Latest news with #CaliforniaFutureHealthWorkforceCommission
Los Angeles Times
4 days ago
- Health
- Los Angeles Times
As California's behavioral health workforce buckles, help is years away
REDDING, Calif. — This spring, the Good News Rescue Mission, which runs the only emergency homeless shelter in Shasta County, received a game-changing, $17.8-million state grant to build a 75-bed residential treatment facility in a region where thousands struggle with drug and alcohol addiction. Now comes the hard part — recruiting and hiring 10 certified substance use counselors and about a dozen other staff members to work at the new site, about 170 miles north of the state capital. 'Ask anyone trying to get staff and it's difficult,' said Justin Wandro, the mission's head of development. 'Try to get people who are willing to work in very intense, very difficult environments. It's hard.' California has long struggled to revitalize its behavioral health system and expand its workforce to meet the needs of its residents, particularly in rural parts of the state like the far north. Six years ago, the California Future Health Workforce Commission warned of a 'severe and growing' shortage across the behavioral health field, including psychiatrists, therapists, social workers and substance use counselors, and noted that two-thirds of Californians with a mental illness go without treatment. Since then, Gov. Gavin Newsom and state lawmakers have set out to transform the behavioral health system, with the Legislature dedicating more than $1 billion to train and recruit providers. Yet, the shortage has only worsened since the pandemic, which exacerbated mental health and addiction issues for many. In April, state health officials revealed that California was short roughly a third of the 8,100 psychiatrists and 117,000 licensed therapists it needed based on 2022 data. And the state's limited training capacity is making it hard to replace the number of retiring practitioners. As a result, existing workers are buckling under the workload while patients without quick access to help during a crisis are turning to costly emergency care. 'It feels helpless, because there is more than you can fix,' said Nick Zepponi, a social worker at the Hill Country Community Clinic CARE Center in Redding. The mental health urgent care clinic is one of the last lines of defense in the fraying behavioral health system in Shasta County, where the suicide rate is more than double the state average and overdose deaths increased more than threefold during the pandemic. 'There's more people than you can help that need it,' Zepponi said. Playing catch-up Under Newsom, the state has increased funding for youth preventive care, revised conservatorship laws, and set up a court-based program to compel treatment for some of the state's most severely mentally ill residents. The Democrat also championed the passage of Proposition 1, a cornerstone of his response to the state's homelessness and drug crises, saying it would add 10,000 treatment beds and housing units and increase access. One of the biggest remaining bottlenecks is the acute shortage of psychiatrists — licensed medical doctors who can prescribe medications such as antidepressants as well as antianxiety and antipsychotic drugs. While the state has opened more slots for training in recent years, it can cost as much as $250,000 a year and requires 12 years of postsecondary education. In 2025, 239 first-year residents enrolled in California psychiatry programs, an all-time high and up from 152 seven years ago. Yet it was far below the 527 first-year psychiatry residents the workforce commission estimated are needed annually from 2025 to 2029. 'The investments have lagged, and because they've been more recent, we're not really seeing as much of the fruit of those investments yet,' said Janet Coffman, a University of California-San Francisco associate professor who specializes in health care workforce issues. 'Some of these psychiatry programs that the state has funded haven't graduated their first class yet.' The state has also expanded the role of other providers, such as nurse practitioners trained to prescribe behavioral health drugs and certified peer counselors who might be able to meet with patients more frequently. Mark Ghaly, former secretary of the state Health and Human Services Agency and one of the architects of Newsom's behavioral health overhaul, said it's better to spread responsibilities among various providers, including some with shorter training timelines, to expand capacity faster. 'You're building workforce plans around models that, frankly, aren't meeting people's needs,' Ghaly said. 'If we try to chase the current models today with the demand that has grown, I don't think you catch up.' In addition to the state's own investments, California is tapping $1.9 billion in Medicaid funds to train, recruit, and retain behavioral health workers, enticing them with scholarships and loan repayments, and helping schools fund new residencies and fellowships. But the program took effect only recently, in January, and there is the looming threat that the Trump administration could rescind the funds at any time. In a statement, U.S. Department of Health and Human Services spokesperson Emily Hilliard said the Centers for Medicare & Medicaid Services has made clear that approved waivers remain in effect. 