Short Takes On News & Events

Report: Difficulties Likely To Persist In Enrolling Asian-Americans, Pacific Islanders

Language and cultural issues, along with immigration concerns, could still pose major barriers to enrolling Asian-Americans, Native Hawaiians and Pacific Islanders in health insurance plans this fall, according to a report released Wednesday by Action for Health Justice, an advocacy coalition that aims to educate these populations about the health law.

The report argues that efforts to enroll people from those ethnic groups were undermined last year by ineffective translations of health law guides; limited language options on the federal online marketplace, healthcare.gov; insufficient training for enrollment assisters and complications in processing applicants’ immigration information. If those issues are not addressed by this year’s open enrollment – which begins Nov. 15 – they will likely continue to be a roadblock to expanding coverage, according to the report.

“Even with some of the advocacy efforts, both on the national level and also in the state-based marketplaces, I think some of the challenges will remain the same,” said Priscilla Huang, senior director of impact at the Asian and Pacific Islander American Health Forum, one of the AHJ’s member associations.

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September 24th, 2014, 8:01 AM by Shefali Luthra

Short Takes On News & Events

How To Fix Medicare? Ask The Public

This KHN story can be republished for free. (details)

Washington is full of ideas to overhaul Medicare. Some would increase the program’s eligibility age, others would charge higher-income beneficiaries more for their coverage. There’s movement to link payment to the quality — rather than the quantity — of care delivered.

Marge Ginsburg decided to ask ordinary Americans how they would change the federal entitlement program.

Seventy-seven percent of participants in her “MedCHAT” group sessions said Medicare should cover at least one year of care in a nursing home, in supportive housing or at a person’s home. Eight-five percent wanted “modest coverage” of dental, vision and hearing services. To help Medicare last another half-century — it turns 50 next year — 85 percent were willing to reduce program spending on current and future beneficiaries.

Over the past year, Ginsburg’s group, the nonprofit, non-partisan Center for Healthcare Decisions, conducted 82 three-hour “MedCHAT” sessions in California with 810 participants to discover what changes they would make to the federal entitlement program. Small groups of eight to 15 people gathered in community centers and churches to use the “MedCHAT” tool on computers with guidance from facilitators. The groups included seniors, young adults, health care professionals and community and senior service leaders, and the interactive simulation tool explored Medicare options among 12 categories of coverage. If participants wanted to add benefits, they had to eliminate others or impose new restrictions on current coverage.

While participants did not eliminate benefits, they accepted stricter criteria or new limitations on current coverage. For example, 82 percent supported the use of defined networks of providers, but allowed the use of a provider outside the set network if approved by a primary care provider. Eighty-eight percent supported “value-based coverage” but also agreed with patients picking up at least half of the tab if research showed the benefits of a treatment “was small, unlikely or more expensive than an equivalent treatment.” Forty-eight percent backed using both penalties and rewards to encourage compliance with medical advice.

So how will Ginsburg’s findings fare in Washington where entitlement reform is the “third rail” of politics — touch it and your career dies?

Health care experts offered their thoughts at a Sept. 19 forum sponsored by the American Enterprise Institute and the Engelberg Center for Health Care Reform at the Brookings Institution where Ginsburg presented her findings.

Don’t confuse what took place in California with what will happen in Congress, said John Rother, a longtime Washington health care policy expert who is now president and chief executive officer of the National Coalition on Health Care. While many changes could be made to Medicare to make it more efficient, “we’ve got to figure this out in a way that minimizes political difficulty,” he said.

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September 23rd, 2014, 5:00 AM by Mary Agnes Carey

Short Takes On News & Events

San Francisco Politician: ‘I Take A Pill Called Truvada’

This story is part of a partnership that includes KQED, NPR and Kaiser Health News. It can be republished for free. (details)

In an effort to combat stigma that has arisen around a treatment that prevents HIV, a San Francisco elected official announced publicly Wednesday that he is taking the medicine. City Supervisor Scott Wiener said that he is taking Truvada, an FDA-approved drug that dramatically reduces the risk of HIV infection. He appears to be first public official to make such an announcement.

Wiener wrote about his experience in The Huffington Post:

Each morning, I take a pill called Truvada to protect me from becoming infected with HIV. This strategy, also known as pre-exposure prophylaxis, or PrEP, reduces the risk of HIV infection by up to 99 percent if the pill is taken once a day. This makes PrEP one of the most effective HIV-prevention measures in existence. …

As an elected official, disclosing this personal health decision was a hard but necessary choice. After all these years, we still see enormous stigma, shame, and judgment around HIV, and around sexuality in general. That is precisely why I decided to be public about my choice: to contribute to a larger dialogue about our community’s health.

