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North Bay Business Journal

Monday, December 16, 2013, 5:55 am

Health Care: Partnership to administer county Medi-Cal programs

Also: Redwood coalition’s Toledo wins $25,000 access grant

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    Dan Verel, Business Journal Staff ReporterPartnership Healthplan of California will begin administering Medi-Cal benefits to former County Medical Services Programs recipients beginning in January 2014 in 14 counties, the Fairfield-based managed Medi-Cal plan announced recently.

    The program for low-income and indigent adults of working age is being folded into managed-care Medi-Cal plans as part of both a statewide effort to streamline services and increased access and an expansion of Medi-Cal under the Affordable Care Act.

    Partnership Healthplan of CaliforniaPartnership will serve some 34,000 additional Medi-Cal beneficiaries across its 14 county service area as a result of the transition, according to Jack Horn, CEO of Partnership.

    It breaks down as such: In Sonoma County, more than 6,600 new residents will be transferred from CMSP into Medi-Cal plans, while there will be about 6,000 newly Medi-Cal eligible residents; in Marin County, more than 2,200 will be transferred, while about 1,800 will be newly eligible; in Napa County, just north of 1,000 will be transferred, while about 1,500 will be newly eligible; in Solano County, about 6,600 will be transferred, while about 6,500 will be newly eligible; in Lake County, nearly 1,800 will be transferred, while some 1,600 will be newly eligible; and in Mendocino County, some 3,000 will be transferred, while about 1,980 will be newly eligible.

    “We have planned for this expansion for a very long time, making changes to our infrastructure, adding personnel and bringing in new technology,” Mr. Horn said. “Partnership and its staff are really looking forward to serving our new members.”

    Partnership is also absorbing enrollees from the Healthy Families program, which is similarly being folded into the Medi-Cal expansion.

    In Sonoma County, more than 12,000 people will be transferred from Health Families to a Medi-Cal plan; in Marin, about 3,000; in Napa, about 4,200; in Solano, about 5,800; in Lake, about 1,500; and in Mendocino, about 2,100.

    Across the six counties, Partnership will have more than 279,000 total Medi-Cal beneficiaries.

    In December, CMSP beneficiaries will receive a letter explaining the changes and directing them to choose a primary care provider from a contracted list in Partnership’s network.

    Partnership recently expanded into eight additional counties in Northern California. It now includes the following counties in its service area: Sonoma, Marin, Napa, Solano, Yolo, Lake, Mendocino, Humboldt, Lassen, Modoc, Del Norte, Shasta, Siskiyou and Trinity.   

    Across its entire region, Partnership will have some 417,000 Medi-Cal beneficiaries.

    ***

    Sutter Medical Center of Santa Rosa has been named one of the nation’s “Top Performers on Key Quality Measures” by The Joint Commission, the leading accreditor of health care organizations in America.

    Sutter Santa Rosa was recognized for its use of evidence-based clinical processes that are shown to improve care for certain conditions, including heart attack, heart failure, pneumonia, surgical care, children’s asthma, stroke and venous thrombo embolism, as well as inpatient psychiatric services.

    The hospital is one of about 1,100 recognized nationally by The Joint Commission, or the top 33 percent of all Joint Commission-accredited hospitals reporting performance data in 2012. Specifically, Sutter Santa Rosa was recognized for achievement in the following areas: heart attack, heart failure, pneumonia and surgical care.

    ***

    Pedro Toledo, director of community and government relations for Redwood Community Health Coalition, has been selected by a public online vote as the 2013 MillerCoors Líder of the Year. Mr. Toledo will receive a $25,000 grant to implement a Latino leadership project with MillerCoors for the Redwood Coalition, a consortium of health centers across Marin, Sonoma, Napa and Yolo counties based in Petaluma.

    “I’m honored to have been selected as the 2013 MillerCoors Líder of the Year,” Mr. Toledo said. “I thank everyone who voted for me – words cannot describe how proud I am of this achievement. I’m excited to use the grant to develop an educational program for parents to benefit the Sonoma County community.” 

