Blog: OnCentral | 89.3 KPCC

OnCentral content migrating to main KPCC site

KPCC — Wed, 14 Aug 2013 06:00:32 -0700

A doctor at South Central Family Health Center examines a patient on June 12th, 2012.; Credit: Mae Ryan/KPCC

KPCC

As of today, KPCC is moving community health coverage to our main news site, KPCC.org. As a result, the OnCentral blog will no longer be updated, and the Twitter and Facebook accounts associated with On Central also will be inactive.

KPCC launched OnCentral as part of an effort to focus on broad issues of health and quality of life, particularly in South Los Angeles. That coverage will remain part of KPCC's ongoing mission and will appear on our main news site.

Existing OnCentral blog posts will remain archived here.

Please let us know if there are issues you feel merit coverage. You can comment below, by email, on our Facebook page or on our Twitter feed (just "@" mention @KPCC).

This content is from Southern California Public Radio. View the original story at SCPR.org.

FAQ: What is Healthy Way LA? What are the links to Medi-Cal and health care reform?

José Martinez — Tue, 13 Aug 2013 06:00:30 -0700

The lobby of South Central Family Health Center in South Los Angeles. Next year, around 133,000 residents in the health center's state assembly district are expected to gain access to Medi-Cal under the Affordable Care Act – which means they're all currently eligible for Healthy Way L.A., a county bridge program.; Credit: Mae Ryan/KPCC

José Martinez

Forget controversial – the Affordable Care Act is just plain confusing. But that can be expected when federal, state and local governments come together in a collaborative effort.

One of the major changes tied to Obamacare is a significant expansion of the federal government's Medicaid program. And here are some answers to your questions.

Q: So what is the Medicaid expansion?

This is one of the law's landmark provisions. It will expand the eligibility requirements for Medicaid – the nation's public health insurance plan – which mainly serves the poor. That's going to give tens of millions of uninsured people across the country coverage. California's Medicaid program – which is called Medi-Cal – is expected to grow by about 1.4 million people.

Q: What about in L.A. County?

A good part of the Medi-Cal expansion will come from Los Angeles. According to Louise McCarthy, the president and CEO of the Community Clinic Association of L.A. County, about 550,000 county residents are expected to be eligible for Medi-Cal coverage under the Affordable Care Act starting on January 1, 2014.

Q: So it's just a waiting game for them?

Not at all. They can actually get free medical services right now. L.A. County has a program called Healthy Way L.A., which in 2010 was restructured as a sort of "bridge to Medi-Cal." Healthy Way L.A. is not health insurance, but it does give those people who will gain Medi-Cal insurance next year a head start, so to speak. It does that by giving them free access to services at county clinics and certain community health centers starting right now – as soon as they sign up.

Q: What kinds of services?

Those enrolled in Healthy Way L.A. get access to primary care, preventive care, specialty services, vaccines, mental health care, and even subsidized E.R. visits in certain cases. Those in the field of health care administration have called it "Medi-Cal Lite," which is still more than many people are getting.

Q: So how do you qualify for Healthy Way LA?

Residents of L.A. County who qualify for Healthy Way L.A. are the same ones who will be newly eligible for Medi-Cal next year. This is just their "bridge," so to speak. The requirements include:

They have to be county residents.
They have to be between 19 and 64 years old.
They have to have been a U.S. citizen or a legal resident for at least 5 years.
They can't be pregnant.
They can't currently be eligible for Medi-Cal.
They can't earn more than 133 percent of the federal poverty level.

Q: What happens from here with Healthy Way LA? What's the timeline?

Well, health providers want to get as many people enrolled in Healthy Way L.A. as possible, as soon as possible. The idea is for these people to quickly find themselves a "medical home" – if they hit the ground running now, and start receiving services and finding "their" doctor, by the time they get full-on Medi-Cal coverage they'll be able, in theory, to just keep doing what they're doing. There won't be any disruption of service, in other words.

Q: What happens on January 1st?

Healthy Way L.A. will in large part cease to exist, and it'll be replaced by Medi-Cal, says McCarthy, of the Community Clinic Association. The idea is for a seamless transition between Healthy Way L.A. and Medi-Cal – those patients are supposed to just roll over automatically. Health leaders are optimistic it'll happen, but the mechanics of that transition are still unclear.

Q: Does it seem like people know about this?

The numbers are pretty telling. There are 550,000 people eligible for Healthy Way L.A. in the county – but according to McCarthy, only 250,000 are enrolled. That leaves officials with less than four months to get those folks on board and into the program before Medi-Cal expands. Health advocates are getting ready to kick a major outreach campaign into high gear to let people know about all the options that Obamacare will bring them. For many people, Healthy Way L.A. will be part of that conversation.

Q: Is that bad if the Medi-Cal expansion goes into effect and those who are eligible haven't yet signed up for Healthy Way LA?

Not necessarily. It mostly means that those people have missed out on months of free medical services. But if you're eligible for the Medi-Cal expansion, you can still enroll starting on January 1, 2014. Healthy Way L.A. is just a way to get to the front of the line and start receiving services now.

Q: One more question: Are officials worried about people falling through the cracks?

Yes, especially when it comes to unauthorized immigrants. But there are resources for them as well. Healthy Way L.A. has two "forms": Matched and Unmatched. Those with Healthy Way LA Matched are the ones who will transition to Medi-Cal next year.

