CaliforniaS $12 billion Medicaid makeover banks on nonprofits buy-in

Published

4 months ago

May 16, 2024

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May 16 2024 KFF Health News

For much of his young life, Jorge Sanchez regularly gasped for air, at times coughing so violently that he'd almost throw up. His mother whisked him to the emergency room late at night and slept with him to make sure he didn't stop breathing.

"He's had these problems since he was born, and I couldn't figure out what was triggering his asthma," Fabiola Sandoval said of her son, Jorge, now 4. "It's so hard when your child is hurting. I was willing to try anything."

In January, community health workers visited Sandoval's home in Turlock, a city in California's Central Valley where dust from fruit and nut orchards billows through the air. They scoured Sandoval's home for hazards and explained that harsh cleaning products, air fresheners, and airborne dust and pesticides can trigger an asthma attack.

The team also provided Sandoval with air purifiers, a special vacuum cleaner that can suck dust out of the air, hypoallergenic mattress covers, and a humidity sensor — goods that retail for hundreds of dollars. Within a few months, Jorge was breathing easier and was able to run and play outside.

The in-home consultation and supplies were paid for by Medi-Cal, California's Medicaid health insurance program for low-income residents. Gov. Gavin Newsom is spearheading an ambitious $12 billion experiment to transform Medi-Cal into both a health insurer and a social services provider, one that relies not only on doctors and nurses, but also community health workers and nonprofit groups that offer dozens of services, including delivering healthy meals and helping homeless people pay for housing.

These groups are redefining health care in California as they compete with businesses for a share of the money, and become a new arm of the sprawling Medi-Cal bureaucracy that serves nearly 15 million low-income residents on an annual budget of $158 billion.

But worker shortages, negotiations with health insurance companies, and learning to navigate complex billing and technology systems have hamstrung the community groups' ability to deliver the new services: Now into the third year of the ambitious five-year experiment, only a small fraction of eligible patients have received benefits.

"This is still so new, and everyone is just overwhelmed at this point, so it's slow-going," said Kevin Hamilton, a senior director at the Central California Asthma Collaborative.

The collaborative has served about 3,650 patients, including Sandoval, in eight counties since early 2022, he said. It has years of experience with Medi-Cal patients in the Central Valley and has received about $1.5 million of the new initiative's money.

By contrast, CalOptima Health, Orange County's primary Medi-Cal insurer, is new to offering asthma benefits and has signed up 58 patients so far.

"Asthma services are so difficult to get going" because the nonprofit infrastructure for these services is virtually nonexistent, said Kelly Bruno-Nelson, CalOptima's executive director for Medi-Cal. "We need more community-based organizations on board because they're the ones who can serve a population that nobody wants to deal with."

Newsom, a Democrat in his second term, says his signature health care initiative, known as CalAIM, seeks to reduce the cost of caring for the state's sickest and most vulnerable patients, including homeless Californians, foster children, former inmates, and people battling addiction disorders.

In addition to in-home asthma remediation, CalAIM offers 13 broad categories of social services, plus a benefit connecting eligible patients with one-on-one care managers to help them obtain anything they need to get healthier, from grocery shopping to finding a job.

The 25 managed-care insurance companies participating in Medi-Cal can choose which services they offer, and contract with community groups to provide them. Insurers have hammered out about 4,300 large and small contracts with nonprofits and businesses.

So far, about 103,000 Medi-Cal patients have received CalAIM services and roughly 160,000 have been assigned personal care managers, according to state data, a sliver of the hundreds of thousands of patients who likely qualify.

"We're all new to health care, and a lot of this is such a foreign concept," said Helena Lopez, executive director of A Greater Hope, a nonprofit organization providing social services in Riverside and San Bernardino counties, such as handing out baseball cleats to children to help them be active.

Tiffany Sickler runs Koinonia Family Services, which offers California foster children mental health and other types of care, and even helped a patient pay off parking tickets. But the program is struggling on a shoestring budget.

"If you want to do this, you have to learn all these new systems. It's been a huge learning curve, and very time-consuming and frustrating, especially without adequate funding," she said.

