. behavioral health services, specialty needs services, St. Vincent’s College, the Michael J. Daly Emergency Department and the new Elizabeth M. Pfriem Swim Center for Cancer Care.

 An exciting development for administrators is the medical center’s partnership with Quinnipiac University. Last year the center was named primary clinical partner with Quinnipiac’s new Frank H. Netter MD School of Medicine, which will matriculate its inaugural class this September.

 “That’s something I personally spearheaded,” says St. Vincent President Stuart Marcus, MD. “Quinnipiac chose us as their primary teaching hospital. Having medical students here will allow us to expand our community focus. There’s nothing more important than training tomorrow’s physicians.”

 “That’s really exciting, to think that we’ll have a role in training medical students,” adds Davis. “The focus with Quinnipiac is really primary care.”

 The center is determined to keep tabs on its quality of care. To help do this, a Patient & Family Advisory Board was established in 2007. The group is charged with ensuring that care is focused on patients and their families, that there’s open communication between patients and staff about issues and concerns, maintaining an atmosphere of respect and building patient satisfaction, and strengthening community ties, among other responsibilities.

 General governance of care is guided by the medical center’s adherence to the National Council of Catholic Bishops’ Ethical and Religious Directives for Catholic Health Care Services guidelines. In its mission statement the center stresses its commitment to “the healing ministry of Jesus.” It aims to “provide quality, holistic care to all faiths with special concerns for those who are poor, vulnerable and underserved.”

 That was a major draw for Marcus when he considered joining the St. Vincent’s staff.

 

“One of the reasons I came to St. Vincent’s is the community focus regardless of the [patient’s] ability to pay,” he says. “The mission drives the strategy and the operations and the culture at the hospital.

 “Each person is a person. Bridgeport is the largest city in Connecticut and the poorest city in Connecticut. It’s a very diverse community,” says Marcus, who admires “St. Vincent’s ability to treat all patients along the spectrum of that diversity.”

 Marcus holds a unique administrative perspective. Like Davis — a registered nurse — Marcus, a physician, brings a practitioner’s viewpoint to medical center decision-making.

 “I came here in 2006 because of the cancer center,” Marcus says. “Another draw here is the holistic care,” he adds, citing the Swim Across the Sound fundraiser as particularly impacting.

 “It’s an example of how St. Vincent’s offers holistic care — mind, body and spirit. Therapeutic massage, yoga, aquatherapy, all are offered because of funds raised by the Swim.”

 Following in line with that first needs assessment by the Daughters of Charity, St. Vincent’s continues to gauge community needs through regular surveys.

 “We look at some of the most pressing needs in the community and put services in place to meet the needs,” says Marcus. Most urgent maladies have included diabetes, heart disease, cancer and asthma.

 A high level of breast cancer, as well as disparities among minority patients, prompted the health center to augment its preventive-care offerings. A mobile mammography screening, for example, increases screening access for underserved populations, according to Marcus.

 Community assessments sometimes uncover surprises. Marcus says he underestimated the behavioral needs of the community until they were brought to light through analyzed surveys.

 After that, says Marcus, “We certainly put more resources into place.” For example, “We opened up a separate behavioral health section in our emergency department. That was very difficult because behavioral health patients require different types of attention — a different skill set to help them.”

 Being able to measure success tangibly is one of the rewarding aspects of being part of St. Vincent’s administration, notes Davis. Take, for example, those safety improvements. In situations where so much can happen and so many variable are involved, even incremental changes can be crucial.

 “I wanted to change the notion that it was given that a patient on a ventilator gets pneumonia” — a not uncommon development in hospitals. “In three and a half years,” says Davis, “we haven’t had a patient on a ventilator get pneumonia.

 “There’s something called birth trauma [mechanical injury during the birth process] that happens to babies,” Davis adds. She proudly notes, “We haven’t had a birth trauma in over four and a half years.”

 

 Yale’s Mary Tinetti has devised an innovative, holistic approach to fighting senior fells

 

 

It’s a fact of life: As people get older, gravity starts to become dangerous. Falling is associated with many health threats — broken bones, damaged joints, sometimes even death for the elderly. Falling may be common, but according to one Yale Researcher, common doesn’t mean acceptable.

