Dr. Janet Coffman, a health services researcher at the University of California, San Francisco, presented results from the 2015 survey on California physician participation in the state's Medicaid program, Medi-Cal. Dr. Coffman examined physician acceptance of new patients overall and by specialty type, practice type, and region. She also considered how these results compare to different benchmarks for assessing adequacy of physician supply and how current Medi-Cal physician supply compares to the supply in previous years.
Alan Mckay, CEO of Central California Alliance for Health (CCAH), a Medi-Cal managed care plan serving members in three Central California counties, provided several examples of strategies employed by CCAH to address physician access challenges. These efforts fall into four areas: (1) increasing physician supply, (2) supporting physician retention, (3) promoting the best use of the available healthcare workforce, and (4) reducing the need for physician services.
The California law that requires the state's Medical Board to administer a mandatory physician survey is set forth in Section 2425.3 of California's Business and Professions Code. Access the full text of the law.
Publication
SHADAC Newsletter - September 2016
The SHADAC newsletter contains updates on SHADAC activities, news from the states, resource updates, and blog highlights. Subscribe to our newsletter here.
California Employers Continue to Offer Insurance, but Fewer Workers Enroll (Cross-Post)
August 16, 2016:
This blog was originally published on August 2, 2016, on the California Health Care Foundation's ACA 411 Insights Blog.
Most Californians under age 65 with health insurance receive it through an employer, but since 2009 the availability of employer-sponsored insurance (ESI) in the state has been on the decline. A key question around the Affordable Care Act (ACA) was whether the reforms would further erode ESI coverage.
The share of eligible workers who actually enrolled in ESI coverage did decline between 2013 and 2015 in California. Also known as the "take-up" rate, this figure declined from 86.4% in 2013 to 80.2% in 2015, a statistically significant change. This decline brings California closer to the national average take-up rate of 79%, which was statistically unchanged between 2013 and 2015.
Availability of ESI for Workers' Family Members Remained Stable, While EnrollmentDropped Among Low-Income Family Members
Many individuals obtain ESI as a spouse or dependent of another worker, so it is helpful to track trends in the availability and take-up of ESI at the family level.
Between 2013 and 2014 (the latest year for which data are available) the share of families in California with any offer of ESI was statistically unchanged, as was the share of families with any ESI offer who enrolled all eligible family members. However, there was a significant decline in enrollment in ESI among low-income families. The share of families with incomes below 138% of the federal poverty level who were offered ESI and enrolled all eligible family members declined by nearly 13 percentage points from 49.4% to 36.7%.
The reduction in the share of employees and low-income family members deciding to enroll in ESI when eligible could be driven by multiple factors, including cost and the availability of alternative coverage options, such as Medi-Cal and subsidized coverage through Covered California.
SHADAC has been engaged in a project sponsored by Foundation for a Healthy Kentuckyto assess the impact of the ACA in Kentucky over time. We are grateful for this opportunity and to be working with the foundation at a time of significant change.
As part of our project work, we produce quarterly snapshots intended to provide the most up-to-date data available on select health reform topics of interest to the state. In a newly-released snapshot, we focus on data from the first quarter of 2016. Here are a few highlights:
Remaining Uninsured
We are still reporting on the significant drop in uninsurance from the access expansion provisions of the ACA. In the current report we also identify some of characteristics of the remaining uninsured: When compared to those with coverage, the uninsured are more likely to be Hispanic/Latino, young adults (age 19-25), have low incomes and less likely to have some college education or a college degree.
Uncompensated Care
We continue to monitor the significant drop in uncompensated care over time. The most recent data, however, show an uptick in uncompensated care for rural hospitals. This is a trend we will be watching closely.
Child Medicaid/CHIP Participation
In many of our reports we compare Kentucky to the U.S. and neighboring states. From 2013-2014, Kentucky had the second largest increase in children’s Medicaid/CHIP participation rates compared to neighboring states, with 94 percent Kentucky child participation in 2014. West Virginia and Arkansas also show high rates of child Medicaid participation (95.9% and 95.8%, respectively).
Medicaid Service Provision
Medicaid covered over 6,500 births in Kentucky in the first quarter of 2016 along with thousands of prevention screening services, including: 6,300 for colorectal cancer; more than 5,400 for Hepatitis C; and more than 9,500 for breast cancer.
Enrollment
Medicaid covered nearly 611,000 working-age adults (ages 19-64)in the first quarter of 2016. The Medicaid expansion was particularly important for young adults in the state: over 50% of the expansion population was age 19-25 (23%) or 26-34 (28%).
Evaluation of the Minnesota Accountable Health Model: First Annual Report
The State Innovation Model (SIM) Program is sponsored by the Centers for Medicare and Medicaid Services (CMS) and administered by CMS’s Center for Medicare and Medicaid Innovation (CMMI). SIM provides funding and support to states to transform their public and private health care payment and service delivery systems with the aims of lowering health system costs, maintaining or improving health care quality, and improving population health.
In 2013, Minnesota received a SIM award to implement and test the Minnesota Accountable Health Model. Between October 2013 and December 2016, the Minnesota Department of Human Services (DHS) and the Minnesota Department of Health (MDH) are implementing the Model across the state of Minnesota.
The State Health Access Data Assistance Center (SHADAC) is managing the state-level self-evaluation efforts for the Minnesota Accountable Health Model project during 2015 and 2016 under a contract with DHS and in collaboration with both DHS and MDH. Five goals have been identified for Minnesota's self-evaluation. These goals include:
Document the activities carried out under the Minnesota Accountable Health Model.
Document the variation in design, approaches, and innovation in Minnestoa Accountable Health Model activities and programs.
Identify opportunities for continuous improvement in Minnesota Accountable Heatlh Model activities and programs.
Examine how the Model has contributed to advancing the goals of SIM in Minnesota.
Identify lessons learned for sustaining the Minnesota Accountable Health Model beyond Minnesota's SIM grant.
This report describes the activities conducted during, and the results from, the first year of this two-year evaluation.