Tag Archives: california

California announces SHOP exchange insurers and rates

Joseph Burns

About Joseph Burns

Joseph Burns (@jburns18), a Massachusetts-based independent journalist, is AHCJ’s topic leader on health insurance. He welcomes questions and suggestions on insurance resources and tip sheets at joseph@healthjournalism.org.

The health benefit exchange for California’s 500,000 small employers named six health insurers last week and announced the rates those insurers will charge. Small businesses (meaning 50 or fewer workers) employ 4.5 million workers in California.

This news from California may be useful to health care journalists covering the exchanges in other states, particularly those 16 states (and Washington, D.C.) that are running their own exchanges.

With this announcement on Aug. 1, California becomes the second state to publish the names of the insurers and their rates for its Small Business Health Options Program (SHOP) exchange, following Oregon and Washington, D.C. Enrollment on the exchanges begins Oct. 1 for insurance coverage effective Jan. 1. The Golden State’s health benefit exchange is called Covered California.

In the Los Angeles Times, Marc Lifsher writes that more than 7 million Californians under age 65 are uninsured, including 25 percent of all workers and 40 percent of workers at companies with fewer than 10 employees. Continue reading

Las Vegas hospital sends 1,500 patients with mental health issues to other cities

Pia Christensen

About Pia Christensen

Pia Christensen (@AHCJ_Pia) is the managing editor/online services for AHCJ. She manages the content and development of healthjournalism.org, coordinates social media efforts of AHCJ and assists with the editing and production of association guides, programs and newsletters.

Nevada has been shipping mental health patients out of state as it has cut funding for mental health services, according to a Sacramento Bee investigation.

In recent years, as Nevada has slashed funding for mental health services, the number of mentally ill patients being bused out of southern Nevada has steadily risen, growing 66 percent from 2009 to 2012. During that same period, the hospital has dispersed those patients to an ever-increasing number of states.

Cynthia Hubert, Phillip Reese and Jim Sanders report that Rawson-Neal Psychiatric Hospital in Las Vegas, the primary state psychiatric hospital, put more than 1,500 patients on Greyhound buses bound for other cities.

The reporters reviewed bus receipts kept by Nevada’s mental health division. Southern Nevada Adult Mental Health Services has had a contract with Greyhound since July 2009, a bus company spokesman said. He also revealed that “Greyhound has contracts with ‘a number’ of hospitals around the country, but declined to identify them.”

Mental health professionals in other places are quoted as saying putting someone with a mental illness on a bus is risky and several said their counties don’t do it.

The Center for Medicare and Medicaid Services is investigating Rawson-Neal and the situation has prompted statements from California’s Senate president and a member of the U.S. Commission on Civil Rights.

Investigation exposes police inaction in face of abuse allegations at Calif. facilities

Andrew Van Dam

About Andrew Van Dam

Andrew Van Dam of The Wall Street Journal previously worked at the AHCJ offices while earning his master’s degree at the Missouri School of Journalism, and he has blogged for Covering Health ever since.

In recent weeks, California Watch’s long-running focus on abuse of the developmentally disabled at state-run institutions has coalesced into a broad indictment of the flawed oversight and enforcement programs at those facilities.

Ryan Gabrielson’s centerpiece is a classic deep investigation which relies on a mix of data and anecdotes to show that, even though the centers are equipped with a state-run police force, in 36 incidences of alleged abuse over the past four years, “documents obtained by California Watch reveal that patients suffered molestation, forced oral sex and vaginal lacerations. But for years, the state-run police force has moved so slowly and ineffectively that predators have stayed a step ahead of law enforcement or abused new victims, records show.”

Beyond that, California Watch has gone above and beyond to make their investigation as accessible and shareable as possible with a share-friendly chart, an 11.75-minute YouTube video, or even an “explainer” companion piece.

Community relies on foreign-educated doctors

Andrew Van Dam

About Andrew Van Dam

Andrew Van Dam of The Wall Street Journal previously worked at the AHCJ offices while earning his master’s degree at the Missouri School of Journalism, and he has blogged for Covering Health ever since.

Armed with reams of data, The Bakersfield Californian‘s Kellie Schmitt charged headlong into the potential minefield of issues surrounding foreign educated-physicians with “Importing Doctors.” The series delivers a thorough take on the ramifications of the fact that the majority of her county’s doctors attended medical school overseas. (The national average, for the record, is around 25 percent).

In addition to her opening piece, which considers the benefits and drawbacks of relying on international medical graduates, Schmitt filed follow-up installments keying in on specific questions raised by her overall investigation. Of particular interest is the clear line she draws between foreign-born physicians who attended medical school in their home country before they came to the United States and American-born physicians who attended schools, often located in Mexico and the Caribbean, that cater to students who were unable to gain admittance to American medical schools. It’s a distinction that a less-nuanced data analysis could easily overlook.

