5 Things California: IHA Atlas, Novartis, Jonathan Barrera

This will be the first year we host three conferences in California: in SacramentoLos Angeles (Sept. 19), and San Diego (Nov 28).  We’d be thrilled if you decided to join one of them!

Now, onto 5 Things We’re Watching in California health care for May, 2018.


1.  IHA releases its cost, quality atlas

The Integrated Healthcare Association has finalized its second  California Regional Health Care Cost & Quality Atlas, bringing together “multi-payer data by geographic region—including commercial insurance, Medicare, and Medi-Cal—on more than 30 standardized measures.”

One key finding:  “HMO products delivered 22% higher clinical quality and 9% lower costs than PPO products when member cost sharing is included.”  Another:  the statewide average out of pocket (OOP) expense paid by a beneficiary of an HMO was $69.  The average OOP expense for a PPO model was $838 per beneficiary.


2.  Senate Subcommittee 3 gets DSH update

The Senate Budget Subcommittee 3 on Health and Human Services received an update from the Department of State Hospitals earlier this week. You can find the video here, or we have a brief rundown of some of the topics covered for you here. DSH oversees the largest inpatient forensic mental health hospital system in the nation.

In addition to adding new facilities and beds outside of the 5 state hospitals, DSH is working with LA County to provide treatment for Incompetent to Stand Trial (IST) patients in community settings. The Legislative Analyst’s Office “thinks this is a potentially promising way of treating IST patients” but “recommends approving it on a limited term basis and requiring that it be evaluated to make sure that this is an effective approach.”


3.  Novartis, Michael Cohen, and Senate probe

In case you missed it, earlier this month Novartis announced it had paid Michael Cohen $100,000 per month for twelve months. It only took one meeting with him before the company realized Cohen, President Trump’s adviser, had no depth of knowledge in health policy (something usually confirmed before contracts are signed).  That amount is high, even by DC standards, and is apparently more than Novartis pays its lobbyists already on contract.

When Novartis considered leaving the contract, it chose not to saying it didn’t want to “anger” Cohen. This week, Novartis’ general counsel stepped down.

This follows Novartis’s payment of hundreds of millions in fines for bribery of public officials and “kickbacks” in foreign countries. US. Sen. Ron Wyden (D-OR) and Sen. Patty Murray (D-WA) have started a probe into the contract, with Wyden saying it “raises the specter of corruption.”


4.  Video: Jonathan Barrera, WestPac Wealth Partners

Jonathan Barrera is a financial wellness advisor at WestPac Wealth Partners, which focuses on financial planning for medical professionals. He joins us in this episode of “What They’re Watching” to discuss provider costs and retirement.

“The beautiful thing about the medical industry in general is it’s about caring about what you do and many individuals go above and beyond what a normal individual would do because they love doing what they do. So we do find a lot of physicians that say “Even though I would retire, I would most likely keep on working.” So we want to find that equal balance.”


5. Two big moves in Medicare

The Bi-Partisan Budget Act passed by Congress allows for the inclusion of non-health care services to be covered supplemental benefits for MA plans starting in 2020.  I detail some of the background on this here.  This means that strategies related to the social determinants, for example, can be funded in Medicare if a plan chooses to cover them.

CMS also proposed several updates to Medicare payment policies and rates. Among them is a requirement to have hospitals publish a list of “their standard charges” online in an effort to “empower consumers.” This is an incremental step, but a good one and one we’re likely to get more of from Seema Verma’s shop.