Health care reform opens opportunities.

UCLA nurse practitioner Abigail Striblea talks to a patient at the Union Rescue Mission in the skid row area of downtown Los Angeles.

Afflicted with pulmonary arterial hypertension and breathing difficulties, Carol Volckmann was unable to get much help from physicians near her home in the Cascade Mountains in Washington state. Desperate, she began consulting physicians elsewhere and ultimately chose UCLA pulmonologist Dr. Rajan Saggar.

Volckmann said the result was “excellent care,” as well as a new and vital member of her health care team: Kathy McCloy, one of 160 nurse practitioners (NPs) spread across the UCLA Health System.

Hundreds of miles south and a world away at the UCLA School of Nursing Health Center at the Union Rescue Mission in the skid row section of downtown Los Angeles, nurse practitioner Hannah Bampton spends Wednesday nights with homeless families.

“Dr. Saggar prescribed very aggressive medication for my treatment,” said Volckmann, who speaks with McCloy regularly from Washington. “Then Kathy came in and spent a lot of time with me and my husband, making us feel comfortable. This could all be very scary, but we don’t feel scared because we know she’s right there for us.”

“I’m available all night for families that need to be seen for anything,” Bampton said. “By doing that, we’ve decreased the number of unnecessary urgent care visits. Someone might call 911 if there was no one there. But with a night nurse there, the kid doesn’t need to go to an ER, because I’m going to help him here.”

McCloy and Bampton are a new breed of health care provider that figures to play a pivotal role in health care in this country. Increasingly, it is a nurse practitioner whom patients see when they go to their doctor’s office. They also visit them at clinics, in retail pharmacies and hospitals.

Patients make more than 600 million visits to the nation’s 157,000 nurse practitioners every year, according to the American Association of Nurse Practitioners. Those visits are expected to increase as 35 million new patients enter the health care system in the next few years as a result of the Affordable Care Act.

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Related link:
Community impact: Nurse-run clinics

Supports outreach, education to underserved populations about obtaining health insurance.

Sergio Aguilar-Gaxiola, UC Davis

The UC Davis Center for Reducing Health Disparities and UC Berkeley’s Health Initiative of the Americas each have received $1 million grants from Covered California, the state’s health insurance marketplace, to provide outreach and education to underserved populations about obtaining health insurance.

The agency is awarding 48 grants totaling $37 million.

The primary targets of Covered California’s outreach and education efforts are the estimated 5.3 million Californians projected to be uninsured or eligible for tax credit subsidies in 2014. Later this fall, Covered California will offer the state’s residents access to health care through marketplaces established through the federal Patient Protection and Affordable Care Act. Coverage will be available Jan. 1, 2014.

The UC Davis center will partner with El Concilio, the Council for the Spanish speaking, in a collaboration called Nuestra Salud es Primero (Our Health Comes First), to educate nearly 133,000 primarily Spanish-speaking Central Valley residents about Covered California. The grant begins July 1 and ends in December 2014.

The Center for Reducing Health Disparities was selected as an outreach partner because of its expertise in educating diverse underserved groups about health. With its partner El Concilio, it will reach out to Latinos eligible for affordable health insurance programs through Covered California. Efforts will focus on Latinos who live in counties in the Central Valley (Sacramento, Yolo, El Dorado, Placer, San Joaquin, Stanislaus, Merced, Madera, Fresno and Kern).

Fifty-four percent of California Latinos are uninsured — one in four from birth to age 64, said Sergio Aguilar-Gaxiola, the center’s director and a clinical professor of internal medicine.

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May 3 event will air later on UCTV.

Mark Laret, UC San Francisco

Academic and health industry leaders will discuss the latest efforts to achieve better health care at a lower cost at the University of California Center for Health Quality and Innovation’s second annual colloquium Friday (May 3) in Oakland.

UC San Francisco Medical Center CEO Mark Laret will give the keynote address, “A Call to Action for Academic Medical Centers to ‘Think Differently.’” David Lansky, president and CEO of the Pacific Business Group on Health, will provide an employer’s perspective on health care costs and quality.

