TAG: "Health care reform"

Study: Hospital mergers, acquisitions leading to increased patient costs


Counterintuitive findings published in Journal of the American Medical Association.

The trend of hospitals consolidating medical groups and physician practices in an effort to improve the coordination of patient care is backfiring and increasing the cost of patient care, according to a new study led by a UC Berkeley health policy expert.

The counterintuitive findings, published today (Oct. 21) in the Journal of the American Medical Association, come as a growing number of local hospitals and large, multi-hospital systems in this country are acquiring physician groups and medical practices.

“This consolidation is meant to better coordinate care and to have a stronger bargaining position with insurance plans,” said study lead author James Robinson, professor and head of health policy and management at UC Berkeley’s School of Public Health. “The movement also aligns with the goals of the Affordable Care Act, since physicians and hospitals working together in ‘accountable care organizations’ can provide care better than the traditional fee-for-service and solo practice models. The intent of consolidation is to reduce costs and improve quality, but the problem with all this is that hospitals are very expensive and complex organizations, and they are not known for their efficiency and low prices.”

Robinson teamed up with study co-author Kelly Miller, program analyst at Integrated Healthcare Association, a nonprofit organization that promotes health care quality improvement, accountability and affordability in California.

The researchers analyzed four years of data, from 2009 to 2012, on 158 major medical groups and 4.5 million patients in California. Groups were put into three categories: owned by physicians, owned by a local hospital or hospital system, or owned by a large hospital system that spans multiple geographic markets in the state.

The measure of costs included physician visits, inpatient hospital admissions, outpatient surgery and diagnostic procedures, drugs, and all other forms of medical care except for mental health services. (The researchers did not have data on mental health services since they are paid for separately.)

After controlling for such factors as the mix of severely ill patients and geographic differences in cost, the researchers found that per patient expenditures were 19.8 percent higher for physician groups in multi-hospital systems compared with physician-owned organizations. Groups owned by local hospitals were better, but per patient costs still ran 10.3 percent higher compared with physician-owned groups.

Why would consolidation lead to increased costs? It could be that once a medical group has been acquired, physicians in those groups are expected to admit their patients to the high-priced hospital, Robinson said.

“Hospital-owned medical groups usually are expected to conduct ambulatory surgery and diagnostic procedures in the outpatient departments of their parent hospital, but hospital outpatient departments are much more costly and charge much higher prices than freestanding, non-hospital ambulatory centers,” he said.

Robinson said that public policy should not encourage mergers and acquisitions as a means of promoting collaboration. Instead, he said, policymakers should consider supporting the use of bundled payments for hospitals and physicians to improve coordination of care.

“Hospitals are an essential part of the health care system, but they should not be the center of the delivery system,” said Robinson. “Rather, physician-led organizations based in ambulatory and community settings are likely to be more efficient and provide cheaper care.”

The study authors noted that their findings are limited to California, and that further studies should be done using data from other states.

“Nevertheless, these findings are important since California is the nation’s leader in terms of having physicians participate in large medical groups that already perform the functions ascribed to ‘accountable care organizations’ by the Obama administration,” said Robinson.

The Robert Wood Johnson Foundation provided support for this research.

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Increased hospital use after Medicaid expansion is mostly temporary


UCLA study finds pent-up demand for health care will decline after first year of enrollment.

The expansion of Medicaid to millions of uninsured people should not have the catastrophic impact some predicted for state budgets because the increases in hospital and emergency room usage are only temporary, according to a new study by the UCLA Center for Health Policy Research.

“We found that the surge doesn’t last long once people get coverage,” said Nigel Lo, a research analyst at the UCLA Center for Health Policy Research and the study’s lead author. “Our findings suggest that early and significant investments in infrastructure and in improving the process of care delivery can effectively address the pent-up demand for health care services of previously uninsured people. Fears that these new enrollees will overuse health care services are just not true.”

