5 Things California: Deck chairs and the Titanic, Asm. Lorena Gonzalez, Medi-Cal Mental Health

There are a lot of great outlets covering California health policy. So, when we send you these 5 Things We’re Watching in California health care each month, we recognize you have a lot of information options.

So, these are five items we think are worth knowing about amidst all of the noise in health policy.  Not each of these items might be perfect for you or your team.  Some are deep into policy.  Some are regional and operational in nature. But, our goal in each edition is to give all of our 54,000 California subscribers at least one item – maybe two – that will be uniquely valuable to you.




With help from Marjie High and Emily Boerger

1.  Costs in health care: deck chairs and the Titanic

Cost is increasingly the paramount issue in health care today. That’s not news. But, for as common as this knowledge is, we aren’t always as honest about cost as we could be. We also sometimes try to make it more complicated than we should. In this series, I suggest there are really only two kinds of costs: deck chairs and the Titanic.

I spend a fair amount of time with numbers, data, and metaphor in the series. But, after stewing in the national health expenditure data from CMS for a while, this is the bottom line: for what appears to be the first time in US history, market leverage has more impact on overall health expenditures than both utilization and the costs from service delivery combined.  And, for better or worse, there is simply no other way in our capitalist system to overcome market leverage (read: market failure) than through government action.


2.  Legislation aims to limit surprise billing by hospitals

Asm. Chiu and Sen. Wiener recently introduced AB 1611 after this Vox series found several patients covered by private insurance who were billed tens of thousands of dollars by Zuckerberg San Francisco General. Though 2016’s AB 72 addressed surprise billing from out-of-network providers, it did not consider entire hospitals that may be out-of-network

The new bill would forbid hospitals from billing a patient over and above his or her regular co-pay or deductible charges. It would also limit the amount of non-contracted hospital fees to 150 percent of Medicare rates or the “average contracted rate” in the geographic area, whichever is higher. Proposals to limit surprise or balance billing are gaining traction nationally with similar bills pending in other states and President Trump recently vowing to stop the practice.


3. Joint Health Committees assess Medi-Cal Mental Health System

The Assembly and Senate Joint Health Committees held the first of two hearings last week to gather background on the Medi-Cal Mental Health System. The Committees heard testimony from experts including Catherine TeareJennifer Kent, and Dr. Amie Miller. According to testimony, since 2013 mental health utilization under Medi-Cal managed health plans has skyrocketed, increasing from 32,000 to close to 187,000 adults and yet, over 60% of adults with mental illness do not receive treatment.

Difficulty in providing and coordinating services was attributed to the fact that there are up to eight different sources of mental health funding that are often “braided” together to provide care for one individual. Director Kent listed three issues with the system: child psychiatrists are excessively hard to access; difficulty with transportation to appointments; and gaps in crisis stabilization and intervention delivery. A follow-up hearing on improving the system is scheduled for today, March 5, 2019.


4.  Video: Assemblywoman Lorena Gonzalez

Assemblywoman Lorena Gonzalez represents California’s 80th Legislative District and is Chair of the Assembly Appropriations Committee. She joins us for this edition of “What They’re Watching” to discuss working together in health care.

“I would say to the healthcare industry as a whole, it’s far better when we’re working together. I think from years of sitting on the healthcare committee and in dealing with healthcare issues, it doesn’t help when we point fingers at each other. And that often happens especially when we talk about cost containment. You know, we can’t contain costs because of this actor or that actor. And we see that a lot. For us to make true change and to progress and to all continue to exist, we’re going have to work together. So I’m hopeful that we continue to do that.”


5. UC San Diego Health EDs targeting unique population needs

The Public Health Institute selected 31 participants in the California Bridge Program, an 18-month effort to improve access to and treatment of substance use disorder with Medication-Assisted Treatment (MAT). Selected as a “Star Site,” UC San Diego Health will receive $260,000from the program to train providers to initiate MAT in the ED and to navigate patients into available on-going treatment programs.

UC San Diego Health also recently opened the first “gold” accredited geriatric ED west of the Mississippi. The Gary and Mary West Senior Emergency Care Unit (SECU) targets the special needs of San Diego’s growing aging population by combining state-of-the-art tech, calming surroundings, and specially trained geriatric staff. With $5.5 mil in funding from the West Health Institute, SECU will also serve as an anchor facility for best practice and applied medical research for geriatric care.