Californians increasingly concerned about access to mental healthcare and rising cost of care

https://www.healthcarefinancenews.com/node/139807?mkt_tok=eyJpIjoiTldNMllXTmpNVEJpTVRNMSIsInQiOiI1MVlQdys0d2FHbVZESVVjMDNFS2tnQVNJSlNjS2xsT1BCXC9FdGFZbWI2TDZQcnBJZHZIU2p4Qm9GNEw1K1ZsM1M5SVVPYU51OGxxOVJNRndtTlY1UXFkaFNueDVXbTlWbHRmSHF2YWhhVVdZdkthc0FzOHBIWFN3ZTNXdHVoVTkifQ%3D%3D

For the second year in a row, residents say making sure people with mental health problems can get treatment is their top healthcare priority.

Mental healthcare access remains a top priority for nine in 10 Californians, while the rising cost of physical and mental healthcare is causing increasing numbers of Californians to struggle to pay for prescription drugs, medical bills, and healthcare premiums, finds a new poll from the California Health Care Foundation.

The poll, Health Care Priorities and Experiences of California Residents, offers detailed insight into Californians’ views on a range of critical health issues, including healthcare affordability and access, perceptions on homelessness, the healthcare workforce, Medi-Cal, and the experiences of the uninsured. Results from the survey are also compared to a 2019 CHCF poll on the same topics to identify emerging trends.

WHAT’S THE IMPACT

For the second year in a row, California residents say making sure people with mental health problems can get treatment is their top healthcare priority. Nine in 10 said this was extremely or very important, and 52% said it was “extremely” important — topping all other health issues.

More than one in four Californians (27%) say that they or a family member received treatment for a mental health condition in the past 12 months; 7% say they or a family member received treatment for an alcohol or drug use problem.

Among those with insurance who tried to make an appointment for mental healthcare in the past 12 months, almost half (48%) found it very or somewhat difficult to find a provider who took their insurance. More than half (52%) of those who tried to make an appointment (with or without insurance) believe they waited longer than was reasonable to get one.

Nearly nine in 10 (89%) respondents are in favor of increasing the number of mental healthcare providers in parts of the state where providers are in short supply. And 89% favor enforcing rules requiring health insurance companies to provide mental healthcare at the same level as physical health care.

WHAT ELSE YOU SHOULD KNOW

Meanwhile, a little more than half of Californians (51%) have skipped or postponed physical or mental healthcare due to cost — up from 44% last year. Of those who took this step, 42% said it made their condition worse.

Compared to last year’s survey, Californians are more worried about paying for unexpected medical bills (63% last year; 69% today), out-of-pocket healthcare costs (55% vs. 66%), prescription drugs (42% vs. 50%), and health insurance premiums (39% vs. 44%).

Nearly a quarter of residents said they or someone in their family had problems paying, or an inability to pay medical bills in the past 12 months, while almost one-third of those with incomes under 200% of the federal poverty level report having problems paying their medical bills, compared to 19% of those with higher incomes. Uninsured adults report trouble paying their medical bills (45%) at twice the rate of those with employer-sponsored health insurance (20%).

More than eight in 10 (82%) respondents say it is important to lower the price of prescription drugs — up from 75% last year.

When compared to other issues facing the state, Californians rank healthcare affordability as their top priority among a range of public challenges presented in the poll — with 84% of respondents citing it as extremely or very important.

Improving public education received the same response (84%), closely followed by addressing homelessness (83%), attracting and retaining businesses and jobs (78%), and making housing more affordable (76%). Support for making healthcare more affordable cut across party identification, race, and income lines.

THE LARGER TREND

Ninety-six percent of employers believe improving mental health in the workplace is good for their business, but only 65% indicate their company provides adequate mental health services, according to findings from a December survey released by national nonprofit Transamerica Center for Health Studies.

Generally, there’s awareness that an employee’s physical health has an impact on absenteeism and productivity. But mental health, formerly a taboo subject, is garnering increasing recognition as well, and for the same reasons.