Using two years of claims data from 182,000 low-income, uninsured people enrolled in California’s state-run health insurance programs, the UCLA researchers found that people who previously had had the least medical care used hospital emergency rooms at a high rate of 600 visits per 1,000 people. But usage declined sharply in the first quarter to 424 visits (a 29 percent drop), followed by another 25 percent decline the following quarter. Between 2011 and 2013, the overall decline was 69.5 percent (183 ER visits). The report also shows that their hospital admissions declined sharply, from 194 to 42, a decline of 78.5 percent.

“California’s success should set an example for states that are on the fence about expanding Medicaid,” said co-author Gerald Kominski, professor of health policy and management and director of the Center for Health Policy Research. “It’s an investment: Build more infrastructure and care delivery early on, and you can manage chronic care, address unmet health care needs, and keep cost increases to a manageable level.”

The Affordable Care Act has extended Medicaid eligibility in 27 states, but many other states have refused coverage in part because of predictions that state budgets would be overwhelmed by the demands of the previously uninsured, particularly once federal subsidies stop covering the full expansion cost in 2017. Three states — Indiana, Missouri and Utah — are considering expansion, and other state legislatures will soon debate the issue.

The Obama administration is pushing states to expand Medicaid, arguing that they are not only leaving millions of their residents uninsured, but are also forcing their hospitals to absorb billions of dollars in uncompensated costs for treating people without insurance.

The UCLA study looked at data from two programs in California — the Health Care Coverage Initiative, which ran from 2007 to 2010, and the Low Income Health Program, which ran from 2011 to 2013. On Jan. 1, 2014, these enrollees became part of the 1.5 million Californians who were able to transition under the Affordable Care Act into Medi-Cal, California’s Medicaid program that provides health insurance to low-income people.

The authors said that because California’s Low Income Health Program had provided preventative medical care and regular treatment for chronic diseases, the newly insured were no longer dependent on emergency room treatment and hospitalization. Improving care delivery through the use of an assigned source of primary care, care coordination and health risk assessments, as well as greater availability of specialty services and culturally competent self-care also potentially helped manage pent-up demand, they said.

The UCLA results provide new insights into previously published findings that costly emergency room visits in Oregon increased by 40 percent during the year after the state expanded Medicaid eligibility. By examining data over a longer period of time, the UCLA study was able to determine that such spikes in usage were only temporary.

The study was funded by the California Department of Health Care Services and the Blue Shield of California Foundation.

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UCLA Health System, Anthem join others to launch Vivity


Unique product created by insurer and seven health systems aligns care for SoCal members.

The UCLA Health System and six other top hospital systems in Los Angeles and Orange counties have partnered with Anthem Blue Cross to offer Anthem Blue Cross Vivity, an integrated health system. This partnership — the first in the nation between an insurer and competing hospital systems — will help the medical centers enhance the health of all Anthem Blue Cross Vivity members and enable them to share financial risk and gain.

The six other hospital systems — all of which have hospitals ranked among Los Angeles County’s top 30 by U.S. News and World Report — are Cedars-Sinai, Good Samaritan Hospital, Huntington Memorial Hospital, MemorialCare Health System, PIH Health and Torrance Memorial Medical Center.

“Vivity will create economies of scale, allowing us to provide the highest quality and affordable health care to thousands of Californians,” said Dr. David Feinberg, president of the UCLA Health System and CEO of the UCLA Hospital System. “UCLA is proud to join Anthem Blue Cross and its hospital partners at the vanguard of health care delivery in the U.S.”

Vivity continues the move away from traditional fee-for-service reimbursements that may create incentive for providers to increase the volume of medical procedures they perform, and it continues the trend toward a structure that financially rewards activities that keep patients healthy.

“This is an exciting and historic time,” said Pam Kehaly, west region president for Anthem Blue Cross. “This innovative venture will create a foundation to significantly advance the medical delivery system, simplifying the care experience and creating a structure with aligned incentives to eliminate waste and redundancy and improve overall health.”

This is just the first step in aligning the delivery system. Longer term, value will come from future improvements in efficiency and effectiveness enabled by such things as a common electronic medical records system, shared care management systems, joint wellness resources and other enhancements.

