The first thing to know is AB 39 by Jim Beall (D-San Jose) is really AB 3632.
The new bill, to be heard when the Legislature goes back to work Jan. 3, was written to replace money appropriated this year by the old bill (AB 3632), which was vetoed by Governor Schwarzenegger and his blue pencil at the end of the last session.
That’s the simple part. Explaining just what that money is for, that’s a little tougher.
Driver’s License Numbers Among Lost Records
The California Department of Public Health has never had the kind of loss of medical records that it had yesterday, according to Kevin Reilly, Chief Deputy for Policy and Programs at CDPH.
“We’ve had much smaller instances where a laptop was stolen,” Reilly said. “But nothing like this.”
A magnetic tape was mailed to the Capitol from West Covina (near Los Angeles), but when it arrived in Sacramento, it was just an empty envelope.
Dooley Hopeful, Realistic on Health Care Changes
California’s recently appointed secretary of Health and Human Services, Diana Dooley, sat down with us this week to talk about the present and future of health care in California. The full story and interview will appear Thursday in California Healthline’s Feature section.
Dooley knows this is a pivotal time in California’s history in terms of health care policy. As the first in the nation to start a health benefits exchange as mandated under the health reform law, California is poised not only to revamp its own complicated and arcane health care system, but also possibly to influence the way the rest of the nation approaches health reform.
But how all of that will play out over the next three or four years is not the only thing on the new secretary’s plate.
Integrated Care at Heart of Health Reform?
As pressure ramps up to reduce health care costs and increase quality, there is a more pressing need for physicians and hospitals to work collaboratively. That was the word from Laura Jacobs of the Camden Group, who presented the core ideas at a recent briefing sponsored by the California HealthCare Foundation, which publishes California Healthline.
“The Affordable Care Act has certainly been an accelerator for the trend we’ve seen in physician-hospital integration,” Jacobs said. “Payment reform, which is an inherent part of the ACA, is one of the things that’s driving this acceleration, and in some ways modification, of the ways physicians and hospitals are integrated.”
In the recent past, she said, physicians had independent practices, and hospitals were concerned with operating their facilities. But with the introduction of managed care, physicians banded into group practices as a way to share risk, she said. Those practices, and the HMOs they dealt with, created a different relationship with hospitals.
Putting Prime Interest in Primary Care
Kelly Pfeifer, who recently took over as the medical director for the San Francisco Health Plan, knows the problems of medical economics all too well.
“We’ve been spending lots of money for health care and not getting a lot for it,” Pfeifer said at a forum in Sacramento put on by the Center for Health Improvement. “We’ve been paying for volume, not quality, and that’s what we get.”
Pfeifer also said she knows a few solutions for medicine’s troubles. “I do have hope that we can get out of this mess,” she said. “The answer is to invest in primary care.” Pfeifer had several examples of primary care innovations that have shown promise.
Study Out Next Week on Continuous Coverage
In a study to be released Thursday, a UCLA researcher drew some interesting conclusions about the impact of California’s 12-month continuous Medicaid eligibility policy on continuity of care.
Shana Lavarreda, Director of Health Insurance Studies at UCLA’s Center for Health Policy Research, just completed a study funded by SHARE (the State Health Access Reform Evaluation, a program of the Robert Wood Johnson Foundation). It tracked where children received care in 2000 and 2001, to measure the effect of the continuous care policy implemented in 2000.
First, she said, one finding really surprised her: “One big finding was that there were still half a million children in California who had discontinuous coverage,” Lavarreda said. “With the huge surge in coverage [after the continuous coverage policy went into effect], we thought children would be covered and remain covered — but you still had kids that were on and off the program.”
Policy Brief Tackles Waiver Policy
A policy brief issued this week summarizes the many facets and programs of the recent federal Medicaid waiver agreement — including one program that few people know about, and which could have a profound effect on public hospitals in California.
“It’s a very exciting and critical element of the waiver,” according to Melissa Stafford Jones, president and CEO of the California Association of Public Hospitals and Health Systems.
“It embodies the principles of health care reform into a system that’s smarter and provides more coordinated care,” Stafford Jones said. “It really puts California at the leading edge of that national effort.”
A Time of Adversity and Opportunity
It’s an unusual time to be Secretary of all things health care in California.
On the one hand, Diana Dooley will take over the Department of Health and Human Services at a time when budget cuts have already worn the public safety net down to spider-web thinness.
And she arrives with a new budget deficit looming that could gut many existing health care and service programs. In fact, outgoing Governor Schwarzenegger asked lawmakers to cut more than $1 billion from Medi-Cal and the Healthy Families programs, and to eliminate the $1.4 billion CalWORKS program altogether.
Proposal Sends Shiver Through Health Agencies
The budget proposed by the governor yesterday, which includes deep cuts to health care programs in California, is unlikely to be passed in its current form, political experts said.
Legislators have made it clear that they most likely will wait for incoming Governor Jerry Brown to take office in January before taking on the latest budget shortfall. And legislative leaders have expressed support for health and human service programs: from contributing an amicus brief last week to a lawsuit that would reverse cuts in mental health programs, to lobbying for repeal of Schwarzenegger’s line-item vetoes last month of many human services programs.
But whether or not any of the proposed budget cuts happen, the latest budget reduction plan is a huge red flag to health care advocates.
Governor Transition Might Hinder Grant
The new governor takes office on Jan. 3 — but that would be too late for California to apply for a large federal innovation grant, according to a number of health care advocate groups.
“We’re in this lull period,” Lucien Wulsin of the Insure the Uninsured Project said, “with the outgoing Schwarzenegger administration and the incoming Brown, there’s this whole handoff thing.”
And since the innovation grant application has to go in by Dec. 23, Wulsin said that’s a little worrisome.