Covered California Fights to Improve Health Care Quality in the Golden State

Posted: May 23, 2016

by John Hansen

Covered California, along with being the exchange for Obamacare California, now has 1.6 million individual and family enrollees in the state. That gives California’s state exchange additional clout to advance their agenda, which is affordable, quality care for all in the state of California.

The affordable part of this vision will be achieved through offering government subsidies and continuing to pressure health insurance carriers to keep prices low. But what about quality? How can Covered California use its leverage to improve the quality of health care in California?

Covered California Moves to Require All Carriers to Assign Primary Care Physicians

In April 2016, Covered California decided to require all California health insurance carriers to assign Primary Care Physicians to all their members. This includes members who are on PPO plans as well.

Everyone in California should have a name and a phone number on their fridge of a doctor they can see who takes their health coverage. Covered California is hoping this will help get more people to visit the doctor not only when they are sick, but also to get preventative check-ups, tests and labs.

Hopefully, this will lend toward improved health in California. Better health means lower health care costs, and it should ultimately translate to more affordable California health insurance rates.

This is definitely a power play by the California State Exchange. However, most agree that it is Covered California’s job to engage in this battle. We all agree that affordability and quality of care are worth fighting for. And, who better to engage in this fight than the California Exchange? Even health insurance carriers like Blue Shield of California are agreeing that this is what’s best.

The big question is, “How far will Covered California go with this?” How much pressure will the California State Exchange put on the health insurance carriers and providers to change? And, what will they do next?

California State Exchange Expected to Check Health Outcomes

The agenda of the ACA is affordability driven by increased quality of care. So the agenda of Obamacare California must be the same. Quality of care must be improved. For many top officials, this quality is expected to be achieved not only by encouragement, but also by strict accountability.

As they say in management, “Inspect what you expect.” Recent press conferences with Peter Lee have given California carriers and providers hints that requiring the assignment of primary care physicians is only the beginning of the war on quality that Covered California is planning to wage.

Ultimately, Covered California is expected to get very intrusive. Leaders in health care anticipate America’s largest state run exchange to start checking health outcomes in various areas including:

• Hospital Quality
• Admission Rates
• Infectious Disease Rates
• And more!

Obamacare California Expected to Publish Health Outcomes

The point of gathering this data is not so Covered California can privately give pats on the back or privately reprimand carriers and providers. No, they are expected to carry a much bigger stick than that. Likely, the Obamacare California Exchange will make this data public.

Public transparency will advance the agenda of the California Health Insurance Marketplace faster than anything else. Consumers will know which carriers and which providers are best at dealing with cardiac, cancer, diabetes, etc. The insured in California will know which health plans have the best survival rates for various diseases, and which provide the best quality coverage for child birth.

This is expected to have significant effects on consumer shopping choices. If cancer runs in your family, you may want to know which providers in your area have the best ratings regarding cancer treatment.

When this information starts affecting shopping choices, this will put heavy pressure on carriers and providers to improve health outcomes. If they do not, it will hit their bottom line. For all of California will know which carriers and which providers are doing the best job when it comes to improving the health of California’s insured population.