California Healthcare News Apr 23, 2014

California Healthcare News

  • Paid news articleIn Brief: Covered California Final Enrollment Almost 1.4 Million

    Apr 17, 2014 By Payers & Providers Staff


  • Paid news articleHealth Plans Dominate In Arbitration

    They Often Mandate The Venue, And Win 80% of The Time

    Apr 17, 2014 By Ron Shinkman


    If a health plan enrollee wants to overturn their insurer's denial for covering a medical procedure or test, their chances are about even money if they file an appeal with state regulators to have the decision overturned.

    But if that same enrollee wants to sue that health plan, they face a much tougher battle.

  • In Brief: Rand Says 9.3 Million Have Gained Coverage From ACA

    Apr 10, 2014 By Payers & Providers Staff


  • Paid news articleQuality Initiative Saves Dignity $30 Million

    Hospital System Trains Nurses To Focus On Infections, Falls

    Apr 10, 2014 By Payers & Providers Staff


    A training regimen for nurses that was mostly performed via the Internet helped Dignity Health save about $30 million and avoid a multitude of hospital-acquired infections, patient falls and other avoidable incidents at its 32 inpatient facilities statewide.

    Dignity was able to train about 600 of its nurses to become more cognizant of medical conditions and modes of care more likely to lead to HAIs and other avoidable conditions. The nurses, known as “measureventionists,” received much of their training via informational webinars streamed over the Internet. They were trained to focus on and implement specific protocols for ensuring that quality of care remained high.

  • Paid news articleCMS Releases Doc-Specific Pay Data

    But Information Gaps in Vast Database Raise Concerns

    Apr 10, 2014 By Ron Shinkman


    The Centers for Medicare & Medicaid Services released a vast – and at times incomplete – database of provider-specific payment data Wednesday after years of often acrimonious debate about whether such numbers should be made available to the public.

    The agency said it decided to release the data, which covers fiscal 2012, after weighing the privacy rights of the providers against that of the public having more transparency in financial vagaries of healthcare delivery, where the cost and pricing of care can vary widely depending on provider and geographical area.

  • Startup Firm Provides Tailored Insurance

    Stride Health Aims to Plug Gaps Left by Exchanges

    Apr 3, 2014 By Daniela Hernandez


    Tommy Leep spent weeks researching insurance plans after leaving his job at a Silicon Valley venture capital firm in December and becoming an independent consultant.

    "I was afraid that if I hurt myself, it would cost me a lot of money," said the 29-year-old, who enjoys playing soccer, running and surfing.

  • In Brief: Covered California Enrollment Tops 1.2 Million

    Apr 3, 2014 By Payers & Providers Staff


  • Paid news articleSurgical Centers Sue UnitedHealth

    They Claim Lapband Payment Bar; Insurer Suggests Fraud

    Apr 3, 2014 By Ron Shinkman


    A group of California outpatient surgical centers has sued UnitedHealth Group, claiming the Minnesota-based insurance giant has systematically blocked claims they have submitted for performing lapband weight-loss surgery on hundreds of patients.

    UnitedHealth countered that the surgery centers were all affiliated with the controversial 1-800-Get-Thin billboard marketing campaign to bring in patients.

  • Paid news articleReport: Many Immigrants Eschew Care

    Those With Deferred Action Face Multiple Access Barriers

    Apr 3, 2014 By Ron Shinkman


    The 300,000 young Latino immigrants in California who qualify for the Deferred Action for Childhood Arrivals program are less likely to use healthcare services than their U.S.-born counterparts even though they are also less healthy.

    That's the finding of a new study by the UC Berkeley Center for Labor Research and Education, the UCLA Center for Health Policy Research, and the Philip R. Lee Institute for Health Policy Studies at UC San Francisco.

  • In Brief: Signatures For Micra Proposition Submitted

    Mar 26, 2014 By Payers & Providers Staff


  • The Cal State Insurance Conundrum

    Many Students Say They Can't Afford Coverage

    Mar 27, 2014 By Heidi de Marco and Daniela Fernandez


    Angelica Cabrera doesn't have insurance. There was a time when she thought she didn't need it, but now that she's trying to pay for school and rent on her own, she can't risk getting sick.

    “It’s been really tough. Sometimes, I can’t even pay my bills,” said the 22-year-old communications major at San Jose State University. “I really need this.”

