California Healthcare News Sep 22, 2014

California Healthcare News

  • Paid news articleIn Brief: Hunn Departs Providence Health; St. Joseph Hoag Places Clinics In Apartment Complexes

    Sep 18, 2014 By Payers & Providers Staff


  • Paid news articleAnthem, So. Cal Hospitals Collaborate

    Vivity Health Expected to Offer Competitive Business Rates

    Sep 18, 2014 By Ron Shinkman


    In an apparent move to offer healthcare coverage to businesses at a lower price and with better integrated delivery of services, Anthem Blue Cross has teamed with Southern California's leading urban medical centers to create a new insurance product called Vivity.

    The managed care plan includes many of the major acute care providers in the Los Angeles area, including Cedars-Sinai Medical Center, the UCLA Health system, Good Samaritan Hospital, Huntington Memorial Hospital in Pasadena and the five-hospital MemorialCare system in Long Beach and Orange County. The participating hospitals and Anthem will divide any profits derived from Vivity.

  • UCLA Launches Telemedicine Initiative

    LiveHealth Online Aimed At Patients With Busy Schedules

    Sep 18, 2014 By Anna Gorman


    Patients looking for convenient medical appointments can now see UCLA Health System doctors using their cell phones, computers or tablets.

    It’s part of an ongoing effort at UCLA and elsewhere to extend alternatives to the in-person doctor visit to busy consumers outside rural areas.

  • Paid news articleExchange Gears Up For Enrollments

    Covered California Rolls Out Ad Campaign, New Grants

    Sep 18, 2014 By Payers & Providers Staff


    With the open enrollment period for 2015 now just weeks away, Covered California is trying to build on the success of its initial year by ramping up an $94 million outreach campaign.

  • In Brief: Employer Premiums Rise Modestly; Support For Props. 45, 46 Waning

    Sep 11, 2014 By Payers & Providers Staff


  • Paid news articleStartup Buys Citizens Choice Health

    Alignment Wants to Make Splash in Medicare Advantage

    Sep 11, 2014 By Ron Shinkman


    A well-funded Orange County startup has acquired a Medicare Advantage health plan to gain a toehold into the Southern California market.

    Irvine-based Alignment Healthcare purchased Cerritos-based Citizens Choice Health Plan for an undisclosed sum. Citizens Choice, which also goes by the name Honored Citizens Choice, had about 13,000 Medicare Advantage enrollees in Los Angeles and Orange Counties and was headquartered in Cerritos.

  • DMHC Fines Dental Plan $25,000

    Data Sent Directly to Physicians’ Smart Devices

    Sep 10, 2014 By Payers & Providers Staff


    The Department of Managed Health Care has fined United Dental Care of California $25,000 for failing to pay provider claims in a timely manner and with the appropriate interest, as well as underinsuring its corporate staff.

  • Paid news articleScripps Launches Monitoring Pilot

    Data Sent Directly to Physicians’ Smart Devices

    Sep 10, 2014 By Payers & Providers Staff


    San Diego-based hospital operator Scripps Health has launched a brief pilot project that will allow for remote monitoring of some of its most fragile patients through the smartphones and other devices carried by its medical staff.

    AirStrip, a Texas-based mobile healthcare firm, has agreed to provide its miniaturized monitoring devices to place on Scripps heart surgery, intensive care, trauma and other critically ill patients.

  • Paid news articleKaiser Acquiesces on $4 Million Fine

    Prefers Improving Mental Health Services Over Litigation

    Sep 11, 2014 By Ron Shinkman


    After months of wrangling with one of the state's health plan regulators, Kaiser Foundation Health Plan has thrown in the towel, agreeing to pay a large fine for limiting access to mental health services and improve its existing service.

    Kaiser will pay a $4 million penalty levied by the Department of Managed Health Care last year, although the Oakland-based insurer and healthcare provider said in a statement that the fine “was unwarranted and excessive, and (the DMHC) ignored the very compliance standards that they had expressly approved.”