Mary Tinetti is Yale’s Gladys Phillips Crofoot Professor of Medicine in Geriatrics, Professor of Epidemiology in Chronic Diseases and Investigative Medicine. She’s also section chief in geriatrics.

In her 26 years as a physician, there was a sense from the elderly population and other physicians that little or nothing could be done to prevent falls.

“It was inevitable,” Tinetti says. “It was just something that happened when people got older. "

Over the past two decades, Tinetti and her co-investigators at Yale New Haven have identified that although falling is common and is associated with a lot of bad outcomes, seniors who are most at risk for having a fall are in many cases identifiable.

“By identifying the risk factors or the problems that they have that put them at risk for falling, we actually can institute treatment to decrease that risk of falling,” she says. After that, the next step is to get the information out to doctors and incorporated into the care of at-risk patients.

“We want to decrease that risk, and then get that treatment incorporated into clinical practice,” Tinetti says. The fruits of her labor are being practiced not just in greater New Haven, but across the country now.

Mark Garilli, interim CEO at New Haven’s Tower One assisted living community, calls Tinetti’s work invaluable to his elderly population.

“Our goal is to keep folks living independently longer,” he says. “They come here, they have the key to their own apartment, they have their own kitchen and our goal is to keep them living healthy, safely and longer independently.”

Fall prevention receives significant attention at Tower One/Tower East.

“Environment plays a big role in that, in terms of how their space is arranged. They need to have clear paths from point A to point B,” Garilli says.

At a recent presentation at Tower One, Tinetti spoke about a person’s five senses, and how human beings take advantage of those.

“As people age, those senses can dull, so we need to look to our stronger senses with our wayfinding,” Garilli says. For example, those who can’t see so well can rely on the sense of feel to navigate from one spot to another.

 

“We look forward to hearing more from Mary, and more about what she can offer our residents above and beyond our own wellness approach,” says Garilli. “Falls are huge here, even though we do everything we can to prevent them.”

“The most important thing is to become more proactive, take away the obstacles that create falls in our own environment, but it’s also important to continue to educate our residents — and Mary plays a big role in that,” Garilli adds.

“As our residents’ senses and bodies change, they need to learn to adapt to better prevent the falls,” he says.

That’s not always the easiest thing to do with an aging person.

“We think that one of the biggest things about the education is convincing folks to accept that their body is changing and recognize that they are changing,” says Garilli. “They should understand what the serious risks from a fall entail. It could mean going to rehabilitation and not coming back to live independently.”

Most of the fall risk that older people see comes from muscle weakness, bone weakness from osteoporosis, cognitive impairment from dementia, postural blood pressure (a sudden drop in pressure when one stands up), tripping hazards in the environment and medications.

What is unique and different about Tinetti’s approach is that in medicine, researchers often identify one disease and then a treatment. She looked at it differently, looking at all of the different problems and different interventions.

“Some of it older people can do themselves,” she explains. “They can keep their environment safer. And for some, it is working with a physical therapist to improve their balance and gait and strength. For others, it’s using the correct walking device.”

She says that medications used to treat other illnesses are often to blame for unsteady footing and falling.

“Medications can have good effects and bad effects,” Tinetti allows. “Physicians prescribe individual drugs for the good effects, but what happens is we wind up with many bad effects, and only some good effects.”

She works with physicians to prescribe medications not just on one disease, but what’s best for the overall wellness of the patient.

Tinetti’s team also works with nurses in home care to work with older adults to make their homes safer, to check their blood pressure not just sitting, but also lying and standing.

Tinetti’s research was undertaken through a clinical trial that was so successful it led to funding from the Donahue Foundation, a Connecticut foundation that helped her implement her findings working with physicians, home-care agencies and physical therapists in the Hartford area.

Fellow researcher Dorothy Baker also received funding from the state legislature to disseminate the information throughout Connecticut. In 2009, Tinetti also received a grant from the MacArthur Foundation for her research at Yale.