A panel discussion on what health plans are looking for from providers will feature health insurance executives from Anthem Blue Cross, Blue Shield of California and Health Net Inc. Another panel will focus on innovations by researchers from UC Davis, UC Irvine, UCLA, UC San Diego and UCSF.

There also will be poster presentations, an announcement of innovation center grant winners and remarks by UC Health Senior Vice President Dr. John Stobo, innovation center Executive Director Terry Leach and UC Office of the President enterprise risk management Director Terri Kielhorn. (View agenda.)

Media interested in attending the 9 a.m. to 4 p.m. event at the Oakland Marriott City Center, 1001 Broadway, should call (510) 987-9200. Talks from the colloquium also will air on UCTV beginning in mid-May. For a schedule, and to view videos from the first colloquium, visit: www.uctv.tv/chqi.

About UC Health
University of California Health includes five academic health centers — UC Davis, UC Irvine, UCLA, UC San Diego and UC San Francisco — with 10 hospitals and 18 health professional schools and programs on seven UC campuses. For more information, visit http://health.universityofcalifornia.edu.

About the UC Center for Health Quality and Innovation
UC Health launched the Center for Health Quality and Innovation in October 2010. The center is designed to promote, support and nurture innovations at UC medical center campuses and hospitals to improve quality, access and value in the delivery of health care. For more information, visit http://health.universityofcalifornia.edu/innovation-center or email chqi.info@ucop.edu.

UCSF study highlights need for medical homes to ID mental health disorders at young age.

Adolescence is a unique period of change when many mental health disorders are known to first emerge.

According to experts, approximately 20 percent of adolescents report symptoms of mental health problems, and half of lifetime cases of mental health disorders begin showing symptoms by age 14.

Yet despite the known prevalence of mental health issues during this critical time in a young person’s life, nearly half of adolescents are lacking a medical home – family-centered, coordinated and continuous health care – according to a new study from UC San Francisco’s Department of Pediatrics. This study is timely as expansion of medical home models are being implemented through the Patient Project and Affordable Care Act.

“A higher percentage of adolescents have mental health conditions rather than physical conditions, which really drives home the importance of coordinating care and giving referrals,“ said lead author Sally Adams, R.N., Ph.D., a specialist in the Division of Adolescent Medicine at UCSF.

“There’s a big problem with trying to coordinate mental health care and the system is failing families,” she added. “If mental health is addressed early, it can lessen the impact, so it’s important to be proactive.”

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These hybrid health care providers are increasingly common — and increasingly critical.

Afflicted with pulmonary arterial hypertension and having great trouble breathing, Carol Volckmann was unable to get much help from the physicians near her home in the Cascade Mountains in Washington State. Desperate, she began consulting physicians elsewhere and ultimately chose UCLA pulmonologist Dr. Rajan Saggar.

Volckmann says the result was “excellent care,” as well as a new and vital member of her health-care team: Kathy McCloy M.S.N. ’96, one of 160 nurse practitioners (NPs) spread across the UCLA Health System.

“Dr. Saggar prescribed very aggressive medication for my treatment. Then Kathy came in and spent a lot of time with me and my husband, making us feel comfortable,” explains Volckmann, who speaks with Mc-Cloy regularly from Washington. “This could all be very scary, but we don’t feel scared because we know she’s right there for us.”

Hundreds of miles south and a world away at the UCLA School of Nursing Health Center at the Union Rescue Mission in downtown Los Angeles, nurse practitioner Hannah Bampton M.S.N. ’11 spends Wednesday nights on the women’s and family floor, where the homeless families stay.

“I’m available all night for families that need to be seen for anything,” she says. “By doing that, we’ve decreased the number of unnecessary urgent-care visits. Someone might call 911 if there was no one there, but with a night nurse there, the kid doesn’t need to go to an ER, because I’m going to help him here. I’m physically there with them.”

McCloy and Bampton are a new breed of healthcare provider that figures to play a pivotal role in health-care reform in this country. Increasingly, it is a nurse practitioner that patients see when they go to their doctor’s office. They visit them at the Minute Clinic at CVS stores and in the hospital. In fact, more than 600 million visits are made to the nation’s 155,000 nurse practitioners every year.

