Has there ever been a time of greater excitement, anticipation, and concern in health care than we saw in 2009? Perhaps not. Or perhaps not as great as what we will see in 2010. At this writing, it appears we are at the brink of historic health care reform being signed into law in Washington.
But what that will mean on the ground here in California is not likely to be known for several years. What we will face, for sure, are the effects of the fragile economy that has seen the safety net for millions of Californians battered and sometimes broken. We will see continued economic turmoil that will swell the ranks of the uninsured and underserved. And because this reform effort has morphed from a focus on "health care reform" to a focus on "health insurance reform," we will still be dogged by higher health care costs and reduced access to care for our most needy residents.
In anticipation of this tumultuous time, CHCF launched a new resource in January 2009 — the California Health Care Almanac, an online clearinghouse for important data and analysis on the key aspects of the state's health care economy. Almanac reports focus on critical segments of the delivery system (providers and payers) along with overviews of cost and quality drivers in the state. The website consolidates these data-rich reports under one umbrella at www.CHCF.org/almanac.
It is our view that many crucial decisions will need to be made in the state over the next few years on how to implement any health care reform legislation. Such decisions need to be based on facts and clear-headed analysis of statewide, regional, and local health care circumstances. We will continue to produce these facts and analysis to promote improvements in the quality of care, access to appropriate medical services, and attention to the catastrophic consequences of continued health care cost inflation. The foundation published a number of new almanac reports over the course of 2009 to fill gaps in current information, and will continue to update the almanac throughout 2010 with analysis on issues as varied as children's health, Medicare, and long term care.
Backbone of the Safety Net
A March 2009 CHCF report described the critical role community clinics play for both uninsured Californians and Medi-Cal enrollees. The Financial Health of Community Clinics illustrates the tenuous financial circumstances that many people confront.
With the rapid growth in patient visits to California community clinics, clinics' revenues and expenses increased dramatically between 2003 and 2006. As clinics are heavily dependent on income from Medi-Cal, which contributes nearly 70% of revenues from patient services, changes in Medi-Cal reimbursement and eligibility will have a major impact on clinics and programs. In addition, cutbacks due to California's fiscal crisis led to reductions in state grant–funded health programs as well as to a decrease in the availability of loan capital. Although ARRA (the economic stimulus package) provides some supplemental funding opportunities, the relief is likely temporary.
All Health Care Is Local
In a state as large and diverse as California, there are often marked differences in regional health care delivery systems. To delve deeper into these differences, a new series of market reports examined the varying health care economies of six major regions of the state. These in-depth, cross-industry reports relied on extensive interviews with key players in each region, highlighting the significant differences in how physicians, hospitals, and health plans relate to each other and the impact of those relationships on access to care, costs, and quality. The reports provide a detailed picture of local health care systems and identify common themes and emerging issues that will influence how Californians receive medical care.
Quality of health care, while often more difficult to quantify than cost or coverage, is of central importance to consumers and purchasers. The almanac's Quality of Care Facts and Figures provides a comprehensive look at the quality of care delivered in California over the average lifetime. The state's providers perform better than average on a number of maternal and child health measures but fall short in many areas of care for older individuals. California's performance on prevention-oriented measures is also mixed — a good showing on preventing hospitalization for conditions that can be treated in an outpatient setting, but poorer performance on vaccinations for elderly patients. In spite of a significant increase in attention to quality, and greater transparency of results, progress has been slow.
Connecting Purchasers with Providers
Whether coverage is sponsored by employers, purchased by individuals, or provided by Medi-Cal or Medicare managed care arrangements, California's health plans and insurers play a key role in connecting purchasers with providers. A new almanac snapshot, California Health Plans and Insurers, assembled data from California's two insurance regulators to describe consolidation in the insurance markets, with five insurers receiving 76% of $91.9 billion in medical insurance revenue.
Among those covered by these private health plans, a diminishing percentage are enrolled in managed care — with plan enrollment regulated by the California Department of Insurance growing at 22% and enrollment in managed care (regulated by the California Department of Managed Health Care) relatively flat. The percentage of seniors choosing managed care has stayed strong in California, with nearly one-third of all beneficiaries selecting Medicare Advantage coverage options. This gives California the fourth-highest enrollment rate of Medicare managed care enrollment in the nation. Managed care plans continue to be a significant player in Medi-Cal coverage as well, with half of all Medi-Cal beneficiaries in managed care. The almanac's Medi-Cal Facts and Figures presented CHCF's annual comprehensive overview of this important program.
The Year Ahead
Over the course of 2009, the almanac also provided a steady stream of comprehensive data and interpretation of results for different areas of the delivery system that the foundation has tracked for some time, including Health Care Costs 101, Long Term Care Facts and Figures, and California's Uninsured. New almanac reports to be released in 2010 will focus on hospitals, physicians, and the health care workforce, among other subjects.
Many of the trends seen in 2009 are likely to continue. If a federal health insurance reform bill is enacted, new uncertainties will arise and new opportunities for California will slowly unfold. Yet a large share of the envisioned coverage expansion builds on the weak foundation of California's budget. With a California economy nearing the breaking point and funding for Medi-Cal and Healthy Families on shaky ground, fundamental change in how medical care is delivered and financed in the state is needed to stabilize the system. Against this backdrop, the CHCF California Health Care Almanac aims to provide a solid framework of data and analysis to help build a more stable health care future for California.