AM Alert: California's mental health services examined

A topic close to the heart of Senate President Pro Tem Darrell Steinberg- mental health - is the focus of a significant amount of public agency activity today.

The Mental Health Services Oversight and Accountability Commission, created by voters in 2004 via Proposition 63, meets in San Francisco to discuss integrating mental health care -- in particular for substance abusers -- into a statewide health care regime. Experts expected to testify include Barbara Garcia, director of the San Francisco Department of Public Health; Sandra Naylor Goodwin, president of the California Institute for Mental Health; and Deputy Chief Louise Rogers of the San Mateo County health system.

The California Health Facilities Financing Authority also meets to discuss how to disperse millions of dollars in grants to help counties bolster their mental health services. That comes courtesy of Steinberg-spearheaded budget legislation signed earlier this year that seeks to invest more money in community-based mental health services and crisis response teams.

VIDEO: Andy Vidak's victory in the 16th Senate district sets off some electoral dominoes, Dan Walters says.

FIELD POLL: The latest in a series of Field Polls is out, examining California's relationship with potential presidential contender Hillary Clinton. The analysis is up online, and you can take a look at the data here.

TALKING TAXES: Much of the discussion of California's taxes is framed in terms of the Golden State's tax rates relative to those of other states (we're looking at you, Rick Perry and Phil Mickelson). A talk today by Professor Darien Shanske of UC Davis will take a look at the fiscal issues particular to different states, including a deeper dive into local finances throughout California. From noon to 1:30 p.m. at 1130 K Street.

STEM-CELL SCIENCE: The Independent Citizens Oversight Committee of the California Institute for Regenerative Medicine, which has faced scrutiny over the process by which it awards grants, meets in Burlingame from 9 a.m. to 5 p.m. today. Among other topics, they'll examine their policy around compensating stem cell donors.

PHOTO: The exterior of the Sacramento County Mental Health Treatment Center photographed Wednesday, September 30, 2009. The Sacramento Bee/Carl Costas.

Read more here: http://blogs.sacbee.com/capitolalertlatest/2013/07/am-alert-californias-mental-health-services-examined.html#storylink=cpy

via Sacramento Bee

To stay fiscally healthy, state's hospitals want fewer patients

http://www.latimes.com/health/la-me-hospital-changes-20120305,0,5184223.story

By Anna Gorman, Los Angeles Times

March 4, 2012, 5:15 p.m.

To survive the unprecedented challenges coming with federal healthcare reform, California hospitals are upending their bedrock financial model: They are trying to keep some patients out of their beds.

Hospital executives must adapt rapidly to a new way of doing business that will link finances to maintaining patients' health and impose penalties for less efficient and lower-quality care.

It's too soon to know precisely how the changes will affect patients. But experts say more will be treated in clinics and doctors' offices than in hospitals. And when they are admitted, their hospital stays could be shorter.

"How can we change our mind-set from how many patients we have in the beds to how many patients we are keeping healthy and out of the hospital?" asked Michael Rembis, president and chief executive of Hollywood Presbyterian Medical Center. "We haven't figured out how to do that yet."

The federal reform law changes the way hospitals and doctors will be paid. Going forward, fees will be based on patient outcome rather than on how long patients stay in the hospital or how many services they receive. And hospitals will be penalized for preventable readmissions and hospital-acquired infections.

Promoting higher-quality hospital treatment is long overdue, said Anthony Wright, executive director for the consumer group Health Access. "We were inadvertently subsidizing bad care," he said.

Wright said he hopes the new incentives will lead to more coordinated treatment for patients.

In preparation for the healthcare overhaul, many hospitals are replacing paperwork with electronic record systems and working more closely with physicians to improve care and reduce the number of unnecessary tests.

"As hospitals and physicians think about how they are going to care for populations, they recognize they have to collaborate," said David O'Neill, senior program officer at the California HealthCare Foundation.

Some hospitals are going a step further and partnering with physicians to form accountable care organizations, groups that agree to offer coordinated care for Medicare patients. Under the reform law, the organizations will share the savings from lowering costs and improving care.

The California Medical Assn., a leading doctor alliance, says the new accountable care groups will succeed only if physicians still have the autonomy to make medical decisions on behalf of their patients.

"If they are dominated by the hospitals, they will fail," said Francisco Silva, the association's general counsel. "They will not reduce costs or improve efficiency.... It has to be a true partnership."

Hospitals that don't adapt may have to eliminate services or close their doors, according to the California Hospital Assn. Already, the state has fewer hospital beds per capita and shorter hospital stays than the national average.

"Everyone is scrambling on the hospital side to prepare for fewer patients," said Jim Lott, executive vice president of the Hospital Assn. of Southern California. "It does change the paradigm."

The shifts — which will occur along with ongoing cuts in Medicare and Medi-Cal — don't take effect until 2014, but already they are prompting hospitals to cut costs and stop duplicating services wherever possible.

Hollywood Presbyterian is working with nearby hospitals to identify the best and most cost-effective treatments. In addition, the hospital is trimming expenses and entering new partnerships with outpatient clinics to keep discharged patients from returning to the hospital unnecessarily.

Providence Health & Services, Southern California, which operates five hospitals, has offered voluntary buyouts and streamlined supply purchases. The hospital group also is trying to reduce the chances of medical complications and is standardizing treatment of some illnesses to improve efficiency.

The Providence hospitals couldn't afford to wait until healthcare reform takes effect in two years, said senior vice president and chief executive Michael Hunn. "The numbers are not sustainable," he said. "We have got to get our arms around waste."