  • Helming The ACA’s Biggest Success

    Peter Lee on Beating Exchange’s Enrollment Projections

    Mar 27, 2014


    The story of the Affordable Care Act has been limned with woe: Balky websites, people supposedly losing their insurance coverage, declarations by many prominent voices that it is a “trainwreck,” among other less-than-charitable descriptions.

    But there have also been successes, and the Golden State can lay claim to many of them. The biggest one of all may be the Covered California insurance exchange. Forecasters with the University of California projected that a maximum of 830,000 residents would obtain coverage through the state's exchange. It topped the 1 million mark earlier this month, with open enrollment continuing through Monday.

  • Many Immigrants Don't Know They're Eligible For Coverage

    Those Eligible For Deferred Action In California Among Them

    Mar 19, 2014 By Anna Gorman


    Carlos Velazquez’s skateboard slipped out from beneath his feet and he spiraled onto the ground, landing hard on his left arm.

    He decided not to go to the doctor after the 2012 accident, resorting to over-the-counter pain medication and home remedies.

  • In Brief: UCSF Discloses Potential Data Breach; Measles Cases Up

    Mar 20, 2014 By Payers & Providers Staff


  • Bad News For Some New Mothers

    Kaiser Links Gestational Diabetes to Heart Disease Risk

    Mar 20, 2014 By Payers & Providers Staff


    A new study by Kaiser Permanente researchers has linked gestational diabetes to a higher risk of heart disease in early life among the women who experience the condition.

  • Blue Shield Forms Yet Another ACO

    Third Pact With Hill, Dignity is in San Joaquin Valley

    Mar 20, 2014 By Payers & Providers Staff


    San Francisco-based Blue Shield of California has launched its second accountable care organization in the past week, working with hospital operator Dignity Health and the Hill Physicians Medical Group to deliver integrated care in northern San Joaquin Valley.

  • Paid news articleLawmakers Mull New Charity Care Bills

    Hospitals Are Staunchly Opposed To AB 503, 1952

    Mar 20, 2014 By Payers & Providers Staff


    New bills pending in the California Legislature would provide guidelines for not-for-profit acute care facilities to provide certain levels of charity care in order to preserve their tax-exempt status has raised the hackles of the hospital sector once more.

  • Paid news articleCovered California Enrollment Tops 1 Million

    Nearly 50% Above The Highest Numbers Projected

    Mar 20, 2014 By Ron Shinkman


    New York has yet to reach 700,000. Minnesota has barely broken 100,000. Ohio is struggling to reach 80,000. Oregon would be happy to obtain 40,000.

    Those are health plan enrollment numbers from various state health exchanges, some of which have embraced the Affordable Care Act, others that have been more hostile to the reform law.

  • Paid news articleIn Brief: Blue Shield Starts Inland Empire ACO

    Mar 13, 2014 By Payers & Providers Staff


  • Exchange Has Missed Latino Enrollees

    Covered California’s Early Marketing Mistakes Are Blamed

    Mar 13, 2014 By April Dembosky


    It's been decades since the advertising industry recognized the need to woo Hispanic consumers. Big companies saw the market potential and sank millions of dollars into ads. The most basic dos and don'ts of marketing to Latinos in the U.S. have been understood for years.

    So when officials with Covered California, the state's health insurance exchange, started thinking about how to persuade the state's Latino population to enroll in health plans, they should have had a blueprint of what to do. Instead, they made a series of mistakes. As a result, just 7% of people who enrolled in Covered California health plans through the end of January speak Spanish as their first language -- substantially less than the nearly 30% of Spanish speakers in the state.

  • Paid news articleDHS, City of Hope Impacted By Breach

    Theft of Billing Service Computers Affect at Least 173,900

    Mar 13, 2014 By Ron Shinkman


    A huge breach involving the personal data of some 173,900 patients in Southern California has affected both the Los Angeles County Department of Health Services and at least one private hospital operator, officials have disclosed.

    The county DHS and the Department of Public Health said that the theft of eight computers from a Torrance branch office of billing giant Sutherland Healthcare Solutions on Feb. 5 may have compromised the data of as many as 168,500 county residents who receive healthcare services through Medi-Cal and other county programs.

  • In Brief: Sen. Gaines Sues Covered California; Consumer Watchdog Wants Surgeon Investigated

    Mar 6, 2014 By Payers & Providers Staff


  • Union Continues Push To Cap Hospital Costs, Salaries

    May be Decided By Voters

    Mar 6, 2014 By Pauline Bartilone


    A California health care workers’ union is collecting signatures to get two measures onto the ballot that it says would lower healthcare costs.

