Connect with us

Published

on

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

Continue Reading

Entertainment

GB News show with Rishi Sunak broke broadcasting rules, Ofcom finds

Published

on

By

GB News show with Rishi Sunak broke broadcasting rules, Ofcom finds

GB News could face punishment after a programme with Rishi Sunak broke broadcasting rules.

Regulator Ofcom said it was considering a “statutory sanction” after finding ‘People’s Forum: The Prime Minister’ breached impartiality guidelines.

GB News called it “an alarming development” that “strikes at the heart of democracy”.

The hour-long show, which aired on 12 February, saw members of the public put questions to the prime minister. However, it received 547 complaints.

Ofcom said in March that five other GB News programmes featuring politicians acting as presenters – including two hosted by Jacob Rees-Mogg – also broke impartiality rules.

The watchdog said the show featuring Mr Sunak was fine in principle, but “due weight” should have been given to an “appropriately wide range of significant views” other than the Tories’.

These should have happened during the programme itself or “in other clearly linked and timely programmes”.

It said Mr Sunak “had a mostly uncontested platform to promote the policies and performance of his Government in a period preceding a UK General Election”.

“We have therefore recorded a breach of rules 5.11 and 5.12 of the Broadcasting Code against GB News,” it added.

Follow Sky News on WhatsApp
Follow Sky News on WhatsApp

Keep up with all the latest news from the UK and around the world by following Sky News

Tap here

Read more from Sky News:
Infected blood scandal ‘not an accident’, inquiry finds
Assange wins bid to bring appeal against extradition to US

The channel was quick to hit back at the ruling and denied breaking the impartiality rules.

“The regulator’s threat to punish a news organisation with sanctions for enabling people to challenge their own prime minister strikes at the heart of democracy at a time when it could not be more vital,” it said.

“Our live programme gave an independently selected group of undecided voters the freedom to challenge the Prime Minister without interference,” added the channel.

It said neither producers nor the prime minister had seen the questions beforehand and Mr Sunak was kept “under constant pressure and covered a clearly diverse range of topics”.

Continue Reading

Sports

Source: Boeser (blood clots) not expected in G7

Published

on

By

Source: Boeser (blood clots) not expected in G7

Vancouver Canucks right wing Brock Boeser is not expected to play in Game 7 of their second-round series against the Edmonton Oilers on Monday because of a blood-clotting issue, a source told ESPN, confirming a report.

There’s no timeline for his return to action. The Canucks had no comment on Boeser’s status.

Boeser didn’t skate in practice Sunday. Coach Rick Tocchet would only say at a media availability that “he needed the maintenance day.”

Boeser, 27, leads the Canucks in goals (7) and is tied for the lead in points (12) during the postseason. He established career highs in goals (40), points (73) and games played (81) during the regular season.

The Canucks winger has had some MVP moments during their playoff run. His hat trick in Game 4 against the Nashville Predators led them to a comeback win. Boeser’s three points in the first period of Game 3 led Vancouver to a win over Edmonton.

It’s the second significant injury for Vancouver in the playoffs after a regular season of relatively good health for the team’s core players. Starting goaltender Thatcher Demko, a finalist for the Vezina Trophy as the NHL’s best netminder, hasn’t played since Game 1 of the first round because of a knee injury. Edmonton won Game 6 at home Saturday night to force Monday’s Game 7, the only seventh game of the second round of the Stanley Cup playoffs. The winner faces the Dallas Stars in the Western Conference finals.

The Boeser injury news was first reported by Vancouver-based hockey journalist Irfaan Gaffar.

Continue Reading

Sports

U.S. advances at hockey worlds; Canada now 6-0

Published

on

By

U.S. advances at hockey worlds; Canada now 6-0

PRAGUE — Dylan Cozens scored two goals and had an assist to rally Canada past Switzerland 3-2 for its sixth win in six games at the ice hockey world championship on Sunday.

Canada leads Group A with 17 points, two more than the Czech Republic in second with Switzerland another point back in third. The three teams had already clinched a spot in the playoff round.

Cozens has scored six goals at the tournament and is tied atop the scoring table with American Brady Tkachuk and Finland’s Oliver Kapanen.

Nick Paul also scored for Canada and goaltender Jordan Binnington made 20 saves including a penalty shot in the second period when the score was 2-2.

Cozens found the roof of the net on a power play 1:42 into the game to give Canada an early lead.

Switzerland answered with two goals.

Kevin Fiala wristed an equalizer past Binnington in the opening frame on a power play.

Romain Loeffel put the Swiss 2-1 up in the middle period with a slap shot from the blue line.

Cozens tied it again at 2-2 from the top of the left circle on a power play.

Paul scored the winner for Canada on a power play, completing a series of passes by scoring into an open goal midway through the second.

Canada will complete the preliminary round on Tuesday against the Czech Republic, when Switzerland will face Finland.

In Group B, Latvia prevailed over Slovakia 3-2 in a penalty shootout. The result sent the United States to the next round.

Tkachuk scored three power play goals and added an assist to help the United States rout Kazakhstan 10-1.

Its fourth victory lifted the Americans to second place in Group B with 13 points, one ahead of Germany and Slovakia with a game against Latvia, which has nine points, on Tuesday to play in the preliminary round.

Johnny Gaudreau had a goal and four assists to become the United States record scorer with 43 points, one more than Patrick Kane.

Matt Boldy scored twice and had four assists, Brock Nelson and Luke Kunin both had a goal and an assist, and Gavin Brindley and Kevin Hayes also scored.

Alex Nedeljkovic made 13 saves.

In a four-goal opening period, Tkatchuk tipped in a shot by Zach Werenski on a power play to increase the U.S. lead to 2-0, and buried a rebound to make it 4-0 on a power play.

He completed his hat trick to increase the advantage to 8-0 with a one-timed shot from the right circle on another power play in the final period.

Alikhan Omirbekov scored the consolation goal for Kazakhstan when his team was 9-0 down.

In Group A, Austria beat Norway 4-1 and is tied for fourth place with Finland.

The top four from each group advance to the playoff round.

Continue Reading

Trending