Those visits are going to skyrocket as 35 million new patients enter the system in the next few years via the Affordable Health Care Act. At the UCLA School of Nursing, this vital new front in health care is taking shape.

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Event will be May 3 in Oakland.

Mark Laret, UCSF

>>Register online or download form
>>View agenda

University of California Health colleagues are encouraged to register now for the UC Center for Health Quality and Innovation’s second spring colloquium, 9 a.m. to 4 p.m. May 3 at the Oakland Marriott City Center, 1001 Broadway, Oakland. The registration form can be downloaded or filled online.

Space is filling up for the colloquium, which is open to anyone at UC’s medical centers and health professional schools who is working to improve health care delivery, population health and efficiency of care at UC Health. Registration closes April 26.

The colloquium will address the changing health care marketplace, increasing financial challenges, and clinical and operational approaches available to UC Health to compete as health care reform unfolds.

David Lansky, Pacific Business Group on Health

UC San Francisco Medical Center CEO Mark Laret will give the keynote address, “A Call to Action for Academic Medical Centers to ‘Think Differently.’” David Lansky, president and CEO of the Pacific Business Group on Health, will provide an employer’s perspective on health care costs and quality. A panel discussion, “What Health Plans are Looking for From Providers,” will feature Paul Markovich, president and CEO of Blue Shield of California; Aldo De La Torre, vice president, provider engagement and contracting for California, Anthem Blue Cross; and Steven Sell, president of Health Net Inc.’s Western Region Health Plan and Health Net of California.

Along with remarks by UC Health Senior Vice President John Stobo, UC Chief Risk Officer Grace Crickette and innovation center Executive Director Terry Leach, there also will be poster presentations, talks from five innovation center fellows and an announcement of innovation center grant winners. (View agenda.)

The colloquium registration fee is $75. A limited number of registration fee waivers will be available for UC Health professionals, faculty and staff. Please contact claudia.schwarz@ucop.edu or (510) 987-0287 for more information.

Attendees interested in reserving a room at the Oakland Marriott City Center can take advantage of paying a group rate by April 18. Space is limited. For more information, visit the Marriott’s website or call (510) 451-4000 (reference “UCOP CHQI Colloquium” for group rate).

The colloquium has been approved for AMA PRA Category 1 Credits™ continuing medical education, jointly sponsored by the UC Davis Health System Office of Continuing Medical Education and the UC Center for Health Quality and Innovation.

Accreditation
This activity has been planned and implemented in accordance with the Essential Areas and Policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of the UC Davis Health System and the UC Center for Health Quality and Innovation. The UC Davis Health System is accredited by the ACCME to provide continuing medical education for physicians.

Credit designation
Physician credit: The UC Davis Health System designates this live activity for a maximum of 4.75 AMA PRA Category 1 Credits™. Physicians should only claim credit commensurate with the extent of their participation in the activity.

AMA PRA Category 1 credit acceptable for multidisciplinary team members
Nurse: For the purpose of recertification, the American Nurses Credentialing Center accepts AMA PRA Category 1 Credits™ issued by organizations accredited by the ACCME. For the purpose of relicensure, the California Board of Registered Nursing accepts AMA PRA Category 1 Credits™ (report 4.75 hours of credit and fill in “CME Category 1” for the provider number).

Physician assistant: The National Commission on Certification of Physician Assistants (NCCPA) states that AMA PRA Category 1 Credits™ are acceptable for continuing medical education requirements for recertification.

About the UC Center for Health Quality and Innovation
The UC Center for Health Quality and Innovation, launched in 2010, is charged with identifying best practices, convening key stakeholders to facilitate the exchange of knowledge and funding innovative projects that demonstrate improved value in the health care delivery system. The center is governed by a board composed of the six UC medical school deans, five UC medical center CEOs and chaired by the UC Health senior vice president. For more information, visit http://health.universityofcalifornia.edu/innovation-center or email chqi.info@ucop.edu.

Study shows flaws in use of discharge diagnoses to determine validity of ER visits.

