Monthly Archives: June 2013

How Important Is Cost Transparency To Lowering Health Costs?

AetnaRate_Images Money_Apr62012

(flickr: Images Money)

The largest public employees retirement system in the country – CalPERS – has plenty to gain from a drop in health care costs. After all, they cover 1.6 million employees, retirees and their families in California.

Now they’re saying, they found a way to decrease the amount they’ve spent on knee and hip replacements by 19 percent in a year, which could have implications for other employer health plans.

Lisa Aliferis blogged about the CalPERS experiment in controlling costs right here on State of Health about a year ago. Aliferis wrote that they decided to tackle costs around these two surgeries, which cost them $55 million dollars a year in 2008.

Now, you might not think there would be much difference in the price for getting a knee or hip replacement across the state. But think again. CalPERS asked Anthem Blue Cross — which manages its PPO plans — to examine the range of prices for these operations in California.

Anthem came back with the startling information that CalPERS was paying $15,000 on the low end to $110,000 on the high end, a more than seven-fold difference from lowest to highest.

“So we started asking ourselves,” Kathy Donneson, Chief of the CalPERS Heatlhy Plan Administration Division told me, “what are we getting from the $110,000 surgery that we couldn’t get from the $15,000 surgery?”

That’s when CalPERS turned to what’s called a “value based purchasing” approach for elective hip and knee replacements, starting with its non-Medicare population. CalPERS set a threshold price of $30,000 for the hospitalization and device charges for these operations. That $30,000 is slightly higher than the average price CalPERS had been paying for a hip or knee replacement. Anthem identified 46 hospitals across the state which would do these operations at the threshold price.

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LGBT Couples Face Ongoing Hurdles in Health Care Parity

(Rachel Dornhelm/KQED)

(Rachel Dornhelm/KQED)

The Supreme Court ruled today to repeal the Defense of Marriage Act (DOMA) and expand the legal definition of marriage. Married people enjoy a slew of federal benefits and in California, gay couples already enjoy many of those same rights. One problem, however, is that some LGBT couples have faced hurdles accessing a number of those privileges.

In January 2011, the Department of Health and Human Services adopted a policy to address one important benefit that married couples already enjoyed: hospital visitation rights. Under that policy, people can choose practically any individual they would like to be at their hospital bedside, from a spouse to a partner to a friend. The policy is not specifically tailored to gays and lesbians; it applies to everyone.

Within the LGBT community in California, advocates say the visitation policy seems to be working well. There are far fewer people being denied the right to be with their loved ones in their time of need.

“I haven’t heard of anything in awhile in California,” said John Davidson of Lambda Legal, a civil rights advocacy group for lesbians and gay men. “A lot of hospitals have become more aware.”

But that’s not the case everywhere – and that can make a difference when people are visiting other states. Continue reading

Low-income California Children Among Least Likely to Get Dental Care

Almost 60% of California children on Medi-Cal did not receive any dental care in 2011 (nmoira/flickr)

Almost 60 percent of California children on Medi-Cal did not receive any dental care in 2011. (nmoira/flickr)

Young people who don’t get the routine dental care they need find themselves at a disadvantage, studies have shown: not just in overall health but also in school performance.

Now a study from the Pew Charitable Trusts finds that California is among the 10 states where low-income children are least likely to receive dental care.

Almost 60 percent of children with Medi-Cal did not receive any dental care in 2011, said co-author Jane Koppelman.

“What it means is that kids can have insurance, they can have (Medi-Cal), but it’s more like a hunting license than an entitlement,” says Koppelman, research director for the Pew Children’s Dental Campaign. “It’s a license to try to find a dentist who can give you care. And in a lot of areas that is quite a trial.”

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Advocates Prepare for Confusion and Resistance to Obamacare Among Asians

By Mina Kim, KQED

Doreena Wong will lead a $1 million effort to educate the state's Asian populations on the state-run insurance market Covered California.

Doreena Wong will lead a $1 million effort to educate the state’s Asian populations on the state-run insurance market Covered California.

There’s talk the Obama administration will try to enlist the help of NBA players to sell the federal health law to young men. For its part, Covered California, the state’s new health insurance marketplace, plans to spend millions on an ad blitz and social media strategy. But in a state as diverse as California, one of the toughest challenges will be reaching ethnic communities where English is a second language.

In Orange County’s Little Saigon neighborhood where suburban-style strip malls fill with Vietnamese storefronts, the Affordable Care Act isn’t top of mind.

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Can Air Pollution Cause Asthma in Kids? How About Autism?

(Getty Images/Thinkstock)

(Getty Images/Thinkstock)

We all know air pollution is not great for your health, but two new studies this week stressed just how bad it can be for children, infants and the developing fetus. Exposure to air pollution at a young age, these studies showed, can lead to an array of long-lasting health problems, including asthma and autism.

It’s not just that polluted air can, say, trigger asthma attacks. Now, researchers are finding that exposure to air pollution may actually cause some diseases.

“We’re discovering some of the long-term effects of this air pollution: things like lung development in kids,” said Georges Benjamin, executive director of the American Public Health Association.

“Communities should be informed of what they’re breathing.” — Paul Cort, Earthjustice
A study led by UCSF found that African American and Latino infants living in communities with high automobile exhaust are more likely to develop childhood asthma than those living with less pollution. This is significant because minority communities are more likely to live near congested roadways.