'That said, states should not rely on temporary demonstration funding as a substitute for sustained, direct investment in their healthcare workforce,' Hilliard added, saying the agency would continue to evaluate the outcomes of California's experiment, which sunsets at the end of 2029. Health advocates warn that California is so behind that any slowdown in behavioral health workforce funding would be detrimental. HHS Secretary Robert F. Kennedy Jr.'s move to fold the nation's mental health agency into a new department focused on chronic care and disease prevention, national advocates say, could spell trouble for program funding generally. Uber to the ER Kelly Monck, who lives in a pool house behind her mother's middle-class suburban home in Redding, struggles with depression. Despite having health coverage and knowing her way around the healthcare system, she often can't get an appointment with her psychiatrist when thoughts of suicide creep in. 'We've been fighting this demon since I was 15 years old,' said Monck, 38, who is deaf and has Ehlers-Danlos syndrome, a connective tissue disorder that has collapsed her airway and left her reliant on a ventilator and feeding tube. In April, Monck overdosed on her heart medication. Seeking help, she called her therapist, who eventually persuaded her to go to the emergency room. She took an Uber and waited in the ER for hours, she said, but there was no open treatment bed and she was released. Rather than go to the ER a second time, Monck called Hill Country when suicidal thoughts returned the following week. She had hoped that providers there could expedite an appointment with her county psychiatrist or adjust her medications. But clinic counselors aren't licensed to prescribe medication and could do little more than ensure she wasn't an immediate danger to herself. It wasn't until her mother drove her 250 miles to Stanford Medicine's psychiatry unit that she was able to get her medications adjusted. She didn't see her regular psychiatrist for two more weeks. Monck isn't alone. In some regions of the state, it can take patients months to see a psychiatrist, and those who urgently need help are increasingly turning to costly ER care. In 2022, patients with mental health or substance use disorders accounted for 1 in 3 inpatient hospitalizations and 1 in 6 emergency room visits, state data show. In ERs, doctors can often do little more than temporarily stabilize these patients, since long-term treatment beds are nearly impossible to find. Shasta Regional Medical Center, one of Shasta County's two major hospitals, has created a temporary holding area in the ER for mental health patients, in addition to 18 existing inpatient beds, said Brenten Fillmore, the hospital's director of behavioral health. 'It's not how the system is designed to work,' Fillmore said. 'There just are not enough beds to service the need, particularly when it comes to difficult cases.' Healthcare providers say most patients are better served in office and outpatient settings where regular appointments with clinicians could help them avert a crisis. The state estimates Shasta County has about a third of the psychiatrists and little more than half the licensed therapists it needs, significantly below the state average. More than once, clinicians at Hill Country have made the three-hour journey to take a client to the nearest medication-assisted detox facility, in Eureka, or farther south to San Francisco, said Brandy Gemmill, a substance use counselor. But once patients are sober, it's rare to find an opening in a longer-term residential program. 'What I struggle with is the lack of resources,' Gemmill said. 'Where do we send them? So then, they're back on the street and it's happening all over again.' When patients repeatedly fall through the cracks, Zepponi said, workers like him are at high risk of burnout, something that has hit behavioral health clinicians particularly hard. Every six months or so, when a slight twinge of dread starts to creep in at work, Zepponi knows he needs to schedule a week off if he wants to keep doing the job he loves. 'That's when I know I really need time off, and I have to act quickly.' Turning to GoFundMe In 2018, the Camp fire tore through the foothills of the Sierra Nevada in Butte County, killing 85, destroying about 14,000 homes, and displacing more than 50,000 people. Within weeks, patients with post-traumatic stress disorder, depression, and anxiety flooded into local hospitals and doctors' offices, but few providers were equipped to help them. An estimated 40 to 60 physicians left the region after the fire, deepening the shortage. A group of local doctors set out to reverse the trend, and last year the nonprofit Healthy Rural California launched the state's first psychiatric residency program north of Sacramento. Rachel Mitchell, director of the program, said even with a $1.5-million grant from the state for planning, the organization had to cobble together roughly $75,000 via private donations and a GoFundMe campaign to welcome its first class of four psychiatry residents. The federal grant money they rely on for operations, administered by the Health Resources and Services Administration, has been a volatile funding source. 'We'd love to get six students per class, but at this point we can't afford to,' Mitchell said. Program administrators want to tap into a more stable funding stream through CMS but must first wait for its partner, Enloe Medical Center in Chico, to recruit psychiatrists to teach and supervise residents. Its first class will graduate in 2028. Mai-Duc writes for KFF Health News, which publishes California Healthline, an editorially independent service of the California Health Care Foundation.