  • In Brief: Most Anti-Prop. 45 Money Coming From Insurers; U.S. Attorney Files Suit Against Two Watsonville Nursing Homes

    Sep 4, 2014 By Payers & Providers Staff


  • DMHC Fines Safeguard Health $100,000

    Latest in Series of Penalties For Unfair Payment Patterns

    Sep 3, 2014 By Payers & Providers Staff


    The Department of Managed Health Care has fined Safeguard Health Plans $100,000 for engaging in what it determined was an “unfair” pattern of claims handling and payments.

  • Paid news articleA Preventative Care Delivery Twist

    Programs in Unconventional Settings Boost Compliance

    Sep 4, 2014 By Ron Shinkman


    A new study by UCLA researchers has concluded that the best way to provide preventative care to underserved populations may be to deliver it within their communities as opposed to waiting for them to show up and ask for it.

    An examination of 20 such preventative care outreach programs by the UCLA Center for Health Policy Research has concluded that they all provide far higher success rates in getting underserved and minority communities screened for conditions such as breast and colorectal cancers. Four of the programs are based in California, including three in San Francisco.

  • Paid news articleCDPH Says Underage Tobacco Sales Up

    First Increase Seen Since 2008; In-Store Signage Drops

    Sep 4, 2014 By Ron Shinkman


    A new report by the California Department of Public Health indicates that sales of tobacco to minors – which has generally been trending steadily downward over the past two decades – spiked upward sharply this year.

    In addition to the uptick in sales to buyers under the age of 18, there was also a significant drop in signage in stores that sell tobacco warning sales were prohbited to minors.

  • In Brief: Sharp Pulls Out of Pioneer ACO; Covered California To Add Dental Benefits

    Aug 28, 2014 By Payers & Providers Staff


  • Exchange Paying For Gender Changes

    Blue Shield Among Plans Providing Some Coverage

    Aug 28, 2014 By Anna Gorman


    Devin Payne had gone years without health insurance – having little need and not much money to pay for it.

    Then Payne, who had a wife and four children, realized she could no longer live as a man.

  • Paid news articlePrime Files RICO Suit Against Union

    Claims SEIU-UHW is Attempting to Destroy its Business

    Aug 28, 2014 By Ron Shinkman


    Prime Healthcare Services rarely hesitates to use bareknuckle tactics as part of its business operations. A lawsuit it has just filed against California's biggest healthcare labor union could be said to be "Exhibit A" of such conduct.

    The Ontario-based Prime has sued the Service Employees International Union-United Healthcare Workers, claiming the union had violated provisions of the Racketeering Influenced and Corrupt Organizations Act (RICO), a federal statute typically used to prosecute organized crime figures.

  • In Brief: Officials Reiterate Lack Of Ebola Threat; UCSF Warns Of Anti-Bacterial Soap

    Aug 21, 2014 By Payers & Providers Staff


  • Daughters Of Charity Pushes Back

    It Criticizes Unions For Concerns About Pending Deal

    Aug 21, 2014 By Ron Shinkman


    The financially struggling Daughters of Charity Healthcare System has issued choice words to outside parties trying to have a say in its potential sale: Butt out.

    In a sharply worded statement, Daughters Chief Executive Officer Robert Issai on Wednesday claimed that a labor union and “special interest” groups were interfering with the Los Altos Hills-based not-for-profit chain's quest for a buyer.

  • Paid news articleER Docs Oppose Tenet Staffing Plan

    They Form Coalition to Protest Use of Out-of-State Firm

    Aug 21, 2014 By Payers & Providers Staff


    A group of emergency physicians has banded together against an apparent plan by Dallas-based Tenet Healthcare Corp. to use a staffing company to fill many of its physician positions at hospitals it owns in California.

    The American Academy of Emergency Medicine and the California chapter of the American College of Emergency Physicians have created a group called the Coalition for Quality Hospital Care to combat the move, which officials say could displace long-established physicians from practicing at Tenet-owned hospitals.