Finally, while the investigation’s results are illuminating, health care journalists will probably be even more interested in Schmitt’s “How we crunched the numbers” sidebar, which can be found on the left sidebar of this story. The paper used data from the state medical board and the American Board of Medical Specialties.

Meth and other drugs overwhelm reservations

Andrew Van Dam

About Andrew Van Dam

Andrew Van Dam of The Wall Street Journal previously worked at the AHCJ offices while earning his master’s degree at the Missouri School of Journalism, and he has blogged for Covering Health ever since.

New America Media’s Jacob Simas and Two Rivers Tribune‘s Allie Hostler joined forces to examine how the nation’s rural methamphetamine epidemic has devastated the Hoopa Valley Indian Reservation in Northern California, as well as the nation’s American Indian population in general. The Indian Health Service does not track drug abuse, and hard tribe-by-tribe numbers are hard to come by, but the scope of the problem is clear.

Meth abuse rates have reached 30 percent on some rural Indian reservations, and in some Indian communities as many as 65 percent of all documented cases involving child neglect and placement of children in foster care can be traced back to parental involvement with methamphetamine. California Indian Legal Services estimates that in nearly every case they oversee that involves a child being removed from their home, one or both of the parents is using meth. Often in those cases, the baby itself was born with prenatal exposure to the drug.

The broken economy in Hoopa and resulting poverty – the annual household income on the reservation hovers around $13,000 and most families receive tribal government assistance – would seem adequate to explain away the high rates of substance abuse. But those in the community with a sense of history say it’s much more complicated.
Melodie George-Moore teaches English and Native American literature at Hoopa High School. She’s also a leader of traditional Hoopa ceremonies. She believes Hoopa’s drug problem has its roots in historical trauma.

The reservation’s rampant substance abuse has its roots in what the duo calls Hoopa’s “broken economy,” as well as the “historical trauma” unique to conquered native populations. But whatever the cause, the meth epidemic’s public health impact is far-reaching and long-running.

“People who were using during a different time of their life – some might even be in leadership roles in the community – that exposure is now manifesting itself as a very serious disease, because of speed use 30 to 40 years earlier,” she said. “There are young people lining up on dialysis, fetal exposure issues, developmental and behavioral issues… There are days when it’s absolutely overwhelming, some of the realities we see here, the physiological and social realities.”

The second installment in the series focuses on efforts to solve the problem, which include grassroots movements and sweat lodges, as well as a thoroughly overwhelmed infrastructure.

The Tribe’s court estimates that alcohol or substance abuse is a factor in approximately 65 to 70 percent of eviction cases heard by the court, and 75 to 80 percent of child custody and divorce cases. In 2010 the court reported that alcohol or substance abuse was a significant factor in 80 percent of the child abuse and neglect cases heard on the reservation.

The articles were produced as a project for The California Endowment Health Journalism Fellowships, a program of USC’s Annenberg School for Communication & Journalism.

Calif. program of bundled dental care for children gets a checkup

Andrew Van Dam

About Andrew Van Dam

Andrew Van Dam of The Wall Street Journal previously worked at the AHCJ offices while earning his master’s degree at the Missouri School of Journalism, and he has blogged for Covering Health ever since.

About 18 years ago, California implemented a program of “geographic managed care” for children’s dental coverage in Sacramento. Now, in partnership with The Sacramento Bee, Jocelyn Wiener of CHCF’s Center for Health Reporting provides an exhaustive report card on the program and its outcomes.

In her centerpiece, Weiner writes that “the state pays private dental plans in Sacramento County a monthly fee – currently about $12 – for each Medi-Cal child assigned to them. The amount paid is the same whether or not the child sees a dentist.”

Last year, Wiener writes, the state paid almost $20 million to the five plans it works with in the capital city. In exchange, “The plans are obligated to provide 24-hour emergency care for children with severe dental problems, to schedule all other appointments within a month, to see at least 38 percent of enrolled patients each year and to report that data to the state.”

State data may be skewed, some of Weiner’s sources said, because Sacramento dentists are less likely to overtreat, and less likely to report when they do treat, since they get paid their lump sum regardless. Nonetheless, the numbers that are out there paint a discouraging picture.

In fiscal year 2010-11, only 30.6 percent of more than 110,000 Sacramento children with Medi-Cal – the government insurance program for the poor – saw a dentist, according to state data. By comparison, nearly half of their Medi-Cal peers statewide visited a dental office. That year, the county ranked third worst in terms of the percentage of kids who got care in the state – above only rural Alpine and Trinity counties. During the three previous years, it was the state’s lowest performing children’s dental system, state numbers show.

The state is working on ways to improve the program, but for now long times and access issues persist. For more context, see Richard Kipling’s piece on how San Diego county is succeeding in providing dental care to children despite similar geographic challenges.

