Latest California Healthline Stories
State Laying Foundation for Duals Conversion
The state’s Department of Health Care Services released a series of draft papers this week, outlining some of the concerns and aims of its planned conversion program, which will eventually offer managed care choices to dual eligibles — those Californians who are eligible to receive both Medi-Cal and Medicare benefits.
The latest paper, released yesterday and expected to be posted on the DHCS website today, looks at the possible scope of that transition and finds it could include many more than the 150,000 people originally estimated for the conversion program.
“There are 370,000 duals in Los Angeles County alone,” according to Peter Harbage of Harbage Consulting, who worked on the papers. “There are another 250,000 in the next four largest counties. The paper opens the conversation on that point, as well as on other key issues.”
The Benefits of Changing Medicare’s Drug Benefit
Medicare Part D is Exhibit A in how a health reform can evolve from partisan legislation to beloved protection. Aware of the drug benefit’s popularity, but facing real fiscal concerns, lawmakers are broaching delicate changes to the program.
Quality Ratings Offered in Medicare Enrollment Window
Open enrollment for Medicare starts at the end of next week. This week, the federal government launched its online service to help people make Medicare decisions. This year, ther service offers a little something extra, according to David Sayen, the regional administrator for CMS.
“This enrollment period is different,” Sayen said. “For the first time, we’re rewarding quality.”
Medicare Advantage plans now will be rated for quality of care. Part D prescription drug plans will continue to be rated for quality.
Pitfalls and Promise of Converting California’s Dual Eligibles
The state would like to move “dual eligibles” — Californians who receive both Medicare and Medi-Cal benefits — into managed care plans. State officials say the move would save money and improve care, but it’s a big and complicated task.
Reform’s Unanswered Question: To Trim or Transform Medicare?
More cuts to Medicare are looming, just months after the Affordable Care Act sliced billions in program spending. Whether the new changes will be sweeping or merely substantive remains to be seen.
Accounting for the ACO Backlash by Recounting DRG Fight
All kinds of health care stakeholders seem to agree: CMS’ proposed ACOs are profoundly disagreeable. But is this criticism truly new or just providers’ traditional resistance to federal efforts to overhaul health care payment?
Medicare’s Old Age Problem Is New Again
Is 67 the new 65? Republicans have again proposed hiking Medicare’s eligibility age as a gambit to extend program solvency. Some have championed the plan, but many policy analysts — and much of the public — are resisting the idea.
Paul Ryan’s Radical Plan To Reform Medicare not so Radical
While Republicans’ plan to transform Medicare into a voucher program is being hailed as groundbreaking, the model has been floated for decades. Here’s a look back at the history of Medicare vouchers — and what makes Ryan’s plan different.
Suzanne Delbanco of Catalyst for Payment Reform Discusses Ideas on Paying for Care
Suzanne Delbanco, executive director of Catalyst for Payment Reform, spoke with California Healthline about a growing movement to improve the delivery of care by transforming health care payment structures across the U.S.
$500 Million in Medicare Underpayments in California?
A California attorney has filed a class action lawsuit, saying that Medicare knowingly underpaid physicians in 10 counties in California, as well as dozens of counties in 32 other states. The suit alleges $500 million in underpayments in California, and a total of $3.2 billion throughout the nation.
“Medicare has acknowledged that certain counties are being underpaid, according to standards they set back in 1996,” according to attorney Dario de Ghetaldi, of the Corey, Luzaich, Pliska, de Ghetaldi & Nastari law firm. “It’s a problem they’ve created, and it’s a problem they’ve allowed to continue to exist.”
San Diego County physicians lead the nation in Medicare underpayment, Ghetaldi said.