Anthem Blue Cross Vivity will provide members with more predictable costs, a simpler experience and convenient access to some of the best primary care doctors, specialists and hospitals in the region. For doctor visits, medical procedures or prescriptions, Vivity members only pay a co-pay; they don’t have to worry about meeting deductibles or deciphering complicated medical bills. The seven hospital systems and their affiliated medical groups have built a network of doctors that provides both quality care and affordable prices to Vivity members in Los Angeles and Orange counties.

CalPERS, the nation’s second largest purchaser of health benefits and an early adopter of health care system innovations, has already agreed to use Vivity network doctors and hospitals within its Select HMO network in Los Angeles and Orange counties. Large group brokers can start requesting proposals on Oct. 1, with coverage beginning on Jan. 1, 2015.

The name Vivity captures a fresh perspective on health care. Coined from vivify, meaning “to enliven or animate,” the name speaks to the energized team of providers coming together to deliver a uniquely people-centric offering.

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Coalition teams to help reduce heart attacks, strokes in San Diego County


UC San Diego part of regional project awarded $5.8M Health Care Innovation grant.

Approximately 84 million people in the United States suffer from some form of cardiovascular disease, and about 720,000 Americans have a heart attack every year, which works out to one every 44 seconds. To address these alarming statistics, the Be There San Diego Initiative has been awarded a $5.8 million Health Care Innovation grant for a coalition project to help reduce heart attacks and strokes in San Diego County.

The initiative’s program, San Diego: A Heart Attack and Stroke Free Zone, is a regional collaboration of health care organizations and stakeholders to improve health care delivery and patient outcomes.

The goal during the three year project is to enroll 4,000 high-risk patients and lower their blood pressure and cholesterol levels through evidence-based practices and a better understanding of the importance of treatment adherence. The project will also promote heart attack and stroke prevention measures, test novel, cost-effective technology solutions and provide educational opportunities both for patients and within the physician community.

Partners in the Be There Initiative include UC San Diego Health System, Arch Health Partners, Scripps Health, Sharp HealthCare, Kaiser Permanente, Palomar Medical Center, Naval Medical Center, Veterans Administration, the San Diego County Medical Society Foundation, the County of San Diego Health and Human Services Agency, community clinics and others. UC San Diego Health System serves as the fiscal agent for the project.

“Health organizations that are competitive in the market will be working together for the benefit of San Diego patients,” said Anthony DeMaria, M.D., principal investigator of the Heart Attack and Stroke Free Zone program and cardiologist at UC San Diego Health System. “This approach will decrease our community’s risk for cardiovascular disease and could result in saving millions in the county by preventing half of the heart attacks and strokes that would have otherwise occurred in the participating patient population.”

Patients will be educated about the program, consented and enrolled through their physician’s office beginning later this year. Participants will also receive blood pressure cuffs to monitor levels at home and work closely with a health care coach.

“Because it’s a silent condition, we find that many patients are unaware of having hypertension, and only about 40 percent of patients diagnosed with high blood pressure take their medication, which can directly lead to cardiovascular disease. We hope through the Heart Attack and Stroke Free Zone program, we can increase this to 80 percent,” said Katherine Bailey, executive director of the Be There Initiative.

The Health Care Innovation grant supporting the project is made possible by the Centers for Medicare and Medicaid Services (CMS) through the Affordable Care Act and is part of an ongoing effort to advance innovative solutions in delivering and improving patient care across the nation.

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Tackling tomorrow’s health challenges


Stanley Prusiner among UC participants at New York Times health conference.

New York Times correspondent Elisabeth Rosenthal and Nobel laureate Stanley Prusiner discuss developments in Alzheimer's research at the Health for Tomorrow conference at UCSF Mission Bay. (Photos by Susan Merrell, UC San Francisco)

By Alec Rosenberg

Nobel Prize winner Stanley Prusiner is not resting on his laurels.

Instead, the 72-year-old UC San Francisco neurologist has set his sights on solving one of the biggest challenges facing health care today: Alzheimer’s disease.

Prusiner made a passionate plea for tackling Alzheimer’s and other neurodegenerative diseases Thursday (May 29) at the New York Times Health for Tomorrow conference at UCSF Mission Bay Conference Center. The conference, which featured experts from the University of California and across the country, addressed the changing landscape of health care.