Visits to the emergency room are not always for true medical emergencies – and some policymakers have been fighting the problem by denying or limiting payments if the patient’s diagnosis upon discharge is for “nonemergency” conditions.

A new UC San Francisco study challenges that framework by showing that criteria used as a basis to determine the appropriateness of an ER visit and to deny payment is inherently flawed. The study analyzed nearly 35,000 visits to hospital emergency departments around the country.

The research is published online Wednesday in JAMA, The Journal of the American Medical Association.

Overuse of the ER for nonemergency visits is often touted as a costly problem in the United States. The new study highlights the complexity of the issue by showing that using discharge diagnoses to determine the validity of an ER visit could have serious implications, including dissuading patients from using the ER when they really need it.

While many patients are given a diagnosis upon discharge that their condition was treatable through primary care, other similar patients actually required immediate emergency care or to be admitted to the hospital, the researchers found.

The authors conclude that strategies aimed at narrowly reducing use of the emergency room are unlikely to improve a community’s general health or to lower health system costs.

“This study highlights the flaws of a system that fails to distinguish between information available at arrival in the emergency department and information available at discharge,” said lead author Maria C. Raven, M.D., M.P.H., a UCSF assistant clinical professor of emergency medicine. “Attempting to discourage patients from using the ER based on the likelihood that they would have nonemergency diagnoses risks sending away patients who require emergency care. The majority of Medicaid patients, who stand to be disproportionately affected by such policies, visit the ER for urgent or more serious problems.”

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Policy experts offer vision for better care at lower cost.

An unprecedented, yearlong collaborative effort involving policy experts from the University of California, Berkeley, CEOs of major health insurers and health care delivery systems, and leaders from California’s public sector has produced a detailed roadmap that would transform the state’s health care system and improve care and outcomes while saving billions of dollars in the process.

The members of the Berkeley Forum for Improving California’s Healthcare Delivery System have agreed to support a risk-adjusted global budget model of paying for coordinated care, and today (Feb. 26), will issue a detailed report on specific actions that would save the state of California $110 billion – about $800 per household annually – over the next decade.

Global budgets, whereby physicians and hospitals optimize care under pre-determined expenditure targets, are a major shift from today’s predominantly fee-for-service environment. The current system, in which providers are paid for each treatment or procedure rendered, leads to the provision of more and duplicative services rather than efficient care that promotes good health, the report authors said.

Stephen Shortell, UC Berkeley

“For the first time, the key actors who deliver and pay for our health care have come together to support a roadmap for fundamental change in how we buy and provide health care services,” said forum chair Stephen Shortell, the Blue Cross of California Distinguished Professor of Health Policy and Management at UC Berkeley and dean of the School of Public Health. “They agreed that fee-for-service must be put to bed and that they support actions to move towards global budgets that will facilitate major innovations in delivering better, more coordinated care.”

The report comes as the state prepares to implement the Affordable Care Act, which will add millions of additional people to the health insurance roster. (A copy of the forum’s full report, “A New Vision for California’s Healthcare System,” and its executive summary are available online here.)

Convened by experts from UC Berkeley’s School of Public Health, forum members include presidents and CEOs of Anthem Blue Cross, Blue Shield of California, Cedars-Sinai Health System, Dignity Health, Health Net, HealthCare Partners, Kaiser Permanente, MemorialCare Health System, Monarch HealthCare, Sharp HealthCare and Sutter Health. The heads of these hospital systems, medical groups and health insurers joined state and federal health care officials in a series of meetings held throughout the past year.

UC Berkeley’s Richard Scheffler, Distinguished Professor of Health Economics and Public Policy and director of the Petris Center on HealthCare Markets and Consumer Welfare, and Liora Bowers, director of Health Policy and Practice at the Petris Center, are lead authors of the report. While designed in the context of California’s unique set of health care challenges, the initiatives endorsed by the forum offer relevant and realistic reforms for states across the country, they said.

“The report represents an innovative private sector approach to a problem that the federal and most state governments have failed at: improving quality and slowing the rate of health care spending,” said Scheffler.