    Mr. Toledo was among 12 outstanding Latino leaders nominated by local and national nonprofit organizations for their leadership and contributions to their communities. 

    ***

    Connie Aust, director of social and financial services for The Council on Aging, was recently appointed to the Sonoma County Commission on the Status of Women by Supervisor Efren Carrillo.

    Ms. Aust is a licensed professional fiduciary and has been with the Council on Aging, a Sonoma County nonprofit that provides legal, financial, social and nutritional services for seniors, for 22 years. 

    The Sonoma County Commission on the Status of Women was established in 1975 to promote equal rights and opportunities that enhance the quality of life for all women and girls and to address issues of discrimination and prejudice that negatively affect women in Sonoma County.

    ***

    Queen of the Valley Medical Center said it will delay the opening of its $122 million Herman Family Pavilion addition that was poised to open this month, in response to a self-reported compliance issue with the Centers for Medicare and Medicaid as well as its looming implementation of electronic medical records.

    The 191-bed hospital said it reported the accidental death of a 59-year-old Medicare patient last April, which may have resulted from certain decisions by hospital staff. That subsequently spurred a resource-intensive survey by CMS that is expected to be completed within the next few months, according to the hospital.

    In addition, the St. Joseph Health–owned hospital is also working to meet a February 2014 deadline of full implementation of a Meditech electronic medical records system. The two issues together forced the hospital to delay the opening of the pavilion, which the hospital said was the easiest matter to temporarily put aside.

    Exactly when the pavilion will now open is not clear, but hospital officials said they are confident it would be early spring in 2014.

    In a statement, hospital CEO Walt Mickens said Queen of the Valley voluntarily reported the accidental death, though he did not reveal specifics.

    “In keeping with our commitment to a culture of integrity, active compliance and the delivery of the highest-quality care, we self-reported an event to the California Department of Public Health earlier this year,” Mr. Mickens said. “We are now awaiting the Centers for Medicare and Medicaid Services acceptance of a detailed plan we created showing the steps we are taking to ensure full compliance regarding this issue. We expect CMS surveyors to return within the next month or two to assess the changes we have made. We are optimistic CMS will be satisfied with our efforts.”

    The three-story pavilion will have six suites for operations, 16 pre- and postoperation bays, 20 private intensive care rooms and a clinical and pathology laboratory that can add space as needed.

    It will also contain what the hospital, a level 3 trauma center, said is the region’s first “hybrid” operating room — an OR suite with the most advanced imaging capability available. The imaging system provides surgeons and radiologists with real-time imaging that will aid them during the most difficult of surgeries, including cancer, heart and brain procedures, according to the hospital.

    ***

    U.S. Rep. Mike Thompson, D-St. Helena, introduced legislation that would expand access to mental health care for Medicare recipients. H.R. 3662, the Mental Health Access Improvement Act, would add thousands of licensed mental health counselors and marriage and family therapists to the network of providers eligible to serve Medicare beneficiaries.

    Medicare currently recognizes psychiatrists, psychologists, clinical social workers and psychiatric nurses to provide covered mental health services. However, mental health counselors and marriage and family therapists, who Rep. Thompson said have equivalent education and training to clinical social workers and provide roughly 40 percent of mental health services, are not eligible to be reimbursed by Medicare.

    The bill would fix the “discrepancy “by making mental health counselors and marriage and family therapists, eligible to serve Medicare beneficiaries, adding more than 165,000 licensed practitioners to the Medicare program.

    H.R. 3662 is co-authored by New York Republican Rep. Chris Gibson. The bill has been referred to the House Committees on Energy and Commerce and Ways and Means, of which Thompson is a senior member.

    Submit items for this column to Business Journal Staff Writer Dan Verel dverel@busjrnl.com or 707-521-4257.

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