    United Health Care Workers West, or SEIU-UHW, wants to cap what hospitals can charge to 25% above the actual cost of services. SEIU-UHW says on average, hospitals charge 320% above the cost of care.

  • Paid news articleBungled Filings Cost Kaiser $190,000

    DMHC Fines Plan For Mishandling Arbitration Results

    Mar 6, 2014 By Ron Shinkman


    The Department of Managed Health Care has levied $190,000 in penalties and fines against Oakland-based Kaiser Foundation Health Plan for its mishandling of arbitration case records.

    The agency levied $140,000 in fines for 12 cases provided to the agency when it failed to redact names of enrollees, witnesses, attorneys, providers, health plan employees and health facilities so the decisions could be made part of the public record.

  • Paid news articleUCSF Says It’s Financially Sound

    $2.1 Billion Cash on Hand; Tops In Grants From The NIH

    Mar 6, 2014 By Payers & Providers Staff


    The University of California at San Francisco appears not only to have been well-positioned financially last year, but for the future as well.

    UCSF's four professional schools ranked first among the public beneficiaries of funding from the National Institutes of Health in 2013, and second overall in funding. It received $501.6 million in grants and another $15.5 million in contracts.

  • Paid news articleBlue Shield Enters Telehealth Initiative

    Adventist Health Will Provide Services in Northern California

    Mar 6, 2014 By Ron Shinkman


    Blue Shield of California and hospital operator Adventist Health have entered into a pact for the latter to provide telehealth services to the health plan's enrollees in the furthest reaches of the state.

    The agreement covers Blue Shield enrollees in mostly rural and sparsely populated counties in Northern California, both just north of the San Francisco Bay Area and in more far-flung regions closer to the Oregon border.

  • In Brief: Children's Hospital L.A. Receives $17 Million NIH Grant; UCSF and Walgreens Collaborates

    Feb 27, 2014 By Payers & Providers Staff


  • Undocumenteds Eligible For Medi-Cal

    Study Suggests That as Many as 150,000 Are Eligible

    Feb 27, 2014 By Payers & Providers Staff


    A new report by University of California researchers concludes that many thousands of young undocumented Latinos statewide are eligible for Medi-Cal coverage but may not enroll out of fear of alerting authorities to their legal status.

    The report, jointly released by health-oriented research groups at UC Berkeley, UC San Francisco and UC Berkeley, concluded that as many as 125,000 young low-income undocumented immigrants are eligible for Medi-Cal coverage under the state's rules.

  • Paid news articleLAC DHS Launches Homeless Program

    Subsidized Housing Provided to Reduce Health Costs

    Feb 27, 2014 By Ron Shinkman


    The Los Angeles County Department of Health Services (DHS) has embarked on an ambitious public-private program to house thousands of homeless in an effort to cut healthcare costs.

    The county's Board of Supervisors has earmarked $14 million over the next four years to finance the program, which is known as the Flexible Housing Subsidy Pool. An additional $4 million is being provided by a two-year grant from the Conrad N. Hilton Foundation.

  • Paid news articleCABG Mortality Rates Remain Flat

    Steep Drop in Procedures May Cut Chance at Improvement

    Feb 27, 2014 By Ron Shinkman


    The mortality rate for isolated coronary artery bypass graft surgeries at California's hospitals remained flat in 2011 while the number of the procedures dropped in favor of less invasive forms of treatment.

    According to data compiled by the Office of Statewide Health Planning and Development, the overall mortality rate among the 122 hospitals surveyed was 2.01% for 2011, virtually unchanged from the 2% rate reported in 2010 and slightly higher than the 1.9% mortality rate reported in 2009.

  • Paid news articleIn Brief: Kaiser Reports Earnings; Medi-Cal Outreach For Foster Children Begins

    Feb 20, 2014 By Payers & Providers Staff


  • Paid news articleOptum Fined $20,000 By The DMHC

    Plan Engaged in an Unfair Payment Pattern, Agency Rules

    Feb 20, 2014 By Ron Shinkman


    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.

  • Paid news articleCovered California Exceeds Goals

    Current Numbers Top Full Open-Enrollment Projections

    Feb 20, 2014 By Ron Shinkman


    While health insurance exchanges in other parts of the country have struggled to obtain enrollees, Covered California has hit its enrollment goal nearly two months early.