At the core of the forum’s report are two interrelated proposals to fundamentally change how health care services are financed and delivered. The first entails a major shift toward the use of global budgets, which would be adjusted for the underlying health of patient populations. Payments would also be partly tied to quality of care and patient satisfaction measures to ensure that high standards of care are maintained.

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Event will be May 3 in Oakland.

Mark Laret, UC San Francisco

>>Register online or download form
>>View draft agenda

Registration has opened for the University of California Center for Health Quality and Innovation’s second spring colloquium, 9 a.m. to 4 p.m. May 3 at the Oakland Marriott City Center, 1001 Broadway, Oakland (map). The registration form can be downloaded or filled online.

The colloquium will address the changing health care marketplace, increasing financial challenges, and clinical and operational approaches available to UC Health to compete as health care reform unfolds. Talks will include a keynote address by UC San Francisco Medical Center CEO Mark Laret and remarks by UC Health Senior Vice President John Stobo, UC Chief Risk Officer Grace Crickette, innovation center Executive Director Terry Leach and innovation center fellows. (View the draft agenda.)

The colloquium is open to anyone at UC’s medical centers and health professional schools who is working to improve health care delivery, population health and efficiency of care at UC Health.

The registration fee is $75. A limited number of registration fee waivers will be available for UC Health professionals, faculty and staff. Please contact claudia.schwarz@ucop.edu or (510) 987-9590 for more information.

Attendees interested in reserving a room at the Oakland Marriott City Center can take advantage of paying a group rate. Space is limited. For more information, visit the Marriott’s website or call (510) 451-4000 (reference “CHQI” for group rate).

The colloquium has been approved for AMA PRA Category 1 Credits™ continuing medical education, jointly sponsored by the UC Davis Health System Office of Continuing Medical Education and the UC Center for Health Quality and Innovation.

Accreditation
This activity has been planned and implemented in accordance with the Essential Areas and Policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of the UC Davis Health System and the UC Center for Health Quality and Innovation. The UC Davis Health System is accredited by the ACCME to provide continuing medical education for physicians.

Credit designation
Physician credit: The UC Davis Health System designates this live activity for a maximum of 4.75 AMA PRA Category 1 Credits™. Physicians should only claim credit commensurate with the extent of their participation in the activity.

AMA PRA Category 1 credit acceptable for multidisciplinary team members
Nurse: For the purpose of recertification, the American Nurses Credentialing Center accepts AMA PRA Category 1 Credits™ issued by organizations accredited by the ACCME. For the purpose of relicensure, the California Board of Registered Nursing accepts AMA PRA Category 1 Credits™  (report 4.75 hours of credit and fill in “CME Category 1” for the provider number).

Physician assistant: The National Commission on Certification of Physician Assistants (NCCPA) states that AMA PRA Category 1 Credits™ are acceptable for continuing medical education requirements for recertification.

About the UC Center for Health Quality and Innovation
The UC Center for Health Quality and Innovation, launched in 2010, is charged with identifying best practices, convening key stakeholders to facilitate the exchange of knowledge and funding innovative projects that demonstrate improved value in the health care delivery system. The center is governed by a board composed of the six UC medical school deans, five UC medical center CEOs and chaired by the UC Health senior vice president. For more information, visit http://health.universityofcalifornia.edu/innovation-center or email chqi.info@ucop.edu.

California Advanced Primary Care Institute launched this week.

Heather Young, UC Davis

Heather M. Young, associate vice chancellor for nursing at UC Davis and founding dean at the Betty Irene Moore School of Nursing, joined more than a dozen health care leaders in San Jose Jan. 15 to launch the California Advanced Primary Care Institute (CAPCI), a multipronged effort to improve the appeal of primary care as a career choice for health professionals and also elevate the performance of primary care teams.

CAPCI emerged from a statewide consensus meeting in April 2012 led by the California Association of Physician Groups. The nonprofit foundation convened its first Steering Council meeting Jan. 15. Young was appointed to the steering council.

“I am pleased to be part of this group. In order to meet the increasing demand for primary care in California, it is essential we prepare a variety of health care professionals,” Young said. “We need nurses, physicians, physician assistants and other team members with advanced skills in understanding complex problems and generating solutions, understanding how health systems and health care works and how to improve quality, lead teams and deal with the business aspects of care.”

