TAG: "Health care reform"

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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Related link:
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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Study finds 125K immigrant youth with ‘deferred action’ may be eligible for Medi-Cal

UC reports indicate need, potential for health coverage among undocumented.

Laurel Lucia, UC Berkeley

University of California researchers today (Feb. 25) released two reports that indicate high need and potential for health coverage among undocumented teens and young adults in the Golden State. The findings trail a bill recently introduced in the California Legislature that calls for health care coverage for all Californians regardless of their immigration status.

Up to 125,000 young immigrants are estimated to be Medi-Cal (the state’s Medicaid program) eligible under state policy, according to a new report, Realizing the Dream for Californians Eligible for DACA: Demographics and Health Coverage released by the UC Berkeley Labor Center, the UC San Francisco Philip R. Lee Institute for Health Policy Studies and the UCLA Center for Health Policy Research. DACA, or Deferred Action for Childhood Arrivals, provides temporary work authorization and relief from deportation for undocumented immigrants who came to the U.S. as children. In California policy, unlike that of most other states, low-income individuals granted deferred action are eligible for Medi-Cal.

“This state policy could significantly improve health coverage rates among these young immigrants, increase access to the care they need and reduce the burden on safety net providers,” says Laurel Lucia, a policy analyst with the UC Berkeley Labor Center. “However, immigrant youth may still face barriers to enrolling because they lack information on the program or fear deportation for themselves or family members.”

Out of the 300,000 undocumented Californians estimated to be eligible the DACA program, approximately 150,000 have applied and been granted deferred action. Despite being considered “lawfully present” by the U.S. Department of Homeland Security, DACA youth are not eligible for federally subsidized health programs, such as Medicaid or the new programs created under the Affordable Care Act.

A high need for coverage exists, according the UCLA Labor Center’s Undocumented and Uninsured: Immigrant Youth and the Struggle to Access Health Care in California, the first statewide study about and by immigrant youth on health care access. Researchers surveyed 550 immigrant youth throughout the state, including DACA-eligible and undocumented youth.

The UCLA Labor Center researchers found that 69 percent of immigrant youth did not have health insurance, while half delayed getting the medical care they felt they needed in the past year. Nearly all (96 percent) of those delaying care cited cost or lack of insurance as reasons.

“Without health care, immigrant youth and their families must rely on Band-Aid solutions,” says Imelda Plascencia, one of the report authors.

“They wait for hours at free clinics for partial care or find ways to pool resources with friends and family,” says Plascencia, who also is undocumented. “Whenever they interact with the formal medical system, the fear of deportation is present. These experiences are inhumane.”

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Why UC is participating in Covered California

UC is helping to increase access to affordable health care.

By Alec Rosenberg

University of California medical centers and physicians are playing an important part in helping increase access to health care through the federal Affordable Care Act.

The law is expected to expand health insurance coverage to millions of Americans by extending Medicaid coverage and creating health exchanges that will offer affordable health insurance options. California’s exchange, called Covered California, is aimed at those who don’t have insurance through their employer or another government program.

Californians who purchase a health benefit plan through Covered California and are looking to access UC’s five medical centers and 5,000 physicians for in-network health care can do so by selecting Anthem Blue Cross as their health care provider. UC Health has a systemwide agreement with Anthem to participate as a Tier 1 provider in the exchange that includes medical centers at UC Davis, UC Irvine, UCLA, UC San Diego and UC San Francisco.

Other insurers on the Covered California exchange also offer access to UC medical centers and physicians, such as Western Health Advantage with UC Davis and Health Net with UCLA and UC San Diego. Through Covered California, individuals may be eligible to receive financial assistance to make health care more affordable. However, if an enrollee already has access to affordable health insurance through another source, such as an employer or government program, the enrollee may not qualify for financial assistance through Covered California. So far, more than 400,000 people have enrolled in health insurance plans through Covered California.

As a public trust, UC has a responsibility to help Covered California be successful and to provide Californians access to affordable health care, said Dr. John Stobo, UC senior vice president for health sciences and services.

At a November summit attended by UC regents, chancellors, medical center CEOs and medical school deans, Stobo explained that UC is participating in Covered California because of its public trust role, even though its medical centers will receive lower reimbursements.

UC Health is a vital part of California’s safety net, providing half of the transplants and one quarter of extensive burn care in the state, as well as providing $444 million in charity care in the past year.

“We understand that we have a responsibility to address issues that affect society,” Stobo said.

As part of those efforts, UC not only is a participant in Covered California but also is doing outreach to inform the public about the exchange and health care reform.

For example, UC Davis has promoted its Covered California involvement at community venues, special events and its own facilities, staffing and passing out fliers at more than 70 events such as farmers markets and community health and safety fairs.

UC San Diego is hosting educational events for the public to learn about the Affordable Care Act and has distributed more than 3,000 fliers about its participation to patient areas, libraries, community centers and at events including the Chargers Blood Drive.

UC San Francisco hosted a town hall about Covered California that included state elected officials and Rep. Nancy Pelosi, House Democratic leader.