    According to new data from Covered California and the Department of Health Care Services, health plan enrollment through the first half of February has reached 828,638. That includes more than 100,000 who have obtained coverage so far this month.

  • Paid news articleIn Brief: Covered California Enrolls More Than 728,000

    Feb 13, 2014 By Payers & Providers Staff


  • Paid news articleACA Uneven For Molina, Health Net

    Only One Reports a Big Bump up in Enrollment, Revenue

    Feb 13, 2014 By Ron Shinkman


  • Paid news articleKahn, Margolis Announce Departures

    Heads of Large L.A. County Health Plan, Medical Group

    Feb 13, 2014 By Payers & Providers Staff


    Two top Southern California healthcare executives are departing their posts in the coming months.
    Robert J. Margolis, M.D., chief executive officer of DaVita HealthCare Partners, is stepping down on March 1. He will remain as co-chairman of the organization and will provide strategic counsel.

  • Paid news articleSalary Cap Initiative Inching Forward

    OIG Says it May Tie Medicare Payments to Compensation

    Feb 13, 2014 By Payers & Providers Staff


    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.

  • Kaiser Able To Step Up AAA Screenings

    Uses EHR System to Identify Highest-Risk Patients

    Feb 13, 2014 By Payers & Providers Staff


    About 10,000 Americans die every year when their aortas burst, the result of a medical condition known as an abdominal aortic aneurysm. Few aortas with bulging walls are diagnosed prior to an aneurysm.

    Diagnosis can occur with the use of a simple ultrasound procedure. A bulging aorta can be corrected with surgery, and while the procedure is complex, rates of survival are far higher than those who undergo repair after their aortas burst – the mortality rate in the latter instance is more than 50%.

  • Paid news article13 Hospitals Fined $745,000 By CDPH

    Linked To Five Patient Deaths; Five Fines Were Undisclosed

    Feb 6, 2014 By Ron Shinkman


    The California Department of Public Health has issued administrative penalties to 13 hospitals and issued fines totaling $745,000 for errors that placed patients in immediate danger.

    The incidents, which occurred between 2010 and last year, led to the deaths of at least five patients, according to the records publicly disclosed by the agency late last week.

  • Paid news articleIn Brief: L.A. Expands Covered CA Provider Network; Up To 1.8 Million Enrolled In Medicaid

    Feb 6, 2014 By Payers & Providers Staff


  • Paid news articleNew ACO Focuses On Rural Hospitals

    Creates an Affordable Model For Cash-Strapped Facilities

    Feb 6, 2014 By Ron Shinkman


    Of the hundreds of accountable care organizations formed in recent years, this one might be the oddest: a collection of nine hospitals scattered across three states, some of them more than 2,000 miles away from one another.

    But this particular California-headquartered ACO reaches a niche many other do not: rural hospitals.

  • Paid news articleIn Brief: Covered California Releasing Ratings; Rural ACO Formed

    Jan 30, 2014 By Payers & Providers Staff


  • California Endowment Grants $23M

    Money Will Be Spent on Medi-Cal Enrollment Outreach

    Jan 30, 2014 By Payers & Providers Staff


    The California Endowment has granted $23 million to help 36 counties in California with outreach in order to increase enrollment in Medi-Cal.

    The money will be used for outreach to Californians who may be eligible to enroll in the program but have not yet done so. Specific groups will be targeted for Medi-Cal enrollment, including those mental health needs; the homeless, those who are incarcerated or on parole, those with limited English proficiency and young men of color.

  • Paid news articleOPA Releases Annual Report Card

    Kaiser Scores Highest Among Plans, Medical Groups

    Jan 30, 2014 By Payers & Providers Staff


    California's Office of the Patient Advocate unveiled its latest report cards on the state's health plans and medical groups earlier this week, with officials proclaiming them as having more depth than past efforts.

    The OPA released grades on 16 of California's largest HMOs and PPOs, and more than 200 medical groups. The quality of care in the 2014 report did not vary substantially compared to last year's report, officials said.

  • Paid news articleProgram For Poor Cuts ER Visits By Half

    Use of Medical Homes, Education Key to HCCI’s Reduction

    Jan 30, 2014 By Ron Shinkman


    A federal demonstration project that expanded safety net coverage for some of California's poorest residents also dramatically cut the number of hospital emergency room visits among certain segments of that population.

    That was the conclusion of UCLA researchers who have recently reported on the multi-year project, known as the Health Care Coverage Initiative. It expanded coverage in 10 California counties to include more than 236,000 residents.


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