April 21, 2014
Area(s) of Interest: Professional Development & Education
On the closing day of the Western Health Care Leadership Academy, Covered California Executive Director Peter Lee told attendees that he recognizes that the roll out of the Affordable Care Act (ACA) has been a "bumpy ride," but that he looks forward to working with the physicians of California during this "new era" of health care.
"This is beginning the new era of health care – an era where health care is a right, not a privilege," said Lee. "That is what will make the ACA truly historic."
Lee urged the hundreds of physicians, practice managers and other health care stakeholders in attendance to remember that the ACA is the biggest change in health care since the launch of Medicare over 50 years go.
"If we go back 50 years ago, the launch of Medicare was not smooth, it was not without controversy, it was not without calls for boycotts from some in the physician community," said Lee. "And yet today, it's something we all take for granted – the fact that we have a Medicare system to make sure that our seniors get access to high quality care."
According to Lee, Covered California and the contracted health plans could have definitely benefited from another 6 months to a year of lead time, but such a delay would have also meant a delay in getting literally millions of people insured.
"We're continuing to work to build and improve a system that we think is going to be here for many, many years to come, and I look forward to us working together to improve a system that will be historic in changing what health care is for California and the nation," said Lee.
Lee admits that there is still a lot of work to do, particularly in the area of network adequacy.
"We're going to be relying on the regulatory standards of network adequacy and see how those work – do we need to lean in and do more? That's what we're looking at right now," said Lee. "We are looking to plans to keep updated their provider directory information. This is an area where, without a doubt, plans are stumbling. This is an area where the plans could have used more time and they doing fixes."
Lee insists Covered California recognizes and takes to heart that the ACA is not just about coverage. It's about getting people the care they need.
"We need to make sure that once people are covered, that people are actually getting care. Again, this isn't about coverage, it's about addressing disparities in care, about addressing wellness and prevention, and getting people the care they need."
Part of this will be done by looking at claims data and using consumer surveys, says Lee. "We have in process a long-term set of analytics and methodologies to understand what consumers are really facing – looking at the clinical information on what care are people getting, and on a timely basis, are they getting the care as needed?"
Lee told attendees that Covered California will be reviewing very substantial clinical analytics for all the care that is being provided to Covered California enrollees. Through the analytics, Lee hopes that we can ensure that the promise of coverage isn't an empty one, and that patients' needs are being met.
"This is a moving process, a process that we are learning and we appreciate learning from you what's working and what's not working," said Lee. "But also we look forward in many ways to making history with you."