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Western HealthCare Leadership > 2014

for boycotts from some in the physician community,” said Lee. “And yet today, it’s something we all take for granted – the fact that we have a Medicare system to make sure that our seniors get access to high quality care.” According to Lee, Covered California and the contracted health plans could have definitely benefited from another 6 months to a year of lead time, but such a delay would have also meant a delay in getting literally millions of people insured. “We’re continuing to work to build and improve a system that we think is going to be here for many, many years to come, and I look forward to us working together to improve a system that will be historic in changing what health care is for California and the nation,” said Lee. Lee admits that there is still a lot of work to do, particularly in the area of network adequacy. “We’re going to be relying on the regulatory standards of network adequacy and see how those work – do we need to lean in and do more? That’s what we’re looking at right now,” said Lee. “We are looking to plans to keep updated their provider directory information. This is an area where, without a doubt, plans are stumbling. This is an area where the plans could have used more time and they doing fixes.” Lee insists Covered California recognizes and takes to heart that the ACA is not just about coverage. It’s about getting people the care they need. “We need to make sure that once people are covered, that people are actually getting care. Again, this isn’t about coverage, it’s about addressing disparities in care, about addressing wellness and prevention, and getting people the care they need.” Part of this will be done by looking at claims data and using consumer surveys, says Lee. “We have in process a long-term set of analytics and methodologies to understand what consumers are really facing – looking at the clinical information on what care are people getting, and on a timely basis, are they getting the care as needed?” Lee told attendees that Covered California will be 20 | THE BULLETIN | MAY/JUNE 2014

reviewing very substantial clinical analytics for all the care that is being provided to Covered California enrollees. Through the analytics, Lee hopes that we can ensure that the promise of coverage isn’t an empty one, and that patients’ needs are being met. “This is a moving process, a process that we are learning and we appreciate learning from you what’s working and what’s not working,” said Lee. “But also we look forward in many ways to making history with you.”



Visit the California Medical Association Flickr page at to see the photographs from this year’s conference!



Mark your calendars and plan to join us for the 18th Annual Western Health Care Leadership Academy, planned for May 29-31, 2015, at the Loews Hollywood Hotel. Additional information will be posted at www. when available. Our keynote speaker will be Malcolm Gladwell, international bestselling author whose books have changed the way we think about sociological changes and the factors that contribute to high levels of success.

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2014 May/June  

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