Tinetti’s work also involves research about multiple chronic conditions, since in medical research, doctors typically look at an individual disease and diagnoses.

“Since older adults typically don’t have one disease, we’re just beginning to understand that if you really want to provide the most effective and appropriate health care for older adults with multiple diseases, we have to start looking at the benefits and harms of treatments in patients with multiple chronic diseases,” she says.

Tinetti’s team has identified the frequency of multiple chronic conditions, identified common combinations of diseases, and identified situations where, treatment for, for example, heart failure might make their lung disease worse, or treatment for dementia might exacerbate the patient’s urinary incontinence.

“We’re looking at those combinations of diseases, with the idea that eventually we’ll help doctors and patients make the most effective decisions for people with multiple diseases,” she says.

Tinetti has a profound curiosity when it comes to the aged. She says it comes from her early days as a physician a quarter-century ago. Training to become an internist, most of her patients were older and she became aware that what she had learned in medical school and residency training didn’t always seem to apply well to an older patient population.

“If we gave them the state-of-the-art treatment, we often made them worse,” she says. “We were often focused on their disease when the patients were focused on their functions.”

Following her training, Tinetti joined the faculty at Yale and began to research and find the answers to the questions that were most important to older patients.

“I used my observations in caring for patients to perform the research that I do,” she says.

She hopes that research is preventing falls and enriching the lives of the elderly here and around the world.

 

 Veteran insurance exec Counihan heads state’s health-insurance ‘exchange’

 

 

 

Last June Kevin J. Counihan was appointed by Gov. Dannel P. Malloy to head Connecticut’s Health Insurance Exchange. Creating health exchanges in each state is an essential part of the federal government’s Patient Protection & Affordable Care Act (Obamacare). Counihan comes to Connecticut from Massachusetts, where he was chief marketing officer for that state’s Health Insurance Connector Authority, the health-care exchange developed as part of the Bay State’s reform law. He has also been senior vice president of sales and marketing for Tufts Health Plan and a regional vice president for Cigna Corp. Counihan holds an undergraduate degree from the University of Michigan and an MBA from Northwestern University’s Kellogg School of Management.

 

 

 

 

How did you get from the private to the public sector?

 

[Massachusetts became] the first state in the country to adopt a mandated health-insurance plan requirement. Like auto insurance, or seat belt laws, helmet laws, it required all residents 18 and above to have health insurance. The [law] created an insurance exchange that served as the foundation for Obamacare and the Affordable Care Act.

 

 

 

When did you start at CHICA and what was the job?

 

In 2006 the executive director was named; I was recruited that summer. In these kinds of startups these jobs get very amorphous. My job was to do the marketing research, product design, create the metal tiers — gold, silver, bronze — to enroll members, to help create the Web enrollment portal, to work on the call center. It’s one of those jobs that you start out doing a little bit of everything.

 

 

 

What is a health exchange?

 

Essentially an online insurance store. It’s a means for individuals and small businesses to buy health insurance in an easier, simpler and more transparent way. The idea is to help garner more value for enrollees through more competition, and to help promote new entrances into markets. They’re a pro-competition, free-market means to buy health insurance. We have five major health plans in [Connecticut]; we’re going to have a sixth one coming in next year and maybe a seventh. In Massachusetts about four plans have about 96 percent of the market share.

 

 

 

What is the role health exchanges play? Is it just for competition, and if there was more competition would we still need it?

 

The exchange by law has to serve all features required by the law, but it’s an online marketplace. It’s intended to make it easier for people to shop for health insurance — make it simpler to buy, simpler to compare plans, simpler to make decisions, and in the case of federal law, make it easier for them to understand if they’re eligible for federal subsidies.

 

 

 

Have a lot of companies entered the exchange in Massachusetts?

