Generate an explanation for the given claim using the provided supporting material from the paragraph. Please consider the following points while generating an output. 1) The claim will always have supporting proof in the paragraph, and the paragraph will have a clear point of view supporting the claim. 2) There can be instances where direct correlation to the claim is not available. Make use of the sentences in the paragraph to provide a corresponding output supporting the claim. 3) The explanation should be at least one and at most twelve sentences long.

Ex Input:
Paragraph: Moira O’Neill, director of the Office of the Child Advocate, said the center operated by Granite Pathways was unusual in that it was licensed by the Department of Health and Human Services but was not certified by the division that oversees child welfare. While that’s not a requirement because the Division for Children, Youth and Families didn’t directly place children at the facility, without that certification, it is unclear who had oversight over quality and safety, O’Neill said. “We have issues with the extent of oversight DCYF provides to certified agencies, but at a bare minimum, they know who’s there, they re-certify them every two years, they provide technical assistance. There’s some expectation that someone has an idea of what’s going on in the program,” she said in an interview. Republican Gov. Chris Sununu and the health department announced on Nov. 27 the state was canceling its contract with Granite Pathways, which had been operating the 36-bed facility in Manchester for just over a year. A summary report released by the department Monday said that in a span of less than two weeks, four of the 10 residents were taken to hospitals after taking drugs one of them smuggled in, a fifth took multiple doses of prescription medication in an apparent suicide attempt and a sixth drank a bottle of hand sanitizer. The remaining residents have since been transferred, and the contract officially ends Dec. 27. Some of the residents at the center were known to the child welfare agency, said O’Neill, who has been reviewing their records. “In our preliminary review, we found that there were children who were placed there who have really complicated needs, and we don’t know if that program had the capacity to serve those needs,” she said. O’Neill said she sent the Department of Health and Human Services a list of questions in late November about what the facility knew about the children, its capacity to meet their needs and how the program was supervised. As of Tuesday, she had not received answers. “If we are going to understand the circumstances that prompted seven ambulance transports, we must understand how those children came to be at the facility and what transpired in assessing and treating them,” she said. Jake Leon, spokesman for the Department of Health and Human Services, said the department agrees with O’Neill that it is important to ensure that children get the services they need. He said the department has addressed and continues to address similar questions, but responses must remain confidential to protect clients’ privacy. “DHHS monitored Granite Pathways’ compliance with its contractual obligations and is still compiling information regarding the organization’s noncompliance. There is also an ongoing investigation by DCYF that must be kept confidential,” he said in an email. Patrica Reed, state director at Granite Pathways, said the nonprofit’s leaders and board of directors were still reviewing the health department’s report. “The end of this contract does not end Granite Pathways’ commitment to its mission of supporting individuals with substance use disorders and mental illness in achieving their life goals as valued members of their communities,” she said in a statement. But the trouble at the youth treatment center has raised questions about the state’s approach to funding substance abuse treatment in general and Granite Pathways in particular. Since 2016, it has been a subsidiary of The Fedcap Group, a New York-based nonprofit that focuses on helping people overcome barriers to economic well-being through workforce development, education, occupational health and economic development. With close to $300 million in annual revenue, the parent organization has government contracts in 22 states, and its acquisitions include Easterseals programs New York, Rhode Island and parts of Texas. In New Hampshire, Granite Pathways was a year into a four-year, $15.6 million contract for the youth treatment center. According to the state expenditure register, the organization has been paid $4.1 million since 2012, including just under $900,000 in the current fiscal year. Under the hub-and-spoke system the state launched this year to connect people to opioid addiction resources, Granite Pathways was awarded $5 million in federal funding over multiple years to run the two largest hubs, in Manchester and Nashua. Contracts are approved by the five-member Executive Council, and at least one member has expressed concern about Granite Pathways in the past. In June, when the council approved a $345,000 contract related to treatment for adolescents, Councilor Andru Volinsky noted that the organization already was running the opioid response hubs and called for “continued vigilance” to ensure it could keep up with all its responsibilities. “We’ve had, in particular when trying to quickly build out our substance abuse response, a number of instances where the financial management of private nonprofits was not strong. We haven’t really had strong capacity to oversee that at DHHS,” he said in a recent interview. “My concern at the time of this Granite Pathways contract was that we were again placing what I think are state responsibilities onto a private contractor, and we still haven’t built an infrastructure to oversee those private contractors.” Volinsky, a Democrat, said he doesn’t know whether the state should build out its own capacity to respond to the substance abuse crisis, or whether it’s enough to rely on outside groups and closely monitor them. “I could legitimately understand the arguments either way,” he said. “But to almost blithely continue to invest in outside agencies without oversight doesn’t make sense.” In announcing the closing of the youth treatment center, officials said the state is taking 30 days to review all of its contracts with Granite Pathways and may take further action. The health department also has increased its oversight of substance use disorder treatment centers in the last year after one of the largest facilities closed. Those efforts have included financial audits and the appointment of a new director at the Office of Program Integrity. Claim: Child advocate sees lack of oversight at youth treatment hub.

Ex Output:
New Hampshire’s only residential treatment center for teens struggling with addiction operated with an apparent lack of oversight before it was shutdown earlier this month, the director of a state watchdog office said Tuesday.


