Payers & Providers – Issue of June 3, 2010

8/9/2019 Payers & Providers Issue of June 3, 2010

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Nearly six years after Californians voted tolevy a millionaires surtax to fund increasedmental health services, data from LosAngeles County suggests a steep drop inhospitalizations, incarcerations and thehomeless rates of the mentally ill.

The decreases which the Los AngelesCounty Department of Mental Health haspegged directly to public-privatepartnerships created after the passage ofthe Proposition 63 are saving the regionstaxpayers of millions of dollars a year,officials say, although its hospitalizationdata was vigorously disputed by an officialrepresenting the regions inpatientproviders.

Passed by voters in November 2004,Proposition 63 levied a 1% tax on all

annual incomes above $1 million. Itgenerates about $750 million annually, ofwhich Los Angeles County receives about$250 million.

According to Debbie Innes-Gomberg, theLACDMH district chief who overseesProposition 63 funds, the extra money hasallowed the county to contract with privateproviders at a level of funding that allowsthem to keep their caseworker-to-clientratio as low as one for every 15 patients.

Usually, caseloads exceed 75 or 150patients per caseworker. A one to 15 ratiois a luxury...but the providers can give

them exactly what they need, Innes-

Gomberg said, adding that the needs ofthose with severe mental health issuescan be so intense that a low caseloadratio is required.

We provide a whole personapproach, said Dave Pilon, president ofthe Los Angeles chapter of the socialservices organization Mental HealthAmerica. LACDMH pays the agency $5.7million a year to take care of 360 clientswith severe mental illnesses in what iscalled a Full-Service Partnership. MHAmonitors their medication intake, secureshousing, provides counseling and jobtraining, among other services. Clientsoften perform clerical jobs at the agency,and work at a delicatessen operated byMHA.

According to Pilon, the clients it serveshave experienced a 67% drop inhospitalizations and a 75% decrease inthose incarcerated since the FSP beganwith the county in 2005.

Pilon noted that the $16,000 itreceives per client per annum is enoughto meet their needs. We can use theeverything it takes approach toreintegrate them back into society, hesaid.

Prop. 63 Yields Results In L.A. CountyHospitalizations, Jailing of Mentally Ill Said to Plunge

California Edition

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Payers & Providers

Countywide, the number of clientsunder the age of 18 hospitalized atpsychiatric facilities due to mental health

issues has dropped by 40%, according toLACDMH. The number of adults under theage of 60 hospitalized has dropped 44%,and the number of older adults hasdropped 42%. Hospitalization daysdropped 16% for adults and 17% for olderadults.

The change in homelessness rates wereeven more dramatic, with a 64% dropamong adults. The number of days adultswere incarcerated dropped by 38%.

County officials claim that the drops injail and hospital days alone have saved$39.8 million overall.

However, the drop in hospitalizationswas disputed by the Hospital Associationof Southern California, which representsmost of the hospitals countywide,including both public and psychiatricfacilities.

If theyre looking at the overalleffectiveness of their programs, they getan F grade, said HASC Executive Vice

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President Jim Lott, who is also a memberof the Payers & Providers Editorial Board.Lott contends that the regions emergency

rooms are filled with mentally unstablepatients that the facilities are oftenforced to hold voluntarily for up to 72hours.

Weve had a very low cooperationrate from (LACDMH), said Lott, whosuggested that the agency wasmanipulating its data.

LACDMH spokeswoman KathleenPich said the programs have beeneffective in terms of diverting thementally ill away from ERs and intourgent care facilities or primary carephysicians with extended office hours.

There is a lot of need and hospital ERsare feeling that, but many more peopleare being diverted, she said.

Pilon noted that there have been someissues in terms of readmitting clientsback into the FSP if their symptoms flareback up. But its still working prettywell, he said.

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In Brief

CNA Uses Satire inAnti-Whitman

Campaign

The confrontational style of theCalifornia Nurses Association has

taken a satirical turn as the labor unionhas paraded a queen meant torepresent gubernatorial candidate MegWhitman statewide during the spring,including a stop at the home of formerGov. Pete Wilson earlier this week

The CNA, which represents about50,000 nurses statewide, has beentrotting out a Queen Meg characterfor a variety of public appearances.The character, who is ferried to eventsin a royal chariot, is meant to satirizethe wealth ofWhitman, the billionaireformer chief executive ofcer ofeBaywho has used tens of millions ofdollars of her own money to nanceher campaign to secure the

Republican nomination for governor.CNA spokeswoman Liz Jacobs saidthe union opposes Whitman becauseof her pledge to cut 40,000 state jobsif elected governor this November.Many of those people are nurses, shesaid.

The Queen Meg character made astop at Wilsons Los Angeles home tothank him for pledging his support in aradio ad that reiterated Whitmansstance against undocumentedimmigrants. The CNA planned torebroadcast a version of the ad thisweek on Spanish-language radiostations to stir up anti-Whitmansentiment among Latino voters.