Alzheimer’s already has a large impact on health care: It’s the sixth-leading cause of death in the U.S. — more than breast cancer and prostate cancer combined — and nearly half of people age 85 and older have the disease, Prusiner said. Without action, it will get worse — the prevalence of the disease is projected to triple by 2050 to as many as 16 million Americans.

“This is a huge, huge problem, and we’re not doing nearly enough,” said Prusiner, a UC San Francisco professor of neurology and director of the Institute for Neurodegenerative Diseases. “This is such an important area. There is no substitute for research. That’s going to really make a difference.”

Stanley Prusiner, UC San Francisco

Filling the pipeline

The National Institutes of Health provides only $500 million in research funding for Alzheimer’s, compared with more than $5 billion for cancer research, even though each costs society about $200 billion a year, Prusiner noted.

While many drugs treat cancer and hundreds more are in the pipeline, no single drug today halts or slows neurodegenerative diseases, he said. Prusiner, who just wrote a memoir, “Madness and Memory,” about his Nobel Prize-winning discovery of prions — infectious proteins that could be at the root of neurodegenerative diseases such as Alzheimer’s and Parkinson’s — aims to change that.

In April, UCSF formed a new collaboration with Japan-based pharmaceutical company Daiichi Sankyo Co. Ltd. This joint venture, capitalizing on Prusiner’s research, is focusing on developing drugs and molecular diagnostics for multiple neurodegenerative diseases, including Alzheimer’s and Parkinson’s.

“I’m very optimistic now that we are going to get there,” Prusiner said. “This is a huge step forward. We need 10 more of these around the world.”

UC President Janet Napolitano

Making progress

UC is conducting research on health’s most pressing problems, teaching the next generation of health professionals and working to improve health care quality, access and affordability, said UC President Janet Napolitano, who delivered welcoming remarks at the conference.

“There are no quick fixes, but I think working together we can make steady progress,” Napolitano said.

Indeed, research is being conducted throughout UC on Alzheimer’s and many other health issues. Napolitano noted that UC San Francisco leads a team that was just awarded a $26 million federal grant — part of President Obama’s Brain Initiative — to create an implantable device that will retrain the brain to recover from mental illness. She also pointed to research by conference speakers David Kilgore of UC Irvine and Michael Fischbach of UC San Francisco.

David Kilgore, UC Irvine

Countering ‘diabesity’

Kilgore, a clinical professor of family medicine, talked about the problem of “diabesity”: Diabetes rates have tripled in the last 20 years, while more than two-thirds of adults are considered to be overweight or obese. Among Kilgore’s patients at a UC Irvine clinic, 70 percent have diabetes, often in combination with other chronic diseases.

“The challenge of chronic disease has completely changed what it’s like to be a primary care physician,” Kilgore said.

More prevention is needed, Kilgore said. He started group medical visits for patients with diabetes. They receive extra information about nutrition, exercise and receive a healthy cooking lesson.

“They love it,” Kilgore said.

UC San Francisco's Michael Fischbach and Stanford's Justin Sonnenburg discuss research into gut bacteria.

Going with the gut

Fischbach, a UC San Francisco assistant professor of bioengineering and therapeutic sciences, discussed his research on the gut with collaborator Justin Sonnenburg, a Stanford University microbiologist who has a bachelor’s degree from UC Davis and a doctorate from UC San Diego. They are studying gut bacteria and how it could help reveal the causes and new treatments for Crohn’s disease and obesity.

“The beauty of being in basic research is you don’t know where you’re going to end up,” Fischbach said after their panel presentation. “It’s nice to be on a journey where you don’t know where the ship lands. I hope it’s going to improve human health.”

Seeking solutions

The Health for Tomorrow conference addressed issues ranging from the impacts of the Affordable Care Act to rethinking how to deliver care in the 21st century to issues of access, affordability and applying technology. Speakers included Marilyn Tavenner, administrator of the Centers for Medicare & Medicaid Services; Diana Dooley, secretary of the California Health and Human Services Agency; New York Times correspondent Elisabeth Rosenthal; CEOs Toby Cosgrove of the Cleveland Clinic and Bernard Tyson of Kaiser Permanente; and several with UC ties.

