Report: Region Not Ready for Health Reform in 2014

Sacramento Business Journal by Kathy Robertson –

September 28, 2012: About 227,500 Sacramento area residents will be eligible for health coverage in 2014, but an already strained regional safety net is not prepared to care for them, a new market analysis of the region concludes.

Slightly more than half of the newly insured will be Medi-Cal patients, placing a huge burden on emergency departments and community health centers that typically serve this population.

Without community action to beef up the system and collaborate on more comprehensive approaches to care, the system will be overwhelmed, according to the analysis commissioned by the Sierra Health Foundation and aired at a public forum in Sacramento Thursday.

“We have a fragmented safety net. We all know about state and local budget cuts — and the Affordable Care Act will bring thousands more to coverage,” Congresswoman Doris Matsui said. “How will we care for them?”

The Sierra Health Foundation launched the Sacramento Region Health Care Partnership in October 2011 to strengthen Sacramento’s safety net and examine the region’s preparedness for health reform. The partnership conducted research and focus groups. The resulting reports — a marketing analysis and strategic plan — were released Thursday.

Facing the launch of expanded coverage less than 18 months away, the market analysis identified critical issues. The strategic plan provides a road map to address them.

Critical issues include:
Regional capacity in community health clinics that is below average
Growing demand for the safety net will accelerate with health reform
Roughly half the region’s community clinics are losing money
Currently, the safety net is overly dependent on high-cost hospital and emergency department services
Community clinics and emergency rooms will likely reach capacity before 2016
The newly insured population is expected to be sicker than the current population in public programs
About 60 percent of the newly insured patients will be covered by Medi-Cal
The number of federally qualified health centers — which get higher reimbursement for Medi-Cal patients — is lower than the state average and other regions
The current safety net lacks a lead agency, coordination and integration
Health reform offers an opportunity to rethink how primary care is currently provided by the safety net.

Given the short time-frame, the strategic plan picked four top priorities. They include:
Better collaboration among providers
Better coordination for patients
Capacity building for providers
Better integration between primary and specialty care.

“The ACA. Let’s leverage it; let’s use it to benefit all of us in Sacramento,” Matsui said at the forum. “This is not just another study, another analysis, another plan. We are going to do something about it.”

The market analysis and strategic plan were funded by the Sierra Health Foundation with support from The California Endowment and the Sacramento Region Community Foundation. The team of consultants included The Abaris Group, the Public Health Institute and Hatches Consulting.

Reactions from speakers included praise for the effort, concern about the challenges — and a sense of urgency.

“It’s about time. We have patients out there not getting services and that’s really unconscionable in a community like ours,” said Dr. Claire Pomeroy, CEO of the UC Davis Health System.

After a discussion of the challenges, Dr. Ken Kizer, director of the Institute for Population Health Improvement at the UC Davis Health System offered an urgent call to action.

“I’ve been involved with dozens, if not hundreds of similar conversations over the last 30 years that didn’t go forward in the way we wanted,” he said. “I would hope that, going forward, we would be impatient and look for outcomes, not more rhetoric.’

To propel the effort forward, the Sierra Health Foundation announced a $3 million commitment to launch three parts of the strategic plan over the next 36 months. They include building capacity in area community clinics to meet increased demand, work on public policy to create a climate that’s supportive of the goals in the plan and efforts to educate the public and get residents engaged in the process.

The first step will be discussions with community clinics that want to expand about what kind of technical support they need,followed by a request for proposals for the funding to do it.

Source: John & Rusty Report via Cal Choice