Unmatched is for the undocumented. The criteria are basically the same as they are for Healthy Way L.A. Matched. The difference is Unmatched beneficiaries cannot be U.S. citizens or legal residents. While the Matched program will cease to exist once the Medi-Cal expansion goes into effect, the Unmatched program is slated to continue providing coverage.

This content is from Southern California Public Radio. View the original story at SCPR.org.

Institute of Medicine: US lags in evaluating obesity prevention efforts

José Martinez — Sat, 03 Aug 2013 06:00:27 -0700

A report finds that the U.S. does a poor job of tracking which obesity programs work best.; Credit: Chris/Flickr Creative Commons

José Martinez

When it comes to preventing obesity, the U.S. is lagging behind other nations in figuring out how effective its efforts are in convincing people to lose weight.

A new report from the Institute of Medicine says if the U.S. were more systematic and consistent at doing that, it would have a better chance at selecting the best programs to invest in. (Read the report below.)

On a related note, the institute also says overall investment in obesity programs is too sporadic.

South Los Angeles has the highest child obesity rate in L.A. County – and its adult rate is second highest, and well above the county average. About 1 in 3 southside adults are obese, compared to about 27 percent of U.S. adults.

The IOM report characterized the challenges facing U.S. health officials as largely structural. Among the authors' findings and comments:

Obesity prevention data is not monitored at neither the community nor the national levels. It should.
The monitoring programs that do exist lack: leadership, coordination, infrastructure, guidance, accountability and capacity.
Communities that want to monitor the progress of their obesity prevention programs often lack the resources to do so.

The IOM wrote that national and community evaluation plans should be "interdependent," noting that's when they'll have the best shot at preventing obesity. The authors wrote that will require "organizational change and support across multiple federal, state, and local governmental agencies and departments," in collaboration with other partners.

Better evaluation of obesity prevention efforts will make them more likely to be adopted on a more widespread level, concluded the authors.

Evaluating Obesity Prevention Efforts - A Plan for Measuring Progress

This content is from Southern California Public Radio. View the original story at SCPR.org.

UCLA: Great Recession may mean more Californians eligible for Medi-Cal expansion

José Martinez — Thu, 01 Aug 2013 11:51:14 -0700

Researchers from UCLA say a demographic shift among California's uninsured means that the Affordable Care Act's Medi-Cal expansion may "encompass a larger number of people than was anticipated" before the law was enacted.; Credit: John Moore/Getty Images

José Martinez

The economic recession that began in California in 2008 may have implications for the Medi-Cal expansion scheduled to take place at the beginning of next year under the Affordable Care Act. According to the authors of a new brief from the UCLA Center for Health Policy Research, this means the Medi-Cal expansion under the ACA may "encompass a larger number of people than was anticipated" before the law was enacted.

State legislators have currently opted to expand Medi-Cal to an additional 1.4 million Californians. The South Los Angeles area is home to roughly 209,000 of those people, according to separate data provided by UCLA.

Further, the number of those who were uninsured swelled, from 6.4 million in 2007 to 7.1 million in 2009. And more jobs may not necessarily help. Even a worker with wages at or near minimum wage working full time may be eligible for MediCal under the expansion (depending on family size).

The Great Recession that also swept across the country "did not affect all counties in California equally." The report says Los Angeles County, for example, saw a "moderate impact." In 2009, this meant:

More than 40 percent of L.A.'s uninsured were between the ages of 26 and 44. Another 22 percent were between 45 and 64.
More than 44 percent earned 133 percent of the federal poverty level or less; another 42 percent made between 134 percent and 400 percent of the federal poverty level.
About 63 percent were U.S.-born or naturalized citizens.

Statewide, by 2009, the recession meant that uninsured Californians were more likely to be U.S.-born citizens, more likely to have lower household incomes and more likely to be unemployed.

Unauthorized immigrants are not eligible for Medi-Cal.

The authors concluded with a note that it "remains to be seen" whether the change in demographics of the uninsured population is only temporary.

This content is from Southern California Public Radio. View the original story at SCPR.org.

'A critical moment': Officials talk preparations for implementation of health care reform

José Martinez — Mon, 29 Jul 2013 13:37:41 -0700

A medical assistant at UMMA Community Clinic in South L.A., checks on a patient's progress. On Monday morning, Congresswoman Maxine Waters hosted a roundtable discussion with local and state officials and workers to focus on one question: What's the status of health care reform implementation in California and L.A. County?; Credit: Christopher Okula/KPCC

José Martinez

Congresswoman Maxine Waters convened federal, state and county leaders on Monday morning to discuss the status of health care reform implementation in California and, more specifically, Waters' congressional district.

The verdict? There's still a whole lot of work to be done.

"Getting the word out is perhaps the greatest challenge we face over the next six months," said Waters, speaking to representatives from a host of agencies and groups, including the California Endowment, Covered California, the Insure the Uninsured Project and the Community Clinic Association of Los Angeles County.

Editor's Note: OnCentral receives financial support from the California Endowment.

Dr. Robert Ross, the president and CEO of the California Endowment, called it a "critical, critical moment."

"This is our Super Bowl," he said. "Certainly nothing this big has happened since Medicare or Medicaid. That was 50 years ago, so you do the math."

