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May 24, 2012 | 3:47 PM | By

Meet the New Costs, Same as the Old Costs

By David Gorn, California Healthline

(Photo: Kaiser Health News)

(Photo: Kaiser Health News)

After more than a year of battling over eliminating and then restructuring adult day health care coverage for Medi-Cal beneficiaries, California’s budget for delivering that care is similar to what it was before all the haggling started.

The Community-Based Adult Services program grew out of a lawsuit challenging the state’s proposal and replaces the Adult Day Health Care program. CBAS will provide services to 80 percent of previous ADHC beneficiaries and is funded at a similar level to the original program.

“The original budget for ADHC was $170 million, and the current CBAS budget is

“I guess I just don’t understand why we had to go through all of this.”
$155 million,” said Lydia Missaelides, executive director of the California Association of Adult Day Services. “That means you’re looking at roughly the same cost to provide the same services to 80% of the beneficiaries.”

Of course, that doesn’t count the expense of legal battles, or the daunting number of man hours spent designing and implementing a new system, not to mention the constant arguing and debating over more than a year, she said. Missaelides sighed at the idea of it. Continue reading →

FILED UNDER: Money, Policy, Adult Day Health Care, Medi-Cal
May 21, 2012 | 10:56 AM | By

Proposition 29: First Cigarette Tax Increase in 13 Years. Yes or No?

By Sarah Varney

(Ferran Jorda: Flickr)

(Ferran Jorda: Flickr)

California voters are schizophrenic when it comes to regulating smoking. Polls show broad support for bans on smoking on sidewalks and public parks. Some cities have even outlawed smoking in apartment buildings.

But in 2006, the state’s voters rejected a ballot measure to hike cigarette taxes. While California was once the most aggressive state in taxing cigarettes, the tax rate here is lower than that of 32 other states. At 87 cents a pack, California’s cigarette taxes are 60 cents lower than the national average.

Proposition 29 — on the ballot June 5 — would change that. It would raise the tax on cigarettes to almost $2 a pack.

Jane Warner, president of the American Lung Association of California, hopes voters will be game to raise tobacco taxes when they decide the fate of Prop 29. “We’ve made this initiative very simple,” she says. “It was written by the American Lung Association, the American Cancer Society and the American Heart Association. It is very simple, very clear — to save lives.”

The Centers for Disease Control has found increasing the price of cigarettes reduces demand. Teenagers are especially sensitive to price, so if the tax is approved, fewer of them would pick up the habit. Right now about 12 percent of Californians smoke. That rate could drop significantly if Prop 29 is approved.

Continue reading →

FILED UNDER: Money, Policy
May 14, 2012 | 4:42 PM | By

Governor’s New Budget Slices — Again — Into Health Care

(Max Whittaker: Getty Images)

(Max Whittaker: Getty Images)

Governor Jerry Brown released his revised budget this morning and the cuts to health and human services are significant. Since the economy soured in 2007, state cuts to health and services programs have exceeded $15 billion .

Today the governor announced:

  • An additional $400 million in cuts to Medi-Cal, mostly to hospitals and nursing homes
  • Reductions to the “Healthy Families” program which covers children, effecting their access to health care. Potential savings are $48 million
  • Reducing In-Home Support Services hours by seven percent for a savings of $99 million
Anthony Wright of Health Access, a statewide advocacy group said these cuts would effect virtually all Californians. “These ugly cuts are a body blow to the health system on which we all rely,” Wright said in a statement. “These are the wrong cuts at the wrong time, during an economic downturn when Californians need this help the most, and when we need to get ready for health reform to maximize the benefit for our families and our state.”

In a conference call with reporters today, Secretary of Health and Human Services Diana Dooley said the cuts to her agency were inevitable. “The problem we have and always have in health and human services is this is where most of the spending is. The spending is in education and health and human services to a very large degree, and the only place you can cut back are the places where you are spending.”

The governor’s revised budget depends on voters passing his tax increase proposals expected to land on the November ballot.  A poll last month by the Public Policy Institute of California showed 54 percent support for the governor’s plans — but tax increases require a two-thirds majority to pass. If his tax proposals do not pass, more cuts will be necessary to balance the state’s budget.

FILED UNDER: Money, Policy, California Budget, Health and Human Services
May 10, 2012 | 12:23 PM | By

Why Isn’t Kaiser Less Expensive?