  • Paid news articleAuditor Rips DHCS On Drug Medi-Cal

    Says Lax Oversight Led to Widespread Billing Fraud

    Aug 21, 2014 By Ron Shinkman


    California's auditor has issued a blistering report on the Department of Health Care Services' management of the network of substance abuse programs that provide care for Medi-Cal enrollees, suggesting those providers may have defrauded the state of as much as $93.7 million.

    According to the report, the state auditor identified as many as 2.6 million separate outpatient services “that are potentially indicative of fraudulent activity.” DHCS operates the program in conjunction with the state Department of Alcohol and Drug Programs (ADP).

  • In Brief: WellPoint Will Change Its Name; CDPH Says Ebola No Threat

    Aug 14, 2014 By Payers & Providers Staff


  • Paid news articleGrowth Helps Lift Kaiser’s Earnings

    ACA Boosts Individual, Medicaid Enrollment Numbers

    Aug 14, 2014 By Payers & Providers Staff


    Driven by an improving stock market and more health plan enrollees, Kaiser Permanente has reported improved earnings for the second quarter ending June 30 and for the first half of 2014.

    The Oakland-based Kaiser reported net income for the quarter of $14 billion, up 5.2% from the second quarter of 2014. Net income reached $1 billion, up 20% from the $800 million that was reported for the year-ago quarter.

  • Income Dictates Diabetic Amputations

    Poorer Californians Twice as Likely to Lose Their Limbs

    Aug 14, 2014 By Anna Gorman


    People with diabetes in low-income neighborhoods in California are twice as likely to have a leg or foot amputated as those living in wealthier areas, according to a study released last week.

    The study, published in the journal Health Affairs, underscores the stark differences in outcomes for diabetes patients throughout the state.

  • Paid news articleDMHC Fining More Reluctant Payers

    Moves Toward Record Number of Penalties For Late Claims

    Aug 14, 2014 By Ron Shinkman


    For years, health plans in California have been required to pay providers in a timely manner for services that have been rendered. After a years-long lull, the agency regulating such payments has been issuing significant penalties and fines.

    The Department of Managed Health Care has issued an average of six penalties a year since the late 1990s. So far this year, the DMHC has issued seven penalties against health plans for not making payments in a consistently timely manner – usually within 45 days of receiving a claim or five days within determining a dispute of a payment. Those penalties have also been accompanied by $172,500 in fines.

  • In Brief: Kaiser Receives $7.3 Million NCI Grant; Most Americans Exempt From ACA Penalty

    Aug 7, 2014 By Payers & Providers Staff


  • Health Net Releases Strong Earnings

    ACA Boosts Individual, Medicaid Enrollment Numbers

    Aug 7, 2014 By Payers & Providers Staff


    Buoyed by growth in commercial and Medicaid enrollment as part of the Affordable Care Act, Woodland Hills-based Health Net posted strong numbers for the second quarter ending June 30.

  • Group Releases Prop. 45 Savings Projections

    Consumer Watchdog Says Passage Could Save $1 Billion

    Aug 7, 2014 By Payers & Providers Staff


    The advocacy group that is the primary backer of Proposition 45 claims that if voters pass the initiative in November, they could save themselves as much as $1.2 billion a year in lower healthcare insurance premiums.

  • Paid news articleIHA Hip Replacement Initiative Fizzled

    Mutual Suspicions Doomed Bundled Payment Project

    Aug 7, 2014 By Ron Shinkman


    An ambitious experiment in bundled payments to control the cost of hip replacement surgery in California was a failure, according to a study by the Rand Corp.

    The project, which had been spearheaded by the Oakland-based Integrated Healthcare Association, and had both federal and private funding, was apparently beset by suspicions between the participating hospitals and health plans and health plans, according to the study, which was published in the most recent edition of the journal Health Affairs.

  • Paid news articleBlues Collaborate On Massive HIE

    Cal INDEX Will Start With as Many as 9 Million Lives

    Aug 7, 2014 By Ron Shinkman


    Anthem Blue Cross and Blue Shield of California have been longtime rivals in the business arena, but the two health plans have joined forces to create something the state does not yet have: A comprehensive and fully integrated healthcare information network (HIE).