While almost all employers believe improving mental health in the workplace is good for their business, 17% of employers acknowledge not offering any resources at all. The most common mental health resources offered by employers are stress management classes (39%) and mental health awareness training (39%).
 

California Health Policy Poll Released

https://elink.clickdimensions.com/m/1/52313696/02-b20044-0c24a5f919b04c9baf7a61e0f9656ec6/6/989/a24990fd-e009-4b4b-be17-ea9b7c8eef0e

Increases in Worry Over Health Care Costs and Skipping/ Postponing Treatment Due to Cost Over the Last Year

PERCENTAGE WHO SAY THEY ARE VERY OR SOMEWHAT WORRIED ABOUT…

 

For 2020, California Goes Big On Health Care

For 2020, California Goes Big On Health Care

https://www.comstocksmag.com/kaiser-health-news/2020-california-goes-big-health-care

California is known for progressive everything, including its health care policies, and, just a few weeks into 2020, state leaders aren’t disappointing.

The politicians’ health care bills and budget initiatives are heavy on ideas and dollars — and on opposition from powerful industries. They put California, once again, at the forefront.

The proposals would lower prescription drug costs, increase access to health coverage, and restrict and tax vaping. But most lawmakers agree that homelessness will dominate the agenda, including proposals to get people into housing while treating some accompanying physical and mental health problems.

“This budget doubles down on the war on unaffordability — from taking on health care costs and having the state produce our own generic drugs to expanding the use of state properties to build housing quickly,” Gov. Gavin Newsom said in a letter to the legislature, which accompanied the $222.2 billion budget proposal he unveiled last Friday. About a third of that money would be allocated to health and human services programs.

But even with a Democratic supermajority in the legislature, these proposals aren’t a slam-dunk. “There are other factors that come into play, like interest groups with strong presence in the Capitol,” including Big Pharma and hospitals, said Shannon McConville, a senior researcher at the nonpartisan Public Policy Institute of California.

Drug Pricing

Newsom’s plan to create a state generic drug label is perhaps his boldest health care proposal in this year’s budget, as it would make California the first state to enter the drug-manufacturing business. It may also be his least concrete.

Newsom wants the state to contract with one or more generics manufacturers to make drugs that would be available to Californians at lower prices. Newsom’s office provided little detail about how this would work or which drugs would be produced. The plan’s cost and potential savings are also unspecified. (Sen. Elizabeth Warren of Massachusetts, who is seeking the Democratic presidential nomination, proposed a similar plan at the federal level.)

Because the generics market is already competitive and generic drugs make up a small portion of overall drug spending, a state generic-drug offering would likely result in only modest savings, said Geoffrey Joyce, director of health policy at USC’s Leonard D. Schaeffer Center for Health Policy & Economics.

However, it could make a difference for specific drugs such as insulin, he said, which nearly doubled in price from 2012 to 2016. “It would reduce that type of price gouging,” he said.

Representatives of Big Pharma said they’re more concerned about a Newsom proposal to establish a single market for drug pricing in the state. Under this system, drug manufacturers would have to bid to sell their medications in California, and would have to offer prices at or below prices offered to any other state or country.

Californians could lose access to existing treatments and groundbreaking drugs, warned Priscilla VanderVeer, vice president for the Pharmaceutical Research and Manufacturers of America, the industry’s lobbying arm.

This proposal could “let the government decide what drugs patients are going to get,” she said. “When the governor sets an artificially low price for drugs, that means there will be less money to invest in innovation.”

Newsom’s drug pricing proposals build on his executive order from last year directing the state to negotiate drug prices for the roughly 13 million enrollees of Medi-Cal, the state’s Medicaid program for low-income residents. He also ordered a study of how state agencies could band together — and, eventually, with private purchasers such as health plans — to buy prescription drugs in bulk.

