California Healthcare News

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Kaiser Statewide Enrollment and Utilization data Free
Jan 19, 2018

Kaiser Permanente statewide had 8,630,410 members as of September 30, 2017, including 136,447 Medi-Cal risk, 1,115,804 Medicare risk, 664,336 Individual products and 823,650 small group products. 

Disgraced Hospital CEO Receives Lengthy Prison Sentence Premium Content
Jan 18, 2018

The former chief executive officer of Pacific Hospital has received a lengthy sentence for orchestrating a long-running kickback scheme involving spinal surgeries performed at the Long Beach facility that also took down a state senator.

Using Food Stamps To Improve Overall Health Premium Content
Jan 18, 2018

Rebeca Gonzalez grew up eating artichokes from her grandmother’s farm in the central Mexican state of Tlaxcala. But for years after emigrating to the U.S., she did not feed them to her own kids because the spiky, fibrous vegetables were too expensive on this side of the border.

            When she prepared meals at her family’s home in Garden Grove, Calif., Gonzalez would also omit avocados, a staple of Mexican cuisine that is often costly here.

DMHC Fines Contra Costa Health Plan $17,500 Premium Content
Jan 18, 2018

The California Department of Managed Health Care has fined Contra Costa Health Plan $17,500 for mishandling provider claims and failing to provide related reports in a timely manner.

            DMHC fined Contra Costa $12,500 after an audit determined that for the first quarter of 2016, it  paid or contested provider claims in a timely manner 87% of the time. State laws and regulations require a compliance rate of 95%. The plan had similar issues crop up during a 2013 examination.

Kaiser Links Breastfeeding To Lower Rates Of Diabetes Premium Content
Jan 18, 2018

A new study by researchers at Kaiser Permanente has concluded that women who breastfeed their children for a significant duration have a much lower risk of contracting diabetes.

            The study, undertaken by Kaiser’s Northern California division of research in Oakland, found that women who breastfed their children for a minimum of six months were 47% less likely to develop type 2 diabetes than those mothers who did not breastfeed at all. Those who breastfed or less than six months had a 25% lower risk in developing diabetes.

Sutter Health Plus Health Plan Facts and Figures Free
Jan 16, 2018

The Sutter Health Plus HMO was formed in 2014, and now serves almost 80,000 members in Sacramento, San Joaquin, Stanislaus, Yolo, Contra Costa, Alameda, Santa Cruz, San Mateo, San Francisco and portions of El Dorado, Placer, Sutter, Solano, Sonoma and Santa Clara Counties. 

The health plan network includes 30 hospitals and more than 7,000 providers. The plan has almost 200 employees, Sutter Health Plus added 28,000 members during 2017 and 80% of members renewed coverage.





California Drug Overdose Deaths Decrease While National Total Soars Free
Jan 12, 2018

California drug overdose deaths decreased 3.9% from 2016 to 2017, while overall U.S. drug overdose death increased 17.4% during that period. California had 4,628 deaths in 2017 compared to 4,815 in 2016. Nationally, there were 66,324 drug overdose deaths in 2017 compared to 56,488 death in 2016. The twelve month periods measured by the CDC ended in May for each year.





Source: CDC

Year Begins With Denti-Cal Benefits Restored Premium Content
Jan 11, 2018

Susan Inglett’s dental coverage changed just after she got a root canal on one of her top teeth.

            It was 2009, and California was in the midst of a budget crisis. To cut costs, Medi-Cal eliminated non-emergency dental benefits for adults.

            Inglett, 63, of San Diego, needed a crown for that vulnerable tooth, but the state no longer paid for them.

Despite ACA Mandate, Hospitals Taking Time To Expand Community Benefits Premium Content
Jan 11, 2018

The federal health law’s efforts to get nonprofit hospitals to provide more community-wide benefits in exchange for their lucrative tax status has gotten off to a slow start, new research suggests. And some experts predict that a recent repeal of a key provision of the law could further strain the effort.

CMS Paves Way For Medicaid Work Requirement Premium Content
Jan 11, 2018

The Centers for Medicare & Medicaid Services on Thursday issued guidelines for states to impose a work requirement on able-bodied adults to qualify for Medicaid coverage, a first in the 52-year history of the program.