There's plenty of math to do. David Panush, the external affairs director for Covered California, offered the following figures:

There are 40 "working days" until open enrollment for Covered California begins.
Los Angeles County has contracted with six health insurance plans: Anthem Blue Cross, Blue Shield of California, Kaiser Permanente, L.A. Care, Molina Healthcare and Health Net.
In California, there are approximately 5.3 million uninsured.
Covered California will require its plans to cover 10 essential health benefits.
The City of Bell has the highest concentration of any zip code in the state of folks who are eligible for a Covered California subsidy.
2 in 3 potential Covered California consumers live in Southern California.

Panush pointed out that only about 30 percent of those who are eligible will self-enroll in Covered California, meaning outreach is going to be a major part of getting people into the program.

Getting the word out

Sherrie-Ann Gordon, the manager of multicultural markets and specialty programs for the AARP, was also present at Monday's meeting. She detailed what she calls her organization's "ground game."

"For us, it's not just about educating people with the right information," she said. "It's about debunking the myths."

Gordon mentioned an "ACA (Affordable Care Act) Academy," AARP's informal way of teaching people the "basics" of health care reform.

"It's just the things you need to know if someone asks you a question," she said, pointing to places where that sort of conversation may happen – a church, for example.

Gordon said AARP's national office is also putting out materials – complex information pared down to "its simplest form" – and creating webinars designed to inform folks on the ins and outs of health care reform.

"Not everybody has digital access, but everybody has access to hubs," she said, referring to community spaces where a webinar could be shown to a lot of people at once. That's the same idea behind "tele-town halls," where AARP wants to get thousands of people on the phone at once to explain health care reform and take questions.

"For us, it's about scaling up," said Gordon. "Educating 50 [people] is great, but we've got to get to 50,000."

The doctors are 'nervous'

Sherrie-Ann Gordon was speaking figuratively, but in Los Angeles, that number will be closer to 500,000. That's according to Rockard Delgadillo, the CEO of the L.A. County Medical Association, which represents area physicians.

"The doctors are ready to help," said Delgadillo. "And they are nervous. There will be 500,000 newly-insured coming our way."

He offered some context to the figure.

"Well, that's the size of the entire city of Sacramento," he said.

The U.S. is in the midst of a physician shortage, said Delgadillo, and doctors are getting older. When the Affordable Care Act inevitably complicates things, he explained, those older doctors may just retire.

"Going to see your doctor is not the easiest thing to do today," he said. "Now add 500,000 newly-insured on top of that."

The concern of community clinics

Safety-net clinics like South Bay Family Health Care want to make sure some of those newly-insured come through their doors. John Merryman, the health center's senior director for marketing and public relations, says it is South Bay's mission to provide care to people who can't afford it. In order to provide that sort of uncompensated care, the clinic also needs to treat people who can afford it.

But before those patients can pay for care, they have to enroll – and that's the challenge, especially with a patient population that tends to be more transient than it is in other places.

"We have phone numbers that are out of order, we have addresses that aren't accurate anymore," said Merryman. "We have to find a way to reach these folks."

That may mean making appearances at – again – their churches, for example.

"We know everyone gets their information differently," said Louise McCarthy, the president and CEO of the Community Clinic Association of Los Angeles County. "The clinics really want to make sure the clinics remain the providers of choice once [patients] get insurance."

This content is from Southern California Public Radio. View the original story at SCPR.org.

HPV vaccination rate among teenage girls in US is almost double that of South LA

José Martinez — Thu, 25 Jul 2013 10:14:10 -0700

In 2012, about 54 percent of U.S. teenage girls had received at least one dose of the vaccine, but "missed vaccination opportunities remain high," say CDC officials.; Credit: Joe Raedle/Getty Images

José Martinez

More teenage girls have gotten vaccinated against human papillomavirus (HPV) in recent years, but "missed vaccination opportunities remain high" in many communities, including South L.A.

A new report from the Centers for Disease Control and Prevention (CDC) found that only about 54 percent had received at least one dose of the three-dose vaccination in 2012.

That's almost double South L.A.'s vaccination rate: A little more than 29 percent of girls between 13 and 17 years of age have received at least one dose of the HPV vaccine, according to the county's public health department.

South L.A.'s is also the lowest rate of any area in Los Angeles County, whose overall vaccination rate is about 45 percent.

According to the CDC, there are more than 40 types of HPV, the most common sexually-transmitted infection. An estimated 79 million Americans currently live with the infection, which can cause genital warts and certain cancers, including cervical and oropharyngeal.

CDC officials were encouraged by the fact that, between 2007 and 2011, the percentage of girls who'd gotten at least one dose of the vaccine increased every year, from about 25 percent to 53 percent. But coverage leveled off between 2011 and 2012, noted officials, despite plenty of opportunities to get the vaccine:

[A 2012 health survey] shows that 84% of unvaccinated girls had a health-care encounter where another vaccine was administered. Had the 3-dose HPV series been initiated at these visits, coverage for [at least one] dose could be as high as 92.6%.

The authors said in 2012, only about 1 in 3 teenage girls had received all three doses of the HPV vaccine.

The CDC says if 80 percent of adolescent girls received all three doses of the vaccine, it could prevent an estimated 53,000 cases of cervical cancer among girls 12 or older.

This content is from Southern California Public Radio. View the original story at SCPR.org.

