News Headlines

News Headlines
Health care news from around the state and nation

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Covered California Approves Specialty Drug Cost Caps
capital public radio

The Covered California board approved the price caps on specialty prescription drugs today. Monthly caps will range from $150 to $500 per prescription. Most Covered California consumers will have a cap of $250 a month.

Executive Director Peter Lee says Covered California is the first health exchange in the nation to adopt specialty drug caps.

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Sacramento County ER visits jump by 50,000 in 2014
Sacramento Bee

Sacramento County residents visit emergency rooms at a much higher – and growing – rate than the rest of California, new state figures show.

A high number of emergency room visits can lead to increased wait times or, if many patients are uninsured or underinsured, increased health care costs.

Some area hospitals have responded to the influx by establishing programs designed to funnel patients with minor ailments to community clinics. Others have introduced novel tools like allowing ER patients to check in online before coming to the hospital.

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Mental health shortages reach crisis levels
The Desert Sun

Kristy Beard felt her breath vanish.

The grocery aisle at the Palm Desert Costco stretched on forever, a tunnel of crunchy peanut butter and brightly-colored cereal boxes.

She gasped, as if drowning.

The clatter of shoppers and children battered her ear drums. Crowds drew closer, louder, swirling like the claustrophobic whirl of an MRI machine.

There was no escape.

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Individual enrollment tops small-biz health coverage in California
Sacramento Business Journal

The number of Californians with health coverage through small employers dropped below enrollment in the individual market for the first time, a new study shows. Coverage in the small-business market declined 11 percent in 2014 — to 2.1 million — while coverage in the individual market surged 47 percent to 2.18 million, according to a report released Thursday by the California Healthcare Foundation.

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Health Insurers Seek Hefty Rate Boosts
The Wall Street Journal

Major insurers in some states are proposing hefty rate boosts for plans sold under the federal health law, setting the stage for an intense debate this summer over the law’s impact.

In New Mexico, market leader Health Care Service Corp. is asking for an average jump of 51.6% in premiums for 2016. The biggest insurer in Tennessee, BlueCross BlueShield of Tennessee, has requested an average 36.3% increase. In Maryland, market leader CareFirst BlueCross BlueShield wants to raise rates 30.4% across its products.

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Health insurance makes big shift to managed-care regulator
Sacramento Business Journal

A big shift in the individual health insurance market in 2014 gave the California Department of Managed Health Care the most enrollment in all three sectors of commercial insurance.

DMHC now regulates 82 percent of the individual market, 77 percent of the small-group market and 91 percent of the large-group market, according to a new study released Thursday by the California Healthcare Foundation.

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Coded Talk About Assisted Suicide Can Leave Families Confused

Physician-assisted suicide is illegal in most states in the U.S. But there are gray areas where doctors can help suffering patients hasten their death. The problem is nobody can talk about it directly.

This can lead to bizarre, veiled conversations between medical professionals and overwhelmed families. Doctors and nurses want to help but also want to avoid prosecution, so they speak carefully, parsing their words. Family members, in the midst of one of the most confusing and emotional times of their lives, are left to interpret euphemisms.

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Value-Based Care’s Data Problem
The Health Care Blog

Lisa is an administrator at an Accountable Care Organization, or ACO — a new healthcare payment model that encourages coordinated, high-quality, and efficient care. Lisa’s ACO facilitates the program at about 100 clinics around California, and her mission in the first year of operating might seem elementary to an outsider: to report a set of metrics to Medicare that indicate the health of patients who had been seen at these clinics.

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Anthem Blue Cross names new California president
San Francisco Business Times

Anthem Blue Cross, one of the state’s and the Bay Area’s largest health plans, has named a new president to succeed Mark Morgan, who left last month for Amgen Inc. Replacing Morgan is J. Brian Ternan, who will oversee Anthem’s commercial health plan business in California. He starts Tuesday, May 26, and is so new he doesn’t have an official Anthem photograph yet.

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Daughters of Charity hospitals hope to have new buyer soon
San Francisco Chronicle

The fate of six Daughters of Charity Health System hospitals has been in limbo since a deal to buy them fell through in March, but executives hope to announce a buyer by the end of June or early July.

Since Prime Healthcare Services abandoned its $843 million bid to buy the Los Altos Hills nonprofit, officials with the struggling chain, which includes Daly City’s Seton Medical Center and O’Connor Hospital in San Jose, have been negotiating with potential new buyers.

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Hospital board considering new M.D. contract
Fort Bragg Advocate News

Mendocino Coast District hospital is considering a change in its hospitalist program, meant to make sure a doctor is available at the hospital at all times.

Since Jan. 1, the service has been run by Dr. James Gude, a Healdsburg physician who has contracted with the hospital using a combination of local doctors in the daytime and a tele-medicine robot with a audio/video link at night.