 

They don’t at this point; they have roughly 1,000 to 2,000 small-business members in the exchange. The plan being offered is not particularly distinguished from other plans offered by the [private] health plans. Small-business programs offered through the federal program are going to be very similar to CBIA in Connecticut, meaning that it’s a defined-contribution model. An employer picks a benchmark plan — it could be ConnectiCare, HMO 35, Anthem and for example is contributing 80 percent of the cost in the silver tier. Then the employee can either accept that plan or they can take the money provided by the employer for the ConnectiCare plan and buy Anthem or Aetna or United or any other plan. In Massachusetts that’s not the plan offered for small business. For small business there are several different HMOs but they’re offered on a sole-source basis, which means the employer would take ConnectiCare or HMO 35 and the employees can either take it or leave it. It didn’t really differentiate itself, and I think that’s why there’s low membership.

 

 

 

What size companies may enter the exchange, and what size companies are affected by Obamacare?

 

The feds give states the option of defining the employee small-group size as either one to 50 [employees] or one to 150. Many states including Connecticut picked one to 50 initially, but in 2017 the law requires that that automatically gets extended to one to 100.

 

 

 

What percentage of people in Massachusetts have chosen to purchase insurance through the exchange?

 

It’s got about 225,000 to 230,000 enrollees. In a state of 6.5 million that’s three percent [of insured people] in the exchange. Massachusetts started with ten percent uninsured; it has decreased from ten percent to two percent [uninsured], but not all [newly insured] are going through the exchange. It’s really for individuals.

 

 

 

In order to be subsidized will you have to go through the exchange?

 

The subsidies are for individuals only, but small businesses can receive tax credits. But neither are available outside the exchange.

 

 

 

If a small business enters the exchange, do the employees have access to subsidy?

 

They could. The way it works is through the ‘affordability’ provision. If the amount of money paid by the employee for their share of the [health insurance] premium is more than 9.5 percent of their income, they have the ability to opt out of the employer plan and go directly to the exchange.

 

 

 

So a low-income employee can go into the exchange and get a subsidy?

 

Yes. But when that happens the employer pays a penalty of $2,000 per employee. There’s a penalty for employers offering plans that employees can’t afford or they’re not being paid enough in salary to afford coverage. If the employer for example is going to pay at least 50 percent of the cost of the coverage then the remaining percentage which is paid by the employee becomes part of the [formula to determine if the insurance is still] ‘unaffordable.’

 

 

 

So companies that employ low-income workers will have a pretty major burden with those penalties?

 

If you have firms with that type of salary level, those firms are often going to be eligible for tax credits to the employer to make the coverage more affordable. [The Obamacare legislation] tried to contemplate situations where employers who may not be offering coverage right now — beauty salons, nail salons, sandwich shops, etc. — might be able to get some significant tax credits, like 50 percent, in order to offer coverage. But you do need to be in the exchange for that.

 

 

 

Wouldn’t that make for a lot of companies moving into the exchange for subsidies and tax credits?

 

I don’t think so. I think there’s going to be a market for it, but it’s going to be a niche. I don’t think every employer wants to move to a defined-contribution model. I don’t think every employer wants to move to a CBIA type of product.

 

 

 

What are the income levels to qualify for a subsidy?

 

The subsidies are available up to 400 percent of the Federal Poverty Level (FPL). For a family of four right now that’s $92,000.

 

 

 

Is that the same subsidy as Mississippi, where the median income is much lower?

 

Yes. [The federal government doesn’t] regionally adjust things like Social Security, Medicare or Medicaid. They make national laws with national formulas. It certainly benefits some states more than others; that’s true of the tax credits for small business. You can argue it’s a weakness [of the legislation].

 

 

 

How is age banding and pricing handled?

 

What health carriers typically do is they have something called rating slopes, and that is that their rates don’t go up consistently. So they can go up very slowly, and then at [age] 40 they can go higher. The [new] law does away with slopes and moves rates up consistently by year [of age of insured person]. Instead of five-year age brackets it goes up by year. It’ll just continually go up.

 

 

 

But it is still an aged-based pricing plan?

 

There’s obviously a real relationship between age and illness: The older we get the more likely we are to incur medical costs. But there is an age compression ratio. Currently in Connecticut it is six to one — the highest that an older person can pay is six times what a younger person can pay [in insurance premiums]. So if a person at 20 years old is being charged $100, then the highest an older person can be charged is $600. The [Affordable Care Act] changes that to three to one, so it’s going to be cheaper for older people but more expensive for younger.