As part of the conference, five entrepreneurs were invited to give short talks about their health-related startup companies. Three of them studied at UC:

  • Erik Douglas, CEO of CellScope, has a doctorate degree from UC Berkeley and UC San Francisco. The company’s first product, CellScope Oto, turns a smartphone into a digitally connected otoscope, enabling remote care for ear infections, the leading reason for pediatric visits.
  • Anupam Pathak, Lift Labs founder and CEO, has B.S. and M.S. degrees from UC Berkeley. Lift Labs makes active stabilization tools for people living with tremor. Its pocket-sized Liftware, which has a spoon and other attachments, is a “Swiss Army knife for people with tremors.”
  • Joanna Strober, founder and CEO of Kurbo Health, has a J.D. from UCLA. She founded Kurbo after becoming concerned about the consequences of her middle son being overweight. Kurbo has developed a mobile app designed for children and their families to help them lose weight and live healthier lives.

The Health for Tomorrow conference can be viewed on demand, broken down by panel, at www.nythealthfortomorrow.com.

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California’s public hospitals could face $1.5B funding gap


California will fare better than other states but will still feel pain.

Dylan Roby, UCLA

Public hospitals in California that serve the poorest patients could face a $1.54 billion funding shortfall in 2019, when federal funding cuts go into effect. Those cuts, along with health care cost inflation, could jeopardize the financial stability of the state’s safety-net hospital system, according to a study by the UCLA Center for Health Policy Research and Virginia Commonwealth University published in the June issue of the journal Health Affairs.

Several county hospitals — including LAC + USC Medical Center, Santa Clara Valley Medical Center, Alameda Health System, Harbor–UCLA Medical Center and Olive View–UCLA Medical Center — may be especially vulnerable because they receive the highest disproportionate-share hospital (DSH) payments in the state and are located in regions with large numbers of undocumented immigrants who are not eligible for Medi-Cal, California’s version of the Medicaid program.

“Hospitals that can least afford a cut are the most at risk,” said Dylan Roby, director of the UCLA center’s Health Economics and Evaluation Research Program. “Policymakers should ensure that the impending shift in federal funding does not destabilize institutions that are the backbone of public health in California.”

California’s safety-net hospitals rely heavily on federal DSH funding, which compensates them for treating the most vulnerable patients — those who are uninsured and those on Medicaid, primarily children, pregnant women, the disabled and the elderly. In 2010, DSH funds paid more than half of $2 billion in DSH costs ($1.1 billion) to the 21 safety-net hospitals included in the study, with county and state funds covering the rest.

But with impending DSH cuts, the study estimates payments would drop to roughly $830 million to $980 million and leave hospitals struggling to cover $1.38 billion to $1.54 billion in DSH costs in 2019. As many as 4 million Californians and 30 million Americans nationwide are still likely to be uninsured at that time. Without a strong safety-net hospital system, those patients will have few places to turn to for care.

Consequence of legislation

The cuts are a consequence of the Affordable Care Act, whose authors anticipated that as more patients gained health coverage under the ACA, they would generate more revenue for public hospitals, decreasing the need for DSH payments.

But the newly insured patients may not be revenue-generators at public hospitals, and there will be many remaining uninsured patients, according to the study, which used the California Simulation of Insurance Markets to model hospitals’ future patient payer mix. For instance, some of the newly insured patients at public hospitals may switch to private hospitals and take their insurance payments with them.

Other states may fare worse

Hospitals in other states that opted out of expanding their Medicaid programs could be much harder hit than California for two reasons: They won’t get federal funding from Medicaid expansion, and their DSH payments will be cut.

“As challenging as these cuts will be for safety-net hospitals in California, they will be much worse in other states,” said Katherine Neuhausen, lead author of the study and a clinical assistant professor at Virginia Commonwealth University who conducted the research as a Robert Wood Johnson Foundation Clinical Scholar at UCLA. “Safety-net hospitals in states that do not expand Medicaid and those in states that do not target DSH payments to the hospitals with the greatest need could be in jeopardy.”

