Jeffrey S. Hoch, Ph.D.

New CHPR Issue Brief to Inform Medi-Cal Budget-related Decision-making

Karen Shore, Ph.D., and Patricia Powers, M.P.A., with the Center for Healthcare Policy and Research’s Center for Health Decisions, analyzed the impacts on the state’s Medi-Cal program budget of various revenue-generating and expenditure-reducing policies enacted in California over the course of the last decade. Their analysis of this 10-year period, encompassing a major economic downturn as well as more prosperous years, provides valuable lessons in how to maintain this core public program that provides health insurance coverage to 13.5 million people, nearly one of every three Californians. The report describes five major types of policy changes California deployed during this period to manage Medi-Cal program costs and provides examples of each with magnitude estimates:
(1)    Changes in benefits
(2)    Eligibility changes
(3)    Changes to provider/health plan payments
(4)    Delivery system changes
(5)    Other revenue augmentations
One of the major findings is that the proportion of the Medi-Cal budget funded by California’s General Fund declined dramatically, from a high of 39% in fiscal year (FY) 2007-08 to 18% in FY 2017-18. Other, likely less volatile, revenue sources helped to sustain and grow the Medi-Cal program during this period.

Medi-Cal Budget: Lessons Learned from a Review of Policy Changes with Significant Budgetary Impact, 2007-2017, seeks to inform a variety of audiences including state and federal policymakers and staff, state agency staff, health policy analysts and researchers, health care advocates, and beneficiary representatives. To ensure the usefulness of the report to these audiences, a committee composed of current and former budget staff experts from the state legislature, the Legislative Analyst’s Office, the Department of Finance, and the California Budget & Policy Center advised the authors as they designed and conducted the analysis. The committee recommended, for example, that the analysis emphasize long-term structural changes rather than policies that generate one-time savings to achieve a balanced budget in a given year. The final list of major budget policies analyzed includes some that were state-initiated, some that were implemented in response to opportunities made available by the federal government, and others that resulted from ballot initiatives.
The California Health Care Foundation provided funding for this project.
For questions about or comments on the Issue Brief (PDF), please contact Patricia Powers at pepowers@ucdavis.edu.

CHPR Founding Director Receives Lifetime Achievement Award

Klea Bertakis, M.D., M.P.H., the founding director of the UC Davis Center for Healthcare Policy and Research (CHPR), received the Hibbard Williams Award for Extraordinary Achievement at the UC Davis School of Medicine (SOM) Student & Faculty Awards Luncheon held May 18^th. This award, named for the 2^nd Dean of the UC Davis SOM, “recognizes exceptional faculty contributions beyond traditional teaching and research roles.” Dr. Anthony Jerant, CHPR member and chair of the Department of Family and Community Medicine at UC Davis, described recipients of this prestigious award as “those who have made lasting impact at the School and beyond, in areas such as program development, capacity building, leadership, and mentorship,” adding that Dr. Bertakis’ colleagues have long known that she has excelled in each of those roles.
Dr. Bertakis embraced all of those roles when she founded CHPR (then called the Center for Health Services Research in Primary Care) in 1994.

Article in JAMA by CHPR Researchers Informs Prostate Cancer Screening Recommendations

The U.S. Preventive Services Task Force based its new national recommendations about prostate cancer screening on the systematic review of 63 research studies conducted by a team of UC Davis researchers from the Center for Healthcare Policy and Research (CHPR). Led by CHPR faculty member Joshua Fenton, M.D., Professor of Family and Community Medicine, the team’s findings on prostate-specific antigen-based (PSA) screening were published in the Journal of the American Medical Association (JAMA) on May 8, 2018.
Fenton said the USPSTF process is painstaking, methodical and was rigorously vetted with public and expert review prior to, during and after completion of the research. “I’m very proud of our team,” he said, “…and I think we achieved our goal of conveying complete and unbiased information based on current evidence.”
Fenton and his team found, for example, that PSA screening results in false positives in 10-18 percent of all men screened, with higher risk of false positives incurred by men older than 70. Additional harms related to diagnostic biopsies and from treatment are also greater in men older than 70 than in younger men.
Based on these and other findings, the Task Force now recommends against PSA screening for men 70 and older. For men ages 55-69, the Task Force now recommends that the decision to undergo periodic PSA-based screening for prostate cancer should be an individual one that includes a discussion with a clinician about both the potential benefits and the potential harms of screening. Other harms resulting from screening and subsequent treatment can include incontinence and erectile dysfunction.
In addition to Dr. Fenton, authors of the evidence report in JAMA include Heejung Bang, Ph.D., Joy Melnikow, M.D., M.P.H., Meghan Weyrich, M.P.H., and Shauna Durbin, M.P.H., from CHPR and Yu Liu, M.S., from the Dept. of Public Health Sciences at UC Davis.

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