Archived California Healthcare News

California\'s biggest grant recipient from a U.S. Department of Health and Human Services initiative to improve insurance enrollment under the Affordable Care Act was deemed earlier this year to potentially owe that agency millions of dollars due to improperly documented billings. HHS Secretary Kathleen Sebelius announced on Wednesday that Family Health Centers of San Diego received $861,208 as part of a nationwide initiative to get low and middle-income Americans to obtain health insurance as part of the ACA. The initiative is being undertaken by the Health Resources and Services Administration, an arm of the HHS.

The patient-centered medical home program created by Blue Cross Blue Shield of Michigan has been a success, leading to an estimated savings of $155 million during its first three years of operation, as well as improvements in quality of care. Medical homes have been implemented through a variety of pilot projects in recent years. Patients are assigned a regular “home” to initiate all care; it may be a physician\'s office for a commercial health plan enrollee, or a community clinic for lower-income patients. A specific focus is placed on management of chronic conditions such as diabetes and asthma. Patients are also offered services such as 24-hour phone hotlines or same-day appointments to access care quickly.

When the federal government recently gave Florida the green light to vastly expand its experiment with privatizing Medicaid, patient advocates quickly raised an alarm. They cited serious problems with the state’s five-county pilot managed care program and urged close monitoring of the companies that run private Medicaid plans to ensure that they don’t scrimp on care.

A pilot program conducted at El Camino Hospital in Mountain View to speed treatment of lung cancer patients has proven so successful that it will be used by at least three other hospitals in the Southeast, East and Midwest. The program, known as the 360 Community Hospital Program, is spearheaded by the San Carlos-based Bonnie J. Addario Lung Cancer Foundation, It has also drawn interest from hospitals in California, officials said.

At a closed White House meeting in April, President Barack Obama told corporate insurance bosses “we’re all in this together” on implementing his signature health law. But some insurance companies seem to be more in than others. At least five Blue Cross and Blue Shield executives sat at the table of about a dozen CEOs with the president, according to those knowledgeable about the session, first reported by the New York Times. Just as significant is who wasn’t there: chiefs of the country’s biggest and third-biggest health insurers, Minnesota-based UnitedHealth Group and Aetna.

MidMichigan Health has agreed to affiliate with the University of Michigan Health System, creating a system with five acute care and two specialty hospitals providing service in the eastern-central portion of the state. The parties reached terms on an affiliation agreement last week. Although specific financial terms were not disclosed, UM Health will hold a small minority interest in MidMichigan, and control two seats on it 17-seat board of directors.

MCOL, Payers & Providers, and Predictive Modeling News jointly sponsored a survey of health plan and healthcare professionals conducted by MCOL on their prioritization of predictive modeling activities. Survey participants typically have a more active interest in predictive modeling issues. This is the sixth annual survey in this regard, allowing the current results to be compared to responses in prior years. An exclusive report on the survey findings follows.

The California Department of Public Health fined three Northern California skilled nursing facilities a total of $200,000 for lapses in care that led to patient deaths. Two of the facilities are operated by skilled nursing chains, while the third is operated by O\'Connor Hospital in San Jose. All received AA citations, which are the most serious CDPH can issue.