  • In Brief: Torrance Memorial, Miller Children's Hospital Forms Alliance; Kaiser Hospital Grants Nearly $900K

    Jul 31, 2014 By Payers & Providers Staff


  • Paid news articleSonoma Developmental Center Terminated From Medi-Cal

    Had Failed to Undertake All Corrective Actions

    Jul 31, 2014 By Payers & Providers Staff


    The California Department of Public Health has moved to terminate the troubled Sonoma Developmental Center's ability to participate in the Medi-Cal program.

    It's a rare instance of one California government entity taking action against another. Sonoma, which operates 15 residential care facilities for about 170 disabled children and adults in California, is operated by the state Department of Development Services.

  • DOI Says 2014 Premiums Skyrocketed

    But Large Majority of Enrollees Partook of Subsidies

    Jul 30, 2014 By Ron Shinkman


    A new analysis by the California Department of Insurance concluded that many state residents paid far steeper premiums for individual healthcare policies this year than they had in the past.

    According to the analysis, premiums increased an average of 22% to 88%, depending on geographic location and age.

  • Paid news articleUCSF Health, John Muir Join Forces

    They Form Company to Explore Creating Bay Area ACO

    Jul 31, 2014 By Ron Shinkman


    Two potent hospital players in the Bay Area and East Bay have joined forces to create a new healthcare network in the region.

    UCSF Medical Center, the predominant teaching and research hospital in San Francisco, and John Muir Health, a two-hospital system in the East Bay, signed a letter of intent on Wednesday to form a new company that would focus on improving care and cutting costs for the region's residents. A deal is expected to be finalized later this year.

  • In Brief: CDPH Declares Whooping Cough Epidemic; Good Samaritan Hospital, USC Keck Medical School Form Affiliation

    Jul 24, 2014 By Payers & Providers Staff


  • Paid news articlePast Disarray Costs CalOptima $20K

    Exodus of Trustees, Execs Led in Part to DMHC Fine

    Jul 24, 2014 By Ron Shinkman


    Little more than two years ago, CalOptima was in disarray – board members were trading accusations that of self-dealing, their seats were being regularly rotated, and there appeared to be a revolving door to its c-suite.

    That period of disorganization led in part to the Department of Managed Care's decision to impose a $20,000 fine earlier this month against CalOptima, among the largest penalties ever levied against a county Medi-Cal managed care organization.

  • In Brief: Social Services Posts Data On LTC Facilities; CDPH Warns Of Telephone Scam

    Jul 16, 2014 By Payers & Providers Staff


  • Anthem Sued Over Network Issue

    Consumer Group Said it Bait-And-Switched Enrollees

    Jul 17, 2014 By Julie Appleby


    Anthem Blue Cross of California misled “millions of enrollees” about whether their doctors and hospitals were participating in its new plans, and failed to disclose that many policies wouldn’t cover care outside its approved network, according to a class action lawsuit filed earlier this month.

    As a result, many consumers have been left on the hook for thousands of dollars in medical bills, and have been unable to see their longtime doctors, alleges the suit by Santa Monica-based advocacy group Consumer Watchdog.

  • Paid news articleHealthier Finances For State’s Hospitals

    OSHPD Data Suggests They Have Overcome Recession

    Jul 17, 2014 By Ron Shinkman


  • Online Appointments For ER Visits

    Dignity Health Begins Offering Service For Convenience

    Jul 24, 2014 By Anna Gorman


    Three times within a week, 34-year-old Michael Granillo went to Northridge Hospital Medical Center in the San Fernando Valley area of Los Angeles because of intense back pain. Each time, Granillo, who didn’t have insurance, stayed for less than an hour before leaving without being seen by a doctor.

    “I was in so much pain I wanted to be taken care of now,” said Granillo, who lives in Reseda and runs a hot dog cart business. “I didn’t want to sit and wait.”