Yahoo
28-04-2025
- Health
- Yahoo
California's primary care shortage persists despite ambitious moves to close gap
Sumana Reddy, a primary care physician, struggles on thin financial margins to run Acacia Family Medical Group, the small independent practice she founded 27 years ago in Salinas, a predominantly Latino city in an agricultural valley often called 'the salad bowl of the world.' Reddy can't match the salaries offered by larger health systems — a difficulty compounded by a widespread shortage of primary care doctors. The shortage is tied largely to the lower pay and relative lack of prestige associated with primary care, making recruitment difficult. 'It certainly is challenging to expose medical students early in their careers to the joys of this kind of integrated healthcare,' Reddy said. 'The relationships we build and the care we provide truly allow people to live longer with a better quality of life.' Hoping to increase revenue so Acacia can afford to pay more, Reddy has signed the practice up for alternative payment methods with health plans that offer bonuses for meeting certain primary care goals tied to child vaccinations, blood pressure control, and screenings for breast cancer, colorectal cancer, and mental health. Such pay-for-performance arrangements are just one of many efforts by industry players and state officials to confront the problems plaguing primary care. Medical students frequently opt against going into primary care, and that's not good for patients. People with regular primary care providers are more likely to get preventive care that avoids serious illnesses and feel more empowered to advocate for themselves. They're also less likely to encounter language barriers, resort to costly emergency room visits or forgo care. Six years after the influential California Future Health Workforce Commission made a series of recommendations to plug a projected shortage of 4,100 primary care providers in 2030, a number of public and private initiatives have proliferated around the state to address the problem. They include new residency slots, debt forgiveness, waived medical school tuition, new ways of paying doctors, expanded nurse practitioner roles, and a statewide target to increase primary care spending. Hundreds of millions of taxpayer dollars have been allocated for some of these efforts. But numerous academic experts and medical professionals believe those moves, while well intended, have been scattershot and insufficient. 'The pieces are there,' said Monica Soni, chief medical officer of Covered California, the state's Affordable Care Act health insurance marketplace. 'I am worried we started a little too late, and I think it's a little too siloed.' A study published in 2022 by the California Health Care Foundation found that substantial progress had been made on some of those goals, including recruitment of students from low-income households and communities of color. A separate analysis from the foundation showed that, from 2020 to 2023, California jumped about 10 spots in a ranking of states by primary care residents and fellows per capita. However, the latest state data show nearly 15 million Californians live in areas without enough primary care providers to meet patient needs. State budget constraints and potential federal spending cuts, especially to Medicaid, could exacerbate shortages in areas already desperate for clinicians and dampen hopes of building a robust primary care system that state officials and virtually everyone in the industry agree would be a strong defense against serious — and costly — illnesses. Federal cuts could also hit medical training and hospital systems. 'Many of us are very scared about threats from both the Trump administration and Republicans in Congress,' said Kevin Grumbach, a family community medicine professor at UC San Francisco. California's lack of primary care providers, including doctors, nurse practitioners, and physician assistants, is most acute in rural parts of the state, particularly in the north and the Central Valley. Entire rural counties, including Del Norte, Madera, Tulare and Yuba, are designated shortage areas, according to state data. Some densely populated urban areas, including parts of Los Angeles, also confrontshortages. Many Californians face months-long waits for appointments or have to travel long distances or go to emergency rooms for non-urgent medical needs, which means hours spent in crowded waiting rooms for unnecessarily expensive care. In Chico, 90 miles north of Sacramento, the emergency room at the only hospital in town has seen a sharp increase in patients over the past decade, due in part to a lack of primary care providers in the area. 'People who don't have a primary care provider — which is a lot, because there are not enough — end up in the ER when they need routine care,' said David Alonso, a local internal medicine doctor. 