National crisis in oral health

A hearing and a report released this week by Sen. Bernie Sanders (I-Vt.), chairman of the Subcommittee on Primary Health and Aging, put a spotlight on dental health and the lack of access and care many Americans experience. According to “Dental Crisis in America (PDF):”

  • More than 47 million people live in places where it is difficult to access dental care.
  • About 17 million low-income children received no dental care in 2009.
  • One-fourth of adults in the United States ages 65 and older have lost all of their teeth.
  • Low-income adults are almost twice as likely as higher-income adults to have gone without a dental checkup in the previous year.
  • Bad dental health impacts overall health and increases the risk for diabetes, heart disease, and poor birth outcomes.
  • There were more than 830,000 visits to emergency rooms across the country for preventable dental conditions in 2009 – a 16 percent increase since 2006.
  • Almost 60 percent of children ages 5 to 17 have cavities – making tooth decay five times more common than asthma among that age group.

In a statement prepared for the hearing, Sen. Jay Rockefeller (D-W.Va.) said he is “working on legislation to make affordable dental care for our seniors a reality once and for all.”

Cover this topic for AHCJ

This is just the kind of story and report that AHCJ will be tracking and writing about as part of its new “core topic” on oral health. We’re currently looking for a journalist to lead the oral health core topic, a job that will include writing and assigning tip sheets and stories about the subject as well was writing regular blog posts to help journalists cover this important topic.

Project follows the race to make bagged salad safer

Andrew Van Dam

About Andrew Van Dam

Andrew Van Dam of The Wall Street Journal previously worked at the AHCJ offices while earning his master’s degree at the Missouri School of Journalism, and he has blogged for Covering Health ever since.

The latest investigation by California HealthCare Foundation Center for Health Reporting’s Deborah Schoch will make you think twice before ripping into a sack of spring mix, but her work about the myriad food safety challenges posed by bagged salads examines the industry’s struggle to develop technology powerful enough to overcome the existential threat posed by E. coli and friends.

The industry has made great strides since a 2006 outbreak linked to tainted spinach, she writes, but “It’s impossible to stop all pathogens from landing on lettuce and spinach leaves.” And once they’re on the leaves, it seems as if their spread is almost inevitable. They hide in gooey biofilms and resist powerful washes.

Thousands upon thousands of salad leaves are taken to a central plant, washed together, bagged and shipped. Even if only a few leaves are tainted, harmful pathogens can spread in the wash water — the modern salad version of the old adage that one bad apple spoils the whole barrel.

“I would think of it as swimming in a swimming pool in Las Vegas with a thousand people I didn’t know,” said William Marler, a prominent Seattle-based food safety attorney.

Plenty of public and industry money has been aimed at the problem, Schoch writes. “The Center for Produce Safety at UC Davis, founded in response to the spinach outbreak as an industry-public partnership, has pumped more than $9 million into 54 research projects at 18 universities.”

Even the best research can’t reduce the risk of contaminated greens by 100%, scientists said. At Earthbound, Daniels says the ultimate goal is to achieve what scientists call a “5 log reduction,” the equivalent of pasteurizing milk. In short, if an unwashed lettuce contained 100,000 pathogens, the perfect wash system would knock off five “0s” and reduce the pathogen count to 1.

An added bonus? Schoch’s column on whether she (and the experts she talked to) feel like it’s important, or even salutary, to wash their bagged greens.

Experts offer story ideas for covering health reform

Pia Christensen

About Pia Christensen

Pia Christensen (@AHCJ_Pia) is the managing editor/online services for AHCJ. She manages the content and development of healthjournalism.org, coordinates social media efforts of AHCJ and assists with the editing and production of association guides, programs and newsletters.

More than 30 attendees heard local experts sketch the particular challenges and issues presented by the Affordable Care Act in California in the latest “Implementing health reform in the states” panel, hosted by AHCJ’s San Francisco Bay Area chapter on Wednesday night at the San Francisco Chronicle.

Health Reform

The panel, one of a series sponsored by AHCJ, the Alliance for Health Reform and the Robert Wood Johnson Foundation, began with an explanation of exchanges and what’s happening with their implementation (or lack thereof) around the country by Larry Levitt of the Kaiser Family Foundation.

He posed some story ideas, such as: How vigorously will the states promote enrollment through the exchanges? What sort of variations to the ACA might emerge once states have the ability to ask for waivers in 2017?

Kim Belshe, a board member of the California exchange, and Marian Mulkey of the California HealthCare Foundation discussed the California scene, with lots of detail, touching on the state’s large undocumented immigrant population, the challenge of getting people enrolled (since the law of the land is now “performance” –  which means maximum participation), new opportunities for medical professions, such as nurses, to fill gaps in care delivery, and how to ensure coordinated care during the transition period to exchanges so no patient is harmed. This is the accountability part of the ACA, and needs thought and new procedures, Belshe stressed.

