In Brief: Advocacy Groups Sues CDPH Over Prime; ACO Saves $4.7 Million
Advocacy Group Sues CDPH Over Prime Healthcare
A Los Angeles advocacy group has filed suit against the California Department of Public Health, accusing it of not using its power to discipline for-profit hospital chain Prime Healthcare.
The suit, filed June 5 in Los Angeles County Superior Court by Our Salud, contains no specifics. It claims that Prime, which owns 14 hospitals in California, turns away uninsured patients from its emergency rooms. The suit contends this practice disproportionately affects poor and Latino patients, and that the CDPH and its director, Ron Chapman, M.D., have not issued any sanctions to specifically address the alleged conduct by Prime’s management. It asks the courts compel Chapman to sanction Prime.
“All of these facts are well- known, have been reported in the press and in government hearings, but the CDPH fails to correct the actions or stop them all together,” said Elba Romo, an Our Salud spokesperson.
Prime, which was not named as a defendant in the lawsuit, has been the subject of a variety of state and federal probes. California lawmakers have also been pressuring research firm Truven Health to remove Prime facilities from its list of the nation's top hospitals, citing prior sanctions from the CDPH for quality of care issues. Prime regularly cites the Truven list in its promotional material.
Prime was not named as a defendant in the lawsuit, which does not seek monetary damages. A trial date has not yet been set.
An accountable care organization created by Anthem Blue Cross of California and the HealthCare Partners medical group has reaped $4.7 million in savings, according to the two entities.
The ACO includes some 52,000 Los Angeles-area Blue Cross PPO enrollees whose care is closely coordinated and undergo a variety of preventative health screenings.
The collaboration has been able to reduce hospital inpatient days by 18%, inpatient admissions and outpatient visits by 4%, while increasing positive indicators for blood sugar levels and cholesterol, according to outcomes data.
“The impressive results of this ACO program show the synergies achievable with close collaboration between a health plan and a well-organized medical group like HealthCare Partners,” said Michael Belman, M.D., an Anthem Blue Cross medical director. “By sharing a rich set of health-related information on our members with HealthCare Partners, we were able to facilitate their work in effectively managing these patients.”
Anthem Blue Cross is engaged in 14 ACOs in California, and focuses primarily on controlling chronic illnesses within its patient population such as diabetes.
“We are at the forefront of this industry-wide culture change to shift physicians from volume-based compensation to population health-based compensation,” said said Tom Paulsen, M.D., executive medical director for HealthCare Partners.