 

Homelessness

California has the largest homeless population in the nation, estimated at more than 151,000 people in 2019, according to the U.S. Department of Housing and Urban Development. About 72% of the state’s homeless slept outside or in cars rather than in shelters or temporary housing.

Newsom has asked for $1.4 billion in the 2020-21 state budget for homelessness, most of which would go to housing and health care. For instance, $695 million would boost health care and social services for homeless people via Medi-Cal. The money would fund programs such as recuperative care for homeless people who need a place to stay after they’ve been discharged from the hospital, and rental assistance if a person’s homelessness is tied to high medical costs.

A separate infusion of $24.6 million would go to the Department of State Hospitals for a pilot program to keep some people with mental health needs out of state hospitals and in community programs and housing.

 

Surprise Bills

California has some of the strongest protections against surprise medical bills in the nation, but millions of residents remain vulnerable to exorbitant charges because the laws don’t cover all insurance plans.

Surprise billing occurs when a patient receives care from a hospital or provider outside of their insurance network, and then the doctor or hospital bills the patient for the amount insurance didn’t cover.

Last year, state Assembly member David Chiu (D-San Francisco) introduced legislation that would have limited how much hospitals could charge privately insured patients for out-of-network emergency services. The bill would have required hospitals to work directly with health plans on billing, leaving the patients responsible only for their in-network copayments, coinsurance and deductibles.

But he pulled the measure because of strong opposition from hospitals, which criticized it as a form of rate setting.

Chiu said he plans to resume the fight this year, likely with amendments that have not been finalized. But hospitals remain opposed to the provision that would cap charges, a provision that Chiu says is essential.

“We continue to fully support banning surprise medical bills, but we believe it can be done without resorting to rate setting,” said Jan Emerson-Shea, a spokesperson for the California Hospital Association.

 

Medi-Cal For Unauthorized Immigrants

California is the first state to offer full Medicaid benefits to income-eligible residents up to age 26, regardless of their immigration status.

Now Democrats are proposing another first: California could become the first to open Medicaid to adults ages 65 and up who are in the country illegally.

Even though Medicaid is a joint state-federal program, California must fund full coverage of unauthorized immigrants on its own.

Newsom set aside $80.5 million in his 2020-21 proposed budget to cover about 27,000 older adults in the first year. His office estimated ongoing costs would be about $350 million a year.

Republicans vocally oppose such proposals. “Expanding such benefits would make it more difficult to provide health care services for current Medi-Cal enrollees,” state Sen. Patricia Bates (R-Laguna Niguel) said in a prepared statement.

 

Vaping

Dozens of California cities and counties have restricted the sale of flavored tobacco products in an effort to curb youth vaping.

But last year, state legislators punted on a statewide ban on flavored tobacco sales after facing pressure from the tobacco industry.

Now, state Sen. Jerry Hill (D-San Mateo) is back with his proposed statewide flavor ban, which may have more momentum this year. Since last summer, a mysterious vaping illness has sickened more than 2,600 people nationwide, leading to 60 deaths, according to the Centers for Disease Control and Prevention. In California, at least 199 people have fallen ill and four have died.

Hill’s bill would ban retail sales of flavored products related to electronic cigarettes, e-hookahs and e-pipes, including menthol flavor. It also would prohibit the sale of all flavored smokable and nonsmokable tobacco products, such as cigars, cigarillos, pipe tobacco, chewing tobacco, snuff and tobacco edibles.

Newsom has also called for a new tax on e-cigarette products — $2 for each 40 milligrams of nicotine, on top of already existing tobacco taxes on e-cigarettes. The tax would have to be approved by the legislature as part of the budget process and could face heavy industry opposition.

Tobacco-related bills are usually heard in the Assembly Governmental Organization Committee, “and that is where a lot of tobacco legislation, quite frankly, dies,” said Assembly member Jim Wood (D-Healdsburg), who supports vaping restrictions.

 

 

 

 

The fight to keep Medicaid for inmates

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Image result for inmate healthcare

Some local and state officials want Medicaid to start picking up the tab for inmates’ health care, Stateline reports.