'The ER then says, 'OK, you should follow up with your primary care provider,' and they're like, 'We don't have one.'' Yalda Jabbarpour, director of the Robert Graham Center for Policy Studies, a health policy think tank, said failure to invest robustly in primary care has robbed the public of its benefits. The field has historically been underfunded, accounting for less than 5% of national healthcare spending in 2022, according to the Milbank Memorial Fund, a national nonprofit focused on population health and health equity. The consequences are clear. The U.S. spends significantly more per capita on healthcare than other industrialized nations, and yet Americans aren't any healthier. Chronic conditions such as heart disease, diabetes, arthritis and Alzheimer's, as well as mental illness, account for 90% of the $4.5 trillion spent on healthcare every year. Medical students, often faced with staggering educational debt, are increasingly choosing higher-paid specialties over primary care. The average salary of a family medicine physician is slightly over $300,000, compared with more than $565,000 for a cardiologist and over $763,000 for a neurosurgeon, according to one study. 'If you are going to pay over $300,000 to go to medical school, you want to be a neurosurgeon; you don't want to be a family practice doctor,' said William Barcellona, executive vice president of government affairs at America's Physician Groups, a Los Angeles-based professional association representing 360 medical groups and independent practice associations nationwide. Barcellona said the Golden State's high housing costs also make recruiting difficult. But it's not only pay that tempers enthusiasm for primary care. It's also burnout from so many unpaid hours spent recording details of medical visits in electronic health records; haggling with insurance companies for treatment authorization; answering phone calls and emails from patients; or searching far and wide — often in a healthcare desert — for specialists with the right expertise. Debby Lee, the daughter of Hmong immigrants from Laos, experienced this kind of frustration firsthand. Cultural and linguistic barriers faced by her family motivated her to pursue internal medicine. Lee worked part of her residency at a community clinic serving Hmong in the Sacramento area. She loved the patients, as well as her co-workers. But she was burdened by outdated technology that limited the number of patients she could see. 'I just saw myself kind of burning out being in that setting,' Lee said. When the clinic invited her to stay, she declined, taking a job with a bigger health system. Besides residencies, other efforts support primary care. The Health Plan of San Mateo offers grants to help medical practices retain and add to primary care staff. In exchange, the practices — some single physicians serving patients in California's Medicaid program, Medi-Cal — must show they have increased their patient load and retained newly hiredproviders for five years. The idea is to provide capital so doctors can hire the staff they need to run their practices efficiently, increase salaries, offer bonuses, and even take sabbaticals. Such efforts are consistent with one of the main thrusts of the 2019 workforce report: to increase investment in primary care. California recently joined several other states, including Connecticut, Oklahoma and Rhode Island, in setting a target to increase primary care spending. So far, those policies have yielded mixed results. Late last year, California's Office of Health Care Affordability set a target to make primary care account for 15% of total healthcare spending by 2034, more than double the current proportion. It imposes no requirements, relying on the goodwill of health plans to work with medical providers. Greater spending on primary care would mean better pay and more people working in the field, said Richard Kronick, a public health professor at UC San Diego and a member of the OHCA board. 'That's a big change. Will it happen? I don't think anyone can predict the future with any certainty.' Stephen Shortell, a professor emeritus of health policy and management at UC Berkeley, said 'some of that increase might occur, but at some point, it might need to be made mandatory.' In its report, the workforce commission also cited the importance of alternative forms of primary care payment that offer extra cash for quality care. The affordability office has set targets to encourage such payment methods. The aim is to transform the system from one in which every medical service has a price tag to one that treats people holistically, and in which adherence to medical standards brings more money to doctors and their office staff. Such arrangements are common among HMOs, though less so in primary care practices. Where they do exist, different health plans and other payers generally