5 Things California: Financial impacts on providers, “The Special Session,” CalAIM

For many of us, we are not simply “working from home.” We’re at home, trying to work. It’s not the same. And as these weeks grind into months, we should try to give ourselves a little grace to feel less productive than normal. And, the room to simply be sad when we don’t really know why.

So, if you’re feeling a little down, this short video may add perspective. And, if that doesn’t work, I’m always here to answer your note. I may not have anything smart to say in response, but I will read your note and I will see you.





With help from Emily Boerger

1. Implications of DHCS postponing CalAIM

In a “CalAIM Stakeholder Update” email sent last week, DHCS announced the department is postponing CalAIM implementation timelines in order to allow the state to focus on addressing COVID-19. According to the email, DHCS plans to “engage stakeholders and the federal government in both an extension of the existing 1115 waiver and the 1915b Special Mental Health waiver.”

This approach both seems very reasonable given the bandwidth challenges the state faces, and like a huge lost opportunity. Medi-Cal is about to expand to a degree perhaps unimaginable just a few months ago. This is the time for post-COVID thinking to build a new kind of health system. It’s also a time when the ideological gap between the Trump and Newsom administrations could be quickly bridged by innovative ideas that improve the system, but which might not have been politically possible until now.

2. Financial impacts of COVID-19

The COVID-19 pandemic has financially shocked the health care system in jarring ways. One poll finds that medical group practices, on average, are reporting a 55% decrease in revenue and a 60% decrease in patient volume since the start of the public health emergency. Another recent survey reports that 20% of primary care practices predict they will need to close within the next 4 weeks.

Reporter Emily Boerger spoke with four health care leaders from around the state about how the COVID pandemic has impacted their practices, hospitals, and clinics. Offering their perspectives are Lannie Tonnu, Chief Financial Officer of Orthopaedic Institute for Children, Lisa Davies, CEO of Chapa-De, Dr. Brian Grady, President of the San Francisco Marin Medical Society, and Dr. Michael Brant-Zawadzki, Senior Physician Executive at Hoag.

3. New tools to support children’s mental health

A path to addressing the impacts of COVID-related stress on children and families is not yet clear. What is clear, however, is that life in the home during COVID has gotten more complicated. Since early March, the stress from COVID has led to more reports of domestic violencedepression and suicidal ideation than before the disease.

In an effort to support children during the public health crisis, Beacon Health Options has developed an online tool, the Student Assistance Program, to provide students with crisis support, tele-behavioral health, and direct connections to therapists in the students’ communities to some of California’s larger counties. Beacon VP Travis Jackson thinks a paradigm shift is starting to occur as communities live with this new state of normal during COVID. He says this type of program could be an example to other areas of the country of how to address behavioral health needs during a crisis.


4. Health policy in a post-COVID world

During COVID, we have asked our health system to turn operating suites into negative pressure ICUs, to cover all costs related to COVID testing, and to endure the financial peril of collapsing consumer demand. If we want a health system that is agile and resilent, we need a financing model that is prospective, predictable and doesn’t penalize providers financially for doing the right thing for the community – just as the pre-COVID health system could do.

So, in this continuing series titled “The Special Session,” we explore ideas for a post-COVID health system and how policy makers might support a new model for care. These are “think pieces” to support your creative brainstorming, not advocacy positions. Current stories include reinsurance, funding and executing a serological study, and reconsidering hospital and community funding models.

If you have other ideas for health policy in a post-COVID world, I’d love to have you share them. We’ll be building out the stories and ideas over the weeks ahead.


5. Legislators push for transparency

California legislators are pressing Gov. Newsom to provide more information regarding his $1.4 billion deal to buy masks and other protective gear from a Chinese manufacturer, as well as specifics concerning spending revisions to the June 30th budget. In an initial virtual hearing last week, senators expressed impatience that the Governor has yet to release the contract for the deal he struck to buy PPE from China, which administration officials rebutted by citing a need to temporarily withhold details due to the high demand for PPE around the world.

In a subsequent Assembly oversight hearing on Monday, legislators offered mixed reviews for the Governor’s response to the pandemic thus far. While Newsom was applauded for implementing measures that have flattened the curve, legislators called for clarity on where the $7 billion he’s promised to spend fighting COVID-19 will go and how it will affect the budget. At the hearing, a CHHS representative could not put a number on how many tests would be needed to lift social distancing restrictions and a DOF representative pointed to the May budget revision as the point at which more monetary specifics would become available.