3 June 2010
California Edition
Calendar
June 5-8
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E-Mail
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the details of your event, or call
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published in the Calendar section,
space permitting.
Prop. 63 Yields Results In L.A. County
Hospitalizations, Jailing of Mentally Ill Said to Plunge
Nearly six years after Californians voted to
levy a millionaires’ surtax to fund increased
mental health services, data from Los
Angeles County suggests a steep drop in
hospitalizations, incarcerations and the
homeless rates of the mentally ill.
The decreases – which the Los Angeles
County Department of Mental Health has
pegged directly to public-private
partnerships created after the passage of
the Proposition 63 – are saving the region’s
taxpayers of millions of dollars a year,
officials say, although its hospitalization
data was vigorously disputed by an official
representing the region’s inpatient
providers.
Passed by voters in November 2004,
Proposition 63 levied a 1% tax on all
annual incomes above $1 million. It
generates about $750 million annually, of
which Los Angeles County receives about
$250 million.
According to Debbie Innes-Gomberg, the
LACDMH district chief who oversees
Proposition 63 funds, the extra money has
allowed the county to contract with private
providers at a level of funding that allows
them to keep their caseworker-to-client
ratio as low as one for every 15 patients.
“Usually, caseloads exceed 75 or 150
patients per caseworker. A one to 15 ratio
is a luxury...but the providers can give
them exactly what they need,” Innes-
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Gomberg said, adding that the needs of
those with severe mental health issues
can be so intense that a low caseload
ratio is required.
“We provide a whole person
approach,” said Dave Pilon, president of
the Los Angeles chapter of the social
services organization Mental Health
America. LACDMH pays the agency $5.7
million a year to take care of 360 clients
with severe mental illnesses in what is
called a Full-Service Partnership. MHA
monitors their medication intake, secures
housing, provides counseling and job
training, among other services. Clients
often perform clerical jobs at the agency,
and work at a delicatessen operated by
MHA.
According to Pilon, the clients it serves
have experienced a 67% drop in
hospitalizations and a 75% decrease in
those incarcerated since the FSP began
with the county in 2005.
Pilon noted that the $16,000 it
receives per client per annum is enough
to meet their needs. “We can use the
‘everything it takes’ approach to
reintegrate them back into society,” he
said.
Continued on Next Page
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In Brief
CNA Uses Satire in
Anti-Whitman
Campaign
The confrontational style of the
California Nurses Association has
taken a satirical turn as the labor union
has paraded a “queen” meant to
represent gubernatorial candidate Meg
Whitman statewide during the spring,
including a stop at the home of former
Gov. Pete Wilson earlier this week
The CNA, which represents about
50,000 nurses statewide, has been
trotting out a “Queen Meg” character
for a variety of public appearances.
The character, who is ferried to events
in a “royal chariot,” is meant to satirize
the wealth of Whitman, the billionaire
former chief executive ofcer of eBay
who has used tens of millions of
dollars of her own money to nance
her campaign to secure the
Republican nomination for governor.
CNA spokeswoman Liz Jacobs said
the union opposes Whitman because
of her pledge to cut 40,000 state jobs
if elected governor this November.
“Many of those people are nurses,” she
said.
The “Queen Meg” character made a
stop at Wilson’s Los Angeles home to
thank him for pledging his support in a
radio ad that reiterated Whitman’s
stance against undocumented
immigrants. The CNA planned to
rebroadcast a version of the ad this
week on Spanish-language radio
stations to stir up anti-Whitman
sentiment among Latino voters.
In addition to the “Queen Meg”
campaign, CNA’s afliate organization,
National Nurses United, plans a one-
day walkout of 13,000 nurses
statewide on June 10 over stafng
levels at hospitals.
New CEO For Blue
Shield of California
Foundation
Continued on Page 3
NEWS
Mentally Ill (Continued from Page One)
Countywide, the number of clients
under the age of 18 hospitalized at
psychiatric facilities due to mental health
issues has dropped by 40%, according to
LACDMH. The number of adults under the
age of 60 hospitalized has dropped 44%,
and the number of older adults has
dropped 42%. Hospitalization days
dropped 16% for adults and 17% for older
adults.
The change in homelessness rates were
even more dramatic, with a 64% drop
among adults. The number of days adults
were incarcerated dropped by 38%.
County officials claim that the drops in
jail and hospital days alone have saved
$39.8 million overall.
However, the drop in hospitalizations
was disputed by the Hospital Association
of Southern California, which represents
most of the hospitals countywide,
including both public and psychiatric
facilities.
“If they’re looking at the overall
effectiveness of their programs, they get
an ‘F’ grade,” said HASC Executive Vice
IEHP Undertakes Promotores Model
Will Use Outreach Workers to Boost Visits, Vaccines
Inland Empire Health Plan has launched an
innovative program expected to boost the
numbers of enrollees who consume primary
care and avoid hospitalization – as well as
draw out members whose families might have
immigration issues.
Known as Health Navigator, the program
has ve full-time IEHP employees who have
received training as promotores, individuals
with outreach skills who typically work in
Latino communities. They will be assigned to
the more populous areas in San Bernardino
and Riverside Counties, where IEHP operates.
A sixth hire is in the works, according to IEHP
ofcials.
“The struggle for members of Medi-Cal
managed care plans to access care at the
appropriate levels has always been difcult,”
said IEHP Chief Executive Ofce Bradley
Gilbert, M.D. According to Gilbert, only
about half of its adolescent enrollees receive
annual wellness exams, and only 80% of all
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Page 2
President Jim Lott, who is also a member
of the Payers & Providers Editorial Board.
Lott contends that the region’s emergency
rooms are filled with mentally unstable
patients that the facilities are often
forced to hold voluntarily for up to 72
hours.
“We’ve had a very low cooperation
rate from (LACDMH),” said Lott, who
suggested that the agency was
manipulating its data.
LACDMH spokeswoman Kathleen
Piché said the programs have been
effective in terms of diverting the
mentally ill away from ERs and into
urgent care facilities or primary care
physicians with extended office hours.
“There is a lot of need and hospital ERs
are feeling that, but many more people
are being diverted,” she said.
Pilon noted that there have been some
issues in terms of readmitting clients
back into the FSP if their symptoms flare
back up. “But it’s still working pretty
well,” he said.
members receive appropriate vaccinations,
leaving thousands more of its members
vulnerable to contracting serious illnesses.
IEHP, which services Medi-Cal and
Healthy Families members, has also had to
accommodate large-scale growth since the
recession began at the end of 2007.
Enrollment has ballooned 23% since early
2008 to more than 435,000 – making outreach
more challenging.
As a result, IEHP has been pressured to try
and increase the use of primary care services
to cut down on costlier hospitalizations. Other
health plans have used promotores for
outreach, but as contractors through outside
agencies. IEHP is the rst health plan to
directly employ them, according to Gilbert.
The Health Navigators will perform
traditional promotores-style outreach by
Continued on Next Page
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In Brief
Peter Long, the senior vice
president for executive operations
at the Henry J. Kaiser Family