Public hospitals on a ‘shoestring’

Still, California is not immune to the coming budgetary realignment.

California highly targets its DSH payments to 21 public hospitals (just 4 percent of the state’s hospitals), including 15 county hospitals and six University of California hospitals. Many of these public hospitals — which operate half the state’s trauma centers and a quarter of the burn centers, as well as teaching hospitals — are in low-income areas with few paying patients and are especially vulnerable to any loss of funds.

“They’re already operating on a shoestring,” Roby said.

At LAC + USC Medical Center, half the people receiving outpatient services were found to be uninsured, and more than a third were on Medicaid. At hospitals statewide, the figures were much lower: 21.3 percent and 29.3 percent, respectively.

California awards DSH payments to public hospitals based on their numbers of uninsured and Medicaid discharges and their share of uncompensated care costs. Therefore, public hospitals with greater uncompensated care costs and more low-income patients should retain more of their DSH funds, according to the authors.

The authors conclude that California and other states can take steps to close the funding gap and keep hospitals stable. Hospital leaders, they say, could work with policymakers to make sure DSH payments are targeted to the safety-net hospitals that serve the most uninsured and Medicaid patients; states that expanded Medicaid under the ACA could pay higher reimbursement rates to safety-net hospitals for people who are newly eligible for Medicaid, which is already done in California; and safety-net hospital leaders in states that opted out of Medicaid expansion could seek out additional county and state subsidies.

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Could a modest investment expand Medi-Cal to state’s undocumented residents?


A little investment could go a long way, UC Berkeley/UCLA study finds.

Approximately 690,000 to 730,000 undocumented Californians could gain access to routine and preventive health care in 2015 with just a 2 percent increase in state Medi-Cal spending – estimated at $353 million to $369 million – according to a joint study by UC Berkeley’s Center for Labor Research and Education and the UCLA Center for Health Policy Research.

The study looks at certain provisions of the proposed Health for All Act, or Senate Bill 1005, proposed by state Sen. Ricardo Lara (D-Huntington Park/Long Beach) and under consideration in the state Legislature. The proposed legislation would make all low-income Californians who are excluded from federal health reform, including undocumented immigrants, eligible for Medi-Cal. More than 1.4 million undocumented Californians – ineligible for Affordable Care Act coverage programs due to their immigration status  – are uninsured.

“California would be the first in the nation to make its health-insurance program inclusive of all low-income residents and their families, including those who are undocumented,” said Laurel Lucia, policy analyst at the UC Berkeley Labor Center.

The proposed policy would complement the state’s recent role in expanding immigrants’ rights in the absence of federal immigration reform; this includes moves to provide driver’s licenses to all residents and to extend financial aid to undocumented college students who arrived in the United States as children, said Lucia.

The proposed change would move California from a system of disjointed emergency care to more rational and comprehensive care at a relatively low cost per person, according to the study authors. According to the study, some 60 percent of health care costs for California’s low-income, undocumented adults are already paid under long-standing federal policy. Matching dollars are provided by the federal government to the state for emergency and pregnancy-related services available to all low-income Californians, regardless of immigration status. But undocumented immigrants, who make up 9 percent of California’s workforce, often lack access to health-promoting, cost-effective preventive and routine services.

“The undocumented don’t get sufficient access to preventive care and often wait as long as possible before seeking care,” said Nadereh Pourat, director of research at the UCLA Center for Health Policy Research. “Providing preventive care helps the undocumented stay healthy and allows them to continue to contribute to California’s economy.”

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Covered CA open enrollment ends, but many still will transition in and out


UC Berkeley analysis highlights fluidity of California health insurance landscape.

Ken Jacobs, UC Berkeley

Recent media reports about Covered California have focused on the crush of people trying to sign up for the program’s medical insurance programs by March 31, but analysts at UC Berkeley say not to overlook the many people who will join or leave the program after that deadline.

Researchers at UC Berkeley’s Center for Labor Research and Education are providing new data on the large numbers of people who will enter and leave the program over the coming year, outside the open enrollment period, as the program makes more people, due to various life transitions, eligible for coverage.

