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Dear providers, It has been a dramatic summer. While anxiously awaiting federal health care reform, and priding ourselves on universal coverage for children in San Francisco, Healthy Families took a big hit. We were very close to seeing disenrollments from the Healthy Families program, while 80,000 children waited on a wait list. John Grgurina, San Francisco Health Plan’s CEO, worked tirelessly with our association of Local Health Plans to lobby for a legislative solution that allowed Healthy Families to continue. That bill, AB 1422, was passed by the legislature and signed by the Governor, thus reopening the Healthy Families Program and maintaining universal coverage of children in San Francisco. We continue to face tight times, and Healthy Families and Healthy kids members saw an increase in premiums and copays, but at least we know that all of San Francisco’s children can be covered. While the state reduced optional benefits to adult Medi-Cal services on July 1st (including adult dental coverage), SFHP was able to continue coverage of diabetic eye exams, podiatry, speech, audiology and incontinence supplies. Many members will struggle to pay for dental care, and our network’s dental sites will face enormous financial challenges. Fee for Service MediCal members lost all of the above benefits. We are setting up personal visits with all providers with over 100 members, to sit down with you, hear your concerns, share HEDIS results, and brainstorm about ways to improve care for our members. We are collecting best practices to share, and you can check out our website to see what we have amassed so far: SFHP Best Practices We are proud to say that thanks to your exemplary care, five more Medi-Cal measures landed in the 90th percentile this year (top 10% in the nation) and we won the California Gold Award for Quality from the State Department of Health Care Services, for the second year in a row. Our own Betsy Price, RN, MPH, Sr. Clinical Compliance Manager, was also recognized by the state for her work as a Master Trainer. Click here for more details. We will have a new challenge in 2010 – California is now requiring MediCal plans to include BMI percentile measurements, as well as counseling on diet and exercise, as a new HEDIS measure for 2010. With the epidemic of childhood obesity upon us, we are counting on providers to document yearly BMI measurements, and associated counseling, part of routine pediatric care. It is estimated that 1 in 3 children are overweight or obese. With approximately 30,000 SFHP members 18 years old or younger, we have at least 10,000 overweight or obese children enrolled with SFHP. Given the demographics and limited resources of our members and their families, this number is probably even greater. There are not enough specialty resources to manage the needs of these children, and childhood obesity has become a primary care issue. There is a wonderful conference opportunity, and we hope every provider who sees children attends if they can – it will be a practical workshop with real-life tools to help busy primary care providers give effective guidance to families. Click here to register: Childhood Obesity 2010: The Next Generation of Prevention and Management Yours in health, |
