Your Quality of Care

California has taken the idea of managed care for low-income seniors and people with disabilities to a whole new level. Under an agreement with the Obama Administration announced last week, the state will begin shifting both medical care and long-term supports and services to managed care companies in just seven months.

Watch this closely. You may be looking at the future.

Many California residents gave their HMO plans good or excellent scores for providing health care but assigned lower scores for the plans’ access to care, according to a statewide report card from the state Office of the Patient Advocate, the Ventura County Star reports.

Report Card Details

The annual report card scores HMO and PPO insurance plans that cover a total of 16 million California residents (Kisken, Ventura County Star, 3/27).

It ranks health plans depending on how well they meet 40 quality measures (Kleffman, Contra Costa Times, 3/28).

The state needs to be extremely careful with the children being phased out of the Healthy Families program because they’re in danger of losing access to care and services if that transition doesn’t go smoothly, according to a new issue brief from the Lucile Packard Foundation for Children’s Health, based in Palo Alto.

The issue brief follows on the heels of last week’s release of a study on the level of care and services provided to children with chronic illnesses, a study which ranked California near the bottom of the nation in several categories, including access to pediatric specialists.

Whether you are going to the hospital for an outpatient procedure or whether you will be admitted to the hospital for medical illness or surgical procedure, there are certain things you must know and certain things you must do in order to ensure that your reasonable expectations will be met.

1. You must become informed about the terms and limits of your health insurance policy. See if the fees you are being charged can be negotiated ahead of time. If you do not know the terms and limits of your policy, you will not know the financial field upon which you are playing, and the end result may be significantly displeasing to you.
2. Do not be afraid to ask questions of your doctor. By accepting you as a patient he or she has made a contract with you to provide you with the best possible care. This means that the doctor must make time to answer your questions. On the other hand, you must realize that doctors do not have much time in today’s medical environment owing to the system under which they currently work. Therefore, prepare a list of questions for the doctor each day, and set a time during the course of the day that you and the doctor can meet so that these questions can be answered. If possible, e-mail the questions to your doctor before hand.

Look for doctors and office staff who speak your family’s language, or ask for an interpreter if you need one to talk to your doctor or your child’s doctor. Certified medical interpreters are trained to translate health information correctly. They must keep your information private.

Some hospitals provide better care than others. Visit CalHospitalCompare.org, a service of the California Healthcare Foundation, to view ratings of quality of care, patient experience and safety measures for hospitals in your area.

Visit the California Office of the Patient Advocate Web site to learn how health insurance plans rate on the quality of care their members receive, as well as how medical groups, their doctors and other providers rate on the care patients receive.

Overeating, lack of health insurance access and comparatively high poverty are among the many reasons why Americans are less healthy and die younger than people in other wealthy countries, a report requested by the U.S. government showed on Wednesday [January 9, 2013].

The United States spends more per person on healthcare than any other nation but lags on many important health measures amid higher rates of obesity and heart disease and worse infant mortality rates than other rich countries.

The California Primary Care Association has launched an initiative that aims to establish patient-centered medical homes across the state, Modern Physician reports.