5 Things in California: Insulin and Abortion in the Legislature, HIEs and Population Health, Community Supports – State of Reform

The legislature finalized its version of the FY22-23 budget last week. In the final days of June, legislative leaders will meet with Governor Newsom’s office to resolve remaining disagreements. The governor is required to sign off on a finalized version before the end of the month, but heads of state are expected to continue putting the finishing touches on the budget in August.

In this newsletter, we have a summary of two bills we are monitoring, an op-ed by Inland Empire Health Plan CEO Jarred McNaughton on the critical role HIEs should play in managing population health, and a claim by a housing advocacy organization that their work demonstrates the benefits of community supports related to housing.

Thanks for reading!

Eli Kirshbaum
State of reform

1. Insulin Cost Control, Abortion Policy in Legislature

After attempts to reduce the cost of insulin had failed in previous sessions, a invoice restricting patient cost-sharing requirements for insulin is well-positioned to reach Governor Newsom’s office this year. Under Senator Bates’ bill, cost-sharing for insulin prescriptions would be limited to a maximum co-payment of $35 per month. The ACCA opposes the bill, saying it favors diabetic patients over other patients while failing to address the “root cause” of the problem of expensive drugs and increase premiums for all registrants. The bill passed unanimously in the Senate and the Assembly Health Committee.

Another in motion invoice sponsored by Sen. Atkins will increase the number of providers who can perform abortions in the state by allowing registered nurses to provide first-trimester vacuum abortions without the supervision of a physician. Supporters say many NPs are more than qualified to provide these abortions and will provide the necessary support as the state prepares for an influx of out-of-state abortion patients. Opponents argue the state is approaching it the wrong way by repealing recently implemented education requirements for NPs to practice individually. The bill passed the Senate 30-9 and the House Business and Professions Committee 14-3.

2. Advocates call on DHCS to leverage HIEs in population health strategy

Relying solely on claims data collected by DHCS and Medi-Cal managed care plans is insufficient to effectively implement claims. Population Health Management Strategy, according to Jarrod McNaughton, CEO of Inland Empire Health Plan. In a recent op-ed for State of Reform, McNaughton wrote that health information exchanges must be part of the solution, as they provide much-needed clinical data on the state’s most vulnerable people, who are often not not included in the complaints data.

McNaughton noted that claims data is only related to payment and claims do not fully capture underutilization of preventive services. “We urge DHCS to hear from community leaders like me and include clinical data provided by HIEs in its population health plan,” McNaughton wrote. “And as the final budget negotiations take shape, we are advocating for the Governor and Legislature to adopt our funding proposal for data sharing and HIE infrastructure. Without action on both fronts, these programs cannot succeed in the state’s bold mission toward justice and equity in health.

3. What They’re Watching: Rafael Gonzales Amezcua, Aetna Better Health of California

Rafael Gonzalez-Amezcua, chief medical officer of Aetna Better Health of California, is focused on solving the “spending-to-results mismatch” in the healthcare system. As an internist who treats patients with chronic conditions, he also wants to increase preventative care in California, as he has seen many patients with chronic conditions who have not sought treatment because they do not showed no symptoms, who then ended up in emergency. take care of their condition.

“One of the things I’ve noticed is that people with chronic conditions may not have any symptoms and may not seek treatment because they feel fine,” he said. “Or, if they have a mild symptom, there are roadblocks – they can’t get to their doctor, the next appointment isn’t for 3 months, and maybe their doctor hasn’t not recognize the problem – until the problem arises, which could be a heart attack, it could be an exacerbation of asthma or a chronic lung disease like COPD, and then now we are talking about hospitalization, often in intensive care.

4. Housing advocacy organization presents evidence that community supports are beneficial

The Enlightenment Foundationa nonprofit organization that provides health care and housing services to homeless Californians, says its work providing these social services is proof that CalAIM Community supports will benefit the state health system. Optional community supports include housing transition navigation and housing depots – the type of work IF has been doing since 2008.

In a recent DHCS webinar, Pooja Bhalla, Executive Director of IF Healthcare Services, said IF interventions resulted in a 22.2% drop in emergency room visits and a drop in 26.3% of hospitalizations among the homeless population it serves. In one of the counties it serves, Bhalla also said IF saw a 30.7% drop in the cost of care for its homeless population. “Addressing the social determinants of health is not only the right thing to do, but actually saves the system thousands of dollars,” Bhalla said.

5. CalOptima’s New Stance Focused on CalAIM Aims to Improve Delivery of Community Supports

CalOptima recently established a unique position to focus primarily on providing CalAIM and Community supports. CalOptima’s new Medi-Cal/CalAIM Executive Director, Kelly Bruno-Nelson, said unique CalAIM-focused positions like this can ensure plans like CalOptima are aligned with CalAIM’s goals and implement supports. communities according to the needs of the members.

CalOptima implements all 14 Community Supports and Bruno-Nelson plans to hire Community Support Liaisons to help CalOptima providers connect with members in need of certain services. “It’s literally engaging the [Community Supports providers] in those discussions and then trying to develop services in each of those settings that more reflect the needs of our members… It’s just a matter of taking a program that could be implemented in a meat and potatoes way, and really trying to broaden our thinking, and the best way to do that is to involve the community organizations that provide the services. »

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