In California, African Americans and multi-racial people have some of the highest rates of asthma, according to the CDC. But rigorous scientific studies that examine just how the lungs of minority children develop when swamped with car exhaust have been rare. Continue reading

‘Baby Panic’? Women Over 35 May Be Quite Fertile After All

(Getty Images)

(Getty Images)

I walked into the newsroom today startled to see the TV screen tuned to ABC’s Good Morning America streaming (or screaming?) “Baby Panic: How long can you wait to have a baby?” across the bottom of the screen.

I wondered why this discussion was suddenly news again.

I hate the “baby panic” story. I got pregnant easily for the first time at 39. Right on my block, I can quickly count a number of women who also had their first child after 35. Many of us also had children in our 40s. Most of us did this without fertility treatments. I always thought baby panic was a way to get women to “lean out” of their careers.

So it was with some trepidation that I discovered The Atlantic article that appears to be driving this new media frenzy. But this article is different. It debunks the conventional wisdom about women over 35 facing a steep and rapid decline in fertility.

In her piece, Jean Twenge weaves in her personal story: divorced at 30, longing for children, worrying she’d never have them.

Then she dives into the data. For example, where does the statistic showing that one-third of women 35 to 39 will not be pregnant after a year of trying come from? Continue reading

Yes, Young Adults DO Value Health Insurance, Poll Shows

By Jordan Rau, Kaiser Health News

(Getty Images)

(Getty Images)

A strong majority of young adults, whose participation in the health law may be key to its success or failure, strongly believe health insurance is important for them and worth the money, according to a new poll.

As California and other states — as well as the federal government — prepare new online marketplaces for people to purchase insurance this fall, the willingness of young people to buy coverage has been a topic of great uncertainty. Their participation in these marketplaces is considered crucial, since the young tend to be healthier than older people and, therefore, will use fewer medical resources, allowing their premiums to help subsidize the care of the old and sick.

Among age groups, the young are considered the hardest sell on insurance, because the coverage mandated under the 2010 health law is more comprehensive — and therefore more expensive — than the catastrophic policies that many now obtain. Young adults are considered more likely to believe they won’t suffer any horrible illnesses or injuries — a trend that has led to them being labeled “young invincibles.”

More than 71 percent of adults 30 or younger say having health insurance is “very important to them.”
The poll found some reason to believe that the young may not shun the health law requirement that they hold insurance starting next January. More than 71 percent of adults 30 or younger say having health insurance is “very important to them,” according to the poll from the Kaiser Family Foundation. When the pollsters put the question differently by asking whether “insurance is something I need,” more than 74 percent of people under age 30 agreed. Continue reading

Despite Promises, Key Autism Therapy Cut from Medi-Cal

By Ryder Diaz, KQED

(Getty Images)

(Getty Images)

If you don’t have a child with autism, you might not know about Applied Behavioral Analysis. ABA is widely regarded as a necessary and effective treatment.

Now many poor children will lose access to this therapy under deals reached in Sacramento last week. Meanwhile, other kids — including those who become insured under the state’s new Obamacare marketplace — may well continue to have access to this therapy.

Here’s the background: under the Affordable Care Act, states can expand Medicaid, called Medi-Cal in California. People with incomes up to 138 percent of poverty will be eligible. Last week, as the legislature and the administration were wrapping up the state’s budget, the legislature was simultaneously moving forward on final bills to implement the Medi-Cal expansion.

Last Friday, after months of debate, legislators sent two final bills to the governor’s desk to approve the expansion. But for supporters of the expansion, this victory came at the cost — ABA therapy for kids on Medi-Cal was axed. Children’s advocates are frustrated. Continue reading

California Insurance Chief: Bar Anthem from Small Business Marketplace

By Mina Kim, KQED

California’s insurance commissioner Dave Jones says Anthem Blue Cross shouldn’t be allowed to sell small business health plans on Covered California, the state’s new health insurance marketplace being set up under the requirements of the federal health law.  Jones says Anthem, the state’s largest insurer, has been engaging in a “pattern” of “excessive” rate hikes.

“It simply cannot be the case that a health insurer can unreasonably gouge its small business customers and not face any consequences whatsoever,” Jones said.

Under state law, Jones can review health plan rate hikes and declare them unreasonable, but he lacks authority to block them. Continue reading

San Francisco Breast Cancer Advocates Jubilant Over Supreme Court Human Genes Ruling

(William West/AFP/Getty Images)

(William West/AFP/Getty Images)

In a unanimous decision, the U.S. Supreme Court ruled Thursday morning that human genes are not patentable.

The case centered around Myriad Genetics, the holder of patents on two genes, BRCA1 and BRCA2. Some mutations of these genes are associated with an increased risk of breast and ovarian cancer. For women with a strong family history of these cancers, the only place they could be tested was Myriad Genetics, which sometimes charged more than $3,000 for the test.

Breast Cancer Action, an advocacy group based in San Francisco, was a plaintiff in the case, and executive director Karuna Jaggar sounded jubilant in a phone call Thursday morning.

“From our perspective, these patents never should have been granted in the first place,” Jaggar said. “There’s no question that DNA is a product of nature, and so it’s very affirming to see the court rule in our favor.”

BRCA1 and 2 mutations became international news when actress Angelina Jolie revealed that she’d had a preventive double mastectomy after testing showed that she had a specific mutation that put her at very high risk of developing breast cancer.

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