UC Irvine hosted its annual Super Saturday Health Fair, where participants could get health insurance and Affordable Care Act questions answered by Covered California as well as receive a free flu shot, a diabetes screening and a blood pressure checkup.

As part of a team of more than 200 health professionals, UCLA staffed the Care Harbor free health care clinic with trained navigators who helped patients sign up for health coverage.

Additional outreach and education is being done through grants awarded by Covered California, with UC receiving two of these grants, each for $1 million. One is for the UC Berkeley School of Public Health and its Health Initiative of the Americas, which works with 13 subcontractors to reach out to Latinos in both rural and urban areas, particularly part-time, seasonal and contract employees as well as post-secondary students and young invincibles. The other is for the UC Davis Center for Reducing Health Disparities, which is partnering with El Concilio, the Council for the Spanish Speaking, to educate nearly 133,000 primarily Spanish-speaking Central Valley residents about Covered California.

The UC Student Health Insurance Plan launched a health care reform education campaign to inform students that they have new choices in their insurance coverage and to promote understanding of the value of UC-sponsored student health plans.

Californians began enrolling in health plans through Covered California on Oct. 1 and can continue to enroll through March 31, 2014.

For more information, visit:

For more information about Covered California, visit www.coveredca.com or call (800) 300-1506.

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Public insurance fills health coverage gap, new UCLA analysis shows

“Public programs have stepped in as employers have stepped out.”

Mother and childIn the years leading up to implementation of the Affordable Care Act, the percentage of Californians who received their health insurance through public programs continued to rise, likely in direct response to the loss of job-based coverage in the state, according to a new analysis by the UCLA Center for Health Policy Research.

The data for the analysis, collected in 2012 by the California Health Interview Survey, represents the most recent comprehensive statewide source of information on health insurance trends. The fact sheet was funded by The California Endowment and The California Wellness Foundation.

According to the analysis, the percentage of non-elderly state residents receiving health insurance through an employer dipped just below 50 percent in 2011 and remained there in 2012 — a 6 percentage-point decrease since 2001.

Public programs, such as Medi-Cal and Healthy Families, insured nearly 20 percent of Californians in 2012, a 3 percentage-point increase since 2009 and a 5 percentage-point increase since 2001.

“In effect, public programs have stepped in as employers have stepped out,” said Shana Alex Lavarreda, the center’s director of health insurance studies and the lead author on the fact sheet. “The data refutes any lingering arguments that employer-based insurance is the solution to our health care coverage crisis.”

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California Health Secretary Diana Dooley discusses health care reform

Covered California is “off to a very good start,” she tells UC employees.

California Health and Human Services Secretary Diana Dooley, accompanied (left) by Dr. John Stobo, UC senior vice president for health sciences and services, greets California Health Benefits Review Program Director Garen Corbett after her Oct. 8 talk with UC Office of the President employees.

California Health and Human Services Secretary Diana Dooley, accompanied (left) by Dr. John Stobo, UC senior vice president for health sciences and services, greets California Health Benefits Review Program Director Garen Corbett after her Oct. 8 talk with UC Office of the President employees.

By Alec Rosenberg

It’s a historic time for health care in America. And California is helping lead the reforms, said Diana Dooley, state secretary of Health and Human Services.

California’s health insurance exchange launched Oct. 1. The online marketplace allows individuals, families and small businesses to compare policies and buy insurance.

The exchange was created as part of the federal Affordable Care Act, and is expected to increase access to health care, along with an expansion of Medicaid coverage to millions of low-income Americans. About 48 million Americans are uninsured, including more than 7 million Californians.

The state marketplace, called Covered California, in the first week received about 1 million unique visits to its website – second highest in the nation – along with 59,000 phone calls and more than 16,000 completed applications for health insurance.

Diana Dooley

Diana Dooley

“We’re certainly off to a very good start,” Dooley told UC Office of the President employees Oct. 8 at a talk in Oakland hosted by UC Health. “As California goes, so goes the nation.”

Exchange preparations have been complicated and fast paced. For example, only a few contractors were willing to bid on the California exchange’s IT contract, partly because of the compressed timeline: 15 months for a project that typically would take five years, Dooley said.

While there have been a few glitches, “it’s up, and it’s working,” said Dooley, who chairs Covered California.

Call waiting times also have improved – dropping from as long as 40 minutes during the first day to less than four minutes by the fourth day. The goal is 30 seconds, Dooley said.

Despite the current federal government shutdown, the Affordable Care Act is helping bring about a “culture of coverage,” Dooley said. The act requires nearly every American to have health insurance by Jan. 1 or pay a fine.  Eligible low-income residents can receive free or low-cost care through Medicaid, while moderate-income individuals and families using an exchange can receive financial assistance on a sliding scale. Californians using the exchange need to sign up by Dec. 15 to meet the Jan. 1 deadline.

The Affordable Care Act is a three-legged stool, Dooley said. One leg is expanded coverage. The other two legs also are important: improving how care is delivered and financed, and moving to a model that emphasizes prevention and wellness. To succeed, California will need to move from a fee-for-service model to a system of coordinated care that includes a focus on containing costs, she said. It also involves expanding efforts to make Californians healthier.

