Center in the News

Features report "Final Summative Evaluation of California’s Public Hospital Redesign and Incentives in Medi-Cal (PRIME) Program"

The concept of insurance is that everybody pays a little bit towards something, and it’s not a huge burden on a single group,” said Nadereh Pourat, director of the Health Economics and Evaluation Research Program at the UCLA Center for Health Policy Research. “If everybody has better quality of care, the expectation is that the costs are going to be lower.

On this episode of Managed Care Cast, we speak with Nadereh Pourat, PhD, MSPH, associate center director and the director of the health economics and evaluation research program at the UCLA Center for Health Policy Research, and Alex Sripipatana, PhD, MPH, director of the division of data and evaluation at HRSA. Pourat, Sripipatant and colleagues recently published the HRSA-funded study “Intersection of Complexity and High Utilization among health center patients aged 18 to 64” in The American Journal of Managed Care®.

Eliminating the premiums is likely to create more stable coverage for families over time, regardless of whether their income inches up or down, said Nadereh Pourat, associate director of the UCLA Center for Health Policy Research.

“It’s a good idea for those children not to cycle in and out, and the parents don’t have to worry about losing coverage if they can’t afford it in a given month,” she said.

Roughly 108,000 Medi-Cal patients were enrolled in county pilots and 15,000 in managed care pilots during a two-year period, according to an early analysis by UCLA researchers. As a result of the success, federal officials granted a waiver allowing CalAIM to move forward for the next five years. 

Pilot efforts to improve care coordination for California Medi-Cal beneficiaries with historically poor health outcomes, including many individuals with serious mental illness, appear to have weathered the initial challenges associated with the COVID-19 pandemic. A report released this month by the UCLA Center for Health Policy Research states that by the end of 2020, specialty and primary care services for these populations had returned to pre-pandemic levels.

But Nadereh Pourat, director of the Health Economics and Evaluation Research Program at the UCLA Center for Health Policy Research, said if CalCare is implemented well, it could be even more financially beneficial than the current system. A comprehensive system in which everyone is equally covered brings equality and simplicity, two attributes the current system does not offer.

“If you look at the big picture, if you get a product like CalCare that’s really comprehensive and covers everything, and you don’t have any cost sharing, why wouldn’t you go for a better product?” Pourat said.

A new study by the UCLA Center for Health Policy Research examines how the state’s Whole Person Care program, a pilot project launched in 2016 to integrate medical care, mental health services and social supports like housing aid for Medi-Cal beneficiaries from these vulnerable populations, responded to the pandemic’s challenges. In many cases, the findings show, Whole Person Care’s 25 county-based pilot programs were able to successfully pivot in order to continue providing health and social services and enroll participants.