In addition to the Queen Megcampaign, CNAs afliate organization,National Nurses United, plans a one-day walkout of 13,000 nursesstatewide on June 10 over stafnglevels at hospitals.

New CEO For BlueShield of California

Foundation

Mentally Ill (Continued from Page One)

Continued on Page 3

NEWS

IEHP Undertakes Promotores ModelWill Use Outreach Workers to Boost Visits, Vaccines

Inland Empire Health Plan has launched aninnovative program expected to boost thenumbers of enrollees who consume primarycare and avoid hospitalization as well asdraw out members whose families might haveimmigration issues.

Known as Health Navigator, the programhas ve full-time IEHP employees who havereceived training as promotores, individualswith outreach skills who typically work inLatino communities. They will be assigned to

the more populous areas in San Bernardinoand Riverside Counties, where IEHP operates.A sixth hire is in the works, according to IEHPofcials.

The struggle for members of Medi-Calmanaged care plans to access care at theappropriate levels has always been difcult,said IEHP Chief Executive Ofce BradleyGilbert, M.D. According to Gilbert, onlyabout half of its adolescent enrollees receiveannual wellness exams, and only 80% of all

members receive appropriate vaccinations,leaving thousands more of its membersvulnerable to contracting serious illnesses.

IEHP, which services Medi-Cal andHealthy Families members, has also had toaccommodate large-scale growth since therecession began at the end of 2007.Enrollment has ballooned 23% since early2008 to more than 435,000 making outreamore challenging.

As a result, IEHP has been pressured to and increase the use of primary care serviceto cut down on costlier hospitalizations. Othhealth plans have used promotores foroutreach, but as contractors through outsideagencies. IEHP is the rst health plan todirectly employ them, according to Gilbert.

The Health Navigators will performtraditionalpromotores-style outreach by

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Page 3Payers & Providers

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NEWS

In Brief

Peter Long, the senior vicepresident for executive operationsat the Henry J. Kaiser FamilyFoundation, has been named thenew chief executive officer of theSan Francisco-based Blue Shield ofCalifornia Foundation.

With a passion to serve and the

experience to succeed, Peter Longis the right choice to lead theFoundation at this criticalmoment, said Bruce Bodaken,CEO of Blue Shield of California.The San Francisco-based insurerfunds the foundation, whichawarded $28.9 million in grantsduring 2009.

Long succeeds Crystal Hayling,who left late last year for anopportunity in Singapore.

The 42-year-old Long holds adoctorate degree in health servicesfrom UCLA and a masters degree inhealth science from Johns HopkinsUniversity. He said he will focus

on helping California expand theMedi-Cal program to accommodatethe recently approved federalhealthcare reform legislation, aswell as decreasing domesticviolence.

Long will begin his duties onJuly 6.

Health Net Teams WithText4Baby.org

Woodland Hills-based insurerHealth Net has entered into a

partnership with text4baby.org, atexting service that providesinformation to expectant mothers.

The service provides three freeweekly text messages to expectantmothers with healthcare-relatedinformation through theirpregnancy and during the first yearof their childs life. Health Net willpromote the service on its website.

Health Net officials say thepartnership is intended to reducepremature births and infant deaths.

IEHP (Continued from Page Two)

Report Contends HITECH Is FlawedSuggests Changes to Meaningful Use Criteria

Expert Healthcare Communications

!White Papers !Media Campaigns !Newsletters

(818) 848-8510 www.rfsconsult.com

visiting churches and other communitygathering places, but will also make homevisits after poring over immunization andphysician ofce visit records to try andidentify which enrollees need more shotsand exams and personally encourage themto get them.

Gilbert noted that the HealthNavigators are expected to build somelevel of rapport with the IEHP enrollees,particularly those Healthy Familiesenrollees whose parents areundocumented and may be trying toremain inconspicuous.

The really critical portion is building upthe trust, Gilbert said.

The Health Navigator employees receivedtwo months of training, both at IEHPheadquarters and through Latino HealthAccess, a Santa Ana-based agency thatspecializes in training promotores. They havea turnkey program, which is why we turned tothem, said Susan Arcidiacono, IEHPs chiefmarketing ofcer. The First 5 California entitiesin San Bernardino and Riverside Countiesprovided grants of $150,000 a year apiece tofund their training and a portion of theirsalaries.

A new report by Los Angeles-based ManattHealth Solutions concludes that stimuluslegislation that has provided funds forexpanding the use of electronic medicalrecord technology was a good step forward,but that many gaps in implementing EMRsstill remain.

According to the 41-page report, whichwas underwritten by the California HealthCare Foundation, the Colorado Health

Foundation and the United Hospital Fund,there are many hurdles awaiting providerswho wish to participate in the program,known as the Health Information Technologyfor Economic and Clinical Health Act, orHITECH. The legislation is a necessary butnot sufcient step to achieve greater qualityand efciency in healthcare, the reportconcluded.