Dooley formed a task force, Let’s Get Healthy California, whose goal is to have California be the nation’s healthiest state by 2022.

“You’ve got to have some big goals or you don’t achieve very much,” Dooley said.

Dooley also discussed the issue of investment in medical education, saying it needs to be addressed to help fill workforce shortages. She noted UC’s role in training health care professionals. UC Health has the nation’s largest health sciences instructional program, enrolling more than 14,000 students with 17 professional schools on seven campuses.

Dr. John Stobo, UC senior vice president for health sciences and services, praised Dooley as a champion for innovation, transparency and for reforming the health care delivery system.

“She is really committed to addressing the health needs of underserved populations,” Stobo said. “It resonates with UC Health’s mission as a public trust.”

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How will rollout of Affordable Care Act affect you?

UCSF experts discuss potential impact of new health care coverage options.

Josh Adler, UC San Francisco

Josh Adler, UC San Francisco

Open enrollment for California’s new health insurance exchange – called Covered California – will begin on Oct. 1, making available health insurance to millions of state residents who are uninsured or who don’t have coverage from their employers.

This virtual marketplace is the result of the Affordable Care Act (ACA), which included a requirement that states create their own health insurance exchanges or have them set up by the federal government. Coverage will be effective on Jan. 1, 2014, and all health insurance plans that participate in the exchanges must commit to including certain health benefits.

Following are interviews with some of UC San Francisco’s leading experts about the potential impact of these new health care coverage options statewide, nationally, on hospitals and clinics, and on women and children:

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Medicaid use surging in California’s emergency rooms

UCSF study findings could be bellwether of national health care reform.

Renee Hsia, UC San Francisco

Renee Hsia, UC San Francisco

More adults in California are flocking to emergency rooms, especially those on Medicaid who are using ERs at a faster rate than the uninsured or privately insured, according to new UC San Francisco research.

The researchers say the findings could reflect a nationwide trend under the Affordable Care Act. Many uninsured people are expected to transition to Medicaid, and as a result, overall emergency department use may increase because Medicaid patients have higher rates of ER use, as the study found. At the same time, some states are proposing cuts to Medicaid or refusing to expand it, which could exacerbate waiting time in the ER.

The analysis will be published as a “Research Letter” on Sept. 18 in the Journal of the American Medical Association (JAMA).

The study investigated trends in the association between insurance coverage and usage of emergency departments among adults ages 18 to 64.

In California, the number of visits to emergency rooms increased 13.2 percent between 2005 and 2010, from 5.4 million to 6.1 million per year, the researchers reported.

“We undertook the study with an eye toward identifying important coming concerns,” said lead author Renee Y. Hsia, M.D., an associate professor of emergency medicine at UCSF. She is also an attending physician in the emergency department at the UCSF-affilated San Francisco General Hospital & Trauma Center and a faculty member of the UCSF Institute for Health Policy Studies.

“All the findings suggest that emergency department use may actually increase with health care reform, instead of decline, if most of the uninsured patients become eligible and enroll in Medicaid,” Hsia said. “These results should not discourage policymakers from pursuing health care reform. Rather we hope our study will shed some light on issues that need to be addressed as we continue to expand insurance coverage to millions of uninsured patients.”

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State Secretary Diana Dooley to discuss health care reform

Event will be Oct. 8 in Oakland.

Diana Dooley

Diana Dooley

What is the latest on health care reform? Join guest speaker Diana Dooley, secretary of the California Health and Human Services Agency, for a special discussion Tuesday, Oct. 8, from 1:30 to 2:30 p.m. in Franklin Lobby 1 Conference Room at the UC Office of the President, 1111 Franklin St., Oakland.

Dooley will discuss the opportunities and challenges of the federal Affordable Care Act, and the implications for California. The event will be hosted by UC Health Sciences and Services.

Appointed secretary in December 2010 by Gov. Jerry Brown, Dooley leads 13 state departments and chairs Covered California, the new statewide health insurance marketplace created to implement provisions of the Affordable Care Act. She also serves as chair or member of numerous other boards and commissions. Previously, she was president and CEO of the California Children’s Hospital Association.

Dooley began her career as an analyst for the state. In 1975, she was appointed to Brown’s staff during his initial stint as governor. She served as legislative director and special assistant until 1983. Before becoming an attorney in 1995, she owned a public relations and advertising agency. She moved into health care in 2000, when she left her private law practice to serve as general counsel and vice president at Children’s Hospital Central California. She is married to Dan Dooley, UC senior vice president for external relations.

UC Health Sciences and Services provides leadership and strategic direction to advance the education, research and clinical service missions of the university’s 17 health professional schools and 10 hospitals, collectively referred to as UC Health.

To RSVP for the Oct. 8 event, email Communications Coordinator Alec Rosenberg at alec.rosenberg@ucop.edu. Those interested also may participate by audio conference: Dial (866) 740-1260; passcode: 9879207.

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