More expensive Plan B One-Step will be only morning-after pill available over-the-counter in South LA

José Martinez — Wed, 24 Jul 2013 15:30:42 -0700

For the next three years, said the FDA on Monday, Plan B One-Step will be the only brand of the morning-after pill that will be allowed to be sold over the counter with no age restrictions.; Credit: Justin Sullivan/Getty Images

José Martinez

For the next three years, Plan B One-Step will be the only brand of the morning-after pill that will be allowed to be sold over the counter with no age restrictions.

That's what the Food and Drug Administration (FDA) decided on Monday, noting that this period of "exclusivity" will last until April 30, 2016.

FDA spokeswoman Stephanie Yao noted in a statement to KPCC that drug companies seeking to manufacture new, generic versions of the one-step (one-pill) morning-after contraception may still win FDA approval. But they will not be able to sell their product to girls younger than 17 – at least until Plan B's exclusivity expires in 2016.

What this boils down to:

Anyone can buy the brand-name, Plan B One-Step pill.
The only people who will be able to buy generic versions of the one-step morning-after pill are girls 17 and older, and no prescription is required – only age verification.
Girls younger than 17 won't have any access to generic one-step morning-after pills – at all.
As noted by NPR, the two-pill (two-step) version of the morning-after pill will remain available to any girls who can verify that they're 17 or older or any girl younger than that with a prescription.

It's complicated, in other words.

In South L.A., the morning-after pill can be an effective tool in combatting the area's high teen pregnancy rate. The latest public health data indicates the area sees more than 51 teen births for every 1,000 live births, which is by far the highest teen birth rate in Los Angeles County.

But it's not a cheap pill. According to the Boston Globe, Plan B retails for about $50 a pill. That's considerably more expensive than its generic counterparts, which can sell for as low as $20 each. But those less expensive options still carry age restrictions and/or require a prescription.

That can be a problem for girls and women who don't have reliable access to health care because time is of the essence when it comes to the morning-after pill: It's most effective at preventing unintended pregnancies when taken within 72 hours of having unprotected sex.

Plan B, which is manufactured by Teva, was approved for over-the-counter sale to all women of reproductive age in June, after a long, complex battle between federal health officials, the Obama Administration and the courts.

There are some critics of the resulting convoluted restrictions on who can buy what pill.

Dr. Cesar Barba, the interim medical director at UMMA Community Clinic in South Los Angeles, describe the approval of Plan B One-Step for wider sale and the remaining restrictions on cheaper generics as taking "one step forward and kind of a half-step back" in a June interview.

"It's important for access," Barba said at the time. "It's important to be able to give people options without having to go to their doctor in regards to birth control options."

This content is from Southern California Public Radio. View the original story at SCPR.org.

Mayo Clinic study highlights 146 reversals of medical procedures from past 10 years

José Martinez — Wed, 24 Jul 2013 06:00:29 -0700

A woman waits outside the mammogram and women's health services area on the first day of the fourth annual free Care Harbor clinic in South L.A. in 2012. Dr. Felix Aguilar, the president and CEO of UMMA Community Clinic, said he's seen the recommendations regarding mammogram frequency change during his time working on the southside. ; Credit: ROBYN BECK/AFP/Getty Images

José Martinez

Over the past decade, medical experts have reversed course on certain practices and procedures – like hormone therapy for menopausal women, which is no longer a widely recommended treatment.

A new report appearing in Mayo Clinic Proceedings counted how many times this occurred over the past 10 years, and found that doctors reversed course on 146 previously established practices, treatments and procedures.

"That's just the nature of medical knowledge," said Dr. Felix Aguilar, the president and CEO of UMMA Community Clinic in South Los Angeles. "We learn new things, we learn that things do not work, or that things we were doing were actually causing harm. Things get reversed – that's what happens. We move forward with new knowledge."

Aguilar pointed to hormone therapy as an example. He said patients will often come into UMMA with questions about menopause.

"When I was in training, we were told that hormones were good for women who were on menopause," he explained. "And so we would recommend that to everybody. And then it was found that no, that causes harm."

That revelation came after large clinical trials analyzed the benefits of the therapy, which was found to be worse for menopausal women than no medical intervention at all. At the time, said Aguilar, the common knowledge about hormone therapy came from smaller, less reliable studies.

Evolving medical practices

The Mayo Clinic study highlighted a few key medical reversals – that is, according to the authors, "when an existing practice is found to be no better than a lesser therapy:"

Stenting for stable coronary artery disease.
Routinely installing a pulmonary artery catheter for patients in shock.
Using the drug aprotinin during heart surgery.
Using COX-2 inhibitors, a type of drug which targets certain enzymes responsible for causing inflammation and pain.
Applying particularly stringent blood sugar targets for diabetic patients.

Dr. Vinay Presad, the study's lead researcher, said in a statement that the 146 reversals identified by his team "by no means represent the final word for any of these practices."

"But, the reversals we have identified, at the very least, call these practices into question," he said.

Aguilar, who's worked in South L.A. for around six years, said he's seen other medical practices evolve in recent years:

Diabetes treatment. Aguilar says when he was in medical school, insulin "was not the first-line treatment for diabetes." That sort of regimen was reserved for people who had advanced forms of the condition. That led a lot of folks to believe that insulin "was bad for you," he said – which can present a problem, since insulin has since "become the first-line treatment for people whose diabetes is out of control."

Pap smears. "The recommendation was to get Pap smears every year," said Aguilar. And then it wasn't – once a woman has two normal Pap smears, he explained, they only need to get the screening every three years. "When I tell a woman, 'OK, you don't need this,' a lot of patients look at me like, 'Are you sure?'" said Aguilar. "Some women have been getting Pap smears for decades."

