California Healthcare News

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Fast Facts About the CHI -Dignity Health Merger Free
Dec 12, 2017

The announced Catholic Health Initiatives (CHI) and Dignity Health merger to form a new, yet-to-be-named nonprofit Catholic health system that will:
1. serve 28 states, with no overlap between the two systems' hospital service areas
2. include 700+ care sites and 139 hospitals
3. be staffed by 159,000 employees and 25,000 physicians and other clinicians
4. be led by co-CEOs Kevin Lofton (CHI) and Lloyd Dean (Dignity)
5. represent $28.4 billion in FY17 revenue ($15.5 CHI and $12.9 Dignity)

Top Five Health Plans in Total Medi-Cal Managed Care Enrollment Free
Dec 8, 2017

The top five health plans in total statewide Medi-Cal managed care enrollment are:
1. LA Care: 2,042,759
2. HeathNet: 1,493,297
3. Inland Empire Health Plan: 1,232,534
4. Anthem Blue Cross: 787,393
5. CalOptima: 765,750




Source: California Department of Health Care Services, September 2017 Data

The Downfall of Physician Practice Management Firm SynerMed Premium Content
Dec 7, 2017

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.

In Brief: Kaiser Awards $1.3 Million To Ease Food Access Premium Content
Dec 7, 2017

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.

In Brief: CDPH Fines Four Nursing Facilities Premium Content
Dec 7, 2017

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.

Covered California's Paid Advertising Budget Breakdown Free
Dec 5, 2017


Covered California has budgeted $45 million for paid advertising during the 2017-2018 enrollment period, out of their total $111.5 million marketing and outreach budget. Here's how the $45 million in paid advertising was allocated:
  TV - 40.2%
  Digital display - 21.6%
  Radio - 18.4%
  Print - 6.9%
  Search engines - 5.1%
  Social media - 4.2%
  Billboards / Outdoor - 3.3%






Maternal Mortality per 100,000 Live Births, California vs. United States Free
Dec 1, 2017

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."


ACA-Mandated Premium Grace Periods Could Be On Chopping Block Premium Content
Nov 30, 2017

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.

Covered California’s Marketing Campaign Far Outstrips Federal Efforts Premium Content
Nov 30, 2017

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.

In Brief: DMHC Fines Aetna $182,500 Premium Content
Nov 30, 2017

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.

In Brief: Kaiser Uses Computer Prompts To Cut Antibiotic Prescriptions Premium Content
Nov 30, 2017

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.

California's 2017 Uninsured Rate Free
Nov 28, 2017


New CDC data compiled by Covered California indicates that "in the first six months of 2017, California’s uninsured rate dropped to 6.8 percent, the lowest rate since 2013, down from 7.2 percent in the first six months of 2016. Since some of the remaining uninsured are undocumented or are otherwise ineligible for coverage, the number of uninsured individuals eligible to enroll in private insurance or Medi-Cal through Covered California may be even lower, approximately 3.4 percent."

Kaiser Third Quarter Results Free
Nov 21, 2017

For the third quarter ending Sept. 30, 2017, Kaiser Permanente reported combined operating revenues of $18.3 billion. Operating income was $850 million and non-operating income was $408 million in the third quarter. Net income for the third quarter was $1.3 billion. Capital spending was $773 million in the third quarter. 

California Medi-Cal Managed Care Enrollment Free
Nov 17, 2017

California total Medi-Cal managed care enrollment as of September 2017 was 10,729,234. This reflects a reduction of 40,041 enrollees from the previous month, a gain of 263,456 enrollees from one year ago (9/16) and a gain of 862,050 enrollees from two years ago (9/15).


Source: California Department if Health Care Services


Anthem Blue Cross Slapped With $5 Million Fine Premium Content
Nov 16, 2017

Concluding that Anthem Blue Cross of California’s grievance system has been systematically defective for more than a decade, the Department of Managed Health Care (DMHC) has levied a $5 million fine against the insurer, saying that hundreds of enrollees in recent years have been denied an appropriate avenue to settle disputes about their care and who should pay for it.

CMS May Move To Add Work Requirements To Medicaid Eligibility Premium Content
Nov 16, 2017

vision for the state-federal program in two appearances last week, saying her new course give states wide latitude over eligibility and benefits.

            In a speech Nov. 7 to state Medicaid directors, Verma said the program needs to give people “hope that they can achieve a better future for themselves and their families, hope that they can one day break the chains of generational poverty and no longer need public assistance.”

            She has noted other government assistance programs such as food stamps, have similar requirements.

Flu Shot Rate Among Hospital Workers Continues To Rise Premium Content
Nov 16, 2017

A new report by the California Department of Public Health indicated a slight rise in the proportion of hospital workers who received flu shots during the most recent flu season, which ran from October 2016 through March of this year.

Physician Practice Management Firm SynerMed Plans To Shut Down Premium Content
Nov 16, 2017

SynerMed, a company that manages physician practices serving hundreds of thousands of Medicaid and Medicare patients across California, is planning to shut down amid scrutiny from state regulators and health insurers.

            The company’s chief executive, James Mason, notified employees in an internal email Nov. 6, obtained by Kaiser Health News, that audits by health plans found “several system and control failures within medical management and other departments.”

Average California Individual Short-Term Health Insurance Costs Free
Nov 14, 2017

A new e-Health study released data on costs and shopping trends among short-term health insurance shoppers at for the period between the 2017 and 2018 open enrollment periods, and found the average California short term monthly individual premiums were $187 ($109 nationally) and family premiums were $496 ($264 nationally.) The average California annual individual deductible was $4,246 ($4,608 nationally) and the family deductible as $10,638 ($8,785 nationally.)     

Medicaid Health Plans Cleaning Up In California Premium Content
Nov 9, 2017

Medicaid is rarely associated with getting rich. The patients are poor, the budgets tight and payments to doctors often paltry.

            But some insurance companies are reaping spectacular profits off the taxpayer-funded program in California, even when the state finds their patient care is subpar.