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The California Department of Health Care Services has been updating its transition plan to make sure patients in the adult day health care program have somewhere to go when those services officially end on Dec. 1.
DHCS hopes its new plan will help the roughly 35,000 Californians enrolled in about 300 ADHC centers across the state.
“Working with the Department of Aging, the Department of Social Services and the Department of Developmental Services, DHCS has created a multi-faceted approach to provide comprehensive health risk assessments, care coordination, case management and appropriate ongoing services to former ADHC clients,” according to the new transition plan.
How Should the Exchange Adjust Risk?
William Dow, a professor of health economics at UC-Berkeley, said the idea is relatively simple.
“In theory, each individual patient comes with a dollar amount representing their gain or loss to the insurance company,” Dow said at a recent forum in Sacramento. “And that means every enrollee should have the same profit amount.”
If higher risk patients, such as those with diabetes, pay a slightly higher premium, Dow said, that balances the risk that companies take in insuring them.
Lessons Learned From PacAdvantage Failure
The Pacific Business Group on Health (PBGH) has had some experience in running a small group purchasing pool. It’s the organization that took over the Health Insurance Plan of California (HIPC), which was renamed the Pacific Health Advantage or PacAdvantage and operated for a total of 13 years, ending in 2006.
That organization was similar in concept to California’s Health Benefit Exchange. A new report from PBGH outlines some of the lessons the exchange might learn from PacAdvantage’s slow demise.
“The biggest lesson is, exchanges are naturally vulnerable to adverse selection,” according to report co-author Bill Kramer, the executive director of national health policy at PBGH. “When the Pacific Business Group on Health took over HIPC, it was inheriting an adverse selection problem. At a certain point, the adverse selection becomes irreversible and there’s no way to get out of it.”
Cost Drops for Patients with Pre-Existing Conditions
Enrollment for the Pre-Existing Condition Insurance Plan (PCIP) just got a big boost.
Cost has long been suspected as one of the limiting factors to signing up people to the federally funded PCIP program. Now, according to officials of the Managed Risk Medical Insurance Board (MRMIB), the cost of premiums in the plan are about to drop by an average of 18%.
“We have new premiums now with a significant reduction in cost,” MRMIB chair Cliff Allenby said, “at an average of 18%, which is anywhere from 8.2% to 24.3% lower cost.”
Dental Trips Emphasized for Young Children
Low-income children are not getting good dental care, even though many of them have coverage through the state. Shelley Rouillard would like to do something about that.
Rouillard, deputy director of benefits and quality monitoring at the Managed Risk Medical Insurance Board (MRMIB), is leading an effort at MRMIB to get more young children to see the dentist — as early in their lives as possible, she said.
“Studies show that the younger the child (who gets dental care) the less it costs over their life for dental services,” Rouillard said. “So we want the percentage of kids who see a dentist to change, and we’re targeting the youngest kids. We’d like the children ages 0 to 3 to start being seen.”
Exchange Board Handles New Move Quietly
During the most recent board meeting of the California Health Benefit Exchange, board members gingerly approached the last item on the agenda — would the board stick its toe in political waters?
“I don’t know that it’s the board’s place to do this,” board member Paul Fearer offered at one point. Chair Diana Dooley, secretary of the state HHS agency, announced right at the start of the meeting she would abstain from legislative issues.
But clearly the board felt it was the board’s place to get involved in legislative waters — past the toes and ankle and maybe up to the knee — as it voted 3-0 on several motions to involve the exchange board’s input and opinion on half a dozen legislative bills.
New Online ‘Refor(u)m’ for State Health Issues
State efforts to enact national health care reform have proceeded at different paces — a situation made clear in a new online forum designed to help states implement the Affordable Care Act.
At a recent forum featuring representatives from North Carolina, New York and Virginia, the wide disparity of progress among the states became apparent.
It was part of an effort to get states to talk to each other about implementation of national health care reform, coordinated by a recently launched website.
Med Center Lowers Readmission Rates
Karen Rago of UC-San Francisco had an important task: help lower readmission rates of older heart failure patients. It’s one of the targets for health care reform, and the medical center wanted to see how hard it would be to do it.
Pretty hard, Rago said — at least at first.
“We started with a grant, and the aim was to reduce readmission rates at 30 and at 90 days,” Rago said. “That didn’t look like it was going to happen.”
Public Agency Takes Up Political Hammer
The board of the California Health Benefit Exchange voted last week to oppose a bill that would establish a basic health plan and to urge the lawmakers behind AB 52, which would regulate rate increases by insurers, to exempt the exchange from that law.
The board also voted to direct staff to work with legislators on four other bills that deal with the exchange — including two laws that directly refer to the exchange in their identifying titles.
All of the votes were 3-0, with member Robert Ross absent and chair Diana Dooley abstaining.
Veto Caps Tough Week for Adult Day Health Care
Today marks the 21st anniversary of the national Americans with Disabilities Act.
That anniversary carries a bit of a sting this year for seniors and the disabled in California, on the heels of yesterday’s veto by Gov. Jerry Brown (D) of a bill that would have created the Keeping Adults Free from Institutions (KAFI) program, which was supposed to take the place of the current adult day health care program.
Today also was the day set aside for the court hearing challenging the elimination of the ADHC program, but a judge last week approved delay of that hearing until Nov. 1.