California Healthcare News Oct 23, 2014

California Healthcare News

  • Paid news articleAnthem Partly Walks Back Rate Hike

    Reduces Small Group Increase After Jones Objects

    Oct 23, 2014 By Ron Shinkman


    A ballot proposition that would give the California Insurance Commissioner more authority to regulate health insurance rates has an uncertain future when it goes to voters next month, but Commissioner Dave Jones is apparently still able to use his office to soften payer moves to raise rates.

    Just hours after Jones’ office denounced a move by Anthem Blue Cross of California to increase premiums for 120,000 enrollees in small group plans an average of 9.8%, the insurer backed off the plan, instead saying it would raise rates only an average of 7.8%. Jones had asked for an increase of 2.1% instead.

  • Paid news article17 Facilities Cited For Privacy Breaches

    CDPH Has Issued Record Number of Penalties in 2014

    Oct 23, 2014 By Ron Shinkman


    At a time when concerns about patient privacy are regularly being raised by consumer advocates, the state’s hospital watchdog has been investigating and penalizing institutions with an approach that’s all but discreet.

    The California Department of Public Health has issued 22 citations against healthcare facilities for breaches of patient privacy so far this year -- a record since it began issuing penalties in 2009. But the agency tucked the information in a corner of its website so obscure that a CDPH public information officer asked a reporter to email him a link to the page in order to answer his questions.

  • In Brief: Betty Ford Survey Says Pain Patients Want To Give Up Drugs; UC Says Grants Have Big ROI

    Oct 16, 2014 By Payers & Providers Staff


  • Medicaid Expansion Drops ER Visits

    UCLA Study Shows Dramatic Plunge After Enrollment

    Oct 16, 2014 By Payers & Providers Staff


    A new study by UCLA researchers suggests that the overflow of patients into hospital emergency rooms as the result of Medicaid expansion quickly levels off after the new enrollees become acclimated to receiving steady access to healthcare.

  • Paid news articleOPA Releases Annual Care Report Card

    Kaiser Dominates Ratings For Care, Customer Service

    Oct 16, 2014 By Ron Shinkman


    The California Office of the Patient Advocate (OPA) issued its annual report card on the state's health plans on Wednesday, realigning the release of such data so that consumers can use it to selected plans during the open enrollment period that begins next month.

    Elizabeth Abbott, the OPA's director, said the report cards contained 2,000 different data points on the state's largest HMOs, PPOs and medical groups.

  • Paid news articleState On High Alert For Ebola Cases

    CDPH Coordinating With Hospitals For Potential Response

    Oct 16, 2014 By Ron Shinkman


    Although there have been no cases of the Ebola virus reported in California as of yet, the death of one patient in Texas and the subsequent infection of two nurses who cared for him have placed the state's healthcare providers in a state of high vigilance.

    The California Department of Public Health (CDPH) on Wednesday announced that it has activated the state's medical and healthcare coordination center and was negotiating with hospitals to act as designated facilities to treat patients in the state who might be stricken with Ebola.

  • In Brief: Workers' Comp System Could Save Millions With Drug Formulary; MemorialCare Medical Foundation Acquires Imaging Centers

    Oct 9, 2014 By Payers & Providers Staff


  • Paid news articleUCs Launch Center To Study Aging

    Will Focus Research on Age-Related Diseases, Treatments

    Oct 9, 2014 By Payers & Providers Staff


    Researchers at UC Berkeley and UC San Francisco have joined forces to create a new research center that will investigate the aging process and focus on creating new treatments to address age-related diseases.

    The center, known as the Glenn Consortium for Research in Aging, was funded by a $3 million grant from the Glenn Foundation for Medical Research in Santa Barbara.

  • Paid news articleKaiser Grants $1 Million For Ebola Care

    Money Goes to Two Relief Organizations Working in Africa

    Oct 9, 2014 By Payers & Providers Staff


    As the outbreak of Ebola has impacted the United States, Kaiser Permanente is trying to help contain the epidemic at its source.

    The Oakland-based Kaiser has donated a total of $1 million to two healthcare relief organizations working in West Africa: Doctors Without Borders and the International Medical Corps. Both received grants of $500,000 apiece.

  • Paid news articleMajority Of Hospitals Dinged By CMS

    223 Facilities Statewide to be Penalized for Readmissions

    Oct 9, 2014 By Ron Shinkman


    The Centers for Medicare & Medicaid Services plans to penalize a record number of hospitals for readmitting certain patients within 30 days of discharge. California hospitals are no exception, although they are faring better in this round than the average hospital nationwide.

    A total of 223 hospitals, or 64% in California, will be penalized under the Hospital Readmissions Reduction Program, according to CMS data. That's significantly lower than the nationwide average of 75% of hospitals being penalized.

  • Paid news articleMedical Debt Growing Patient Problem

    Healthcare Services Source of Much Bill Collection in U.S.

    Oct 9, 2014 By Ron Shinkman


    Californians and Americans as a whole may have more access to healthcare services as the result of the Affordable Care Act, but they are also slowly drowning in medical debt.

    A new study by NerdWallet concludes that Americans have been squeezed by the double whammy of the Great Recession and continually rising prices for medical services. The San Francisco-based healthcare finance research firm came to this conclusion by crunching data from the Centers for Medicare & Medicaid Services and other federal data, as well as commissioning a poll that was conducted on its behalf by Harris Interactive.

  • Paid news articleIn Brief: Catholic Bishops File Complaint Against California On Abortion Mandate

    Oct 2, 2014 By Payers & Providers Staff


  • Kaiser Grants $1.4 Million To Schools

    Districts Will Use Money to Improve Student, Staff Health

    Oct 2, 2014 By Payers & Providers Staff


    Kaiser Permanente has granted $1.4 million to 13 school districts in Southern California in attempt to make the lifestyles of both students and staff healthier.

    The grants are part of the Thriving School Partnership initiative, which Kaiser launched last year.

  • Paid news articleUCLA Gets $3 Million Federal Grant

    Focus On Limiting Smoking Exposure in L.A. Apartments

    Oct 2, 2014 By Payers & Providers Staff


    The UCLA Center for Health Policy Research has been awarded a $3 million federal grants to mitigate the effects of secondhand smoke on low-income Latino and African-American families who are living in Los Angeles.

    The grant will be used to implement a comprehensive action plan to reduce individual exposure to smoking in apartment buildings in L.A.

  • Paid news articleDMHC Fines Kaiser, Universal $150,000

    Plans Cited For Unfair Payment Patterns, Fiduciary Lapses

    Oct 2, 2014 By Ron Shinkman


    The Department of Managed Health Care levied fines last month against Universal Care and Kaiser Foundation Health Plan totaling $150,000.

    Universal, which is based in Signal Hill, was fined $100,000 for a variety of fiduciary violations, including failure to maintain a fidelity bond for all its officers and directors, engaging in unfair payment practices, failure to pay claims in a timely manner and fees and interest on late claims, and failure to maintain tangible net equity.

  • Paid news articleMedi-Cal Program Lacks Coordination

    Reports Says More “Whole-Person Care” is Required

    Oct 2, 2014 By Ron Shinkman


    A new report from a public interest research firm concludes that despite large safety net insurance expansions in California as a result of the Affordable Care Act, the provider system remains too patchwork and chaotic to provide appropriate care for the state's poorest and neediest residents.

    The report, authored by San Francisco-based John Snow, Inc. and underwritten by the Blue Shield of California Foundation, suggests the state needs to focus on what it calls “whole-person care” - an integration of health and social services that would improve outcomes and cut costs for providing services.

  • 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.


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