 

 

 

What are the bronze, silver and gold tiers you referred to?

 

These are actuarial values to help people determine the amount of coverage that a plan covers. A bronze plan would have a 60-percent actuarial value, which means the insurance company will pay for 60 percent of the costs on average and the individual 40 percent. The silver plan has a 70 percent actuarial value, so he insurance company pays 70 percent and the individual pays 30. Gold is 80-20 and platinum is 90-10.

 

 

 

This seems like poor people get this low-end plan anyway. How ‘progressive’ is that?

 

The poorest people are going to be in Medicaid. You have to have people at 138 percent and above of the FPL before this gold, silver, bronze stuff comes into play. In the exchange, anyone who’s interested in subsidies or shopping there will go into the exchange, then the system will determine if they’re eligible for Medicaid or the tax subsidies, or unsubsidized commercial insurance.

 

 

 

In the commercial marketplace, where do most plans fall in the bronze/silver/gold matrix?

 

Most individuals are in the bronze level. Most small businesses are in the bronze-to-silver [coverage range] and most large firms are in the silver-to-gold level.

 

 

 

There are a lot of non-profit health insurance companies. What advantage does an exchange have over these non-profits?

 

Exchanges are distribution arms, not insurance companies. It’s not about being for-profit or not-for-profit; [the exchange] is there to distribute product that meet the criteria established by the law and by the state. The [Obamacare-mandated] Essential Health Benefits have criteria in the law: patient hospitalization, pharmacy, prescription drugs, X-ray laboratory, mental health, drug abuse.

 

 

 

Who will determine the benefits that have to be covered in the exchange and in health plans generally?

 

Right now all states determine what’s in their Essential Benefits plan until 2016, when [the federal Department of] Health & Human Services takes it over. I’m more concerned about the impact it’s going to have on such things as [benefit] mandates. If the feds establish Essential Health Benefits, they’re going to include a certain amount of what every state may consider mandated coverage. Anything above what the feds require will have to be paid for by the state. This can be extremely expensive for states.

 

 

 

Massachusetts and Connecticut have had among the richest benefits and most advanced health-care infrastructure in the country. Is there a danger now that we’ll see a leveling out with poorer states?

 

The whole purpose of Essential Benefits is to level out — to make Mississippi more like Connecticut and Massachusetts. Many states with very rich mandates – Connecticut, New York, Massachusetts, California, Washington — may have to pay for them. That’s going to be a very different discussion at the legislative level.

 

 

 

Will the state cover ‘medical marijuana’?

 

The benefits in the exchange have to cover all state mandates. So anything — whether it’s in-vitro fertilization, autism and such — all have to be included as plans offered in the exchange. The states will be at their discretion if they want to cover above what the feds require. They [state governments] just have to pay for it. The changes in the law impact all insurance plans, not just the ones sold in the exchange.

 

 

 

So if Connecticut wanted to keep coverage for something like autism but it didn’t pass national muster, then all plans in the state will have to cover autism and the state of Connecticut will have to pay for it?

 

 

 

The federal government in 2016 will establish a minimum standard of coverage. Any state that wants to add richer coverage to that will not have that reimbursed by the feds in the subsidized payment. The states would have to add to the cost of that in the subsidy. Only for people who are being subsidized.

 

 

 

 

 

When does the exchange take effect?

 

Open enrollment [begins] in October for [coverage commencing] January 1, 2014. The open enrollment runs through March 31 [2014]. You can only enroll during a specific period of time. The first time will be a six-month period, and then going forward it will be three months from October 1 to December 31. So if you don’t get in you have to wait until next year. The reason for it is that if people are allowed to enroll at any time, then they’re also going to wait until they get sick to enroll. The penalty for the first year is $95 — not much of a penalty. The penalty in Massachusetts is now about $1,000. My experience is that until [the penalty] gets to that level it’s really not that meaningful.

 

 

 

How many people are uninsured in Connecticut?

 

[Currently] 9.6 percent are uninsured. I think we can reach the Massachusetts [98 percent coverage] number, but it’s going to take several years, as it did in Massachusetts. One of the challenges is that people expect too much of this thing. Some thought that with the exchange, costs were going to go down — things will be 20 percent cheaper, that our uninsured level will drop to two percent. None of those things are true.