  • In Brief: DMHC, Blue Shield Disclose Data Breach; Kaiser Links HIV To Stroke Risk

    Jul 10, 2014 By Payers & Providers Staff


  • Kaiser Opens New Oakland Hospital

    Facility And Offices Cost $1.3 Billion to Construct

    Jul 10, 2014 By Payers & Providers Staff


    Kaiser Permanente has opened up its state-of-the art new hospital and medical offices in Oakland, a project that came with a hefty total pricetag of $1.3 billion.

  • CDPH: STDs On The Rise In California

    Rates of Syphilis And Gonorrhea Tick Upward in 2013

    Jul 10, 2014 By Payers & Providers Staff


    The rates of certain types of sexually transmitted diseases rose substantially in California last year, according to data from the Department of Public Health.

  • Paid news articleHealthCare Partners Gets Falling Grant

    Initiative Will Attempt to Cut Rates of Injuries Among Elderly

    Jul 10, 2014 By Ron Shinkman


    Torrance-based HealthCare Partners is one of 10 providers nationwide participating in an initiative to reduce falls among elderly patients.

    The initiative, organized by the National Institute of Health's aging division and the Patient-Centered Outcomes Research Institute, will spend at least $30 million over the next five years to try and reduce the number of falls among older patients. HealthCare Partners, which was selected in part because it has gathered extensive patient fall data through its electronic medical records system, is the only participant from California.

  • Paid news articleFirst Essential Provider List Released

    Intended For Covered California’s Low-Income Enrollees

    Jul 10, 2014 By Payers & Providers Staff


    Some purchasers of healthcare insurance via Covered California may have had issues with the provider networks of the health plans they selected, but the exchange itself is putting the finishing touches on a list of essential providers available to a large number of enrollees.

    Known as essential community providers, or ECPs, the list was mandated under the Affordable Care Act as a way to address disparities in care based on income, geography and other demographics. It is intended to ensure that people who have become newly insured under the ACA are able to remain with the community providers after they obtain coverage.

  • CDPH Says L.A. County Lax On Nursing Home Inspections

    Led to Incomplete Investigations

    Jun 26, 2014 By Anna Gorman


    Los Angeles County public health staff repeatedly failed to follow state policies on nursing home inspections, leading to improper closure of cases and incomplete and delayed investigations, according to a report issued by the California Department of Public Health.

    After reviewing a sampling of 136 cases received since 2009, the state health department found that L.A. County officials did not properly prioritize or track investigations. The county faces a backlog of hundreds of nursing home safety complaints.

  • In Brief: DMHC Investigating Anthem Blue Cross, Blue Shield

    Jun 26, 2014


  • Paid news articlePatients Receive Little Pricing Data

    California Slightly Better Than Average in National Survey

    Jun 25, 2014 By Ron Shinkman


    A new survey by TransUnion Healthcare concludes that the majority of Americans are confused by the bills they receive from their medical providers, and that few receive any meaningful cost estimates in advance.

  • Paid news articleCan Hospitals Make More With Less?

    Lower Costs Raise Margins Independent of Revenues

    Jun 26, 2014 By Payers & Providers Staff


    Low cost hospitals in California generate less revenue than higher-cost facilities, but they tend to be more profitable.

    That's the conclusion of Cleverley & Associates, an Ohio-based hospital consulting firm that surveyed 74 non-teaching hospitals in California with annual revenue of between $100 million and $300 million per year. Cleverley's firm used 2012 Medicare cost reports from the Centers for Medicare & Medicaid Services and data from the Office of Statewide Health Planning and Development, among other sources.

  • Paid news articlePending Pharmacy Bill Creates Friction

    Mail Order Operations Say Opt-Out Would Hurt Business

    Jun 26, 2014 By Ron Shinkman


    A bill in the state Legislature that would allow health plan enrollees to opt-out of mandatory mail-order prescription drug plans has raised the ire of a lobbying group for that sector, claiming it would lead to Californians forfeiting nearly $2 billion a year in cost savings next year.

    The bill, AB 2418, is in hearings in front of the Senate Health Committee this week after being passed by the Assembly 75-1 late last month. Authored by Susan Bonilla, D-Concord, it would allow any enrollee in a health plan that mandates mail-ordered prescriptions to be able to opt out starting in 2016.


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