Brandon Richards, a Newsom spokesperson, defended CalAIM, saying that it was "on the cutting edge of health care" and that the state was working to increase "awareness of these new services and support."

For nonprofits and businesses, CalAIM is a money-making opportunity — one that top state health officials hope to make permanent. Health insurers, which receive hefty payments from the state to serve more people and offer new services, share a portion with service providers. Related StoriesStudy links higher-potency cannabis use in youth to increased risk of psychotic experiencesUncovering the psychological toll of entrenched school practices on childrenClinical trial in Seattle aims to transform treatment approaches for pediatric IBD

In some places, community groups are competing with national corporations for the new funding, such as Mom's Meals, an Iowa-based company that delivers prepared meals across the United States.

Mom's Meals has an advantage over neighborhood nonprofit groups because it has long served seniors on Medicare and was able to immediately start offering the CalAIM benefit of home-delivered meals for patients with chronic diseases. But even Mom's Meals isn't reaching everyone who qualifies, because doctors and patients don't always know it's an option, said Catherine Macpherson, the company's chief nutrition officer.

"Utilization is not as high as it should be yet," she said. "But we were well positioned, because we already had departments to do billing and contracting with health care."

Middleman companies also have their eye on the billions of CalAIM dollars and are popping up to assist small organizations to go up against established ones like Mom's Meals. For instance, the New York-based Nonprofit Finance Fund is advising homeless service providers how to get more contracts and expand benefits.

Full Circle Health Network, with 70 member organizations, is helping smaller nonprofit groups develop and deliver services primarily for families and foster children. Full Circle has signed a deal with Kaiser Permanente, allowing the health care giant to access its network of community groups.

"We're allowing organizations to launch these benefits much faster than they've been able to do and to reach more vulnerable people," said Camille Schraeder, chief executive of Full Circle. "Many of these are grassroots organizations that have the trust and expertise on the ground, but they're new to health care."

One of the biggest challenges community groups face is hiring workers, who are key to finding eligible patients and persuading them to participate.

Kathryn Phillips, a workforce expert at the California Health Care Foundation, said there isn't enough seed money for community groups to hire workers and pay for new technology platforms. "They bring the trust that is needed, the cultural competency, the diversity of languages," she said. "But there needs to be more funding and reimbursement to build this workforce."

Health insurers say they are trying to increase the workforce. For instance, L.A. Care Health Plan, the largest Medi-Cal insurer in California, has given $66 million to community organizations for hiring and other CalAIM needs, said Sameer Amin, the group's chief medical officer.

"They don't have the staffing to do all this stuff, so we're helping with that all while teaching them how to build up their health care infrastructure," he said. "Everyone wants a win, but this isn't going to be successful overnight."

In the Central Valley, Jorge Sanchez is one of the lucky early beneficiaries of CalAIM.

His mother credits the trust she established with community health workers, who spent many hours over multiple visits to teach her how to control her son's asthma.

"I used to love cleaning with bleach" but learned it can trigger breathing problems, Sandoval said.

Since she implemented the health workers' recommendations, Sandoval has been able to let Jorge sleep alone at night for the first time in four years.

"Having this program and all the things available is amazing," said Sandoval, as she pointed to the dirty dust cup in her new vacuum cleaner. "Now my son doesn't have as many asthma attacks and he can run around and be a normal kid."

This article was produced by KFF Health News, which publishes California Healthline, an editorially independent service of the California Health Care Foundation.

This article was reprinted from khn.org, 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. Source:

KFF Health News

Entertainment

Artist behind ‘disturbing’ sculpture says it’s not intended to cause upset

Published

11 hours ago

September 22, 2024

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Artist behind 'disturbing' sculpture says it's not intended to cause upset

The artist who created a sculpture which has been called “disturbing” and “shocking” says he’s been “surprised” at the backlash but welcomes difficult conversations it might inspire.

Jason deCaires Taylor told Sky News: “I don’t strive of my artwork to divide people or cause upset. But I do try to talk about issues that are pertinent and relevant to our current times.”