 

 

 

Isn’t it typically true that more people buying any product usually drives the price up?

 

If you get more people going into some type of things the price could drop. But health insurance is different — health economics runs counter to normal economics, which is one of the reasons it’s so expensive. We’re expecting to get 120,000 to 150,000 people in the exchange. Medicaid will probably expand by about 75,000 to another 100,000. Between Medicaid and the exchange, we’ll see somewhere in the order of about 200,000 people newly insured — about two thirds of the [presently] uninsured. The laws reimburse at 100 percent the increase in Medicaid for the first few years. But after those first couple years, [cost of coverage] does revert back to the state on a detrimental basis.

 

 

 

What would you like business people to know?

 

The  exchange is going to be up and running in October. We have a website: ct.gov/hix. It has a lot of information for small businesses to understand what their opportunities and obligations are. They should go to that website, speak to their [insurance] broker, speak to our staff and help them understand what’s in the law. You can go through a broker or you can buy direct, but it will cost the same either way.

 

 ’One of the challenges is that people expect too much of this thing. Some thought that with the exchange, costs were going to go down — things will be 20 percent cheaper, that our uninsured level will drop to two percent. None of those things are true.’

 

 Paid sick leave, medical marijuana and First Five top state business headlines

 

 

Several significant developments impacted employment law and other job-related issues this year. Connecticut companies became more liable for alleged sexual harassment incidents. Gov. Dannel P. Malloy’s “First Five” initiative continued to subsidize big companies that promised large-scale job creation. And in one of the more controversial changes, state lawmakers approved the use of medical marijuana, throwing companies into a quandary regarding how to interpret and implement the new law.

“This legislation is about accomplishing one objective: providing relief to those with severe medical illnesses,” said Malloy shortly before signing the bill into law. At that time he also acknowledged lingering skepticism.

“I understand many of the concerns raised by opponents,” Malloy said in a release. “We don’t want Connecticut to follow the path pursued by some other states, which essentially would legalize marijuana for anyone willing to find the right doctor and get the right prescription. In my opinion, such efforts run counter to federal law. Under this proposal, however, the [state’s] Department of Consumer Protection will be able to carefully regulate and monitor the medicinal use of this drug in order to avoid the problems encountered in some other states.”

Although medical marijuana in Connecticut is supposed to be used for life-threatening and debilitating illnesses, it allows for workforce participation for those using it.

While some business leaders were at a loss for words about how they would address the law, others spoke out against it.

“The Connecticut State Medical Society continues to have concern about smoking marijuana for medicinal purposes,” stated Audrey Honig Geragosian, CSMS director of communications. “There is inadequate scientific evidence to suggest its benefits outweigh either concern for patient and public safety or the long-term health risks posed by ingestion through smoking.”

CSMS President Michael M. Krinsky, MD lamented the lack of guidelines. “We have no guidance whatsoever,” he said, adding that physicians should “wait and see how things are written” before making changes to their regular health-care procedures.

With the law’s passage, Connecticut became the 17th state to approve the use of marijuana for medical use.

 

Another law, one that became effective the first of the year, affects employers directly in their pocketbooks. That was the state mandate requiring many businesses to provide workers with paid sick leave.

While many companies had already provided paid sick leave, it hadn’t been mandated by state law. Now, for service-sector jobs in particular, it is. The law specifically includes service workers paid hourly wages such as food-service workers, registered nurses, LPNs, home health aides, dental hygienists, administrative assistants, waitstaff, barbers and hairdressers, and fast food workers, among others. However, small businesses with fewer than 50 employees are exempt, as are a number of categories of manufacturers.

Malloy called the law “good public policy” and said in a statement that it would release service workers from the burden of having to work when sick.

“Without paid sick leave, frontline service workers — people who serve us food, who care for our children, and who work in hospitals, for example — are forced to go to work sick to keep their jobs,” Malloy said in a statement prior to signing the bill into law last year. “That’s not a choice I’m comfortable having people make under my tenure, and I’m proud to sign this bill when it comes to my desk.”