design them differently, which means primary care practices manage multiple payment models, adding to their administrative burden. Reddy's family practice is participating in a one-year demonstration project launched in January intended to reduce that burden by having multiple insurers work together in one payment plan. The project brings together three large insurers — Health Net, Aetna and Blue Shield of California — and 10 independent practices across the state with the goal of improving care while boosting revenue for the medical groups. It is administered by two industry groups, the Integrated Healthcare Assn. and the California Quality Collaborative. On top of customary payments, either for services rendered or monthly per-member allotments, the medical practices receive bonuses for meeting targets or improving their performance on core measures. Participating practices also receive monthly per-patient payments for 'population health management,' which means managing the collective health of their patients. And they can search a single platform to find all their patients covered by one of the three plans. In addition to extra payments and fewer administrative hassles, the health plans pay for a 'practice coach,' whose job is to help primary care groups meet their targets and provide more seamless care. The idea is to add more insurers and medical groups over time, said Todd May, Health Net's medical director for commercial health plans, who is among those driving the project. 'In addition to better outcomes, we'd like to see a stronger, more robust, and more satisfied primary care workforce,' he said. Reddy hopes she can increase Acacia's revenue by 20%, thanks to the extra money from this and other pay-for-performance arrangements. That, she said, would enable her to raise pay for her staff and hire new clinicians. For many years, her practice has limited the number of patients it has accepted. But after searching for the better part of five years, Reddy has hired a new doctor on a half-time basis, and another is coming on board this June. 'This is the most hopeful I have felt in decades,' Reddy said. Wolfson and Sánchez write for KFF Health News, a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF — the independent source for health policy research, polling, and journalism. Phillip Reese contributed to this report. Sign up for our Wide Shot newsletter to get the latest entertainment business news, analysis and insights. This story originally appeared in Los Angeles Times.
Los Angeles Times
28-04-2025
- Health
- Los Angeles Times
California's primary care shortage persists despite ambitious moves to close gap
Sumana Reddy, a primary care physician, struggles on thin financial margins to run Acacia Family Medical Group, the small independent practice she founded 27 years ago in Salinas, a predominantly Latino city in an agricultural valley often called 'the salad bowl of the world.' Reddy can't match the salaries offered by larger health systems — a difficulty compounded by a widespread shortage of primary care doctors. The shortage is tied largely to the lower pay and relative lack of prestige associated with primary care, making recruitment difficult. 'It certainly is challenging to expose medical students early in their careers to the joys of this kind of integrated healthcare,' Reddy said. 'The relationships we build and the care we provide truly allow people to live longer with a better quality of life.' Hoping to increase revenue so Acacia can afford to pay more, Reddy has signed the practice up for alternative payment methods with health plans that offer bonuses for meeting certain primary care goals tied to child vaccinations, blood pressure control, and screenings for breast cancer, colorectal cancer, and mental health. Such pay-for-performance arrangements are just one of many efforts by industry players and state officials to confront the problems plaguing primary care. Medical students frequently opt against going into primary care, and that's not good for patients. People with regular primary care providers are more likely to get preventive care that avoids serious illnesses and feel more empowered to advocate for themselves. They're also less likely to encounter language barriers, resort to costly emergency room visits or forgo care. Six years after the influential California Future Health Workforce Commission made a series of recommendations to plug a projected shortage of 4,100 primary care providers in 2030, a number of public and private initiatives have proliferated around the state to address the problem. They include new residency slots, debt forgiveness, waived medical school tuition, new ways of paying doctors, expanded nurse practitioner roles, and a statewide target to increase primary care spending. Hundreds of millions of taxpayer dollars have been allocated for some of these efforts. But numerous academic experts and medical professionals believe those moves, while well intended, have been scattershot and insufficient. 