Ex Input:
Paragraph: WellPoint, which released lower fourth-quarter results on Wednesday, said that based on age, insurance plan selection, income levels, gender and available pharmacy data, it believes it has set the right premium rates for these new customers. Insurance plans under President Barack Obama’s healthcare reform law went on sale October 1 and into effect on January 1. Initial enrollment data nationwide has shown that the first wave of people who enrolled are older people who can be more expensive to insure because they often have more health problems than young people. Shares in WellPoint rose about 3 percent, or $2.75, to $87.05 in morning trading after the comments. Competitor Aetna Inc shares rose 39 cents to $69.32 while UnitedHealth Group Inc gained 33 cents to $72.03. “There was a concern that a lot of the firms that were involved in the exchanges would be underpriced for the demographic that would find the exchanges appealing, at least over the first year,” Morningstar analyst Vishnu Lekraj said. “What they said was that they priced everything appropriately given the data they have currently, in terms of medical cost utilization,” Lekraj said. WellPoint, one of the biggest players on the exchanges, said that it was still not certain about how enrollment, which is open until March 31, would finally end up, contributing to uncertainty about its 2014 earnings. The company forecast earnings of above $8 per share in 2014, representing a likely drop from the $8.52 it earned in 2013 before special items. Analysts on average were expecting 2014 earnings to fall to $8.39 per share, according to Thomson Reuters I/B/E/S. Chief Financial Officer Wayne DeVeydt said the 2014 outlook reflects about a $100 million negative effect of changes in government policy regarding the rollout of Obamacare. Late last year as political pressure mounted around technology problems on the exchanges and the higher premium rates on new plans, the Obama administration said that older individual plans could be renewed and it increased the number of people eligible for catastrophic coverage. DeVeydt said ACA insurer fees, which are not tax deductible for insurers, would cost earnings $1.10 per share and that it would spend about $30 million on first-year exchange costs. FOURTH-QUARTER PROFIT FALLS  WellPoint said fourth quarter profit fell as consumers increased their use of medical services ahead of the cancellation of some insurance plans at the end of 2013. The company also took a charge for the recently announced sale of its contact lens business, 1-800 Contacts, to private equity firm Thomas H. Lee Partners, which caused a sharp decline in net profit. WellPoint, which sells Empire and Anthem Blue Cross Blue Shield plans, also said its costs went up as it prepared for the rollout of Obamacare, and an expected increase of 1 million new members this year. So far, about 3 million people have enrolled in exchange plans, according to the government. The Congressional Budget Office had forecast that about 7 million people would sign up for 2014 coverage. Sign-ups are lagging targets because of technology problems in the first two months after the launch of the national website HealthCare.gov that sells insurance plans in 36 states. The other 14 states run their own sites. WellPoint said it had received 500,000 applications for new individual health plans that went into effect January 1, most of them for exchange-based plans but some for plans it sells off the exchange. Income-based subsidies from the government are only available for exchange plans. It said most of these customers were new to WellPoint. WellPoint said net profit for the fourth quarter fell to $148.2 million, or 49 cents per share, from $464 million, or $1.51 per share a year earlier. Excluding costs for the sale of 1-800 Contacts and investment gains, earnings fell to 87 cents per share from $1.03 per share, which also included investment gains and acquisition costs. The quarterly earnings were in line with analyst expectations, according to Thomson Reuters I/B/E/S. The company spent 87.8 percent of its premiums brought in on medical claims, up from 87.3 percent a year ago. It said that as old individual plans were being canceled ahead of the introduction of the new 2014 insurance, customers used more medical services. Spending on medical procedures, doctor visits and hospitalizations has been at a historical low for the past several years. This has helped insurers keep these medical cost ratios down while still complying with the Affordable Care Act, which requires them to spend at least 80 percent of plan premiums on care or refund customers the difference. WellPoint said it added 145,000 members during the quarter as it picked up small business customers and new enrollees in the California Medicaid program for the poor. It had 35.7 million members at the end of 2013. Claim: WellPoint says health exchange applicants hit expectations.

Ex Output:
U.S. health insurer WellPoint Inc said on Wednesday the applicants for the new Obamacare health plans are of the age and demographics it had expected, indicating that medical costs will not soar beyond the prices it charges.


Ex Input:
Paragraph: The story does a good job of describing the costs of angiopasty compared to a stress test. The story could have discussed out of pocket costs for patients. The story could have quantified the benefit of stress testing in its ability to avoid angiography and angioplasty associated with it. The story mentions missing cases of heart disease and difficulties of performing the test in older patients as potentional harms of stress testing, but there are other harms that the story should have mentioned. The story adequately describes the design of the current study and points out some important caveats inherent in a database-based study. The story does not exagerrate the seriousness or prevalence of stable heart disease. The story quotes multiple sources. The story mentions angiography as the alternative to stress testing. The story could have done more to describe the pros and cons of angiography compared to stress testing. Clearly stress tests are available. Clearly stress testing is not a new idea. Because the story quotes multiple experts, the reader can assume the story did not rely on a press release as the sole source of information. Claim: More stress tests needed before angioplasties, study says

Ex Output:

"Clinical guidelines from the American Heart Association and other societies recommend routine non-invasive stress testing prior to percutaneous cornonary intervention (PCI, i.e., angioplasty, with or without stenting). However, according to a new study published in this week’s Journal of the American Medical Association, stress testing was used in less than half the patients who underwent PCI in 2004. Furthermore, the rates at which stress testing was performed varied depending on geography and physician characteristics in addition to patient characteristics. These findings suggest that referral to stress testing is sub-optimal and depends – at least in part – on physician prescribing patterns that are not consistent with guidelines and evidence-based medicine. This story does a laudable job of explaining the design of the current study and the relevance of the findings to patients. It does a good job of comparing the costs of stress testing and angiography. The story could have done more to describe the harms of stress testing and provide more information on the pros and cons of angiography versus stenting. The story quotes multiple experts who have differing opinions on the significance of the study’s findings. The quote from Dr Gibbons sums up the issue quite well. ""If everybody thinks they are providing good care, why is there such a difference between doctors?"""