Belshe noted that Medicaid (Medi-Cal) is the foundation of reform, a subject which reporters sometimes overlook. Both she and Mulkey noted that California is a national pacesetter when it comes to reform implementation – a story idea in itself.

The session was moderated by Ed Howard, executive vice president of the Alliance for Health Reform.

On Tuesday night, a similar briefing was held at the University of Southern California, featuring Walter Zelman, Ph.D., a professor and director of health science at California State University-Los Angeles; Daniel Zingale, senior vice president of the Healthy California program at The California Endowment; Anthony Wright, executive director for Health Access, a California health care consumer advocacy coalition; and Deborah Crowe, the health care and biotechnology industry reporter for the Los Angeles Business Journal. Howard, of the Alliance for Health Reform, moderated the session.

Zelman posed a number of questions about reform, mostly about exchanges. To a reporter from Orange County, he suggested a story about the origin of the individual mandate – an idea championed by Republicans early on, he noted, and opposed by Obama and many Democrats. To a question about accountable care organizations and bundling, he suggested stories about how fee-for-service medicine is anything but dead.

Wright offered a look at what’s happening in Sacramento, including a hearing held just a few hours before the briefing.

Zingale mentioned the importance of prevention, and how the ACA encourages prevention. He too pointed out how nonprofits in the state can team up with reporters to educate people about the ACA. He said that the more people know about the law, the better they like it.

From a reporter’s perspective, Crowe offered several practical story ideas that reporters can start writing about today.

John Gonzales  of the California HealthCare Foundation Center for Health Reporting wrote about the panel and Michelle Levander of the California Endowment Health Journalism Fellowships program offers some of the story ideas mentioned by the panelists.

Special thanks to Colleen Paretty, chair of the Bay Area chapter, and Bill Erwin, of the Alliance for Health Reform, for contributing details about the panel discussions for this post.

Web outlet pumps out dozens of stories on prescription drug abuse

Andrew Van Dam

About Andrew Van Dam

Andrew Van Dam of The Wall Street Journal previously worked at the AHCJ offices while earning his master’s degree at the Missouri School of Journalism, and he has blogged for Covering Health ever since.

In partnership with USC’s Annenberg School for Communication & Journalism and a number of other organizations, Santa Barbara online news outfit Noozhawk (about), put together “Prescription for Abuse,” an exploration of the misuse and abuse of prescription drugs in the Santa Barbara area.screen-shot-2012-01-17-at-100653-pm In the extensive, online-only series, the reporters take a look at the problem and its underlying causes, then go a step further by exploring possible solutions as well.

In a uniquely meta twist, the series even looks at how journalism such is advancing public health goals and explains how the project came together. The series features at least 36 individual articles, by my count, and every health journalist who takes the time to browse the full catalog will come across at least a few easily localizable ideas, but in this space I’ll just highlight those stories that deal directly with the series itself:

Calif. center, ethnic outlets partner to examine elderly day care’s demise

Andrew Van Dam

About Andrew Van Dam

Andrew Van Dam of The Wall Street Journal previously worked at the AHCJ offices while earning his master’s degree at the Missouri School of Journalism, and he has blogged for Covering Health ever since.

The California HealthCare Foundation’s Center for Health Reporting partnered with no fewer than nine different organizations to produce a sprawling story package examining the impact of the looming closure of many of California’s adult day health care centers. (Since the project launched, California reached a legal settlement that will allow adults most at risk of institutionalization to continue to receive services previously provided by adult day health centers. Existing centers will be able to provide services through the end of Feb. 2012. See this write-up in California Healthline.)

Jocelyn Wiener’s centerpiece stands alone, but the package really gains steam when you take the time to consider its full breadth and depth.

For those new to the issue, here’s Wiener’s primer and a hint as to why the package grew out of a collaboration with a kaleidoscope of ethnic media organizations.

Los Angeles County – especially its many ethnic minority communities –will be hit hardest by the closures. According to state data, the county is home to more than 60 percent of the program’s 38,000 enrollees statewide. One quarter have dementia. Forty percent are incontinent. Nearly half have a psychiatric diagnosis. More than 70 percent do not speak English.

The centers provide them with transportation, meals, exercise, medication management, physical and occupational therapy, as well as robust social programs that many participants say have renewed their will to live.

Health journalists will find Richard Kipling’s “how we did it” piece to be a natural entry point. Kipling unspools the narrative of how a brief suggestion became an anything-but-brief compendium of multilingual, multicultural, multigenerational reporting. Kipling’s blog also serves as a useful roadmap to the project.

Watch the AHCJ website for more about how this project was reported.

If the video doesn’t appear on your page, please click through to :Bibiana Viernes: Her Center, Her Life” from CAhealthReport on Vimeo.