In a policy brief released today (April 2), the researchers said their data underscores how important it is to recognize the fluidity of California’s health insurance landscape in order to help people smoothly transition from one health plan to another and to avoid becoming uninsured.

“For many people, Covered California is a place where they will access coverage for a short time during a life transition, such as job-loss or divorce. People will enter and leave coverage on a regular basis,” said Ken Jacobs, who co-authored the report along with researchers Miranda Dietz and Dave Graham-Squire.

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Study finds participation in ACOs growing, but not fast enough


Findings suggest that those not joining ACOs have less capacity to manage the chronically ill.

Stephen Shortell, UC Berkeley

When UC Berkeley researchers conducted a national survey of physician practices on their involvement in accountable care organizations (ACOs), they discovered some good and bad news.

“The good news is that practices that have currently joined ACOs appear to have the potential to provide greater value in regard to both cost and quality of care,” says School of Public Health professor and Dean emeritus Stephen Shortell, co-author of the report published online in the journal Health Services Research.

The bad news? According to the study, about 60 percent of physician practices are not participating in ACOs, nor do they have any plans to join in the next year or more.

“Our findings also suggest that those who are not joining ACOs have far less capacity to manage patients with chronic illness,” says Shortell who was involved in developing the ACO concept.

Doctors and hospitals that participate in ACOs are rewarded and penalized based on quality of care provided and the costs their patients incur. Medicare accountable care efforts were launched in 2012 under the Affordable Care Act, and include the Medicare Shared Savings and Pioneer ACO programs. In January, the Medicare Shared Saving Accountable Care Organization Program reported that almost half of participating ACOs spent less money than expected. All together they generated $128 million in savings for the Medicare Trust Funds.

If more physicians joined, the savings would increase, but Shortell says the majority of them are not yet prepared to provide the type of service that would make them succeed as ACOs.

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Quality health care for prisoners can reduce costs, make communities safer


UC Riverside physician among 15 experts urging major reforms in prison health care.

Scott Allen, UC Riverside

With prison costs and populations soaring and more than half of the incarcerated grappling with mental illness, addiction and/or infectious disease, it’s time for doctors to step up and advocate for prison health care reform, using the Affordable Care Act to make many of those reforms possible.

That’s the conclusion of 15 national experts in medicine and law, including Scott A. Allen, former medical director for the Rhode Island Department of Corrections who is now a professor of medicine and associate dean for academic affairs at the UC Riverside School of Medicine. The panel’s recommendations were published this month in the journal Health Affairs, in an article titled “How health care reform can transform the health of criminal justice-involved individuals.”

“There is a false perception that the people in our prisons and jails are isolated, locked behind walls with no connection to the community, but the reality couldn’t be further from the truth,” said Allen, who is also an internal medicine doctor at Riverside County Regional Medical Center. “The majority of the people who are behind prison walls will be released to the community without any linkage to health care, or way to get it, since when the typical prisoners leaves jail or prison, they’re often excluded from all sorts of safety net programs. So we’re setting them up to fail, and failure has high costs to the community.”

This is particularly problematic when you consider that the United States has the highest incarceration rate in the world — “5 percent of the total world population but 25 percent of its prisoners,” Allen said, and many prisons are losing lawsuits because of substandard health care — including the state of California. Allen testified as an expert witness in the ongoing case called Plata v. Brown.

“The state of California is now spending more on prisons than on higher education, and it’s fair to ask, if the state is spending so much money, what are we getting for it?” Allen said. “The Supreme Court — a pretty conservative court — has found that prison medical care is so bad it constitutes cruel and unusual punishment. Even if you ignore the human rights issues and only look at it from the taxpayer standpoint, this is still a very bad deal.”

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UC Riverside hosting Palm Desert health fair, health exchange sign-up event


Certified counselors will provide Covered California enrollment assistance at March 21 event.