The most significant moves are driven by cuts to Medicare and Medi-Cal, which in California make up more than half of hospitals' gross revenues. California also has some of the lowest Medi-Cal reimbursement rates in the country.

Because government insurance programs don't cover costs, hospitals have traditionally relied on private payers to make up their deficits. But that is becoming more difficult because insurers are under pressure to reduce rates as part of healthcare reform.

Hospitals are launching their transformation when revenue growth at some facilities is running at 20-year lows, according to Moody's Investors Service.

"They are being hit on both fronts — fewer patients and getting paid less for each patient," said Brad Spielman, vice president of healthcare ratings for Moody's.

Michael Blaszyk, chief financial officer of Dignity Health, which operates more than 40 hospitals in California, Nevada and Arizona, said healthcare reform has placed hospitals at a "fundamental crossroads."

"All hospitals have had to make choices about what services are appropriate and what services are not," he said. "You cannot continue to operate at a financial loss."

Smaller hospitals will be among the hardest hit because they are on their own in paying for administrative costs and negotiating rates with insurance companies, said Richard Scheffler, a UC Berkeley health economics professor. The ones that join larger health systems are more likely to survive, he said. "Mom-and-pop hospitals have two choices: disappear or join the party," he said.

Long Beach's Community Hospital executives knew their bottom line wasn't improving. So last year, the hospital decided to join MemorialCare Health System, which runs several hospitals in Southern California. Now the hospital is in the black and can focus on care rather than finances, said former board chairwoman Nancy Myers. "If we had not merged ... we probably would not have been able to make it," she said.

Even as hospitals rush to revamp their care, there is still uncertainty about what lies ahead, saidAllen Miller, an L.A.-based healthcare consultant. An increasing number of aging baby boomers may require more hospitalization in the years ahead, complicating efforts to reduce costly admissions.

"No matter how much we think we can decrease hospital admissions, we are still going to need the beds," he said.

Many Returning Home from Prison, War: More Services Needed

By Carla María Guerrero

After leaving prison, Stacy Johnson (left) and Lori Hogg found the services they needed at A New Way of Life to stay off the streets and reintegrate into the community. (Photo by Joshua H. Busch)

Stacy Johnson had no idea what to expect when she was dropped off last August in front of a well-kept home in a quiet neighborhood in South Los Angeles. The 45-year-old had just been released early from serving her third prison sentence. She arrived at A New Way of Life Reentry Project hoping to make a fresh beginning after what had been a tumultuous twenty years.

Every year thousands of men and women like Johnson leave California prisons and return to South L.A. in need of jobs, housing and other supportive services. Their numbers could grow even higher under the state’s new prison “realignment” law, which transfers responsibility for “nonviolent, nonsexual, nonserious” felony offenders from state to county authorities.

According to Los Angeles County’s Criminal Justice Committee, an estimated 9,000 men and women who have served their prison sentences will be released to the county’s supervision by midyear and nearly 15,000 by mid-2013.

At the same time, the end of the Iraq War means the return of a significant number of veterans to the community. They share many of the same critical needs for jobs, housing and health services as those exiting prison. For both populations, locating these services in a community affected by deep budget cuts and the economic recession can be difficult.
But once found, these services can make a huge difference in whether an individual coming back from war or prison successfully reintegrates into the community.

Crucial Help
For Johnson, connecting with A New Way of Life and its founder, Susan Burton, has already changed her life immeasurably. She is in school full time and has been sober for almost three years. Eventually she would like to find a full time job and get her own place.
“I owe [Burton] everything. I came out of prison with nothing. I would’ve been back on the streets, probably using [drugs] again and staying in motels,” said Johnson, who knows firsthand how easy it is to fall prey to addiction.

At 22, Johnson started using crack cocaine and her life started unraveling. That same year, she was convicted of voluntary manslaughter after she picked up a knife to protect herself from being raped. Her assailant died and Johnson got twelve years in prison. After leaving prison she tried to rebuild her life around a new job and a new boyfriend. But he was abusive. She turned to drugs again, lost her job and her freedom, and gained one strike.
After serving two years, she lived in motels or on the streets and took drugs to numb the desolation. “When you are on drugs, you are weak. You are so vulnerable,” Johnson said. She went to jail a third time after being arrested for crack cocaine possession.

According to the California Department of Corrections and Rehabilitation, the state has one of the highest recidivism rates in the country. Nearly seven in ten former inmates will return to prison within three years.

Realign Priorities
For Cpl. Lauren Johnson, a 28-year-old African-American veteran of the Iraq War, knowing about the services and support available is key to successfully reintegrating back into communities.

“My experience was different from most veterans returning home because I was knowledgeable about the resources and services available to me,” she said. Originally from a Texas community with a strong military presence and culture, Lauren Johnson knew what benefits to tap into to help pay for school after her tour in Iraq.

Now working for Congresswoman Karen Bass, Lauren Johnson connects veterans with resources and services in South L.A., including referrals to Veterans Affairs and local organizations that provide housing, employment training and other services.

“It is imperative for us to mobilize for veterans once they come home. They’re used to unit cohesion and sometimes it can be a bit scary when you no longer have that camaraderie and that network you’ve been used to,” she said.

Social service advocates fear additional budget cuts will further erode the safety net in South L.A. at one of the most crucial moments.

“There needs to be an investment in housing, prevention, intervention and education … instead of systems of supervision and further incarceration,” A New Way of Life founder Burton said. “There needs to be a realignment of investment into people and communities so that crime won’t rise but opportunities for jobs and training programs will.”

Carla María Guerrero is the communications assistant at Community Coalition