Author: ITUP

ITUP FY2014-15 Annual Report

ITUP’s FY2014-15 Annual Report is now available for download.

Below, please find a message from our Executive Director, Lucien Wulsin.

Dear Friends and Colleagues,LW Profile

ITUP’s goals for 2014-15 were to build on and accelerate the first year’s successes in Affordable Care Act (ACA) enrollment and to begin building consensus on the necessary next steps in the health reform process to improve health status and lower the costs of care. These included: integrating behavioral and physical health (whole person care), developing the health workforce in medically underserved communities, refining the performance of Medi-Cal managed care, improving the affordability of Covered California and delivery system reforms, and exploring the opportunities of e-medicine.

We were deeply engaged over the past year in the care and financing of the remaining uninsured in Southern California counties, the development of the §1115 waiver renewal concepts, and the transformation of local safety net systems. Many of the concepts developed, discussed, and recommended in our interviews and convenings with Southern California stakeholders were incorporated in the state’s concepts for the waiver renewal.

We updated our ObamaCare educational materials and trained Southern California clinics and community groups through webinars, convenings, and presentations to help consumers enroll in the newly available coverage. We monitor, analyze, and report annually on the trends and impacts of the ACA on usage of hospital inpatient, outpatient, and emergency room services, as well as community clinics. Covered California continued to grow to 1.3 million newly enrolled; Medi-Cal managed care enrollment grew by over 55% and reached over 12 million beneficiaries in July of 2015. Meanwhile, clinics have reported an increase in visits by patients with Medi-Cal and private coverage, accompanied by a 28% decrease in uninsured. In fact, California’s uninsured rate is about half of what it was prior to the ACA, and California is among the top five states most successful in reducing the numbers of uninsured.

There is an emerging need to better explain the new coverage to those newly eligible, and to educate the newly enrolled on the importance of prevention and primary care, rather than waiting for their health to deteriorate to the point of requiring emergency services. We worked with clinics, plans, and community-based organizations through our regional workgroups to identify and to begin addressing these educational needs.

In some communities, the supply of health care professionals is simply insufficient to meet the community’s needs. We prepared a report and convened a workgroup to discuss how to improve participation by solo and small group practices in Medi-Cal managed care. We discussed the potential of e-medicine to help alleviate shortages and highlighted its potential at our annual conference. We also emphasized these workforce needs as an issue to be addressed in the state’s §1115 waiver renewal.

Those with mental illness and substance use disorders receive treatment in three separated programs, with patient confidentiality protections that prohibit information sharing by their providers. Better-integrated and coordinated care has enormous potential and demonstrated capacity to improve their patient outcomes and reduce health costs. We prepared reports, held an issue workgroup, convened Los Angeles stakeholders, and discussed these challenges in our regional workgroups as well as at the annual conference. California has expanded mental health, and recently sought and secured federal approval to expand substance use disorder treatments over the past year. Our workgroups and reports have helped to educate our networks on these developments.

At this year’s annual conference, we featured two well-attended and much appreciated sessions on payment and delivery system reforms in the public and private sectors. In addition, we prepared a report and organized an issue workgroup on payment reforms in Medi-Cal managed care programs.

We also prepared a report and held an issue workgroup on local and state opportunities to improve affordability of Covered California premiums through augmented premium assistance. Healthy San Francisco is the first community to embrace this opportunity.

Our staff has been unstinting in their efforts to support our networks in their efforts to increase care and coverage for California’s remaining uninsured and newly insured. California could not be a leader without the efforts of all of you.

We deeply appreciate and are enormously grateful for the generous support of our funders: Blue Shield of California Foundation, The California Endowment, Kaiser Permanente, The California Wellness Foundation, California Community Foundation, California HealthCare Foundation, and L.A. Care Health Plan.

Best wishes for the New Year and thank you all for the extraordinary opportunity to work with each of you.

 LW signature

Lucien Wulsin Jr.

Executive Director

Advancing the Triple Aim for Employer-Based Health Insurance

Through expanding Medi-Cal and subsidizing private insurance through Covered California for 1.3 million Californians, the Affordable Care Act (ACA) launched the triple of aim of better access, improved care, and reduced costs. As the ACA enters its third year of implementation, California will need to look beyond coverage expansion and evaluate strategies and policies that advance the triple aim framework for employment based health insurance. California’s policymakers and the employer community will need to work together to address needs and challenges that include:

  1. Improving coverage and affordability within the different employer markets (small, midsize, and large)
  2. Implementing payment and delivery system reforms that reward value
  3. Preparing for the impacts of the Cadillac tax
  4. Considering the merits of insurance market mergers.

This report provides background history and key findings from the literature and the latest available survey data on employer health benefits, describes the California context, and outlines issues for policymakers and employers to consider in advancing the triple aim for employer-based health insurance.