How it works: Medicaid beneficiaries lose their coverage while they’re incarcerated — including pretrial detention for people who can’t make bail — and county governments are generally responsible for providing their care, Axios’ Marisa Fernandez writes.

State and local officials want Medicaid to start paying those bills. A single seriously ill inmate — someone with HIV, for example — can quickly strain county budgets, they said.

40 states have already changed their rules so that Medicaid coverage kicks back in more quickly once people are released from jail.

  • Delays in restoring coverage can hurt patients, and in some cases — for example, people who are being treated for certain mental-health issues — can make recidivism more likely.

 

https://www.pewtrusts.org/en/research-and-analysis/blogs/stateline/2020/01/08/in-reversal-counties-and-states-help-inmates-keep-medicaid?utm_campaign=KHN%3A%20First%20Edition&utm_source=hs_email&utm_medium=email&utm_content=81622772&_hsenc=p2ANqtz-9fRnR81-4_9cmDmN8j3MExD7qzNBRPYm6sv1h4nr5zvhn30jRbLmYp0MzuYjC0oPKJWRpJjmwImumSI6_5jWU0ZYmBHQ&_hsmi=81622772

 

U of Iowa Hospitals & Clinics CEO: ‘Everything in healthcare doesn’t need to be done by a hospital CEO’

https://www.beckershospitalreview.com/hospital-management-administration/u-of-iowa-hospitals-clinics-ceo-everything-in-healthcare-doesn-t-need-to-be-done-by-a-hospital-ceo.html

Despite branching out through nearly 60 outpatient clinics, the University of Iowa Hospitals & Clinics in Iowa City — which includes the only comprehensive university medical center in the state — by and large remains a healthcare destination.

As such, demand for inpatient services hasn’t waned, but has kept on par with the surge in outpatient demand that the entire industry is seeing, Suresh Gunasekaran, the CEO of University of Iowa Hospitals & Clinics and associate vice president for the University of Iowa Health Care, told Becker’s Hospital Review.

That’s not to say strategic threats don’t exist. The biggest ones threatening the University of Iowa Hospitals & Clinics are retail medicine providers that cherry-pick services but aren’t able to provide coordinated care, Mr. Gunasekaran said.

“It’s great that today there’s more convenient care being provided by retail providers. The biggest threat, though, is if healthcare consumers start believing that getting disconnected care is worth it,” he said. “We’re in the business of connected care.”

Tackling this challenge will require input from all parties, not just the hospital CEO, he said. Here, Mr. Gunasekaran expands on how University of Iowa Hospitals & Clinics is facing the threat of uncoordinated retail medicine, and answers questions on board oversight and the changing role of the hospital CEO.

 

Question: What do you consider your biggest strategic threat?

Suresh Gunasekaran: Major threats are those healthcare services that don’t believe in team-based care, that focus on cherry-picking a corridor of healthcare without thinking about the health of the whole person.

There’s unmet demand in communities for [accessible healthcare]. If Walmart is willing to offer a clinic, they may be the only clinic for 20 miles. What I’d hope is these kinds of Walmart and CVS providers look at how they partner with players like us. In that sense, we don’t view retail medicine as a threat as much as an opportunity. But when they’re not collaborative, that’s a threat to us. It’s only good if the care is coordinated.

Q: U of Iowa Hospitals & Clinics has its own retail clinics. How do they play into the larger consumerism trend healthcare is seeing?

SG: We’re in our fifth year of offering retail urgent care clinics. We offer a setting that’s lower cost and very competitive with other retail clinics. We’ve seen a lot of uptake and growth within this model, but it’s our ability to say: Hey, urgent care and retail healthcare absolutely have a place, but they need to be connected to our lab in radiology and to our specialists.

The next frontier for us is how to partner with other retail clinics. It’s easy to partner with yourself, but it’s more challenging to make it work with others.

