Federal Marketplace Enrollment:
2015: 8,838,291
2016: 9,625,982
2017 9,201,805
2018 8,743,642
Covered California Enrollment
2015: 1,412,200
2016: 1,575,340
2017 1,556,676
2018 California Open Enrollment continues through January 31st
Source: Covered California
The nurses are back with their gloves off — and not the disposable medical kind.
Despite a legislative setback last year — dealt by one of the state’s top Democrats, of all people — the powerful California Nurses Association stormed the state Capitol last Wednesday to resume their campaign for single payer healthcare.
A brief, partial shutdown of the federal government ended Monday, as the Senate and House approved legislation that would keep federal dollars flowing until Feb. 8, as well as fund the Children’s Health Insurance Program for the next six years.
President Donald Trump signed the bill Monday evening.
The implementation of a dramatic voter-mandated increase in the state tobacco tax last year vaulted California to the top of the states surveyed in the American Lung Association’s annual State of Tobacco Control report.
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.
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.
In early October, an executive at one of the nation’s largest physician-practice management firms handed her bosses the equivalent of a live grenade — a 20-page report that blew up the company and shook the world of managed care for poor patients across California.
For years, she wrote, SynerMed, a behind-the-scenes administrator of medical groups and managed-care contracts, had improperly denied care to thousands of patients — most of them on Medicaid — and falsified documents to hide it.
Kaiser Permanente’s Northern California division has awarded $1.3 million to 15 community organizations to ensure better access to food programs among low-income populations.
The recipients, which include food banks, community clinics and youth centers, received grants ranging from $75,000 to $98,000.
The California Department of Public Health has issued four class AA penalties – the most severe under law -- against nursing homes within the state since last September, records show.
The California Health Care Foundation reports that "After reaching a high of 16.9 in 2006, California's maternal mortality rate (MMR) fell to 7.3 in 2013, which was much lower than the national rate of 22.0 that year. Since 2010, California's MMR has been lower than the federal government's Healthy People 2020* target of 11.4. Statewide collaborative efforts to address the growing problem of maternal mortality have helped reduce preventable deaths. Such efforts help reduce hemorrhage during childbirth and prevent the adverse effects of preeclampsia."
One of the biggest changes to how healthcare policies were issued and paid for came courtesy of the Affordable Care Act. And now one of the biggest changes – how lenient insurers can be with enrollees becoming current on past-due premiums – could undergo dramatic shifts in California and elsewhere.
The marketing blitz is on.
Californians are getting barraged with online pop-up ads, radio spots and television commercials, all aimed at persuading them to sign up for Affordable Care Act health plans during this year’s open-enrollment season.
The Department of Managed Health Care has fined Aetna Health of California $182,500 for 41 instances where the insurer failed to appropriately handle enrollee grievances.
Kaiser Permanente has reduced the likelihood of antibiotic prescriptions for enrollees with sinusitis by 22% through the use of computer alerts for a period of time.
Kaiser said earlier this month that it used computerized alerts to inform their physician network that prescribing an antibiotic may not be the best course of treatment. Antibiotics are generally useless against viral infections, and can cause nausea and other symptoms in patients. Overprescribing antibiotics can also lead to bacterial resistance against such medications in the future.
Oakland-based Kaiser Permanente has developed a new tool intended to identify diabetes patients at greatest risk of developing precipitous drops in blood sugar levels.
The condition, known as severe hypogylcemia, can lead to emergency situations where patients quickly loose consciousness. About 100,000 emergency room visits per year nationwide are connected to the condition. It is often tied to diabetic patients taking medication to control their blood sugar who skip a meal or engage in intense exercise.
The CDPH found that Care Center of Rossmoor in Walnut Creek had improperly replaced a patient’s tracheostomy tube, causing air to flow underneath the patient’s skin. An investigation determined that the patient was improperly placed prior to the replacement of tube. The patient was elevated by about 30 degrees in their bed, when they should have been laying flat. The incorrectly placed tube led to oxygen deprivation in the patient, aggravated by the fact that staff failed to use an oral bag mask to try and improve oxygenation. The patient died about four hours later.
For about 60,000 Covered California customers, choosing a health plan next year will be easier, and possibly more painful, than ever: There will be only one insurer left in their communities after Anthem Blue Cross of California pulls out of much of the state’s individual market.
That means they could lose doctors they trust, or pay higher premiums.
With the Trump administration still telegraphing uncertainty about its intentions toward funding cost subsidies under the Affordable Care Act, the Covered California health insurance exchange, citing what it called a “time of unprecedented uncertainty,” has taken steps to ensure that its enrollees are not rocked with unexpected costs as it nears the crucial open enrollment period for 2018.
Although treatments for breast cancer continue to make improvements, obtaining that care can be an obstacle for women in California.
That's the conclusion of researchers at the UCLA Center for Health Policy Research. In a recent report, it raised significant concerns that women with breast cancer enrolled in Medi-Cal or other public insurance programs were less likely to obtain treatment for their breast cancer in a timely manner and live longer than those enrolled in private insurance.
Blue Shield of California and Hill Physicians Medical Group have started a primary care-based palliative care program in conjunction with Snowline Hospice, which provides services in Sacramento and El Dorado Counties.
"This new program enables primary care providers to offer palliative care services to patients with advanced illness in collaboration with hospice providers who are expert in palliative care," said Marcus Thygeson, M.D., Blue Shield's Chief Health Officer. "This will improve care for seriously ill people and support for their caregivers."