MEDIA ADVISORY: There will be a press conference associated with this event at 11 a.m. in the Building B Auditorium at the UC Riverside Palm Desert Campus. Present will be: Assemblyman V. Manual Perez; Edith Lara-Trad, regional information officer, Covered California; G. Richard Olds, dean of the UCR School of Medicine; Kathy Greco, CEO of the Desert Healthcare District; and Gary Honts, CEO of JFK Memorial Hospital.

UC Riverside Health will host a free health resource fair and sign-up event on Friday, March 21, to assist community members interested in enrolling in Covered California, the state health insurance exchange established in response to the federal Affordable Care Act.

The event is scheduled from 10 a.m. to 6 p.m. at the UCR Palm Desert Center, Building B Auditorium, 75-080 Frank Sinatra Dr. in Palm Desert. Parking will be free.

In addition to Covered California enrollment assistance, the event will include free basic health screenings by UCR Health physicians and Medi-Cal application assistance. English- and Spanish-speaking certified enrollment counselors will be available to assist with enrollment in Covered California health plans. The application process may take up to 90 minutes.

In order to enroll in a Covered California health plan, individuals should bring:

  • Proof of California residency (California driver’s license or California identification card or proof of citizenship/immigration status)
  • Social Security number
  • Total monthly income
  • Number of persons in the household

Appointments are available by calling (866) 893-8446.

The event is supported by several cities and community-based organizations in the Coachella Valley. In addition to UCR Health, the clinical arm of the UC Riverside School of Medicine, the event is being organized in partnership with Covered California, the Desert Healthcare Foundation, and the Path to Health Program of Desert Regional Medical Center and JFK Memorial Hospital. Path to Health is a campaign by JFK Memorial Hospital and Desert Regional Medical Center that offers educational materials and resources for navigating the insurance exchanges and the ACA.

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Why UC is participating in Covered California

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Medical students help ‘connect’ uninsured to health care


Students making a difference in the community.

UCLA medical student Caleb Wilson (standing) talks to student volunteers Lisa Nicholson of UCLA (from the left) and Emma de Montelongo of USC while Natalie Mendez, a client, looks on.

Taking blood pressure readings at health fairs was not exactly Caleb Wilson’s idea of connecting with patients. A second-year medical student at UCLA’s David Geffen School of Medicine, he wanted to do more. “What can medical students do to make a real difference?” he asked.

His response to that question is making a big difference to the Southern California community that he and other UCLA medical students are currently serving.

Wilson, 24, along with first-year medical students Jeff Fujimoto and Brandon Scott, both 25, started a UCLA student outreach and education group last fall, based on a partnership between UCLA student chapters of the American Medical Association and the Student National Medical Association. All three are leaders of these chapters. The goal of the group, Connecting Californians to Care, is to “connect” the state’s uninsured — an estimated 7 million people — to health insurance. The group also has chapters at USC and UC San Diego.

So instead of spending a recent Saturday salsa dancing or playing football – his usual ways of decompressing from the rigors of medical school —  or tutoring fellow students, Wilson was at a community outreach center off Hollywood Boulevard helping the uninsured enroll in health care.

Although heavy rain kept turnout low, Wilson and the other volunteers were upbeat. “It’s a contagious excitement,” Wilson said.

“Medicine has a very human aspect to it,” said Fujimoto in an email. “Reaching out to people and connecting help us become more well-rounded people and physicians as well.”

During the community outreach event, students determined if an individual qualifies for Medi-Cal or Covered California; explained the ins and outs of tax credits, coverage tiers and insurers; then sat down with the person while they enrolled online.

Natalie Mendoza, 25, hasn’t had health insurance for seven years. “I’m lucky I haven’t had any problems,” she said. After studying the enrollment website with student volunteers, she said she would probably go for a bronze or silver plan. “I feel good knowing the options.”

Wilson, Fujimoto and Scott developed the training curriculum for the volunteers with their group adviser, Dylan H. Roby, director of the Health Economics and Evaluation Research Program at the UCLA Center for Health Policy Research and an assistant professor in the UCLA Fielding School of Public Health.

The three students, along with 20 others in the group, are also training to become state-certified enrollment counselors in conjunction with the Saban Community Clinic.

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Related link:
Why UC is participating in Covered California

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