The 50-year-old artist has a history of producing political work but says this one contained “no political intentions at all” and is based on the painting which inspired Shakespeare‘s tragic heroine Ophelia.

The Alluvia – which is made from recycled glass and steel and features LEDs which light up at night – was installed in the River Stour, in Taylor’s hometown of Canterbury in Kent around a week ago.

However, comments posted on Canterbury City Council’s official Facebook page have included accusations that the work is “tone-deaf” and “offensive”.

One wrote: “I can’t be the only person who finds this deeply offensive. She looks like a drowned woman. How did the council not see the link to women as victims of crime or the sad fact so many drown off the Kent coast as refugees.”

Another said: “I find this sculpture absolutely appalling. It’s not just offensive, it’s downright disturbing. The imagery of a submerged figure, reminiscent of a drowning victim, is both morbid and utterly tone-deaf given the tragic drownings that occur along our coastlines. What on earth were the council thinking?”

Others stood up for the work, with one commenting: “More people seem to be “disturbed”, “offended” and “shocked” by this than they do by images of actual drownings which are happening daily along our coasts. Rather than wasting your hate on an artwork that is designed to provoke, why not put some of that energy into something constructive?”

Another wrote: “It’s a beautiful piece of art and nowhere near as disturbing as the previous sculptures that it has replaced. What kind of world do we live in when anything that offends or “triggers” someone, must be removed??”

The sculpture had replaced two similar female forms, also created by Taylor, which had been in the water since 2008 but which had been damaged due to dredging.

‘If it fosters care and sympathy, that’s good’

Taylor told Sky News: “I was surprised… 99.9% of all the feedback that I’ve received has been very positive… But at the same time, I appreciate everybody takes something different from everything they see.”

While he says there is “no connection” between the work and the ongoing migrant crisis taking place further along the Kent coast, he hopes it could inspire empathy for what’s happening out in the Channel.

He said: “It’s an extremely tragic situation, and I don’t think ignoring it is the solution. If [this work] can foster any kind of care and sympathy for that situation, then I think that’s a good thing.”

More than 21,000 people arrived in the UK in small boats between January and September, according to government figures, with at least 45 people dying in Channel crossings this year.

Taylor also said the fact the subject is a young woman is because it draws reference from Sir John Everett Millais’s celebrated painting, on display at Tate Britain.

‘Art without questions is pointless’

Some of Taylor’s past sculptures have raised issues around the climate crisis, Brexit and the plight of those risking their lives on the perilous migration route from West Africa to Spain.

Taylor says: “Art should ask questions. They should make people think about things that should elicit emotions, that’s really critical.

“If things were ignored and if you tried to please everybody with all your artwork, I think you’d make something very benign and quite frankly, pretty pointless.”

He also feels our age of information overload could be part of the reason for the negative feedback.

“We’re so inundated with images and media, with having our phones interrupting us and screens everywhere we look that people look for divisiveness and things that cause clickbait. I think there is an element of people sort of seeking out controversy.”

Taylor said the majority of negative comments online had come from people who had not been to Canterbury and seen the work in real life, with one call for the statue’s removal coming all the way from Orkney.

Responding directly to calls for his work to be taken out of the river, he said: “People are perfectly in their rights to have [an] opinion. But I would urge them to go and see it first.”

‘A dead body doesn’t light up at night’

Chair of Canterbury Commemoration Society Stewart Ross, the charity that commissioned the work, told Sky News: “Some people find it offensive and shocking, we have no objection to that. All public art is open to discussion”.

Comparing calls for the work to be removed to the destruction of art during the Reformation, he said: “I feel strongly about this [call for censorship]. It’s what the Taliban do. If you don’t like it, don’t look.”

Mr Ross said the “confected anger” around the sculpture was “unnecessary” and that the charity was simply “trying to do its best,” adding: “People have been comparing it to a dead body, but I have yet to meet a dead body that lights up in the night”.

Taylor, who has been working as an artist for over 25 years, has sculptures in marine locations around the world including Australia, Mexico, Grenada and Norway. Prices for his sculptures start at around £1,300.