Mammograms. "We used to do yearly mammograms for women 40 and above, and then the data showed that was probably causing more harm than good in most women," said Aguilar. "So we moved to 50 and above."

Digital rectal exams. "Those were a pretty standard part of the male exam," said Aguilar. "Then, a couple years ago, data started showing they were probably unnecessary because they were not as diagnostic as we thought they were." Now, he added, those sort of exams are only used in "very specific situations" where certain symptoms are present – not as screenings.

Although it's medicine's nature to be constantly evolving, said Aguilar, he acknowledged that patients may not always realize that.

"It does create confusion when the medical knowledge changes," he said. "It does also create misunderstandings, because now we're telling people they don't need [certain tests] any longer."

This content is from Southern California Public Radio. View the original story at SCPR.org.

Kogi food truck chef Roy Choi works with South LA teens to open new healthy cafe

Hayley Fox — Mon, 22 Jul 2013 06:00:28 -0700

Working at 3 Worlds Cafe is 20-year-old Oscar Guizar's first job. He said he's grateful for the opportunity.; Credit: Hayley Fox/KPCC

Hayley Fox

The 3 Worlds Cafe is the product of a brainstorming session between food truck guru Roy Choi, and a group of South L.A. high school students.

Choi — best known for his popular Kogi food trucks that feature mash-ups of Mexican and Korean cuisine — began working with students at Jefferson High School two years ago. Together, they developed a menu of healthy drinks teenagers would want to buy.

“It wasn’t a huge political campaign," said Choi. "All I had in my mind was how do you get them to eat fruit and drink smoothies when they have chips and ice cream sandwiches?"

This is where smoothies like the Mango Bomb and Freshy Fresa Banana were born. They’re modeled largely after the familiar fruit carts and paletas (Mexican popsicles) found all over L.A. The smoothies at the cafe are made with fresh fruit and natural sweeteners, like agave and coconut milk, to make them more enticing to youth.

Even the shop's simple set-up on Central Avenue seems to embody a young, vibrant energy. Brightly painted walls are covered with murals created by Roy Choi's tattoo artist. Classic hip-hop station KDAY plays on the stereo. The employees are free to wear their own clothes. There's plenty of nods to Jefferson High School as well, including a "J" in one of the murals, and framed historic photos from the South L.A. campus.

And while the heart of the operation comes from Choi and the teens, it took a hefty financial contribution from Dole Packaged Foods to really get the business up-and-running. In addition to tens of thousands of dollars in start-up funds, the corporation also contributed the first two months of ingredients. After that, they will sell the fruit and yogurt at-cost to the cafe.

“It’s an opportunity just to connect locally with our community and give some personality and a connection to the brand Dole that’s beyond this kind of worldwide brand," said Dole's Director of Field Sales, Stuart McCallistar.

The Coalition for Responsible Community Development (CRCD) is also helping keep the business afloat. Based in Vernon-Central, the CRCD works with local businesses and residents to help foster development and improve quality of life in the area.

The non-profit controls 3 Worlds' lease and subsidizes a portion of the expenses. Executive Director Mark Wilson says the initial revenue will go towards keeping the business afloat and hiring teens from Jefferson High School.

"The purpose of the business as a whole is to create an entrepreneurial training hub for young people in the neighborhood and to create jobs," said Wilson.

The CRCD hopes to use the cafe to teach job skills to youth in the area. For some, this could be as simple as operating a cash register or showing up on time for a shift. Twenty year-old L.A.-native Oscar Guizar is one such employee. Making smoothies at 3 Worlds is his first legit job.

“You know, a lot of places they want to do background checks, they want to make it so hard for someone like myself to become employed so therefore on these streets we resort in selling drugs or robbing people or whatever the case might be," said Guizar. "That’s what I was involved in but luckily I was fortunate enough to come across this opportunity and now I’m trying to better myself.”

For now, the cafe sells a simple menu of coffee drinks, pastries and smoothies. But chef Choi says future plans include adding vegetables to the menu, and eventually free-range meats.

This content is from Southern California Public Radio. View the original story at SCPR.org.

Income, education affect people's ability to get eye care: study

José Martinez — Fri, 19 Jul 2013 11:35:37 -0700

A new study found that people who earn less and don't have a high school diploma are less likely to have access to vision care, leaving them vulnerable to age-related eye conditions. ; Credit: Justin Sullivan/Getty Images

José Martinez

Age-related eye conditions like cataracts, glaucoma and macular degeneration are preventable, treatable and even reversible – but only if you have access to an eye doctor.

A new study appearing in JAMA Ophthalmology reinforces the notion that folks on the lower end of the educational and socioeconomic scales are less likely to have access to eye care, leaving them with little to no access to interventions that can preserve or repair their vision.

Other research has found that access to vision care is an important determinant in whether people maintain good eyesight and visual health.

In South Los Angeles, access to both optometrists and ophthalmologists is extremely limited. That's in part because vision care is usually part of an employer-provided insurance package, something a lot of southside residents don't have.

The other option would be to pay for vision insurance out-of-pocket, said Nina Vaccaro, the executive director of the Southside Coalition of Community Health Centers, who noted that's "not a priority for most people."

"Those are services that, for most of us, we only need once every few years," said Vaccaro in an interview late last year. Those are also services come in particularly handy when conditions like cataracts, glaucoma or macular degeneration start popping up.

