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.”
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.”
What a Waste: Why We Can’t Rein In Extra Health Spending
Don Berwick took a parting shot at the waste in the U.S. health system as he stepped down at CMS, reinvigorating a question as old as Medicare: Why isn’t our system more efficient?
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.
Medicare Physicians Nervously Await Yearly ‘Doc Fix’
In the wake of the congressional debt panel’s failure to come up with long-range budget solutions, California physicians are nervously awaiting the annual holiday tradition of a temporary “doc fix” to adjust the equation that determines how much they’ll get paid for treating Medicare beneficiaries.
Three Meetings To Address Duals Conversion
This week, the state begins a series of stakeholder meetings across California, all looking at different aspects of the ambitious task of converting more than one million people who receive both Medicare and Medi-Cal benefits — known as dual eligibles — to a more comprehensive model of care.
According to Peter Harbage, who has been leading the information-gathering component of the effort, this is an important month in the process. Now that the first wave of input has been solicited, the three meetings scheduled for December can dive deeper into the details.
“The main goal is to talk about the design of the duals demonstration project, so the state can get a better understanding what people believe the challenges and opportunities are, and what consumer protections need to be done,” Harbage said.
New Cost Tool Aims To Boost Pay-for-Performance Model of Care
In an effort to measure value in health care transactions, the Integrated Healthcare Association is introducing a “Total Cost of Care” metric to be used in its pay-for-performance program. IHA hopes the new tool will speed up improvements in clinical quality by providing financial incentives to physicians.
Austerity Won’t Help Physician Shortage, Experts Predict
Cutbacks in Medicare and Medicaid could make it more difficult to deal with a physician shortage in California that threatens to become more severe as millions of newly insured people join the reformed health care system. California groups are lobbying to streamline and subsidize the training of new primary care doctors.
Medicare ACOs a Boon to Senior Care in State?
Don Crane is pretty happy. He’s president and CEO of the California Association of Physician Groups, and he’s been waiting for quite some time for federal officials to finalize the rules governing establishment of Medicare accountable care organizations.
The final regulations announced by CMS could be big news for California, Crane said.
“I think this is going to have a huge impact on the California health care landscape,” Crane said. “What this means is significantly more penetration of ACOs in the senior market.”
When a Law Loses Its Teeth, Can the Reform Still Bite?
After months of industry criticism, CMS’ accountable care organizations are winning plaudits after the agency made the program less intimidating for participants. Some suggest that will make ACOs less effective tools of reform, too.