“My hope is that by disclosing my PrEP use publicly that I can help move the conversation forward and get more people thinking about PrEP as a possibility, and encouraging people to consult with their medical provider,” Wiener said in an interview at his office in San Francisco’s City Hall.

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September 18th, 2014, 9:18 AM by Lisa Aliferis, KQED

Short Takes On News & Events

Lawsuit Accuses Calif. of Denying Care to Medi-Cal Applicants

This KHN story can be republished for free. (details)

California’s lingering backlog of Medi-Cal applications has left hundreds of thousands of people unable to access the health care they are entitled to receive, according to a lawsuit filed Wednesday by a coalition of health advocates and legal services groups.

Photo by Calsidyrose via Flickr

The lawsuit, filed in Alameda County Superior Court, says the state is failing to process applications within 45 days as required by law. Some applicants have been waiting to receive their Medi-Cal cards since the end of last year, according to the suit. The applicants include children, pregnant women and adults with life-threatening health conditions, who advocates say are either postponing treatment or paying cash to see doctors.

Medi-Cal is the state’s version of Medicaid, the publicly funded health insurance program for low-income Americans. About 11 million people receive Medi-Cal benefits in California, including 2.2 million who applied since January. Roughly 350,000 applications are still pending.

The lawsuit cites several cases, including that of Tulare County resident Robert Rivera, who applied for Medi-Cal in January but died of a pulmonary embolism while the state was determining if he was eligible for the insurance. Two months after his death, Rivera’s mother received a letter saying that the benefits had been approved.

Los Angeles County resident Mark Mullin submitted an application in February 2014, but wasn’t approved until four months later — after he sought legal help. During the time his application was stuck in the backlog, Mullin had to undergo an emergency appendectomy.

The suit is asking the state to process cases within 45 days and to grant people Medi-Cal benefits while officials verify applicants’ incomes. The coalition is also asking the state to send notices to Medi-Cal applicants who have been waiting for 45 days notifying them of their right to go before an administrative law judge.

The long wait is “unacceptable,” said Katie Murphy, managing attorney at Neighborhood Legal Services of Los Angeles County. Murphy said she is concerned that the problems will get worse as more people apply for Medi-Cal. “If they are not fixed, more people will continue to wait and more will continue to suffer medical emergencies,” she said.

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September 18th, 2014, 5:00 AM by Anna Gorman

Short Takes On News & Events

One-Quarter Of ACOs Save Enough Money To Earn Bonuses

About a quarter of the 243 groups of hospitals and doctors that banded together as accountable care organizations under the Affordable Care Act saved Medicare enough money to earn bonuses, the Centers for Medicare & Medicaid Services announced Tuesday.

Those 64 ACOs earned a combined $445 million in bonuses, the agency said. Medicare saved $372 million after accounting for the ACOs that did not show success, including four that overspent significantly and now owe the government money.

The bonuses, losses and Medicare savings are teensy sums in the context of a program that spends half a trillion dollars a year on care for the elderly and disabled. But the Obama administration views the results so far as evidence that reorganizing the financial incentives for doctors and hospitals — a key element of the health law – can translate to substantial savings if the program expands nationwide.

ACOS are voluntary affiliations in which doctors and hospitals join together to coordinate care with the lure of earning extra money if they save Medicare money while maintaining the health of their patients. The program aims to encourage doctors to focus on keeping patients healthy and to intervene quickly if they are struggling, rather than waiting until they need complex — and for doctors in the old pay model, lucrative — operations or other kinds of care.

There are now more than 360 Medicare ACOs caring for about 5.6 million elderly Americans, although some of these ACOs are new enough that Medicare is not assessing their performance.

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September 16th, 2014, 4:11 PM by Jordan Rau

Short Takes On News & Events

Frustrated AMA Pitches ‘Action Plan’ On Digital Records

Saying that electronic health records distract doctors, take time away from care and make physicians less productive, an influential doctors’ group called on vendors and government agencies to work with them to develop better, easier-to-use technology.

The American Medical Association asked the Obama administration to abandon its “all or nothing approach” requiring Medicare providers to go digital or be penalized. The group also wants the government  to develop better certification criteria for vendors selling electronic record systems.

It outlined eight areas for overhauling the record systems, with the top priority being to make sure the technology enhances, rather than disrupts patient care. Electronic health records should also promote coordination, enable physicians to delegate to other health care providers and be able to interact with patients’ mobile devices.

Under the 2009 economic stimulus package, Congress authorized $27.4 billion to incentivize doctors to switch from paper to electronic records with the goal of reducing costly errors and duplication and boosting coordination.  The law offers doctors who treat Medicare patients up to $63,750 over five years to help pay for the change if they can prove they’re making “meaningful use” of the systems by, say, submitting prescriptions electronically.  Those who do not go digital are supposed to have a percentage of their Medicare payments withheld beginning next year.  However, the government recently agreed to give certain providers more time and flexibility.