Foundation, has been named the
new chief executive officer of the
San Francisco-based Blue Shield of
California Foundation.
“With a passion to serve and the
experience to succeed, Peter Long
is the right choice to lead the
Foundation at this critical
moment,” said Bruce Bodaken,
CEO of Blue Shield of California.
The San Francisco-based insurer
funds the foundation, which
awarded $28.9 million in grants
during 2009.
Long succeeds Crystal Hayling,
who left late last year for an
opportunity in Singapore.
The 42-year-old Long holds a
doctorate degree in health services
from UCLA and a masters degree in
health science from Johns Hopkins
University. He said he will focus
on helping California expand the
Medi-Cal program to accommodate
the recently approved federal
healthcare reform legislation, as
well as decreasing domestic
violence.
Long will begin his duties on
July 6.
Health Net Teams With
Text4Baby.org
Woodland Hills-based insurer
Health Net has entered into a
partnership with text4baby.org, a
texting service that provides
information to expectant mothers.
The service provides three free
weekly text messages to expectant
mothers with healthcare-related
information through their
pregnancy and during the first year
of their child’s life. Health Net will
promote the service on its website.
Health Net officials say the
partnership is intended to reduce
premature births and infant deaths.
NEWS
IEHP (Continued from Page Two)
visiting churches and other community
gathering places, but will also make home
visits after poring over immunization and
physician ofce visit records to try and
identify which enrollees need more shots
and exams and personally encourage them
to get them.
Gilbert noted that the Health
Navigators are expected to build some
level of rapport with the IEHP enrollees,
particularly those Healthy Families
enrollees whose parents are
undocumented and may be trying to
remain inconspicuous.
Report Contends HITECH Is Flawed
Suggests Changes to “Meaningful Use” Criteria
A new report by Los Angeles-based Manatt
Health Solutions concludes that stimulus
legislation that has provided funds for
expanding the use of electronic medical
record technology was a good step forward,
but that many gaps in implementing EMRs
still remain.
According to the 41-page report, which
was underwritten by the California Health
Care Foundation, the Colorado Health
Foundation and the United Hospital Fund,
there are many hurdles awaiting providers
who wish to participate in the program,
known as the Health Information Technology
for Economic and Clinical Health Act, or
HITECH. The legislation is “a necessary but
not sufcient step to achieve greater quality
and efciency in healthcare,” the report
concluded.
Among the perceived obstacles:
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Page 3
“The really critical portion is building up
the trust,” Gilbert said.
The Health Navigator employees received
two months of training, both at IEHP
headquarters and through Latino Health
Access, a Santa Ana-based agency that
specializes in training promotores. “They have
a turnkey program, which is why we turned to
them,” said Susan Arcidiacono, IEHP’s chief
marketing ofcer. The First 5 California entities
in San Bernardino and Riverside Counties
provided grants of $150,000 a year apiece to
fund their training and a portion of their
salaries.
• Smaller medical practices and rural
providers may have difculty meeting the
“meaningful use” threshold required to
receive incentive payments from the Centers
for Medicare and Medicaid Services, which
administers HITECH.
• The timetables for achieving meaningful
use for the use of EMRs may be too short for
many providers to meet.
• The proposals for achieving better
interoperability of various EMR systems
relies too much on the faith that the private
market will encourage such a movement
The report suggested that CMS provide more
exibility to its “meaningful use” guidelines,
and directly tie it to providers participating in
the health information exchange networks that
are expected to grow on a state and regional
level.
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Payers & Providers
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OPINION
Arnold’s Little Double-Talk Problem
He Claims to Embrace Reform; May Revise Does Not
California is in dire fiscal straights. In
order to recover, all of us must share the
sacrifices and responsibility.
!Yet even as the state faces another
shortfall, we have reached the point where
lawmakers are cutting into the bone of
critical, effective and efficient healthcare
programs. Providers also know
that current capacity will fall far
short from meeting demand
when federal healthcare reform
begins to take full effect in 2014.
Does it really make sense for the
state to be executing cuts to
healthcare services when
lawmakers really need to be
strengthening the safety net for
the deluge to come? Gov. Arnold
Schwarzenegger’s budget
proposals call for just that.!
The Governor has stated that he
will fully support healthcare
reform and implement it in California
as quickly as possible. However, his
budget proposal completely Rodriguez financially viable.
contradicts this statement, decimating
programs that go specifically toward
addressing our state’s ever-growing
uninsured population.!!
In his recent May Budget Revision, the
Governor has called for the complete
elimination of the Expanded Access to
Primary Care (EAPC) program, a program
that is meant to address critical issues of
California’s vast uninsured populations. !
This program, known as a “traditional”
clinic program, represents the only
funding from which California’s nonprofit
community clinics can draw upon in
serving the state’s uninsured population. !
!The Governor also proposed limits to
Medi-Cal benefits that largely affect the
chronically ill. It is common knowledge
among medical practitioners that failure to
control chronic illness is a major
contributor to the rise in healthcare costs.
Also proposed are premium increases to
the Healthy Families Program, which will
lead to an increase in the number of
uninsured children.
For a governor who praises fiscal
responsibility, his proposal ignores one
half of the budget equation – revenue.
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Page 4
Following the release of the May Revise, the
non-partisan Legislative Analyst’s Office
reported that such severe cuts could be
prevented through selective revenue increases
such as fee increases, delays and other fiscal
maneuvers. For too long, service providers
have been asked to shoulder the entire budget
burden. The LAO has also
repeatedly called for some
reforms to the budget process.
Community clinics and health
centers will bear the brunt of
these proposed cuts at a time
when more individuals and
families rely on them for their
medical care. All of these cuts
jeopardize the survival of these
important community providers. If
healthcare reform is to succeed
we need all the medical providers
we have today and more. The
state should not be making it
By impossible for the community clinics
Gloria and health centers to remain
!!Lawmakers cannot make such drastic
cuts to health services and be considered
healthcare reform champions. While we
celebrate the expansion of healthcare
coverage for millions of uninsured, the work
has only just begun. Lawmakers recognize the
critical role community clinics will play in
making healthcare reform a success and the
immense state savings these providers will
bring to our broken healthcare system. While
health care providers really need another
historic investment to meet demand in 2014,
community clinics and health centers are now
in the position of asking policymakers not
make their job impossible. The state must
choose to preserve and protect a stable
healthcare system in California when it is
needed most. !!
Gloria Rodriguez is the President and CEO of
the Community Clinic Association of Los
Angeles County.
Op-ed submissions of up to 600 words are
welcomed. Please e-mail proposals to
editor@payersandproviders.com, or call
(877) 248-2360, ext. 3.
Payers & Providers MARKETPLACE/EMPLOYMENT Page 5