A court decision also could have a palpable impact on business in the state, causing them to become more circumspect in how they deal with alleged workplace sexual harassment.

The state Supreme Court ruled in May that Birken Manufacturing Co. of Bloomfield must compensate a former employee more than $90,000 for failing to address and halt on-the-job, homophobic sexual harassment. The former employee claimed that he suffered mentally and physically because of ongoing, same-sex harassment because of his sexual orientation. He said he reported the situation to supervisors, but the harassment continued. The court sided with the complainant and determined that Birken fostered a hostile work environment due to its inaction.

“You’ve got to have a clear and unambiguous policy to specify that you forbid harassment,” explains Emanuel Psarakis, a Quinnipiac University School of Law faculty member, in assessing consequences of the decision. “You should have a policy and have a procedure for people making complaints. If you find harassment, you must engage in prompt, effective remedial action.”

 

The year also saw broadened legal activity that throws into question the benefit to businesses of intern labor. Last year two former Fox Searchlight Pictures interns — both graduates of Wesleyan University in Middletown — filed suit against the company after working on the Academy Award-winning film Black Swan. They claim that they deserved pay for the menial tasks they performed, which benefited the company.

Since filing the original lawsuit, the pair sought to expand it to include any and all interns who took part in the internship program at Fox Entertainment Group.

Another high-profile lawsuit makes similar claims that interns should be paid for the work they do. This one, filed in March, was against talk show host Charlie Rose and his production company. Coincidentally the plaintiff, like those in the Fox lawsuit, is a Wesleyan graduate.

And, in January, a former intern with Harper’s Bazaar magazine filed suit against its parent company, the Hearst Corp., arguing that she deserved pay for her work.

Many consider the law antithetical to the reasons businesses — especially small businesses — hire unpaid interns in the first place: to help with tasks they cannot afford to hire someone to do. According to the U.S. Department of Labor’s guidelines for internship programs under the Fair Labor Standards Act, the intern must benefit from an internship. What’s more, the work given should be commensurate with training he/she would get in an educational setting, and it should not be of immediate benefit to the employer.

Jill Ferrall, assistant dean for career development at Quinnipiac University’s School of Business, has a suggestion for companies considering hiring unpaid interns — but it’s a solution many employers might not want to hear.

“I always encourage employers to provide some sort of pay, even if its minimum wage,” says Ferrall. She added the ultimately it could benefit the employer by enhancing the quality of an intern’s work.

“Human nature is that if you’re getting paid, even if it’s minimum wage, you’ve got a little more drive,” says Ferrall, “and the student makes [the internship] much more of a commitment.”

 

Permanent, long-term jobs were the focus of the governor’s “First Five” initiative, which accelerated this year. The latest count is nine companies that have taken advantage of the program through its original or extended version.

Funded through the state’s Department of Economic & Community Development (DECD), First Five is a Malloy administration creation that provides financial incentives to selected companies that promise to create at least 200 new full-time jobs in Connecticut during the course of two years, or 200 new jobs within five years and also invest $25 million in the state.

In October Malloy announced that cable operator Charter Communications Inc. would be the latest addition to the First Five group. The Fortune 500 company says plans to invest in excess of $10 million in the state and bring 200 jobs to the region, according to a press release from the governor’s office. In exchange, Charter will receive a $6.5 million loan, repayable over ten years at 2.0 percent. A deferral of principal payments will be effect for three years. The funds are expected to be used for tenant upgrades and to buy office equipment and furnishings at Charter’s 70,000-square-foot facility at 400 Atlantic Street in Stamford.

“Connecticut is competing at every opportunity to attract and retain good-paying jobs with good benefits, and strengthen our position in key industry sectors in the process,” said Malloy. “Charter’s decision to make Stamford its headquarters serves both of these objectives.

“Connecticut is quickly becoming a place where growth industries can thrive,” Malloy added. “Whether it’s bioscience, digital media or another emerging sector of the economy, the message that Connecticut is open for business is clearly taking hold."

