Archived California Healthcare News

Networks of doctors and hospitals set up under the Affordable Care Act to improve patients’ health and save money for Medicare are having varying rates of success in addressing their patients’ diabetes and heart disease, according to government data released Friday. The release is the first public numbers from Medicare of how patient care is being affected by specific networks. These accountable care organizations, or ACOs, are among the most prominent of Medicare’s experiments in changing the ways physicians and health care facilities work together and are paid. The ACOs will be able to keep some of the money they save, but they also take on some of the financial risk if their patients end up being costly.

An Obama administration announcement about payment rates for Medicare Advantage plans in 2015 has set off a dispute about how large – or small – the changes really are. Late Friday, the Centers for Medicare & Medicaid Services announced proposed rates that officials said could mean payment reductions of 1.9 percent for the private plans in the program.

The Department of Managed Health Care has levied a $20,000 penalty on UnitedHealth\'s behavioral health plan for engaging in unfair payment patterns and denying provider claims after they were already authorized. The penalty and fines were levied on Jan. 15 against Optum Health after a survey conducted by DMHC in 2011 found that 11 of 20 claims sampled had had their payment authorization rescinded after services had already been provided to an Optum enrollee. In another survey, five of 50 claims were rejected for no authorization even though authorization had already been issued by Optum.

Jill Freedman felt like her heart was jumping out of her chest. She knew her blood pressure was too high and feared having a heart attack or a stroke. \"I was freaking out,\" said Freedman, 55. \"You get very emotional when you think you could drop dead at any moment.\"

Nearly 3.3 million Americans have signed up for private health insurance plans since October through the online marketplaces created by the health law, with enrollment continuing to surge through January, an Obama administration report said last week. But the number of young adults signing up continues to lag expectations, which could impact insurance premiums next year. Insurance industry officials have been closely watching the mix of customers to make sure they get enough healthy people to balance the cost of covering older Americans who generally require more medical care.

A labor union backing ballot initiatives that would cap hospital prices and the salaries of their top executives is making progress in gathering signatures, officials said earlier this week. The SEIU-United Healthcare Workers West has enlisted 500 paid signature gatherers to obtain the signatures of the 500,000 registered voters required to put the initiatives on the November ballot.

The rollout of the Affordable Care Act last fall has had an uneven impact on two of California's publicly-traded health plans, according to fourth-quarter earnings report released last week.

Woodland Hills-based Health Net saw its enrollment numbers slip, while Long Beach-based Molina Healthcare saw a fairly significant bump.

Now comes the hard part. After negotiating for months over how to overhaul Medicare’s troubled payment system for physicians, the bipartisan leadership of three Senate and House committees has reached a deal on the policy. Their next task could be even harder – finding a way to finance repeal of the “doc fix,” the shorthand for the 1997 formula used to set physician payments, the sustainable growth rate (SGR).

The lure used to get uninsured Americans to sign up for health law coverage was the promise of generous premium subsidies. But the promise comes with a catch for almost 3 million people earning between three and foutimes the federal poverty rate: They may have to pay up to 9.5 percent of their income toward that premium before the subsidy kicks in.