Lawsuit seeks records of penalized LA County health plan – InsuranceNewsNet

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WASHINGTON, April 21th (TNSPol) — The National Health Law Program issued the following press release:

Two USC centers have filed a lawsuit demanding that the LA Care Health Plan release its unredacted quality of care scorecards.

LA carethe nation’s largest public health care plan, serves nearly 2.4 million low-income people Los Angeles County residents across California Medical program, but none of these patients have access to his hidden information about the quality of care provided by the more than 50 medical provider groups in his network.

On April 19of them USC centers filed a lawsuit under the California Public Records Act demanding that LA Care make its dashboards public so consumers can make more informed decisions about their care and taxpayers can be sure their money is alright. spent. Public scrutiny can also bring needed accountability for poor performers who endanger patient health.

The USC Center for Health Journalism and the USC Center for Health Financing, Policy and Management are suing over the release of the scorecards under the California Public Records Act. The Health Journalism Center is seeking records to further its journalistic mission of fostering accountability in the WE health care system and advance health equity and community health and well-being. The Health Financing Research Center seeks the data to further ongoing research to improve transparency for consumers in health care and improve the efficiency of the nation’s health care system.

LA Care annually compiles health care quality and patient satisfaction data into a dashboard that ranks the performance of each medical group in its plan. Since 2016, USC-affiliated centers requested the publication of this data (https://centerforhealthjournalism.org/2018/07/10/free-data-public-accountability-sorely-needed-medicaid-providers), but the health plan refused to disclose unredacted dashboards that reveal the performance of contracted provider groups.

LA Care refuses to provide data widely shared by Medicare, commercial providers

One in three Californians receive their care through Medical, the federal government program that provides health care to low-income children and families. Even though commercial health plans and Medicare have long made this data available, LA Care refuses to share its quality data.

“These are public records of a publicly funded entity and should not be kept secret,” said Michelle Levandefounding director of the USC Annenberg Center for Health Journalism and editor of CenterforHealthJournalism.org.

“Publish public dashboards for LA Care provider groups would be a first step in opening the health care quality black box for low-income children and families in California,” she says.

The trial comes at a time of growing recognition of the need for far greater accountability for Medical managed care plans such as LA Care to ensure they put patients first. To that end, the two centers plan to use the scorecard data to create an interactive web application to help patients decide where to seek care.

In response to law enforcement requests for public records from both centers, LA Care produced the dashboards but removed the names of all listed provider groups, making the dashboards of little or no use to consumers. and researchers. This lawsuit would force LA Care to provide the names with the scorecards.

“LA Care hampers transparency and necessary research because the records it produced removed all names of provider groups that serve its members,” said Glenn Melnick, California Blue Cross Chair in health care financing USC. “Low-income families who receive their health insurance through Medical deserve access to this data so they can make informed decisions about where to seek care. This information should also be made available to taxpayers paying for this program so they can understand the performance differences.”

Transparency needed for health plan found guilty of ‘unprecedented violations’

The need for accountability in the LA Care system was highlighted in March, when LA Care was assessed $55 million to sanctions by the California Department of Health Services and the California Department of Managed Health Care (DMHC) for violation of state health care laws and regulations. In its enforcement case against LA Care, DMHC stated that “[t]The widespread, systemic and relentless nature of these violations is unprecedented and has caused harm to [L.A. Care]Registrants.” LA Care reportedly appealed the penalties but not the findings.

“It is essential that patients know how different provider groups operate so that they can make informed decisions about where to seek care for themselves and their families. This data is readily available and easy to access. share with consumers. It’s unfortunate that legal action is needed to ensure that consumers have this most basic information,” Melnick said.

“Without public scrutiny and patient access to information, how can we ensure that good performers are rewarded and poor performers have their contracts terminated?” Levande asked.

The plaintiffs are represented by the professor Claire Pastor to USC Gould School of Law Access to justice course and Abbi Coursolle and Jane Perkins to the National Health Law Program. California has one of the strictest public records laws (PRAs) in the country, Pastore noted. “California courts have repeatedly ruled that the PRA is intended to cover every conceivable type of document involved in the governmental process. We are confident that the court will decide that LA Care must produce these scorecards,” she said.

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