Among the perceived obstacles:

Smaller medical practices and ruralproviders may have difculty meeting themeaningful use threshold required toreceive incentive payments from the Centfor Medicare and Medicaid Services, whiadministers HITECH.

The timetables for achieving meaningfuuse for the use of EMRs may be too short fmany providers to meet.

The proposals for achieving betterinteroperability of various EMR systemsrelies too much on the faith that the privatmarket will encourage such a movement

The report suggested that CMS provide moexibility to its meaningful use guidelines,and directly tie it to providers participating ithe health information exchange networks thare expected to grow on a state and regionalevel.
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Payers & Providers Page

California is in dire fiscal straights. Inorder to recover, all of us must share thesacrifices and responsibility.!Yet even as the state faces anothershortfall, we have reached the point wherelawmakers are cutting into the bone ofcritical, effective and efficient healthcareprograms. Providers also knowthat current capacity will fall farshort from meeting demandwhen federal healthcare reformbegins to take full effect in 2014.Does it really make sense for the

state to be executing cuts tohealthcare services whenlawmakers really need to bestrengthening the safety net forthe deluge to come? Gov. ArnoldSchwarzeneggers budgetproposals call for just that.!The Governor has stated that hewill fully support healthcarereform and implement it in Californiaas quickly as possible. However, hisbudget proposal completelycontradicts this statement, decimatingprograms that go specifically toward

addressing our s tates ever-growinguninsured population.!!In his recent May Budget Revision, theGovernor has called for the completeelimination of the Expanded Access toPrimary Care (EAPC) program, a programthat is meant to address critical issues ofCalifornias vast uninsured populations. !This program, known as a traditionalclinic program, represents the onlyfunding from which Californias nonprofitcommunity clinics can draw upon inserving the states uninsured population. !!The Governor also proposed limits toMedi-Cal benefits that largely affect thechronically ill. It is common knowledgeamong medical practitioners that failure tocontrol chronic illness is a majorcontributor to the rise in healthcare costs.Also proposed are premium increases tothe Healthy Families Program, which willlead to an increase in the number ofuninsured children.For a governor who praises fiscalresponsibility, his proposal ignores onehalf of the budget equation revenue.

Following the release of the May Revise, non-partisan Legislative Analysts Officereported that such severe cuts could beprevented through selective revenue incresuch as fee increases, delays and other fismaneuvers. For too long, service providerhave been asked to shoulder the entire bu

burden. The LAO has alsorepeatedly called for somereforms to the budget processCommunity clinics and healt

centers will bear the brunt ofthese proposed cuts at a time

when more individuals andfamilies rely on them for theimedical care. All of these cutjeopardize the survival of theimportant community providehealthcare reform is to succeewe need all the medical provwe have today and more. The

state should not be making itimpossible for the community cliniand health centers to remainfinancially viable.!!Lawmakers cannot make such dra

cuts to health services and be considered

healthcare reform champions. While wecelebrate the expansion of healthcarecoverage for millions of uninsured, the whas only just begun. Lawmakers recognizcritical role community clinics will play imaking healthcare reform a success and timmense state savings these providers wibring to our broken healthcare system. Whealth care providers really need anotherhistoric investment to meet demand in 20community clinics and health centers arein the position of asking policymakers nomake their job impossible. The state mustchoose to preserve and protect a stable

healthcare system in California when it isneeded most. !!

OPINION

Arnolds Little Double-Talk ProblemHe Claims to Embrace Reform; May Revise Does No

By

Gloria

Rodriguez

Gloria Rodriguez is the President and CEO

the Community Clinic Association of Los

Angeles County.

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MARKETPLACE/EMPLOYMENTPayers & Providers Page 5

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*New England Journal of Medicine, 2004.

MEDICARE COMPLIANCE ADVISOR - ensures that L.A. Care and its subcontracted provider networkis compliant with all Centers for Medicare &! Medicaid federal regulatory requirements. This isachieved by participating in the annual PPG and quarterly audits, working with internal and externalstaff to correct performance deciencies, identifying internal areas for improvement, serving as thecompliance contact with Plan Partners for member grievance oversight, provider services oversight,and interpreting CMS/SNP Program requirements for L.A. Care. ! Additionally, this individual is aresource to internal staff on compliance matters relating to CMS/SNP standards, including, but notlimited to, marketing materials, grievances and appeals, member rights issues, and claims

adjudication.! Responsible for performing internal audits, monitoring for implementation of correctivemeasures, and interpretation of CMS requirements. ! Working knowledge of federal and staterequirements is required, as well as highly developed analytical skills and excellent verbal and writtencommunication skills.!

For complete job description, requirements, and additional opportunities, visit our website:www.lacare.org!

To be considered, email resume with salary history/requirement to [email protected], referencing
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Payers & Providers MARKETPLACE/EMPLOYMENT Page 6

LOOKING FOR A NEW POSITION?

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Payers & Providers – Issue of June 3, 2010

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