But besides that, Vaccaro said people in South L.A. have more important things to think about.

"People probably prioritize paying their rent, paying their car insurance, putting food on the table, getting school supplies for their kids," she said. "Within the safety net, buying any kind of insurance is a luxury."

The study in JAMA Ophthalmology found that people who had lower incomes or less than a high school education were less likely to report visiting an eye doctor or getting an eye exam. The Los Angeles Times says in South L.A., more than 50 percent of residents who are 25 and older don't have a high school diploma, and more than 40 percent of area households make $20,000 or less annually.

"There is a need for increased awareness about the relationship between social circumstances and [age-related eye disease] and for more research to determine how income and educational inequalities affect health-seeking behavior at the community and individual level over time," wrote the authors in their conclusion.

In South L.A., there's also a disparately high rate of diabetes – about 12 percent of the adult population has the condition, which raises people's risk of vision problems and even blindness.

This content is from Southern California Public Radio. View the original story at SCPR.org.

Report: 4 percent of kids had no consistent access to health care in 2011; South LA rate was 7 percent

José Martinez — Fri, 12 Jul 2013 11:56:24 -0700

According to a new report, 9 percent of children nationwide were without health insurance "at any time during 2011." In South Los Angeles, nearly 7 percent of children were uninsured – higher than the countywide average of 5 percent.; Credit: AFP/AFP/Getty Images

José Martinez

More than 1 in 5 children in the U.S. lived in poverty in 2011, and that rate was disproportionately higher among ethnic children.

That's just one finding from a new report compiled by the Federal Interagency Forum on Child and Family Statistics (FIFCFS), which looked at how children were faring in a wide range of measures, including health, economics and safety. (Read the full report below.)

The county's public health department says in South Los Angeles, more than 31 percent of households had incomes below the federal poverty level in 2011. That's the highest such rate in the county, and well above the rate detailed in the report from the FIFCFS.

Here's how South L.A. compared to the overall U.S. on a few key health-related measures:

Nationwide, 9 percent of children were without health insurance "at any time during 2011." In South Los Angeles, nearly 7 percent of children were uninsured – higher than the countywide average of 5 percent.
That same year, about 4 percent of children in the U.S. had no consistent source of health care. In South L.A., that was true of more than 7 percent of children.
About 87 percent of U.S. children (between 5 and 17) saw a dentist in 2011 – a year when about 15 percent of South L.A. children weren't able to obtain dental care because they couldn't afford it.
South L.A. had a considerably lower rate of teenage girls who received at least one dose of the HPV vaccine: about 29 percent, compared to 53 percent nationwide.
About 1 in 10 children in the U.S. have asthma; that's true of about 9 percent of South L.A. kids.

The report noted that overall, the number of children living in the U.S. "declined slightly," while the percentage of Asian, multiracial and Latino children increased.

One more finding from the FIFCFS report: The authors said the "diet quality scores of children and adolescents would be improved by increasing the intake of vegetables." But in South L.A., only about 78 percent of adults say it's "easy to get fresh produce" where they live. That's by far the lowest rate in the county.

America's Children: Key National Indicators of Well-Being, 2013

This content is from Southern California Public Radio. View the original story at SCPR.org.

10 South LA clinics get more than $1.6 million for patient outreach

José Martinez — Thu, 11 Jul 2013 10:31:06 -0700

UMMA Community Clinic was one of 33 L.A. County health centers to receive federal funding to help patients learn about their insurance options under the Affordable Care Act.; Credit: Christopher Okula/KPCC

José Martinez

The federal government is giving a lot of money to community health centers so they can teach patients about the ins and outs of health care reform – and Los Angeles is no exception.

The U.S. Department of Health and Human Services announced on Wednesday that more than 1,100 health centers across the U.S. were awarded grants totaling $150 million in order to fund the effort to enroll millions of people into health insurance.

Thirty-three of those grants went to L.A. County, which collectively received more than $6.2 million. Of those 33 health centers, 10 are either located in South L.A. or serve patients from the area. The list includes:

Central City Community Health Center, Inc. ($143,612)
Eisner Pediatric & Family Medical Center ($185,456)
JWCH Institute, Inc. ($282,245)
Northeast Community Clinic, Inc. ($99,326)
South Bay Family Health Center ($136,814)
South Central Family Health Center ($171,574)
St. John's Well Child and Family Center ($300,769)
T.H.E. Clinic, Inc. ($120,391)
UMMA Community Clinic ($94,000)
Watts Healthcare Corporation ($142,710)

That adds up to more than $1.6 million for South L.A. All eight member sites of the Southside Coalition of Community Health Centers were among L.A. County's recipients.

Louise McCarthy, the president and CEO of the Community Clinic Association of Los Angeles County, said the clinics will use that money to both train existing staff on how to do effective outreach and hire new staff to expand outreach capacity.

"Each clinic that received this funding received an amount based on the number of patients they serve, the number of folks they have who are uninsured and their capacities related to enrollment," she explained. "They are going to be catering their efforts to the individual community they serve, because every community is going to respond to [outreach efforts] a little bit differently."

For the most part, people who are uninsured are looking at two options: Covered California, the statewide health insurance marketplace, or Medi-Cal, which is slated to expand its rolls by more than 1 million Californians starting in 2014.