MEDICARE COMPLIANCE ADVISOR - ensures that L.A. Care and its subcontracted provider network
is compliant with all Centers for Medicare &! Medicaid federal regulatory requirements. This is
achieved by participating in the annual PPG and quarterly audits, working with internal and external
staff to correct performance deciencies, identifying internal areas for improvement, serving as the
compliance contact with Plan Partners for member grievance oversight, provider services oversight,
and interpreting CMS/SNP Program requirements for L.A. Care. ! Additionally, this individual is a
resource to internal staff on compliance matters relating to CMS/SNP standards, including, but not
limited to, marketing materials, grievances and appeals, member rights issues, and claims
adjudication.! Responsible for performing internal audits, monitoring for implementation of corrective
measures, and interpretation of CMS requirements. ! Working knowledge of federal and state
requirements is required, as well as highly developed analytical skills and excellent verbal and written
communication skills.!

For complete job description, requirements, and additional opportunities, visit our website:
www.lacare.org!

To be considered, email resume with salary history/requirement to recruiter@lacare.org, referencing

It costs up to $27,000 to fill a healthcare job*

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Call Ron Shinkman at (877) 248-2360, ext. 2,

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*New England Journal of Medicine, 2004.

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Payers & Providers MARKETPLACE/EMPLOYMENT Page 6

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