5 Things California: Brad Gilbert, Bills we’re watching, Chris Daher

Our Convening Panel will be meeting this month ahead of our 2020 Northern California State of Reform Health Policy Conference coming up on May 12th. So, now is a good time to send us any ideas you have for topics for this year’s event. We’ll get those in the mix for our discussion as we begin to put the Topical Agenda together for this year’s conference in Sacramento.



With help from Emily Boerger and Madeline Shannon



1. What hiring Brad Gilbert tells us about DHCS

We reported news last week that Brad Gilbert will take the reins at DHCS. It’s one of the most important positions for an administration trying to coordinate across Medi-Cal procurement, efforts to integration care, diverse state politics, and a complex federal relationship. Gilbert comes to the task as the former CEO at Inland Empire Health Plan. He understands the MCO-DHCS relationship, how it can work better, and the value which can be derived from closer coordination.

I think this hire tells us two key things about the future of Medi-Cal. First, this reinforces the administration’s demands that MCOs perform better and have greater accountability. Gilbert knows the points of tension here well. Second, in the great struggle between MCOs and counties that is playing out for the future of the safety net, this is a big bet on MCOs moving forward.


2. Cal-AIM driving to full integration

In a Cal-AIM presentation last week, DHCS proposed a model of complete integration of managed care, specialty mental health, substance abuse and dental services to all managed by one entity, likely an MCO. Not all counties would participate in “full integration.” Any applicant for full integration “would require support” from the county BH department.

When it comes to BH, DHCS proposed in another meeting that they want a “single, integrated behavioral health managed care plan in each county or region” and intend to request that in the next 1915(b) waiver. This doesn’t sound like a county administrator, but rather something like a managed behavioral health plan, though I’m sure that’s not yet set in stone.

3. California’s responds to the CMS MFAR proposal

DHCS submitted 19-page response to CMS’s proposed Medicaid Fiscal Accountability Regulation (MFAR) rule. Michael Goldberg’s reporting says DHCS “raised the alarm” about the impacts and scope of the proposed rule.

The MFAR rule could be a significant funding threat to states, like California and Texas, which fund some of their Medicaid programs through multi-governmental contributions (IGTs). Provider taxes were specifically singled out as a target for limitation and/or exclusion. One insider told me it would mean a $25bn hit to California if the draft is adopted in whole.

4. Video: Chris Daher, Beacon Health Options

Chris Daher is the Vice President of Network Strategy at Beacon Health Options. He joins us in this edition of “What They’re Watching” to discuss telehealth. Daher says Beacon’s use of telehealth has increased access, reduced waiting times to receive services, and resulted in high levels of member satisfaction.

“By using telehealth, we’re having physicians that are doing live videoconferencing and so those patients can get in within like 2 to 3 days. So, it’s a lot quicker access to care and we’ve seen really high member satisfaction scores — up to 95 percent. Ninety-five percent said that they thought their telehealth session was just as good as their face-to-face session. Ninety-six percent said they would use telehealth again.”


5. Key hearings, interesting bills to watch

On Feb. 25th, Assembly Health holds a hearing on the always attention-grabbing subject of “Cost Containment: Considerations for California.”  On Feb. 26th, an important hearing is teed up in Senate Health on “Oversight of Managed Care Plan Responsibilities and Medi-Cal Healthier California for All Proposal.”
Caregiver programs, HIV treatment, juvenile behavioral health and telemedicine are the subject of several new bills in the legislature. AB 2001 would establish an Alzheimer’s and Dementia Caregiver Program, which would expand caregiver education programs. SB 859 aims to curb the spread of HIV and venereal disease, while AB 2018 would institute new treatment protocols for students with mental illness. AB 2007 would allow for a greater expansion of telehealth services.