Improving Healthcare Cost And Quality: The CalPERS Health

Healthcare is a top priority in any administration.

Healthcare is a top priority in any administration. The major challenge many states including California have to battle with is the increasing cost of access quality healthcare.

It is common to find quality health care service providers and hospitals charging high rates. Should quality healthcare services be costly? This was one of the focal points believed to have been addressed at the California Healthcare Summit scheduled for September 12, 2017.

The highlights included a close look at the reasons for the increasing healthcare expenses for patients, families, and employers, among others.

Many speakers were invited to speak at the conference including Liana Bailey-Crimmins, the Chief Health Director at California Public Employee Retirement System (CalPERS).

When it is healthcare in California, you sould think CalPERS.

CalPERS Overview

CalPERS (California Public Employee Retirement System)

CalPERS (California Public Employee Retirement System) is the body saddled with the responsibility and management of health care benefits for retirees and employees in California State.

The services of the organization may also accommodate public agencies and school districts. Currently, the health system caters for about 1.4 million people with an annual budget within the $9 billion mark.

The healthcare benefits, plans, and activities are run by healthcare insurance companies. The companies include Blue Shield, Anthem Blue Cross, United Health and others who offer a dual role as a service provider and insurer such as Sharp and Kaiser Permanent.

CalPERS health care system is administered by three Preferred Provider Organizations (PPO) and nine Health Maintenance Organizations (HMO). The two health care systems make affordability of healthcare available to subscribers.

An HMO service is provided by hospitals and doctors within the HMO network. The service provides subscribers reduced rates. The HMOs include:

  • Anthem Blue Cross
  • Health Net
  • Sharp
  • Kaiser Permanente
  • United Healthcare
  • Western Health Advantage

Health Maintenance Organizations provide healthcare services from specific hospitals and doctors who have a contract with CalPERS on the healthcare plan.

Beneficiaries go with co-payment plan for the service rendered.

But there is no claim forms, no deductible, and there is no restriction based on geographical area although services of HMOs are not available all over California.

The PPO (Preferred Provider Organization)

Much like HMO, this is also a type of medical care system where medical facilities and professionals offer medical services at reduced rates to subscribers. The three PPOs are:

  • PERS Select
  • PERSCare
  • PERS Choice

The plan on PPO service is comparable to a fee-for-service type of plan. The clause here is that beneficiaries must access the services of the PPO network or go with an option to pay higher co-insurance charges.

Drive Towards Improving Quality And Reducing Cost

Improved quality of service at an affordable cost is aimed at in the various changes in plans.

CalPERS strive always to meet the needs of the people within its coverage in California.

Improved quality of service at an affordable cost is aimed at in the various changes in plans on the healthcare system.

To make this happen, CalPERS occasional let go of plans that may probably not be efficient and adds others to bring the needed change in the system.

As at 2012 till now, CalPERS has begun the implementation of Value-based Purchases (VBP) for the PPO plans it runs on the healthcare system.

The purpose is aimed at making incentives available for patients and service providers.

This particular addition was applied in the knee or hip replacement surgery cost limit that was put at $30, 000 back then.

Using Data To Bring-Down Healthcare Cost In California

Chief Director at CalPERS, Liana bailey-Crimmins

To come up with an effective means of achieving an affordable healthcare, innovation with technology seems to be working to reduce the cost of accessing healthcare in California. This was the move by the Chief Director at CalPERS, Liana bailey-Crimmins.

Coming up from a background in IT world as a computer science bachelor’s degree holder, she believes data can be the way to changing the increasing cost of healthcare without compromising the quality of healthcare services for the Californian people.

Ever since she assumed the top position at the information arm of the health care system in 2013, she engaged with data to analyze the trends in healthcare in the state and offered policies to reduce the increasing cost.

Currently, she is experimenting with how to reduce drug prices by introducing a procedure called reference pricing. The move with the reference pricing is geared towards covering three categories of drugs.

These are thyroid medications, estrogens, and corticosteroids. It helps patients have alternative means to cheaper drugs that are equally effective for treatment.

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