'The pieces are there,' said Monica Soni, chief medical officer of Covered California, the state's Affordable Care Act health insurance marketplace. 'I am worried we started a little too late, and I think it's a little too siloed.' A study published in 2022 by the California Health Care Foundation found that substantial progress had been made on some of those goals, including recruitment of students from low-income households and communities of color. A separate analysis from the foundation showed that, from 2020 to 2023, California jumped about 10 spots in a ranking of states by primary care residents and fellows per capita. However, the latest state data show nearly 15 million Californians live in areas without enough primary care providers to meet patient needs. State budget constraints and potential federal spending cuts, especially to Medicaid, could exacerbate shortages in areas already desperate for clinicians and dampen hopes of building a robust primary care system that state officials and virtually everyone in the industry agree would be a strong defense against serious — and costly — illnesses. Federal cuts could also hit medical training and hospital systems. 'Many of us are very scared about threats from both the Trump administration and Republicans in Congress,' said Kevin Grumbach, a family community medicine professor at UC San Francisco. California's lack of primary care providers, including doctors, nurse practitioners, and physician assistants, is most acute in rural parts of the state, particularly in the north and the Central Valley. Entire rural counties, including Del Norte, Madera, Tulare and Yuba, are designated shortage areas, according to state data. Some densely populated urban areas, including parts of Los Angeles, also confrontshortages. Many Californians face months-long waits for appointments or have to travel long distances or go to emergency rooms for non-urgent medical needs, which means hours spent in crowded waiting rooms for unnecessarily expensive care. In Chico, 90 miles north of Sacramento, the emergency room at the only hospital in town has seen a sharp increase in patients over the past decade, due in part to a lack of primary care providers in the area. 'People who don't have a primary care provider — which is a lot, because there are not enough — end up in the ER when they need routine care,' said David Alonso, a local internal medicine doctor. 'The ER then says, 'OK, you should follow up with your primary care provider,' and they're like, 'We don't have one.'' Yalda Jabbarpour, director of the Robert Graham Center for Policy Studies, a health policy think tank, said failure to invest robustly in primary care has robbed the public of its benefits. The field has historically been underfunded, accounting for less than 5% of national healthcare spending in 2022, according to the Milbank Memorial Fund, a national nonprofit focused on population health and health equity. The consequences are clear. The U.S. spends significantly more per capita on healthcare than other industrialized nations, and yet Americans aren't any healthier. Chronic conditions such as heart disease, diabetes, arthritis and Alzheimer's, as well as mental illness, account for 90% of the $4.5 trillion spent on healthcare every year. Medical students, often faced with staggering educational debt, are increasingly choosing higher-paid specialties over primary care. The average salary of a family medicine physician is slightly over $300,000, compared with more than $565,000 for a cardiologist and over $763,000 for a neurosurgeon, according to one study. 'If you are going to pay over $300,000 to go to medical school, you want to be a neurosurgeon; you don't want to be a family practice doctor,' said William Barcellona, executive vice president of government affairs at America's Physician Groups, a Los Angeles-based professional association representing 360 medical groups and independent practice associations nationwide. Barcellona said the Golden State's high housing costs also make recruiting difficult. But it's not only pay that tempers enthusiasm for primary care. It's also burnout from so many unpaid hours spent recording details of medical visits in electronic health records; haggling with insurance companies for treatment authorization; answering phone calls and emails from patients; or searching far and wide — often in a healthcare desert — for specialists with the right expertise. Debby Lee, the daughter of Hmong immigrants from Laos, experienced this kind of frustration firsthand. Cultural and linguistic barriers faced by her family motivated her to pursue internal medicine. Lee worked part of her residency at a community clinic serving Hmong in the Sacramento area. She loved the patients, as well as her co-workers. But she was burdened by outdated technology that limited the number of patients she could see. 