In South L.A., more patients are expected to benefit from the Medi-Cal expansion than from Covered California. An estimated 1.2 million currently uninsured Angelenos are expected to become eligible for one of the two.

McCarthy noted that this latest grant brings the total health care reform-backed funding for L.A. County's health centers to $72 million.

"What's good about this [grant] is it's not just about [Medi-Cal], its not just about Covered California," she said. "It's about whatever people are eligible for, and helping them navigate."

In other words, clinics can use this money to help patients get health insurance through whatever means possible.

There are 51 community health centers across L.A. County, and each year they collectively provide care for more than 1 million patients, most of whom are uninsured.

The Health Resources and Services Administration has the full list of the 125 health centers in California that received funding through this grant.

This content is from Southern California Public Radio. View the original story at SCPR.org.

Study delves into why low-income patients prefer the emergency room to primary care

José Martinez — Tue, 09 Jul 2013 14:04:08 -0700

Researchers said patients on the low end of the socioeconomic scale find hospital and E.R. care to be more affordable, trustworthy and convenient than primary care.; Credit: David McNew/Getty Images

José Martinez

When low-income patients compare hospital care to primary care, they find the former to be more affordable, convenient and trustworthy than the latter.

And that, according to a new study from the University of Pennsylvania, is why those patients tend to use emergency rooms and hospitals more heavily than primary care.

Low-income patients are the norm in South Los Angeles, particularly at community health centers like UMMA Community Clinic. Dr. Tipu Khan is a family physician and the lead obstetrics provider there. He says the patient mentality described in the study is certainly a reality, but "changing a little bit."

"I think it really varies," said Khan. "That's what it used to be prior to the advent of patient-centered medical homes."

Khan said before community health centers started "really boosting up" their presence in South L.A., most safety-net care was provided by county clinics, which he described as "overrun, overburdened and overstaffed." He would know, because he used to work in the county system. Now, though, UMMA is doing better at keeping patients away from unnecessary visits to the E.R. or the hospital, in part through educating patients on why primary and preventive care make for better health outcomes in the long-run.

"The community feels UMMA is closer to their culture and their society because we do a lot of outreach," Khan said.

The researchers on the UPenn study suggested that improving hospital care to reduce readmissions – a big tenet of health care reform – could "backfire," in that doing so would make hospital care "even more attractive" to low-income patients.

"To generate system-wide savings, it's important to make outpatient services [care that doesn't require a hospital stay, like primary care] more appealing to [low-socioeconomic status] patients by addressing their concerns around cost, quality and accessibility," said Dr. Shreya Kangovi, the study's lead author, in a statement.

Meaning that in addition to improving hospital care, health providers also need to work on making primary care the better option for patients. If they don't, noted the study's authors, poorer patients will continue forgoing preventive care and using urgent care, a pattern of behavior that costs the U.S. nearly $31 billion annually and still results in poor health.

Dr. Tipu Khan says that he still has to send patients to the E.R., particularly when wait times at the very busy UMMA Clinic are long and the health center just won't be able to get to someone.

"But it is frustrating, because I know there's nothing that they're going to do [at the E.R.] that we couldn't do here," he said. "Unfortunately, it is definitely a big burden [on the health care system] and a waste of resources, but it's all we have at this point."

Here are some more findings from the UPenn study:

Patients who were surveyed said they trusted the quality of hospital care more than outpatient care, and viewed hospitals as more able to handle complex conditions.
Patients said outpatient care was more likely to have longer wait times and be less accessible via transportation. Emergency care, on the other hand, could be accessed by ambulance and was described as a "one-stop shop" for services.
For uninsured patients, who couldn't afford the fees to see a doctor or specialist, hospital charity care became the only option. For patients on Medicaid, the overall cost of outpatient care was higher due to the additional time and testing that was required.

One important finding from the study: It "debunks" the notion that low-income folks "abuse the emergency room," according to senior author Dr. David Grand.

"To the contrary, these patients eloquently explained to us how we have built a health care system that incentivizes them to wait and get sick in order to get care that is more costly to society," said Grand in the news release accompanying the study.

The research appeared in the journal Health Affairs.

This content is from Southern California Public Radio. View the original story at SCPR.org.

Obamacare delay will have 'some impact' on South LA patients, says clinic CEO

José Martinez — Mon, 08 Jul 2013 14:50:25 -0700

Medical records. A one-year delay in the Affordable Care Act's requirement that large and medium companies provide their employees with health insurance will have "some impact" in South Los Angeles, according to St. John's Well Child and Family Center CEO Jim Mangia.; Credit: Mae Ryan/KPCC

José Martinez

Large and medium companies will have one more year until they're required to provide their employees with health insurance under Obamacare, the Obama Administration announced last Tuesday, which gives those companies until 2015 to fulfill the requirement or face fines.

The requirement — which is part of the Affordable Care Act (ACA) and was originally set to go into effect on the first day of 2014 — means that companies with 50 or more workers must provide affordable health insurance to their full-time employees or else risk tax penalties.

In South Los Angeles, the delay will have "some impact." That's according to Jim Mangia, the president and CEO of St. John's Well Child and Family Center.

"There are patients of St. John's who will have to have insurance through their employers that are not currently providing it," he said. "A large number of our uninsured patients are currently employed."

Meaning those South L.A. patients who work in companies with at least 50 employees would have received health insurance through their employers by the beginning of next year. Now, because of the delay, that likely won't be the case until at least 2015.

