Author Archives: Rachel Dornhelm
Rachel Dornhelm got her start in radio at WHYY. After anthropology graduate school, Rachel lived in Uzbekistan working with youth near the drying Aral Sea. Rachel returned to radio full-time in 2001. Her work has appeared on WNYC, WBUR, Marketplace, NPR news magazines and KQED.
(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 Alferis 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.
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.”
Immediately following the Supreme Court’s decision on the Affordable Care Act, the head of California’s Health Benefit Exchange laid out his vision for revolutionizing the health insurance market.
“We know buying insurance is really complicated. We want to make it as easy as buying a book on Amazon,” said Peter Lee, executive director of the California Health Benefit Exchange.
But as the state has worked to create the actual application for health insurance, the idea of a one-click purchase is far from the reality.
“This is a brand new law and it’s complicated,” says Sam Karp, vice president of programs at the California HealthCare Foundation (CHCF). “It’s reasonable to expect the implementation will take not just a year. It will take a few years.” Continue reading
Facing a huge shortage in doctors in coming decades, two US representatives introduced a bill that would significantly increase the number of Medicare-sponsored residencies. The number of those residencies has not increased in 15 years. The Association of American Medical Colleges (AAMC) is estimating that the U.S. healthcare system could be short hundreds of thousands of doctors in coming decades.
New emergency rules won’t let insurers illegally limit therapy visits.(shannonrosa/flickr)
California regulators have issued emergency regulations aimed at keeping insurance companies from delaying or denying coverage for autism treatment.
Insurance Commissioner Dave Jones announced the approval of emergency rules this week, which take effect immediately.
“Autistic children and their families should now, without delay, receive the transformative treatment that will enable them to succeed in school, their families, and communities,” Jones wrote in a statement.
Insurers have already been required to comply with medically necessary treatment by the state’s Mental Health Parity Law and SB 946, which reinforced the mandate for private insurers to provide behavioral treatment for autism.
However Karen Fessel, executive director of the Northern California-based Autism Health Insurance Project, says these emergency regulations were needed.
“This is an example how even with the right laws in place you still need vigilant regulators who will help interpret the law in ways that they were intended,” says Fessel “Because the health plans often twist things around so much people don’t get the care they need even with the laws.” Continue reading
Family members who were allowed to watch emergency health workers try but fail to resuscitate a loved one appeared to cope better in the months after the death. A new study published in the New England Journal of Medicine today found those family members had fewer symptoms of anxiety and depression months later. The results of the French study also showed that the presence of family members did not interfere with the care.
Many studies have looked at whether or not breastfeeding helps protect against childhood obesity. While plenty find a link, some suggest it may be related to different lifestyle choices by women who choose to breastfeed. This new report in the Journal of the American Medical Association looks at women in Belarus who were part of a program promoting nursing among women who may not have otherwise made that choice. This study found no difference in weight and body fat in children who had been nursed as infants.
California's aging baby-boomer population has policymakers and developers thinking about how to let them age at home. (Justin Sullivan/Getty Images)
California may be the sixth youngest state right now. But it has an outsized population of Baby Boomers.
“They are turning 65 soon,” says Adele Hayutin, a Senior Research Scholar at the Stanford Center on Longevity.
“We’ll have a doubling of our older population over the next 20 years,” Hayutin says. “That makes us aging faster than the United States, which I think is a bit of a surprise to people.”
In a recent paper, Hayutin wrote that projections show in 2040 California’s population will be slightly older than the nation’s as a whole. That has implications for policy makers, developers, and residents — everyone who lives here will feel the effect.
And the sooner the planning starts the better, says Henry Cisneros.
Cisneros is the former Secretary of the U.S. Department of Housing and Urban Development under President Clinton. He just co-edited a book with two scholars at Stanford – Jane Hickie and Margaret Dyer-Chamberlain – called “Independent for Life: Homes and Neighborhoods for an Aging America.”
“When we listen to older Americans themselves,” Cisneros says, “when they describe the things they fear about aging in place … it’s things like isolation, being left alone and not being able to negotiate neighborhood streets. Not being able to get to the doctor or grocery store.” Continue reading
Will employers stop covering employees and push them to the exchanges once they are set up in the 50 states? (STAN HONDA/AFP/GettyImages)
Now that the future of the Affordable Care Act has been decided – to some degree – the debates over what it means have begun.
Does the act potentially impose a tax on Americans or a penalty? Will the health care system become uniformly robust, or will it put a huge burden on physicians in private practice?
And another biggie that you’ll be hearing about:
The Chronicle has a piece this morning, with a link to a report in McKinsey & Company, which suggests: YES, given the opportunity, employers will stop offering coverage. But in Massachusetts, which has a similar law already in place, that hasn’t been the case.
Who is right? Probably this report from the Commonwealth Fund that sorts through a number of studies and concludes it will be hard to know how it will shake out until large employers are eligible for the health exchanges in 2017.
Studies and surveys on the subject aren’t hard to find, but they are hard to reconcile. Just since June 2010, there have been at least seven surveys on the subject.1 So, will 2.7 percent of employers drop coverage as this survey suggests? Or will 18.8 percent drop coverage, as this survey, conducted one month later, suggests? Or were researchers at RAND correct when then calculated in late 2010 that employers would offer coverage to an additional 13.6 million workers once the exchanges, penalties, and various subsidies are all up and running?2
Let the debates begin.
Duf Sundheim was the chair of the California Republican Party from 2003-2007 and remains active in the party. He lives in Los Altos Hills, CA. KQED’s Stephanie Martin spoke to him today about his reaction to the Supreme Court decision.
MARTIN How do you feel that Chief Justice Roberts, a fellow conservative, voted to uphold the law?
SUNDHEIM Well I think he really had a lot of things he was trying to address. One was the specific issue of the mandate and the commerce clause. That’s why I think so many people thought the legislation would be overturned. And the fact he was able to make a bridge to find that it was a tax, not a mandate. I think was very interesting.
I thought the reasoning was a little tortured but I think he was really concerned about the future of the court, the public perception of the court.
So I understand what he was trying to do. Again it’s not a situation where they’re making a decision that ties the hands of the other branches of government. It really transfers to the decision to those two branches. And it’s now up to those two branches to make a decision that’s in the best interest of the people. Continue reading