California- Health Reform Shifting From Planning to Action

Or, put in another way, health reform these days means taking action -- actually implementing plans rather than talking about them.

"Enrollment and eligibility [in the exchange] is where it's at," Kim Belshé, a board member for California's Health Benefit Exchange, said. "This is where the action is. What we aspire to achieve -- seamless, coordinated care for millions of Californians. We are not going to get very far in those goals if we don't do this part of it right. And if we don't get it right, and right off the blocks, then we will be in a world of hurt."

The chance to re-form a vast, dysfunctional health care system in a state bigger than most foreign nations is a chance that comes along rarely, Belshé, former secretary of the state's Health and Human Services Agency, said.

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Challenge 1: The Provider Shortage

The pool of potential exchange participants is enormous. "You're looking at six million uninsured in California," Lucien Wulsin of ITUP said. "Then another two million insured who may be eligible for the exchange, and maybe another three million small business families who could be involved."

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Challenge 2: Transition of Care

California has a number of enormous initiatives going at the same time. Beyond setting up the exchange, the state also is:
-Orchestrating a new system of care for about one million dual eligibles -- those eligible for both Medi-Cal and Medicare benefits;
-Working on a plan to shift 875,000 children from the Healthy Families program to Medi-Cal;
-Moving seniors and persons with disabilities into Medi-Cal managed care plans; and
-Shifting 35,000 Californians from the former Adult Day Health Care services to the new Community Based Adult Services program.

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Challenge 3: The Exchange

Health Benefit Exchange officials have a lot on their plate.

Outreach, advertising, eligibility and enrollment, information technology issues, coordinating with all the governmental health agencies. In addition, a June deadline looms for applying for a federal Level 2 implementation grant.

Exchange officials need to figure out how to reach millions of Californians, work with health insurance plans and brokers, and many competing interests in the state -- as well as devise a streamlined, competitive, high-quality insurance system that's easy to navigate and extremely efficient.


http://www.californiahealthline.org/features/2012/health-reform-shifting-from-planning-stage-to-action-in-california.aspx#ixzz1mHsL8jQ5
Hat tip: California Healthline