Latest California Healthline Stories
How To Protect Seniors During Duals Conversion?
Yesterday’s stakeholder meeting to help plan the duals conversion pilots was partially notable for what it was not.
It was not rancorous, it was not loud and the discussion went relatively smoothly for the Department of Health Care Services, compared with last week’s grilling of DHCS over the smaller conversion of SPDs (seniors and persons with disabilities) to managed care.
“Hearing the issues here today is very important for us,” Melanie Bella of CMS said at the end of the meeting. “A couple of things we said were non-negotiable here are stakeholder involvement, meaningful stakeholder involvement and consumer protections.”
Clashing Views of Transition for Seniors, Disabled
Either the state’s transition to managed care is going great, or it’s a confusing mess.
That would depend on who’s talking. At a joint oversight hearing last week, convened by the Senate and the Assembly committees on health, government officials outlined a generally positive picture for the effort to move Medi-Cal seniors and people with disabilities (SPDs) from Medi-Cal fee-for-service to managed care.
“The transition of seniors and people with disabilities into managed care is part of the triple mandate from [the federal] HHS,” according to Jane Ogle, deputy director at the Department of Health Care Services. “Better health, better quality and more cost-effective care.”
Free Data Spark Innovation, Proponents Say
One of the keys to successful health care innovation is the freeing-up of data, according to Todd Park, chief technology officer for the federal HHS.
“We are working on so many exciting things right now, but the initiative we’re most excited about is the health data initiative,” Park said. “We are unleashing the power of open data and open innovation.”
Park was one of a group of experts who convened in Sacramento Wednesday for a health information technology forum put on by the Center for Health Improvement. One of the co-sponsors was the California HealthCare Foundation, which publishes California Healthline.
New Evidence of Seniors’ Vulnerability
Kathryn Kietzman and other researchers from the UCLA Center for Health Policy Research conducted a series of interviews with California seniors and their families over a one-year period. Their ongoing monitoring yielded worrisome results, Kietzman said — particularly seeing the effect on those seniors of a number of seemingly small budget cuts.
“Even those seniors with low-level needs were strongly affected by these cuts,” Kietzman said, referring primarily to a 3.6% reduction in In-Home Supportive Services and also to a cutback in monthly Supplemental Security Income and State Supplementary Payments. “What we saw was a culmination of sometimes little cuts, sometimes bigger cuts,” she said. “Many times we follow these things at the policy level, but [here] we’ve seen changes at the individual level, particularly for people with chronic care conditions.”
Those cutbacks don’t begin to compare with the state’s trigger cut of 20% of IHSS care, and a state-estimated halving of service to people currently receiving adult day health care services, Kietzman said.
Mandatory Enrollment Draws Attention From Legislators
The state wants to move fee-for-service Medi-Cal beneficiaries who are seniors and persons with disabilities into managed care plans. At the same time, the state is in the initial stages of launching a demonstration project to eventually move up to 1.1 million dual eligibles — those eligible for both Medicare and Medi-Cal benefits — into managed care.
Today in Sacramento, those two significant efforts get some legislative oversight. The Senate and Assembly health committees are holding a joint hearing on how those two efforts will be conducted.
“We want the health care system to be more efficient, but without sacrificing patient care,” Assembly member Bill Monning (D-Carmel) said. “The objective [of both efforts] is to improve patient care. So this is an opportunity to have some transparency for the public and some oversight.”
Dual Eligibles a Tricky Population To Manage
The state Department of Health Care Services wants to integrate care for about 1.1 million dual eligibles in California — people eligible for both Medicare and Medi-Cal services — by moving them to managed care plans.
“These two insurance programs don’t necessarily work well together,” according to Neal Adams, deputy director of the California Institute for Mental Health. “The benefit design is not equal across all platforms.”
Adams was part of a stakeholder summit convened last week by DHCS to discuss the dual eligible demonstration project. It was the first of three stakeholder meetings this month. Others are scheduled Dec. 12 in San Francisco and Dec. 15 in Los Angeles.
Judge Temporarily Stops IHSS Cuts
A federal judge in Oakland issued a temporary restraining order last week, suspending the state’s planned reduction of 20% to In-Home Supportive Services to 370,000 Californians.
Judge Claudia Wilken scheduled a hearing Dec. 15 to decide whether a preliminary injunction should be granted. The state has the option to move that court date, if it desires.
The judicial action came right before the state was set to send notices to IHSS participants — most of whom are seniors — notifying them of the reduction in services. The so-called trigger cuts were ordered by the Legislature back in June, to go into effect Jan. 1, if fiscal targets weren’t met in December. Those targets are unlikely to be met.
California Leading Payment Reform Effort
Steve McDermott runs a physicians group, but it’s his role as patient that makes him an expert on payment reform, he said.
“I had hip replacement surgery and let me say, it is a wonderful thing,” McDermott said. “I went from a grumpy old man to, well, just an old man. But yeah, it probably saved my marriage.”
But a look at the bill could’ve sent him back over the line far past grumpy, if he didn’t have medical insurance. The cost of a hip replacement, he said, is out of whack. “The cost is about $70,000 — not including surgery,” McDermott said. “And the number of uninsured in California is at about 23%, and that’s just unacceptable. If the health care system is the number-one cause of bankruptcies in the state, that’s not good.”
Mental Health Needs High, Treatment Low
About two million Californians are under stress and need some kind of mental health care — and are not getting the help they need, according to a UCLA study released yesterday.
“There are a lot of people with mental health needs, and they aren’t getting adequate care,” UCLA researcher David Grant said. “Men are less likely to seek and receive the care they need, and immigrants definitely aren’t getting their care needs met. And even native-born Latinos and Asians are unlikely to seek treatment, so that’s a definite target for the state to consider.”
The report from the UCLA Center for Health Policy Research is based on 2007 data from the California Health Interview Survey.
Ruling To Prompt New ADHC Transition
It’s too early to know some details of the newest transition plan for adult day health care services, according to state officials. The final settlement of a lawsuit challenging the state’s first transition plan will be released tomorrow, and the federal judge in the case will issue a ruling on the settlement in two weeks.
But that doesn’t stop people from raising questions.
“Which [current ADHC] centers will be eligible to become CBAS (Community Based Adult Services) centers?” Lydia Missaelides of the California Association of Adult Day Services asked. The CBAS program is created in the settlement as a partial replacement for Medi-Cal benficiaries. To save money, state officials eliminated the ADHC program as a Medi-Cal benefit.