He first donated the two original Alluvia figures to the city of Canterbury in 2008.

Technology

Middle Eastern funds are plowing billions of dollars into hottest AI start-ups

Published

11 hours ago

September 22, 2024

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Middle Eastern funds are plowing billions of dollars into hottest AI start-ups

Sovereign wealth funds out of the Middle East are emerging as key backers of Silicon Valley’s artificial intelligence darlings.

Oil-rich nations like Saudi Arabia, United Arab Emirates, Kuwait and Qatar have been looking to diversify their economies, and are turning to tech investments as a hedge. In the past year, funding for AI companies by Middle-Eastern sovereigns has increased fivefold, according to data from Pitchbook.

MGX, a new AI fund out of The United Arab Emirates, was among investors looking to get a slice of OpenAI’s latest fundraise this week, two sources told CNBC. The round is set to value OpenAI at $150 billion, said the people, who asked not to be named because the discussions are confidential.

Few venture funds have deep enough pockets to compete with the multibillion-dollar checks coming from the likes of Microsoft and Amazon. But these sovereign funds have no problem coming up with cash for AI deals. They invest on behalf of their governments, which have been helped by rising energy prices in recent years. The Gulf Cooperation Council, or GCC, countries’ total wealth is expected to rise from $2.7 trillion to $3.5 trillion by 2026, according to Goldman Sachs.

The Saudi Public Investment Fund, or PIF, has topped $925 billion, and has been on an investing spree as part of Crown Prince Mohammed bin Salman’s “Vision 2030” initiative. The PIF has investments in companies including Uber, while also spending heavily on the LIV golf league and professional soccer.

UAE’s Mubadala has $302 billion under management, and the Abu Dhabi Investment Authority has $1 trillion under management. Qatar Investment Authority has $475 billion, while Kuwait’s fund has topped $800 billion.

Earlier this week, Abu Dhabi-based MGX joined a partnership on AI infrastructure with BlackRock, Microsoft and Global Infrastructure Partners, aiming to raise as much as $100 billion for data centers and other infrastructure investments. MGX was launched as a dedicated AI fund in March, with Abu Dhabi’s Mubadala and AI firm G42 as founding partners.

UAE’s Mubadala has also invested in OpenAI rival Anthropic, and is among the most active venture investors, with eight AI deals in the past four years, according to Pitchbook. Anthropic ruled out taking money from the Saudis in its last funding round, citing national security, sources told CNBC.

Saudi Arabia’s PIF is in talks to create a $40 billion partnership with U.S. venture capital firm Andreessen Horowitz. It also launched a dedicated AI fund called the Saudi Company for Artificial Intelligence, or SCAI.

Still, the kingdom’s human rights record remains an issue for some Western partners and start-ups. The most notable case in recent years was the alleged killing of Washington Post journalist Jamal Khashoggi in 2018, an event that triggered international backlash in the business community.

It’s not just the Middle East spraying money into the space. French sovereign fund Bpifrance has inked 161 AI and machine learning deals in the past four years, while Temasek out of Singapore has completed 47, according to Pitchbook. GIC, another Singapore-backed fund, has completed 24 deals.

The flood of cash has some Silicon Valley investors worried about a SoftBank effect, referring to Masayoshi Son’s Vision Fund. SoftBank notably backed Uber and WeWork, pushing the companies to sky-high, valuations before going public. WeWork spiraled into bankruptcy last year after being valued by SoftBank at $47 billion in 2019.

For the U.S., having sovereign wealth funds invest in American companies, and not in global adversaries like China, has been a geopolitical priority. Jared Cohen of Goldman Sachs Global Institute said there’s a disproportionate amount of capital coming from nations like Saudi Arabia and UAE, and a willingness to deploy it around the world. He described them as “geopolitical swing states.”

WATCH: OpenAI is the indisputable leader in AI supercycle

UK

Ex-Harrods director reveals how ‘paranoid’ Mohamed al Fayed created toxic culture at store

Published

11 hours ago

September 22, 2024

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Ex-Harrods director reveals how 'paranoid' Mohamed al Fayed created toxic culture at store

A former Harrods director told Sky News he does not see how security at the department store “wouldn’t have known” about Mohamed al Fayed’s behaviour towards women.