Other businesses participating in the First Five initiative are Cigna, establishing its headquarters in Bloomfield; ESPN, expanding its sports media complex in Bristol; NBC Sports Group, NBC Universal, Stamford; Alexion Pharmaceuticals, relocating its global headquarters from Cheshire to New Haven; CareCentrix, moving an expanded headquarters to Hartford; Sustainable Building Systems, establishing itself in North Haven; Deloitte, expanding operations in Stamford, Hartford and Wilton; and Bridgewater Associates, relocating to Stamford.

 

 WALLINGFORD — The federal government has notified a recently formed non-profit that it will receive funding to apply for licensing as a health insurer in order to create a new, consumer-oriented health benefit plan in Connecticut starting in late 2013.

 

 

 

The award from the U.S. Department of Health & Human Services comes nine months after the creation of HealthyCT, a non-profit created by the Connecticut State Medical Society and its affiliate, CSMS-IPA, an independent practice association. The approval is accompanied by $75.8 million in federal loans to meet anticipated startup costs and reserve-fund thresholds for state licensing.

 

HealthyCT is expected to offer health-insurance products both on and off the state’s Health Insurance Exchange beginning some time next year.

 

 

 

Section 1322 of the Patient Protection & Affordable Care Act allows the creation of non-profit consumer-operated and -oriented plans (CO-OPs) to sell health insurance to the individual and small-business markets. Although HealthyCT is sponsored by physician organizations, it will be open to health-care practitioners and organizations that wish to work with HealthyCT and meet established criteria, organizers say.

 

“Physicians and consumers who believe there is a better way to provide health insurance coverage to Connecticut patients are thrilled that we have cleared this major hurdle,” said David S. Katz, MD, president of HealthyCT’s board of directors. “This affirms our conviction that taking on this challenge is the right thing to do for citizens of Connecticut.”

 

 

The CO-OP will next seek to fulfill state qualifications for a license to offer health insurance working with the state’s Department of Insurance. Contingent on that approval, HealthyCT would begin issuing insurance in next October.

 

 

 

More information about the group can be found at HealthyCT.org as well as on Facebook.

 

 BRIDGEPORT — Joseph John Tiano, MD, of Fairfield has been appointed medical director of the Cardiac Electrophysiology (EP) Laboratory at St. Vincent’s Medical Center. Tiano is an electrophysiologist specializing in non-surgical electrophysiology procedures to correct cardiac arrhythmias or irregular heart rhythms. On active staff at St. Vincent’s since 2010, Tiano has played a key role in the development of a comprehensive arrhythmia service at St. Vincent’s focusing on an innovative new treatment called “hybrid ablation” to correct atrial fibrillation (A-fib). This treatment combines both surgical and non-surgical techniques to correct complex cases of  A-fib.

Tiano recently joined the practice of Cardiology Physicians of Fairfield County, LLC, and was also appointed an assistant professor of cardiology at the Frank H. Netter MD School of Medicine at Quinnipiac University. A graduate of Franklin & Marshall College who earned his MD from Temple University School of Medicine (2003), Tiano is board-certified in internal medicine, cardiovascular medicine and electrophysiology by the American Board of Internal Medicine.

 NEW HAVEN — First Niagara was received the 2012 Corporate Partnership Award from the Visiting Nurse Association of South Central Connecticut (VNA/SCC). The award was presented to David Ring, First Niagara’s head of enterprise banking and New England region president, at the VNA/SCC’s 108th annual meeting and community awards ceremony November 14.

“We’re proud of the tangible results that our sponsorship of the VNA/SCC’s programs has had in the community, and the direct impact of each dollar on greater New Haven residents,” said Ring. “As a result of our support for the Subsidized Care Program, the VNA/SCC was able to provide over 150 home-care visits for individuals [who] wouldn’t have otherwise received necessary treatment.”

In 2011, First Niagara donated $20,000 to help the VNA/SCC continue providing care to the uninsured and underinsured in greater New Haven, and sponsored the group’s Nightingale Awards for Nursing gala with a gift of $7,500. This year First Niagara increased its philanthropic support of the VNA/SCC with a $25,000 grant.