Survey results | Walter Zelman | MCO contracts awarded

With the session now well underway, a few things we’re watching suggest we may need to think differently about how we reform our health care system. Walter Zelman makes the point, but it might also be baked into the anxiety found in our annual survey.

Put another way, we’re looking for the forces of innovation in this month’s edition of “5 Things We’re Watching.”

DJ 5 Things Signature

1. Exec. survey: 54.4% disapprove of mergers

Our 2016 Health Care Executive Outlook Survey is out, and has a few interesting nuggets.  For example, there is some significant anxiety among respondents about increasing consolidation in the marketplace. Of those who disapproved, nearly 20% revealed that they were “very negative.”

Consolidations aren’t the only thing worrying health care leaders in the year ahead. Most described their work in 2016 as “challenged” while a significant number (about 32%) admit they are “frustrated.” “Anxious” came in at 26%, though “optimistic” was the view of 27% of respondents.

2. Video: Walter Zelman, Cal State University

State of Reform was honored to sit down with health care policy veteran Walter Zelman who has been at the center of state and federal level transformations since the Clinton administration. These days Zelman has his eyes on population health outcomes.

In his interview, Zelman suggests that California’s leaders will continue to connect the dots on social determinants in 2016. Looking at “income, education, exposure to toxics” and addressing the critical need to broaden our definitions of health care delivery.



3. Workforce and the future of the safety net

The California Primary Care Association (CPCA) just released a report estimating at current utilization, the state will need 8,243 additional primary care physicians (or 32% of its current workforce) to stay afloat. By HHS’s most recent estimation the national shortage will be 20,400 docs by 2020.

Community safety net clinics will feel the brunt of the shortage the hardest. CHCF shared at a December briefing that 54% (over 1.3 million) new Medi-Cal managed care lives have already been assigned to safety net clinics which equals a 41% growth in 2015. Their consultant suggested that this sudden explosion, coupled with DHCS reduced rates and managing new risk-based payments makes the sustainability of this system “uncertain.”

vera whole health

4. MCO contracts for Medi-Cal in San Diego and Sacramento

Aetna and United Healthcare have been awarded MCO contracts for Medi-Cal in San Diego and Sacramento.  An RFP announced last summer received 5 letters of intent from MCO applicants interested in contracting to manage benefits for MediCal eligible folks, though only these two were “apparently successful.”

Both Aetna and United have been hungry for access to the Medi-Cal market as direct contractors. We’re watching to see how that will manifest now that they have their opportunity. I expect both plans to bring innovative approaches and investment to care coordination and consumer engagement, but providers in both markets will have their own ideas, too. We’ll watch to see how the conversation unfolds.


5. ITUP next week in Sacramento

One of the more prominent convenings of the year in health policy is the annual ITUP conference. The 20th annual iteration will be held next week with a focus on what it “will take to close the coverage gap” in California health care.

I’ll be there next week with JJ and Stephanie from our team. Our ears will be to the ground listening to what folks are talking about, and what holds their attention on the horizon. Though not on the agenda, we’ll be listening for concerns related to mergers before CDI and DMHC, particularly as Commissioner Jones looks to push for concessions. If you’re at the conference too, drop us a note. We’re always interested in smart conversation with smart folks!