Download the report:
Executive Summary
Part 1 | Part 2 | Part 3 | Part 4
Appendix: Healthy San Francisco Premium Assistance

ObamaCare 201 Trainings

ITUP hosted a series of educational trainings entitled ObamaCare 201: Essential Updates Before Open Enrollment, the second set of sessions on the Affordable Care Act (ACA). This series of trainings explained everything there is to know about insurance and coverage under the ACA, discussed immigration status and health coverage, addressed upcoming changes in Covered California and Medi-Cal, and provided a host of resources for enrollment workers, providers, and community leaders. The trainings were held around Los Angeles County for community clinic staff, other medical providers, and community based organizations. This page is a resource for those who attended the trainings and others who find it useful.


Our Fall trainings are now complete. If you are interested in contracting with ITUP for training or have questions, please email



The following materials help you understand and explain ObamaCare. Please distribute widely.

icon_powerpoint Training Presentation              Webinar Slide Deck             Webinar en Espanol Slide Deck

Webinar Video                                                  Webinar Video en Espanol

pdf-icon ObamaCare 101 ToolKit

pdf-icon ObamaCare 201 ToolKit: Essential Updates

pdf-icon California’s Programs for the Uninsured Fact Sheet

pdf-icon ObamaCare & Immigration Fact Sheet

pdf-icon Consumer Fact Sheet

pdf-icon FAQs

pdf-icon Covered California 2015 Plan Designs

pdf-icon Are You Health Smart? Tips for Being a Better Health Consumer


Materials from the 2013 trainings can be found on the ObamaCare 101 page.


These educational trainings are provided with generous support from the California Community Foundation and L.A. Care Health Plan in partnership with the Community Clinic Association of Los Angeles County and Visión y Compromiso

CCF logo LA Care Logo CCALAC Logo PNGvison y compromiso logo

Behavioral Health Workgroup Materials

Posted below are materials from ITUP’s monthly Drug Medi-Cal workgroup.

Agenda from October 2, 2013 Behavioral Health Issue Workgroup
Behavioral Health Workgroup Agenda Behavioral Health Workgroup Agenda.pdf

Materials from the CalMHSA Integrated Behavioral Health Project
Stigma and Attitudes Toward Working in Integrated Care Stigma and Attitudes Toward Working in Integrated Care.pdf
Health Reform and the Transformation of the Delivery of Care Health Reform and the Transformation of the Delivery of Care.pdf
Trainings Needs in Integrated Care Trainings Needs in Integrated Care.pdf
An Update on Integrated Behavioral Health Projects in California Counties An Update on Integrated Behavioral Health Projects in California Counties.pdf
An  Update on Integrated Primary Care and Behavioral Health Services in California Community Clinics and Health Centers An Update on Integrated Primary Care and Behavioral Health Services in California Community Clinics and Health Centers.pdf
IBHP New Resources, Fall 2013 IBHP New Resources, Fall 2013.pdf

Covered California Awards $37 Million in Grants for Outreach and Education

On May 14, 2013, Covered California announced it will be awarding $37 million in grants to 48 organizations for outreach and education efforts to individuals and small businesses. “Together, we can significantly strengthen our effort to ensure as many Californians as possible are aware of and are enrolled in the new health insurance options this fall for coverage beginning January 1, 2014.” said Executive Director Peter Lee. According to the press release, this will be accomplished through the development of educational partnerships that support outreach and education in communities where likely enrollees are located.

Outreach and Education

Covered California aims to reach Californians through outreach and education, to ensure that access to affordable health care is available for individuals and small businesses. With the awarded grants, Covered California’s goal is to increase awareness of new benefits, educate targeted populations about available subsidy programs, and encourage individuals and small businesses to participate in the health insurance exchange.

The number of Californians eligible for individual insurance is projected to be 5.3 million, with half identified as eligible for financial assistance with their premiums. Grant recipients will reach an estimated 9 million individuals and more than 200,000 small businesses. The largest group potentially eligible for federal subsidies is California’s Latino community, which is the target of 37 outreach and education grants. Caucasians are the next largest group, with 24 grants;  African Americans, 24 grants; Middle-Eastern, 11 grants; and Asian-Pacific Islander communities with 20 grants. A detailed list is available at

Organizations that were not awarded grants, may apply to Covered California’s Assisters Program to become Assister Enrollment Entities. Interested organizations can also become part of Covered California’s Community Outreach Network.

See the full press release here


Individual Funding: Access California Services

Anaheim Health Medical Center Foundation

Asian Pacific American Legal Center

Bienestar Human Services, Inc.

Cal State LA University Auxiliary Services, Inc.

California Black Health Network

California Council of Churches

California Health Collaborative

California NAACP

California Rural Indian Health Board, Inc.

California School Health Centers Association

Catholic Charities of California, Inc.