            Under the proposed guidelines, able-bodied adults under the age of 65 would either have to have jobs, actively seek work or engage in other activities to qualify for Medicaid coverage.

Sutter Health Reports Significant Growth In HMO Premium Content
Jan 11, 2018

Sutter Health Plus, the managed care health plan operated by Northern California hospital system Sutter Health and serving medium and smaller employer groups, reported significant growth for 2017.

            According to Sutter Health, enrollment increased 37% last year, with 28,000 new enrollees, and now stands at nearly 80,000.

88 California Hospitals Hit With Annual Medicare Payment Penalties Free
Jan 9, 2018

88 California hospitals were among the 751 nationally hit with annual Medicare payment penalties for having injury rates exceeding the target threshold in the Hospital-Acquired Condition Reduction Program mandated under the ACA.  61% (64 hospitals) were also penalized the previous year, compared to 57% nationally.

SynerMed’s Business Practices Prompts DMHC Cease-And-Desist Order Premium Content
Jan 4, 2018

The California Department of Managed Health Care has issued a rare cease-and-desist order against nine insurers, barring them from assigning contractual risks to Employee Health Systems Medical Group (EHS) due to cost-based network narrowing the regulator said it performed on behalf of the soon-to-close SynerMed.

CDPH Fines Nine Hospitals $549,555 For Endangering Patients Premium Content
Jan 4, 2018

The California Department of Public Health issued 10 administrative penalties and fines against nine hospitals last week for incidents that directly led to the deaths of four patients and endangered the lives of six others. The penalties and fines include:


Trump Administration Defangs Nursing Home Regulation Premium Content
Jan 4, 2018

The Trump administration — reversing guidelines put in place under President Barack Obama — is scaling back the use of fines against nursing homes that harm residents or place them in grave risk of injury.

            The shift in the Medicare program’s penalty protocols was requested by the nursing home industry. The American Health Care Association, the industry’s main trade group, has complained that under Obama, federal inspectors focused excessively on catching wrongdoing rather than helping nursing homes improve.

340B Program Cuts Go Into Effect Premium Content
Jan 4, 2018

A federal court has dismissed a lawsuit filed by hospitals and state hospital associations challenging the Centers for Medicare & Medicaid Services’ (CMS) plan to slash reimbursements for drugs under the 340B program.

Covered California Says Enrollment Up From Last Period Premium Content
Jan 4, 2018

The Covered California health insurance exchange said late last month that enrollment for calendar 2018 had topped 220,000 as of Dec. 15, up from 199,000 during the same time period in 2016, while another 1.2 million Californians had their coverage renewed for 2018. Enrollment continues through Jan. 31 as part of an extended enrollment period.

Anthem California Blue Cross Enrollment Mix Free
Dec 21, 2017

Anthem California Blue Cross Enrollment Mix (as of 9/30/17):
 - 3,987,508 Total Members
 - 3.0% HMO Individual/Small Business
 - 16.0% HMO Large Group
 - 6.4% Medicare Supplement
 - 7.7% ASO
 - 20.0% Medi-Cal
 - 34.1% PPO
 - 0.9% Medicare Risk/Cost
 - 11.9% Aggregate Contracted from Other Plans





Source: Payers and Providers Vitals

CalPERS Basic Plans Prescription Drug Costs Free
Dec 19, 2017

CalPERS Basic Plans 2016 Rx Costs:
 - $1,286.09 million for 10.86 million prescriptions (2.14% increase from 2015) 
 - Avg cost (allowed amount) per Rx was $118.47 (4.80% increase from 2015)
 - Avg cost per day supply was $2.89, (3.82% increase from 2015) 
 - Top 10 non-specialty Rx cost was $121.70 million (13.87% total non-specialty cost)
 - Avg member copay per Rx was $8.95 (7.55 percent), and for $24.20 specialty  
 - Specialty Rx cost increased from $185.76 million to $408.43 million 2012-2016

Percent of California Physicians With Patients by Payer Type Free
Dec 15, 2017

 -  84% of California physicians have Medi-Cal patients 
 - 55% have uninsured patients
 - 74% have Medicare patients
 - 87% have private insurance patients





Source: CHCF: California Physicians: Who They Are, How They Practice