“Primary care is the cornerstone for all of California’s health care delivery systems and sets the foundation for every goal of health care reform,” said Wells Shoemaker, the medical director for the California Association of Physician Groups. “Sadly, California faces a serious erosion of primary care workforce at the same time that our state braces for a daunting bulge in chronic illnesses and the long awaited opportunity through health reform to serve millions of previously uninsured individuals and families.”

California’s primary care workforce is expected to shrink by 30 percent in the next five to eight years as a consequence of retiring professionals and fewer new clinicians choosing to work in primary care.

“If we are going to transform primary care to provide superb, patient-centered care to every Californian, we will need to fundamentally change our approach to training the people who work in primary care,” said physician Kevin Grumbach, a professor at the UCSF Department of Family and Community Medicine, and member of the CAPCI executive management committee. “This new coalition represents an unprecedented partnership between practice organizations and training institutions to equip the workforce for the innovative care models that will drive excellence in primary care throughout California.”

CAPCI received startup funding from the California HealthCare Foundation, The California Endowment, CAPG group contributions, and the California Academy of Family Practice.

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New public-private partnership launched between university and health insurer.

John Stobo

Anthem Blue Cross and University of California Health — UC’s medical centers and health professional schools — announced today the launch of a groundbreaking alliance aimed at addressing some of the most critical issues facing the state’s health care delivery system.

Under this new agreement, Anthem and UC Health will focus on care innovation and California health policy development with the purpose of improving access to affordable, quality health care for California residents. The parties have named this joint venture the California Health Alliance. Both expect an enduring and productive association that will benefit the people of California.

With all five of the world-class UC academic health centers in Anthem’s network, both organizations have a long-standing history of serving residents throughout the state and are uniquely positioned to understand the health care needs of Californians. And, as the state prepares to expand health care through the Affordable Care Act (ACA), both organizations believe that today, more than ever, a collaboration of this type can effectively address the impact expected on the state’s health delivery system as more residents prepare to access medical services.

Among some of the initial areas of focus of this alliance will be the development of accountable care models to better manage costly chronic conditions and the expansion of alternate delivery systems, such as telemedicine to encourage wellness and prevention and to provide access to health care for residents in rural areas. In addition, this new alliance is expected to provide opportunities for research, analysis, literature development and policy recommendations.

“We know that residents of the state look to a future that includes access to quality health care that is affordable,” said Pam Kehaly, president of Anthem Blue Cross. “By teaming with the University of California Health, we are bringing together some of the most innovative minds to help us achieve a common goal: to improve the health and wellness of California residents.”

“As two of the state’s leading organizations, this new affiliation has the ability to revolutionize California’s health care delivery system,” said Dr. John Stobo, senior vice president for UC Health. “By coming together, we know we can develop meaningful research, policy and best practices that can be leveraged on a broader scale to help improve the state’s health care system and the health of the population at large.”

Media contacts:
Leslie Porras, Anthem Blue Cross
(818) 234-3368
leslie.porras@wellpoint.com

University of California Media Office
(510) 987-9200

About Anthem Blue Cross:
Anthem Blue Cross is the trade name of Blue Cross of California. Anthem Blue Cross and Anthem Blue Cross Life and Health Insurance Company are independent licensees of the Blue Cross Association. ANTHEM is a registered trademark of Anthem Insurance Companies, Inc. The Blue Cross name and symbol are registered marks of the Blue Cross Association. Additional information about Anthem Blue Cross and Anthem Blue Cross Life and Health Insurance Company is available at www.anthem.com. Also, follow us on Twitter at www.twitter.com/healthjoinin, on Facebook at www.facebook.com/HealthJoinIn, or visit our YouTube channel at www.youtube.com/healthjoinin.

About UC Health:
University of California Health includes five academic health centers — UC Davis, UC Irvine, UCLA, UC San Diego and UC San Francisco — with 10 hospitals and 18 health professional schools and programs on seven UC campuses. For more information, visit http://health.universityofcalifornia.edu.