"I think you'll see another year of significant numbers of people who are employed and are not being provided insurance by their employers," said Mangia. "And community health centers will continue to eat the cost of that. And hopefully, the Medicaid expansion and other parts of health care that will be implemented will help offset some of that, but I think providers are going to be carrying this for an additional year in serving the uninsured before businesses are forced to insure them."

According to Mark Mazur, the U.S. Treasury's assistant secretary for tax policy, the reason for the delay is the level of concern among business groups "about the complexity of the requirements and the need for more time to implement them effectively."

Mangia called the delay "unfortunate," adding that St. John's "will continue to provide the services and the care to the population."

"But we want to see this law implemented," he said.

This content is from Southern California Public Radio. View the original story at SCPR.org.

Step therapy: A delicate balance between patient care and health care costs (POLL)

José Martinez — Mon, 01 Jul 2013 06:00:27 -0700

The onsite dispensary at UMMA Community Clinic in South Los Angeles. Insurance companies regulate how doctors prescribe certain medications, and most of the time, that works out just fine for patients. But there are exceptions.; Credit: Christopher Okula/KPCC

José Martinez

Loretta Jones doesn't hesitate upon being asked to describe her life living with fibromyalgia.

"It is so painful," she says. "It's so deep into your joint areas."

Jones, 72, is the CEO of Healthy African American Families, a South Los Angeles-based advocacy program that focuses on the health of minority communities.

"Say you had to get up, and someone took a knife and stuck it into you," she said. "And twisted it. That's how this pain feels."

To alleviate the long-term, body-wide pain that fibromyalgia causes, Jones' doctor prescribed the drug Lyrica. But Jones, who has good health insurance, said it took her a year-and-a-half to fill the prescription, because her insurance company had her on a regimen known as step therapy.

What is step therapy?

Dr. Derrick Butler, the associate medical director at T.H.E. Clinic in South L.A., said step therapy is implemented by insurance companies to regulate how doctors prescribe medicine.

"In prescribing, we have to usually start with the generic, base medicines," he said. "And until the patient has [tried those] and failed, or has tried those and had adverse events or side effects, then we are allowed to prescribe to the next level."

Butler described the procedure: Each new prescription ups the ante a little bit. Every new prescription is a step, and insurance companies will only cover certain drugs – usually brand-name, newer, more powerful or more expensive ones – after a certain number of steps have been completed.

For Loretta Jones, that process took too long.

"[I told my insurance company that] the pain keeps me up at nighttime," she said. "I'm crying, sitting in the bathtub, with my feet in the bathtub running cold water on them to stop the pain."

AB 889

If Assemblyman Jim Frazier has his way, stories like Jones' will be a thing of the past. Frazier, who represents California's 11th District, introduced AB 889, a state bill that would, among other things, limit the number of steps in step therapy. (See the full text of the bill below.)

"There are some processes that have even five to six steps before you can receive the intended medicine that your doctor prescribed," he said. "What we're trying to do is at least parallel what Medicare has – no more than two steps is what we're hoping for."

Although Governor Jerry Brown vetoed a similar bill last year, Frazier is optimistic his bill will reach the governor's desk. It was approved by the state Senate Health Committee on Wednesday, and is headed to Senate Appropriations Committee next.

Frazier said patients' quality of life is the driving force behind the legislation. He remembered overhearing a conversation about a mental health patient who couldn't get the medicine he needed and was going through step therapy.

"They were being manhandled to go through this process," said Frazier. "They weren't being cured, they weren't being helped."

Why is step therapy important?

Insurance companies respond to claims about problems with step therapy with concerns about patient safety. Patrick Johnston is the president and CEO of the California Association of Health Plans, whose members collectively cover about 21 million Californians.

"We have a virtual epidemic of prescription drug abuse, and much of it is concentrated [among] young people whose brains are still forming in their teenage years and then into young adulthood," he said. "To the extent that those individuals or anyone is prescribed a serious pain medication, it's important to worry about the possibility of abuse."

The association is officially against AB 889. Johnston said he's wary of applying a single rule – the two-step limit – to step therapy. He added that gradually moving patients from benign to intense medications is an effective, safe way to dole out prescriptions – and that when certain situations call for it, there are ways steps can be accelerated or even skipped.

"To jump immediately to Oxycontin or some of the really useful, but dangerous drugs, would be a mistake," he said.

Dr. Derrick Butler, from T.H.E. Clinic, noted that in addition to patient safety, step therapy also helps with another very big aspect of health care: "It's all about cost."

Here's how: Generic medication is generally much, much cheaper than brand-name drugs. If the generics are effective, insurance companies can save hundreds – even thousands – of dollars per patient by making them try those before even giving them the option of more expensive brand-names. Multiply that by the number of people covered by an insurance plan, and it's easy to see how step therapy can keep costs down.

"I think it's necessary," said Butler of step therapy, "because I think we do need to control costs in health care. In order for us to really expand health care as we're going to do, we have to control costs."

It's also uncommon for patient health or safety to be affected by step therapy.

"I'd say 80 percent of patients can control their chronic conditions with generic medications," he said.

Folks like Loretta Jones, of course, are unfortunate exceptions. But Dr. Butler says in those situations, patients and doctors just have to "make enough noise" to the insurance companies, who will usually acquiesce to persistence.

What do you think about step therapy?

AB 889

This content is from Southern California Public Radio. View the original story at SCPR.org.