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In a Health Affairs Interview, California Health Stories with National Implications

In a Health Affairs Interview, California Health Stories with National Implications

Picture of Barbara Feder Ostrov

A new Health Affairs interview with California HealthCare Foundation CEO Dr. Mark Smith caught my eye because if you read closely, you can find some intriguing new story ideas for journalists interested in health.

A so-called "conversion foundation," created in 1997 after Blue Cross of California became a for-profit company, the California HealthCare Foundation aims to improve the delivery and financing of health care in the state.

Here's my favorite quote from Smith: "We've learned the hard way that in working with government, efficiency is not always the highest priority."

Smith was talking to Health Affairs Editor-in-Chief Susan Dentzer about the mixed success of an online application CHCF helped develop to improve access to California's Medicaid program, known as Medi-Cal, and SCHIP program, known as Healthy Families.

He continues:

The county-based enrollment process involves 26,000 full-time eligibility workers. So what on the surface might seem like a no-brainer is actually fraught with politics around jobs, state-county relationships, etc. However, amid California's fiscal crisis, the governor and legislature have directed the development of a single statewide enrollment system, with a Web-based portal, so this may be an opportunity to change things. We'll see.

So there you have it: story idea #1: Will that single enrollment system actually happen? When? What could it mean for the millions of Californians eligible for these government-subsidized health insurance programs? Has this already happened in other states? Is California in the vanguard here, or late to the party? Will there be pushback from local government unions? What will happen to the certified application assistants, whose pay was a welcome source of money for local social service agencies? This is one of those health policy stories that seem boring on the surface – but dig deeper and you'll likely find some real political catfights over jobs and money.

And here's story idea #2 (you may have to wait a bit for this one).

We are currently involved in trying to put together a "joint registry" in California. Our objective is to have, two years from now, a database that can tell you, in more or less real time, every replacement knee joint and hip joint that's been inserted in the state; who the surgeon was; what the hospital or accountable care system was; what the device was; the brand, make, and model of the device; and the functional status of the patient.

I'll leave it to my colleague William Heisel, author of ReportingonHealth's Antidote blog, to help you mine that database for investigative stories once it's up and running.

Here's story idea #3:

We're actively trying to fund what we hope will be models of high-volume, high-efficiency, low-cost care. One possibility we're working on now is an eye surgery center in San Francisco based on the principles of the Aravind Clinic in India, in partnership with private eye surgeons.1 This represents a "focused factory" approach: specialized platforms that can usually provide high-quality care more cheaply.

And story idea #4:

The other possibility we're currently exploring is a high-volume, low-cost endoscopy center at a safety-net hospital, using the same principles of high efficiency and cost-effective staffing models. It might be one gastroenterologist working with five nurse anesthetists and ten medical technicians, for example. The task is to figure out the highest "throughput" of patients possible within the limits of good, safe, legal practice. The idea is to figure out how to provide these high-cost interventions more cheaply, rather than simply cutting payments to ophthalmologists or gastroenterologists.

So, there you have it: four story ideas, mostly for California journalists, but with national implications.

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