Central Valley Health Network

Coalition for Humane Immigrant Rights of Los Angeles

Community Health Councils

Council of Community Clinics

East Bay Agency for Children

Fresno Health Communities Access Partners

Infoline of San Diego (2-1-1 San Diego)

John Wesley Community Health (JWCH) Institute

Loma Linda University Medical Center

Los Angeles County Federation of Labor

Los Angeles Unified School District

Planned Parenthood Mar Monte, Inc.

Redwood Community Health Coalition

Sacramento Employment and Training Agency

San Bernardino Employment and Training Agency


Santa Cruz County Human Services DepartmentSEIU Local 521

SEIU United Long Term Care Workers

Services Center

Social Advocates for Youth (SAY), San Diego

Solano Coalition for Better Health

St. Francis Medical Center of Lynwood Foundation

The Actors Fund

The East Los Angeles Community Union

The Los Angeles Gay and Lesbian Community  Services Center

The Regents of the University of California

UC Davis, Center for Reducing Health Disparities

United Ways of California

University of Southern California

Valley Community Clinic

Ventura County Public Health

Visión y Compromiso


Small Business Funding:

California Asian Pacific Chamber of Commerce

California Association of Non-Profits

California Hispanic Chambers of commerce Foundation

California Small Business Education Foundation

Small Business Majority


16th Annual Conference

See below for resources from the 16th Annual Statewide Conference California’s March to 2014: Paving the Road to Health Reform.

Photos from the Conference!
Click Here!

Conference Audio Sessions
Opening Remarks By Funders
California Health Benefit Exchange 1/2
California Health Benefit Exchange 2/2
§1115 Waiver 1/2
§1115 Waiver 2/2
Breakout Sessions: Implementation of the §1115 Waiver 1/2
Breakout Sessions: Implementation of the §1115 Waiver 2/2
Breakout Sessions: Purchasing Strategies 1/2
Breakout Sessions: Purchasing Strategies 2/2
Breakout Sessions: Outreach and Enrollment 1/2
Breakout Sessions: Outreach and Enrollment 2/2
Honoring- E. Richard Brown
Insurance Regulation
Essential Health Benefits 1/2
Essential Health Benefits 2/2
The Future of Medi-Cal
Discussion Panel 1/2
Discussion Panel 2/2

Conference Presentations
Honoree Bios Honoree Bios.pdf
Future of Medi-Cal Plenary - Andy Schneider Future of Medi-Cal Plenary - Andy Schneider.pdf
Teaser Slides Teaser Slides.pdf
Exchange Plenary - Peter Lee Exchange Plenary - Peter Lee.pdf
Waiver Breakout - Alex Briscoe Waiver Breakout - Alex Briscoe.pdf
Waiver Breakout - Lee Kemper Waiver Breakout - Lee Kemper.pdf
Waiver Breakout - Srija Srinavasan Waiver Breakout - Srija Srinavasan.pdf
Essential Health Benefits Plenary - Marjorie Ginsburg Essential Health Benefits Plenary - Marjorie Ginsburg.pdf
Essential Health Benefits Plenary - Susan Philip Essential Health Benefits Plenary - Susan Philip.pdf

Conference Binder
Conference Binder Conference Binder.pdf

The conference binder is password protected for copyright purposes. All conference attendees will be emailed this password.

Conference Documents
ITUP Conference Agenda ITUP Conference Agenda.pdf
Conference Sessions Conference Sessions.pdf
Creating the California Health Benefits Exchange: Progress to Date Creating the California Health Benefits Exchange: Progress to Date.pdf
Exchange_Reco_01202012 Exchange_Reco_01202012.pdf
Summary_1115_01202012 Summary_1115_01202012.pdf
1115_Waiver_Implementation_01202011 1115_Waiver_Implementation_01202011.pdf
Medi-Cal_Transformation_01202012 Medi-Cal_Transformation_01202012.pdf

Session Notes
Waiver Plenary Waiver Plenary.pdf
Waiver Breakout Waiver Breakout.pdf
Outreach and Enrollment Breakout Outreach and Enrollment Breakout.pdf
Insurance Regulation Plenary Insurance Regulation Plenary.pdf
Essential Health Benefits Plenary Essential Health Benefits Plenary.pdf
Future of Medi-Cal Plenary Future of Medi-Cal Plenary.pdf
Medi-Cal Discussion Panel Medi-Cal Discussion Panel.pdf