The AMA says that isn’t sufficient to address the problems.

“The meaningful use program and the regulatory structure associated with it initially has been a wonderful impetus to get health systems to adopt [electronic health records],” said Dr. Steven J. Stack, president-elect of the AMA, adding: But the “processes associated with it have become overly prescriptive, rigid and unreasonable and have themselves become a barrier.”

The group said that one of physicians’ chief concerns is that the programs often have clunky menus that require what it called “the collection of time-consuming information of questionable value” and data that is no more than “clutter,” such as lists that do not differentiate between a patient’s current and out-of-date medications.

That information distracts the physician, is often irrelevant to the care of the patient and leads to “excessive clicking and scrolling” on behalf of the doctor, the organization said.

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September 16th, 2014, 12:55 PM by Roni Caryn Rabin

Short Takes On News & Events

No Time To See The Doctor? Try A Virtual Visit

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.

The doctors are available through LiveHealth Online, an already-existing service designed for business travelers and parents who may not have the time to show up for an appointment.

“There is a need for the entire health care industry to be a lot more responsive to what patients want,” said Samuel Skootsky, chief medical officer of the UCLA Faculty Practice Group and Medical Group. “One way to do that is to have multiple channels of access to doctors.”

The traditional medical appointment “is not convenient for everybody,” Skootsky said.

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September 16th, 2014, 12:15 PM by Anna Gorman

Short Takes On News & Events

CDC Survey Finds Drop In Uninsured

This KHN story can be republished for free. (details)

UPDATED AT 12:10 P.M.

The federal government’s first survey of the nation’s insured rate since the health care law’s new marketplaces began found a decrease in the number of adults without coverage, particularly among young adults.

The National Health Interview Survey of people during the first three months of this year found that the number of adults under 65 without health insurance dropped to 18.4 percent from 20.4 percent in 2013. Among all ages, the survey found that the uninsured rate dropped to 13.1 percent from 14.4 percent in 2013; 41 million people still lacked insurance.

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September 16th, 2014, 8:30 AM by Jordan Rau

Short Takes On News & Events

California Exchange Seeks To Enroll 500,000 More People

This KHN story can be republished for free. (details)

Covered California, the Golden State’s online health insurance marketplace, announced Monday that it will be spending close to $100 million as it aims to enroll 500,000 new people during the second round of open enrollment, which begins in two months.

The state also will be trying to help about 1.2 million Californians renew health plans they received thanks to the nation’s Affordable Care Act during the inaugural enrollment period last fall. The numbers do not include the roughly 2 million who signed up for Medi-Cal, the state’s health insurance program for the poor.

The renewal process hasn’t been finalized, but beginning sometime in early October, customers who bought plans through Covered California will get letters explaining the details, a Covered California spokesman said. People will have a chance to switch plans, and the state will re-examine consumers’ eligibility for government subsidies.

The state’s outreach efforts include a $46-million radio, TV, print, and social-media ad campaign that will target and feature African Americans, Latinos and Asians who have benefited from access to health insurance. Some ads have already started running in English and Spanish throughout the state. Ads in Asian languages are set to begin next week in the Los Angeles, Bay Area and Central Valley markets.

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September 16th, 2014, 8:25 AM by Daniela Hernandez

Short Takes On News & Events

Apparent Retail Glitch Triggers Copays For Birth Control

CVS Health is investigating a potential glitch in its drug pricing system that appears to have charged women copayments for prescription birth control – though the scope of the error is unclear.

The problem came to the attention of Rep. Jackie Speier, D-Calif., after one of her staffers attempted to buy generic prescription birth control in Washington D.C. and was charged a $20 copay.

The retailer’s error, highlighted in a letter to the company from Speier, runs counter to a provision of the federal health law that mandates insurance coverage of women’s preventive care – a category including generic prescription birth control – without cost sharing.

Speier’s office said it also has received similar complaints both from women in D.C. and in her California district. In these cases, the customers may have been covered by different insurance plans, but a coding error appeared to have accidentally attached the cost-sharing to the purchases, Speier’s office said. They added that the issue could have affected retailers other than CVS, but that it is still too early to tell who has been charged or where.

CVS did not comment on what may have caused the copays to be charged or how many people they may have affected. But the charges add up — women often shell out between $10 and $35 per month in copays for birth control pills. Under health law rules, insurers are allowed to charge copays for non-generic birth control pills but should not be charging them for generic versions.

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September 11th, 2014, 2:48 PM by Shefali Luthra