(tedeytan: Flickr)

(tedeytan: Flickr)

The federal health law aims to tackle the problem of high health care costs by providing financial rewards to providers who do a better job coordinating patient care. But one shining example of that future has been here in California for decades. It’s Kaiser Permanente which is often touted as the nation’s best hope for bringing health care costs more in line with other developed nations.

Kaiser rose out of a utopian, industrialist dream. During the 1930s and 40s, Henry J. Kaiser wanted to make sure the workers at his Richmond shipyard were steady and strong.

George Halvorson, Kaiser’s CEO, draws a direct link between Henry Kaiser’s approach to building ships and his approach to designing a health system. “When Henry built things he tended to assemble an entire team to build all the parts,” he says. ”So when he started providing health care to his workers, he used that model which was to have a Kaiser hospital, Kaiser clinics.”

“They got to where they are, in part, by being the cost leader in the market. And they no longer are.”
Kaiser Permanente opened its doors to the public in 1945 — and offered health coverage that was considerably less expensive than conventional insurers like Blue Cross.

The strategy worked because it owned and operated its own hospitals and clinics and directly employed physicians. Continue reading →

FILED UNDER: Money, Health Insurance Premiums, Kaiser Permanente
May 7, 2012 | 4:45 PM | By

Lessons Learned from the War on Smoking, Applied to Obesity

Could a public campaign against obesity help people in the same way anti-smoking campaigns have? (Dave Whelan: Flickr)

Could a public campaign against obesity help people in the same way anti-smoking campaigns have? (Dave Whelan: Flickr)

Expect to hear a lot about obesity prevention in the coming days. A four-part HBO documentary about the obesity crisis debuts next week. Today, the Centers for Disease Control opened a major conference examining strategies to help Americans with this significant health challenge. At a report released this morning, researchers said obesity prevalence will increase about 33 percent in the next 20 years — climbing from one-third of Americans affected now to a 42 percent rate by 2030.

And believe it or not 42 percent is good news — that’s down from the 50 percent estimated in prior years.

Despite first lady Michelle Obama’s Let’s Move campaign and its greater attention on childhood obesity, many public health leaders are frustrated with slow progress and say more must be done. They call for a different approach, using strategies similar to those used in the anti-tobacco movement. It was only after anti-tobacco advocates embraced community-based activism that smoking rates began to drop from a high of 42 percent in the mid-1960s to just over 19 percent today, they say. Continue reading →

FILED UNDER: Money, Policy, Children's Health, Obesity
May 4, 2012 | 12:29 PM | By

High-Deductible Health Plans: Health Access or High Risk?

Check the health of your savings account when you sign up for a high-deductible health plan. (401k_Flickr)

Check the health of your savings account when you sign up for a high-deductible health plan. (401k: Flickr)

Health care costs are skyrocketing and premiums along with them forcing some employers — especially small businesses — to drop coverage altogether. But others are moving to “high-deductible health plans.” Five times as many businesses offer high deductible health plans as in 2005, according to the UCLA Center for Health Policy Research.

But how do these plans play out for employers — and workers themselves?

Kelley Weiss of the Center for Health Reporting found unpleasant surprises for both owners and employees. Six  years ago, Casey Coonerty-Protti took over her family’s business – Bookshop Santa Cruz — a 46 year institution in the heart of downtown. Between the lagging economy and pressure from online books, maintaining a bookstore is not easy. Protti has struggled to continue to offer health insurance. When she started, her company offered a $2,000 deductible, but she’s had to steadily increase the amount of the deductible to $5,000.

From Weiss’ report: Continue reading →

FILED UNDER: Money, Policy, Health Savings Accounts, High-Deductible Health Plans
May 3, 2012 | 2:42 PM | By

Rural California Hospitals Slow to Digitize

By Eve Harris

Fall colors in Quincy. (Somesh Kumar: Flickr)

Fall colors in Quincy. (Somesh Kumar: Flickr)

High in the Sierra in the town of Quincy, doctors at Plumas District Hospital are using iPads in the clinic. Technicians and nurses are also getting better acquainted with their new electronic health records (EHR) system. This 25-bed hospital has gone digital.

Plumas District joins a digitizing trend at least partially sparked by financial incentives in the federal health care law. Plumas District CEO Doug Lafferty was recruited just nine months ago to get the EHR up and running. In a recent interview he said his adopted community is full of “wonderful people.”