Q: U of Iowa Hospitals & Clinics is a state agency, so your board is really the board of regents of the state of Iowa. Have you faced increased pressure from the board to take up any initiatives?

SG: The board of regents has asked we keep a couple issues front and center. There continues to be inadequate maternal healthcare resources for the young moms of Iowa, with more and more hospitals unable to recruit staff to deliver babies. Data shows maternal death is increasing in Iowa, which is a very, very troubling statistic. So we are bringing the full strength of the University of Iowa together on this. We just got a huge research grant from the federal government to create better models for maternal health across the state.

Mental health is another area, and a huge area of priority for our governor. We are looking at expanding our residency program to rural areas that are underserved for mental health. Other things we’re looking at is the workforce shortage and social determinants of health.

Q: How do you think the CEO role will evolve over the next decade? Will we see more hospital CEOs take stances on bigger public issues?

SG: Hospitals within the healthcare industry have [historically] been very insular. You almost could run your business without worrying about the rest of the system. Now with healthcare reform and greater governmental and employer scrutiny of healthcare costs, folks are asking hospital systems to answer for what’s going on in a broader industry. And of course, CEOs have to embrace that journey.

Are we going to get involved in those multiple different steps? Not just access to care, not just the pricing of care, not just care coordination, not just how to get the community to get engaged in their own health. The CEO of the future has to have a stance on all of these, because it’s impossible to go where we need to go without being involved.

Perhaps the CEO is not that important. At the end of the day when you look at these issues, it’s important that we’re at the table, but the community needs to come first. It’s an opportunity for employers to take the lead. It’s an opportunity for the government to take a lead. Everything in healthcare doesn’t need to be done by a hospital CEO, and in the future, probably isn’t best done by a hospital CEO. We need to be one part of the team.

Q: You’ve been leading the University of Iowa Hospitals & Clinics for a little over a year now. Is there any piece of advice you would go back and give yourself on day one?

SG: Never lose the voice of the patient. I got that at the end of my first year, and I think that beginning with the voice of the patient would’ve been very, very powerful. It’s somewhat impractical that you show up to a new job, and of course, you’re going to meet the people within your organization first. But never forgetting the voice of the patient and being able to hear who you are in their eyes and in their words would have been very powerful [on day one]. But I’m making up for lost time.

 

Medicare for All’s missing mental health discussion

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Illustration of a health plus on a therapist couch.

America’s mental health care system is in dire need of an overhaul, but the real specifics are largely missing from the 2020 debate about health care.

Why it matters: Suicide and drug overdose rates continue to rise, and the U.S. faces a shortage of mental health providers and a lack of access to treatment.

The big picture: Private insurance is plagued with holes in mental health coverage. Even even though insurers are legally required to cover behavioral health the same way as physical health, they don’t.

Yes, but: “Medicare to All” may not solve the problem, Mental Health America president and CEO Paul Gionfriddo told me.

  • “Medicare would need to be redesigned significantly,” he said.
  • Medicare has its own coverage flaws. It would also be crucial to design a system that encourages preventive and early identification services rather than just post-crisis care.

There’s also a shortage of mental-health providers. Paying mental health providers more could help address this, but care delivery would also need to be redesigned, Gionfriddo said.

  • Rural areas, for example, would likely still struggle to attract and support these providers because of their remoteness and population size.
  • The big wild card is how many mental health providers would participate in a Medicare for all program or opt out of insurance entirely,” said the Kaiser Family Foundation’s Larry Levitt.

For Democrats who support Medicare for All, highlighting how it could help mental health care could have a political upside.

  • Talking about mental health care needs humanizes the candidates, indicts the shortcomings of private insurance and provides rationale for the need for significant reforms around the current system,” Democratic health consultant Chris Jennings said.