Five women have alleged they were raped by Fayed, who died last year at the age of 94, with several others alleging sexual misconduct.

A legal team representing alleged victims confirmed on Saturday morning they have “had over 150 new inquiries” since the airing of a BBC documentary on Fayed.

The Harrods’ ex-director, who reported directly to Fayed, said: “There was security everywhere, all the phones and offices were bugged, with cameras everywhere.

“I just put it down to paranoia, wanting to know he was getting his pound of flesh from us. The nature of the man was to set everyone against each other, to set directors against each other.

“Whether Fayed’s own offices or stuff had surveillance, I wouldn’t know. But to get into his suite of offices you had to have an appointment, PAs had to arrange it, it was very secure.”

He added: “The only thing I was aware of was that someone said he had lots of PAs and they were all blondes. I thought that he just wanted to surround himself with pretty women.”

The former director, who spoke to Sky News on the condition of anonymity, said the culture at Harrods was toxic.

“It was very much keep your head down, no one helped each other. It wasn’t a team as you knew Fayed was trying to catch everyone out.

“He was always trying to make fun of people in front of others, which he thought was very funny.”

Harrods said in a statement on Thursday it was “utterly appalled” by the allegations of abuse and apologised to Fayed’s alleged victims.

The department store has also set up a page on its website inviting former employees to come forward if they have allegations.

Meanwhile, Education Secretary Bridget Phillipson has defended Sir Keir Starmer after it emerged the Crown Prosecution Service (CPS) declined to bring charges against Fayed while the prime minister was director of public prosecutions.

The CPS considered bringing charges against the former Harrods chairman in 2009 and 2015 but concluded there was not “a realistic prospect of a conviction”.

The minister told Sky News that tackling violence against women was a “personal priority” while Sir Keir was head of the CPS as director of public prosecutions between 2008 and 2013.

“I don’t know the details of what happened in 2009, there sometimes can be issues with the evidence that’s presented by the police, whether that can lead to a conviction,” Ms Phillipson said.

“The first time that I ever knew who Keir Starmer was when I saw him on television as director of public prosecutions, talking about the personal priority that he attached to tackling violence against women and girls, so he’s got a personal commitment to it.

“He turned the CPS around while he was leading it to focus on that. But, clearly, if there have been issues that should be considered, that should happen.”

A Downing Street spokesperson said Sir Keir did not handle Fayed’s case, adding it “did not cross his desk”.

The CPS also provided early investigative advice to the Metropolitan Police in 2018, 2021 and 2023 following allegations made against Fayed.

However, a full file of evidence was never received by the CPS in each of these instances and they were given no further action by police.

Former Victims’ Commissioner Dame Vera Baird accused the CPS of only taking “cases they could win”, saying the organisation was “a den of negativity for all sexual offence allegations and for the people who made them”.

She told Sky News: “They have always been valued for the proportion of cases they win. So you do 20 [cases] and you [win] 15 – 75%, that’s good. But if you only do 10 because 10 are really, really safe, then you get nine of them – that is a super rate of conviction.

“Their interest mitigated for all of that time against the interests of people who severely needed to have the help of the criminal justice system to get over the awful way that they were treated by their assailants. And now it’s very clear that Mr Fayed was one of those.“

She also said the CPS’s treatment of women may have affected its decision to not take charges against Fayed.

“Women who come forward with complaints of this kind are underestimated and undervalued, and to some extent seen as a liability who [is] likely to be volatile or emotionally not very well, largely because of the way they’ve been treated,” she said.

But Dame Vera defended Sir Keir for his “ahead of the game” approach to violence against women while he was director of public prosecutions.

“They were doing their best and for instance, the CPS was the first ever government organisation to have a violence against women and girls strategy.

“Keir initiated a report by a very highly-regarded lawyer about how the CPS should systematically get away from the myths about prosecution and about sex offences, that it impeded them from taking cases forward. That was a very strong thing to do.”