But in contrast to his own prior experience in major, urban hospitals, Lafferty said most of the Plumas District staff have never worked anywhere else. Sure, the iPads are welcome, but when it comes to the nitty-gritty of implementing an electronic system of medical records, change can be painful. The culture of “consistency” leaves no doubt that he is “a change agent,” Lafferty said.

While Plumas District has been fortunate to have the capital and leadership to make this change, other California towns are not so lucky. A recent nationwide report confirmed the widely-held concern that small, nonteaching and rural hospitals are lagging behind their urban counterparts in adoption of electronic health records.

Continue reading →

FILED UNDER: Money, Place Matters, Electronic Health Records, Rural Health
May 2, 2012 | 10:43 AM | By

Cash-Only Practices: Better for Patients or Just Better for Doctors?

By: Kamal Menghrajani

Patient Jayaludchemy Yogaratnam visits with Dr. Hisana Qamar at a MedLion practice in Monterey.

Patient Jayaledchumy Yogaratnam visits with Dr. Hisana Qamar at a MedLion practice in Monterey. (Kamal Menghrajani)

Some wealthy patients pay thousands of dollars each month to keep a personal physician on call at all times. In case of emergency, the patient can quickly access a doctor who knows them well and who they trust to make good medical decisions.

Now this “concierge medicine” model is being scaled down to reach people with more modest financial resources. One such practice that’s starting up in Northern California is called MedLion. Started in Monterey by Dr. Samir Qamar, the practice is offering what he calls “direct primary care.” Patients see their doctor for advice on treating the flu or a chronic illness. The doctor takes on fewer patients overall — about half that of a typical primary care provider — and presumably have more time to spend with each one.

But this sort of care comes at a cost. These practices do not accept insurance, meaning patients must pay cash in order to be seen. In MedLion’s case, there is a monthly fee to buy a spot on the doctor’s limited roster, and an additional $10 fee for each office visit. For everything else, the patient pays out of pocket — including basics like x-rays and blood tests. Continue reading →

FILED UNDER: Money, Concierge Medicine
April 27, 2012 | 2:00 PM | By

Steps Toward Lower Cost, Higher Quality Health Care

(Vic: Flickr)

(Vic: Flickr)

No one seems to have a problem with shopping for the best price when it comes to a new computer or a car. But there’s something about shopping for health care prices that seems different. It’s also a lot harder. Prices aren’t transparent. The L.A. Times reported earlier this month on the challenges individual patients can have in trying to find the best price.

At the same time, consumers have become more concerned about cost. According to the Kaiser Family Foundation, premiums for family coverage have more than doubled in the last ten years  — 113 percent — and the share the worker pays of the premium is up even more — 131 percent.

The cost of health care has been going up, faster than the rate of inflation. The federal health care overhaul takes aim at this problem and seeks to lower cost and improve quality of care at the same time. One program gaining traction is through focusing insurance design on value. For example, some plans reward healthy behaviors, such as quitting smoking or exercising regularly. Continue reading →

FILED UNDER: Money, Policy, Cost, Quality
April 27, 2012 | 9:00 AM | By

Checks in the Mail: Millions to Receive $1.3 Billion in Health Insurance Rebates

By: Julie Appleby, Kaiser Health News

(Robin DeGrassi James: Flickr)

(Robin DeGrassi James: Flickr)

Millions of consumers and small businesses will receive an estimated $1.3 billion in rebates from their health plans this summer under a provision of the health care law that effectively limits what insurers can charge for administration and profits, a new study projects.

Almost one third of people who bought their own insurance last year will get rebates averaging $127, according to an analysis of state data by the nonpartisan Kaiser Family Foundation. (KHN is an editorially independent program of the foundation.)

“This alone is not going to make health insurance affordable for large numbers of people, but it is getting excess administrative cost out of the system,” says Larry Levitt, a study author.

The percentage of consumers and businesses in line for rebates varies widely by state. In Texas, for example, 92 percent of consumers who purchased individual policies are expected to get rebates because insurers spent too little of their premium dollars on medical care. But in Vermont, Rhode Island, Iowa and Hawaii, insurers are likely to owe less than 1 percent of consumers who bought policies on the individual market. Continue reading →

FILED UNDER: Money, Health Care Overhaul, Insurance Rebate