 

 

 

What to expect as Kaiser’s 4,000 behavioral health workers launch 5-day strike statewide

https://www.sacbee.com/news/local/health-and-medicine/article238378533.html

Image result for What to expect as Kaiser’s 4,000 behavioral health workers launch 5-day strike statewide

Kaiser Permanente’s behavioral health clinicians will be picketing Monday outside the health care giant’s Sacramento Medical Center on Morse Avenue, joining in a weeklong labor strike that will affect services at more than 100 facilities around California.

Roughly 4,000 psychologists, psychiatric nurses and other behavioral health workers — members of the National Union of Healthcare Workers — say they want the company to shorten wait times for return appointments and reduce therapist caseloads.

“I know of nowhere else but in the Kaiser system that there is literally no definition of a caseload or maximum number of patients for which one is responsible,” said Susan Whitney, a Kaiser therapist in Kern County. “There are about 35 therapists and social workers that serve Kaiser’s Kern County population of 109,000 members, only one mental health worker for every 3,000 members. In contrast, Kaiser primary care physicians have a panel, or caseload, of 1,500 patients, and also have staff such as nurses and medical assistants that support them.”

Kaiser executive Michelle J. Gaskill-Hames said that proposals made to the union would keep Kaiser therapists among the highest paid in California, with excellent benefits, as well as offering them more time in their schedules for patient appointments and to take care of administrative tasks. Rather than strike, she said, the company has asked the union’s leadership continue to work with a mediator and Kaiser Permanente.

“Like every other health care provider, we are seeing a significant demand for mental health care in the face of a national shortage of qualified professionals,” said Gaskill-Hames, Kaiser’s senior vice president for Northern California hospital and health plan operations. “Despite this shortage, we have hired nearly 500 new therapists in California this year alone.”

The clinicians had initially planned the strike for mid-November but postponed it out of respect for the family of the late Kaiser CEO Bernard Tyson, who died unexpectedly last month.

WHAT UNION MEMBERS HAD TO SAY

The strike is to compel Kaiser to make mental health care as much of a priority as physical health care, Whitney said. Treating mental health issues also improves physical health, she said, as numerous studies have shown.

Since Kaiser was fined several years ago for lengthy waits for first appointments, the company has worked under state supervision to improve its performance in this area, Whitney said, but as it has improved in that metric, return appointments have become more difficult to schedule.

Vicki Hoskins, a therapist in Orange County, said that if a patient completed an intake appointment today and wanted to return to see her, that patient would have to wait until March. There is a backlog of vacant positions in some offices, she said, so new hires are often filling those rather than adding to the workforce.

WHAT KAISER LEADERS HAD TO SAY

Kaiser has been jointly working with an external mediator to help reach a collective bargaining agreement with the union, Gaskill-Hames said.

She said the mediator recently delivered a proposed compromise to both sides, but the union has rejected it and announced plans to strike instead of working through the mediated process.

This is union’s sixth noticed strike within a single year, and the repeated call for short strikes is disruptive to patient access, operational care and service, said Gaskill-Hames, who described the union’s action as irresponsible.

A strike puts patients in the middle of bargaining, which is not fair to them, especially during the holidays when rates of depression can spike, she said.

HOW WILL THE STRIKE AFFECT PATIENTS?

Kaiser Permanente will try to minimize patient disruption, Gaskill-Hames said, but the company may be forced to reschedule appointments and devote resources from elsewhere in the organization to address the continuity of care.

WHEN AND WHERE WILL PICKETS BE PROTESTING?

In the Sacramento area, pickets will be out from 6 a.m. to 2 p.m. at Kaiser’s Sacramento Medical Center, 2025 Morse Ave., on Monday; at the Roseville Medical Center, 1600 Eureka Road, on Wednesday; and at the South Sacramento Medical Center, 6600 Bruceville Road, on Friday. On Thursday, they will rally at the State Capitol at 10th and L streets at 10:30 a.m. and at the Department of Managed Health Care, 990 Ninth St., at 11:30 a.m. Elsewhere in the Central Valley, pickets will be at Fresno Medical Center, 7300 N. Fresno St., Monday through Friday.