'I just saw myself kind of burning out being in that setting,' Lee said. When the clinic invited her to stay, she declined, taking a job with a bigger health system. Besides residencies, other efforts support primary care. The Health Plan of San Mateo offers grants to help medical practices retain and add to primary care staff. In exchange, the practices — some single physicians serving patients in California's Medicaid program, Medi-Cal — must show they have increased their patient load and retained newly hiredproviders for five years. The idea is to provide capital so doctors can hire the staff they need to run their practices efficiently, increase salaries, offer bonuses, and even take sabbaticals. Such efforts are consistent with one of the main thrusts of the 2019 workforce report: to increase investment in primary care. California recently joined several other states, including Connecticut, Oklahoma and Rhode Island, in setting a target to increase primary care spending. So far, those policies have yielded mixed results. Late last year, California's Office of Health Care Affordability set a target to make primary care account for 15% of total healthcare spending by 2034, more than double the current proportion. It imposes no requirements, relying on the goodwill of health plans to work with medical providers. Greater spending on primary care would mean better pay and more people working in the field, said Richard Kronick, a public health professor at UC San Diego and a member of the OHCA board. 'That's a big change. Will it happen? I don't think anyone can predict the future with any certainty.' Stephen Shortell, a professor emeritus of health policy and management at UC Berkeley, said 'some of that increase might occur, but at some point, it might need to be made mandatory.' In its report, the workforce commission also cited the importance of alternative forms of primary care payment that offer extra cash for quality care. The affordability office has set targets to encourage such payment methods. The aim is to transform the system from one in which every medical service has a price tag to one that treats people holistically, and in which adherence to medical standards brings more money to doctors and their office staff. Such arrangements are common among HMOs, though less so in primary care practices. Where they do exist, different health plans and other payers generally design them differently, which means primary care practices manage multiple payment models, adding to their administrative burden. Reddy's family practice is participating in a one-year demonstration project launched in January intended to reduce that burden by having multiple insurers work together in one payment plan. The project brings together three large insurers — Health Net, Aetna and Blue Shield of California — and 10 independent practices across the state with the goal of improving care while boosting revenue for the medical groups. It is administered by two industry groups, the Integrated Healthcare Assn. and the California Quality Collaborative. On top of customary payments, either for services rendered or monthly per-member allotments, the medical practices receive bonuses for meeting targets or improving their performance on core measures. Participating practices also receive monthly per-patient payments for 'population health management,' which means managing the collective health of their patients. And they can search a single platform to find all their patients covered by one of the three plans. In addition to extra payments and fewer administrative hassles, the health plans pay for a 'practice coach,' whose job is to help primary care groups meet their targets and provide more seamless care. The idea is to add more insurers and medical groups over time, said Todd May, Health Net's medical director for commercial health plans, who is among those driving the project. 'In addition to better outcomes, we'd like to see a stronger, more robust, and more satisfied primary care workforce,' he said. Reddy hopes she can increase Acacia's revenue by 20%, thanks to the extra money from this and other pay-for-performance arrangements. That, she said, would enable her to raise pay for her staff and hire new clinicians. For many years, her practice has limited the number of patients it has accepted. But after searching for the better part of five years, Reddy has hired a new doctor on a half-time basis, and another is coming on board this June. 'This is the most hopeful I have felt in decades,' Reddy said. Wolfson and Sánchez write for KFF Health News, a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF — the independent source for health policy research, polling, and journalism. Phillip Reese contributed to this report.
