When it comes to health care policy, California is one of the most progressive states in the nation. This past year, Governor Newsom signed into law a state-level individual mandate. He also increased subsidies to the middle-class and expanded coverage to undocumented California residents. In addition, the state is investigating a single-payer system through a new commission.
This past week’s California Association of Health Plans (CAHP) conference in Palm Springs, California brought together over a thousand of health care professionals to learn how health plans are responding to these policy changes and planning for potential future changes. Stakeholders from all states could learn from CAHP’s conversations, to bring ideas back to their home state to revitalize their health ecosystem.
In case you were not able to attend, here is a recap of the key topics discussed:
Addressing Social Determinants of Health in Medicaid
Medicaid programs across the nation are grappling with how to best address social determinants of health (SDOH), as Dr. Chris Esguerra, Senior Medical Director of Blue Shield Promise Health Plan, said: “Social determinants of health are causing a lot of buzz.”
California’s Medicaid program, Medi-Cal, has been tackling determinants, too. This topic is especially important for Medi-Cal since homelessness in the state is double the nation-wide average with food insecurity and barriers to housing driving the growth. In fact, in 2019, most counties in the state saw double digit increases in homelessness rates. Alongside Dr. Esguerra, Beau Hennemann, Director of Special Programs at Anthem and Dr. Priya Batra, Senior Medical Director of Family and Community Health at Inland Empire Health Plan, said key issues remain unresolved: defining the best ways to address SDOH, identifying the current barriers and partnering with plans. The speakers all said it is of utmost important to partner and “speak the same language.”
Dr. Batra said in order to address SDOH at the community-level, one must go upstream in two ways: first, outside the biomedical model, and, second, outside the health care system via policy. Inland Empire Health Plan (IHEP) addresses two SDOHs: housing and linkage to community resources. IHEP tackles the first stream in housing by screening for housing needs, funding permanent supportive housing and building housing support resources. IHEP tackles the second stream in housing by lobbying for policy change, such as pushing for additional funds for permanent supportive housing and partnering with local legislators on housing.
IHEP addresses the first stream in linking members to community resources by screening members for social needs, which includes partnering with providers to promote screening, incorporating validated items into assessments and conducting in-person screening when appropriate. IHEP addresses the second stream in linking members to community resources by developing a regional referral and tracking platform, supporting social service organizations (via outcomes-based funding and co-location), and lobbying for policy support in reimbursement for social need screen and fulfillment.
State-level Health Policy Innovations
California has taken actions to preserve gains and build on the Affordable Care Act (ACA). Its chief accomplishment in this vein has been its recent reinstatement of the individual mandate and penalty. The federal decision to remove the individual mandate penalty likely contributed to a 23.8% drop in the number of new consumers signing up with Covered California and potentially hurt the risk mix, according to Charles Bacchi, President and CEO of CAHP, and Wade Overgaard, Senior Vice President of California Health Plan Operations. Starting on January 1, 2020, California consumers will need to maintain minimum essential coverage, receive an exemption, or pay a penalty. The mandate, in combination with subsidies for middle-class consumers with incomes between 400 and 600 of the federal poverty level, is projected to bring 229,000 newly insured individuals to the market.
Another innovation on California’s part is its new contractual requirements with Covered California’s eleven carriers, which are already seeing early impacts. First, since plans are required to have the same benefit designs and to meet the same standards for quality and delivery reform, plans compete on value. Second, as California presses plans for better hospital engagement in safety and maternity health, California has seen lower rates of low-risk C-sections and big reductions in health care-associated infections. Third, since each consumer is matched to a primary care provider, there has been better primary care access and coordination. Fourth, as plans are required to collect race and ethnicity data, there has been a better understanding of health and care disparities.
The state has also put effort into incentivizing value-based payment programs. California gave $540 million of incentives to providers for improving clinical care for high-cost or high-need populations. To address SDOH, California also increased incentives for beneficiaries with substance use disorders, serious mental illness or homelessness. The state will give incentive payments for provides that meet specified measures of health care quality in areas such as prenatal/post-partum care, early childhood preventative care, chronic disease management and behavioral health integration.
Lastly, by expanding Medi-Cal to undocumented young adults aged 19 to 26 starting January 1, 2020, 90,000 enrollees will be eligible for full-scope Medi-Cal benefits. This legislation satisfies California’s strategic priorities of “building a healthy California for all” and “improving the lives of California’s most vulnerable.”
Softheon will also be attending the HLTH conference in Las Vegas, Nevada next week! Look out for our recap blog then.