Panel Takes on State Health Care Issues

The health care picture in California is coming into focus with significant recent progress but an even greater amount of work remains to be done, according to a panel of experts assembled yesterday in Sacramento by the Public Policy Institute of California.

Panelists at the event, part of PPIC’s series on California’s future, discussed the expansion of Medi-Cal and the creation of Covered California and posed questions about the next steps in health care reform.

“Medi-Cal now is really a mainstream program in California,” said Sandra Hernández, president and CEO of the California HealthCare Foundation, which publishes California Healthline. “Estimates are that one in three Californians are going to be on Medi-Cal and that’s a big change.”

Hernández said the shift in care delivery could make a huge difference to the state, and to all Californians. “This is a tremendous opportunity because so many people have accessed the system. So we get to think about how we design that program, and to make sure we use the delivery system at the right place and right time,” Hernández said.

That restructuring of care delivery could save money and improve outcomes, Hernández said. “That’s really version 2.0 for health care in California,” she said.

Diana Dooley, Secretary of Health and Human Services for California, said she has been heartened by the state’s health reform progress.

“If we saw how big it was or how hard it might be,” Dooley said with a smile, “maybe we wouldn’t have done it.”

The enrollment success California has had so far with Covered California and in Medi-Cal will lead to change, Dooley said.

“We have a lot of people enrolled now and we’ll see where they get care and how they get care,” she said. “I expect it will be a little like the pig in a python,” she said, where the increasing pressure of the problem will force a solution.

“It won’t be able to function in the way it has in the past,” Dooley said. “It’s going to be different.”

Dooley expects innovations to develop from the chaos. That’s what happened in Los Angeles County, said Mitchell Katz, director of the Los Angeles County Department of Health Services,

“One of my concerns has been how I’m going to deal with specialty exams,” Katz said. When he first took the job in Los Angeles, he said, cardiac exams were scheduled for nine months away. “That’s just not workable,” he said, that doesn’t make any sense. If you actually need a cardiac exam, you can’t wait nine months for it.”

His department started using an electronic consult system, he said. “And now we’re doing 25,000 consults a month,” Katz said. “These are mind-boggling numbers, and it’s all working.”

That solution was borne as a direct result of system demand, Katz said.

“So yes, it is possible to use the access demands to do things in a different way,” he said.

Dooley said the top priority moving forward is cost transparency. That sentiment was echoed by Hernández.

“Transparency of cost — it’s the North Star we should be following,” Hernandez said.

Cost transparency will lead to a central goal of health care reform, she said: “Affordability is the end of road.”

Dooley said the work so far has been hard, but there is much still to do.

“The biggest surprise [of health care reform so far] was that we’ve been able to do this,” Dooley said. “But there is no ‘Mission Accomplished’ sign yet. We have a ways to go.”

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