Confirmed Speakers
Alex Briscoe, Director Alameda County Health Care Services Agency
Dan Castillo, CEO, Children’s Hospitals of Orange County Health Alliance
Richard Chambers, CEO, CalOptima
Toby Douglas, Director, California Department of Health Care Services
Peter Long, CEO, Blue Shield of California Foundation
Mitchell Katz, Director of Health Services, Los Angeles County Department of Health Services
Lee Kemper, Executive Director, County Medical Services Program
John Arensmeyer, Founder and CEO, Small Business Majority
Kim Belshe, Board Member, California Health Benefit Exchange
Anthony Wright, Executive Director, Health Access
E. Richard Brown, Director, UCLA Center for Health Policy Research
Andy Schneider, Consultant
Burt Margolin, CEO, The Margolin Group
Srija Srinivasan, Director of Strategic Operations, San Mateo County Health System
Elizabeth McNeil, Vice President, California Medical Association
Elizabeth Landsberg, Director of Legislative Advocacy, Western Center on Law and Poverty
Howard Kahn, CEO, L.A. Care Health Plan
Marian Mulkey, Director of Health Reform and Public Programs Initiative, California HealthCare Foundation
Daniel Zingale, Senior Vice President, Policy, Communications, and Public Affairs, The California Endowment
Kaiser Permanente Community Benefits Program
Peter Lee, Executive Director, California Health Benefits Exchange
Paul Fearer, Board Member, California Health Benefit Exchange
Sharon Levine, Associate Executive Medical Director, Permanente Medical Group
Christopher Perrone, Deputy Director, CA Healthcare Foundation
Lucien Wulsin, Executive Director, Insure the Uninsured Project
Katie Marcellus, California Health Benefit Exchange
Rick Kronick, Deputy Assistant Secretary for Planning and Evaluation, US Department of Health and Human Services
Marjorie Ginsburg, Executive Director, Center for Healthcare Decisions
Hermann Spetzler, CEO, Open Door Community Health Centers
Tangerine Brigham, Director, Healthy San Francisco


Conference Program

SHOP Exchanges: Let’s Talk About Choice, Baby

[The following post was written by Micah Weinberg, Senior Policy Advisor for the Bay Area Council.]

Today the Pacific Business Group on Health (PBGH) issued a paper I wrote with Bill Kramer which reviewed the “lessons” from California’s experience for those setting up the new small employer (SHOP) exchanges in federal healthcare reform.  PBGH was the administrator of California’s own small employer exchange from 1999-2006.  This exchange, PacAdvantage, ultimately had to close due to a number of factors including its attracting a relatively unhealthy pool of enrollees.  If we learn from its experience, though, SHOP exchanges may succeed where PacAdvantage failed.

Part of that success will be understanding the key value proposition of these new marketplaces.  The main thing of value that these exchanges offer is choice.  But, as we write in the paper, the experience of PacAdvantage shows that choice can come in many forms. The two main types are “employer choice,” in which management selects among a number of health plans for their workers and “employee choice,” in which management provides a certain level of financial assistance and leaves the selection of health plans up to the workers entirely. The most commercially successful product offered through this purchasing pool was a hybrid that combined employer and employee choice. The “PairedChoice” product allowed an employer to select among a number of different PPOs, one of which would be paired with an HMO from the large integrated delivery system, Kaiser Permanente. Employees then chose between the PPO and the HMO paying higher premiums if they wanted lower point-of-service costs.

PacAdvantage developed this product after determining that although employers who participated in this pool were allowed to offer a wide range of employee choices, few actually did, and most that did so utilized a “paired PPO/HMO” structure.  Many employers offered a more limited version of employee choice because they found that the administrative burden was higher when their employees selected from among a large number of health plans. In theory, the administrative burden of employee choice can be outsourced to the exchange or to a broker. Since there is a single bill, the administrative demands on small businesses should be the same whether their employees select among two plans or twelve. In reality, however, employers are often expected to handle employee concerns about access to doctors or coverage decisions of insurers; therefore, the actual administrative hassle is higher when employees select from among a wider range of insurance plans.

PairedChoice split this difference by providing a highly structured set of choices that were attractive to employers while providing some autonomy to employees. Through incorporating elements of cost-conscious consumer choice, it may have helped to encourage price competition among the health plans. We suggest in the paper that SHOP exchanges should consider offering hybrid choice options to employers in addition to unrestricted employee choice.  The appeal of the PairedChoice product was also based, in part, on the price advantage of the Kaiser Permanente HMO. In the past ten years, though, other HMOs in California and throughout the nation have developed differentiated networks that allow them to become more price competitive. Hence a small group exchange may be able to offer a broader range of choices for a similar “paired” product.

The Waiver, CPE’s & County Funding

On Tuesday, May 10 from 1:00 to 3:00 p.m., the Western Center on Law & Poverty (WCLP) and the National Health Law Program (NHeLP) are co-sponsoring a training on the waiver.

Led by Jonathan Freedman of the L.A. County Department of Public Health, the meeting will focus on county decisions about designing Low Income Health Programs (LIHPs) and other waiver infrastructure to draw down federal reimbursement funds using Inter-Governmental Transfers (IGTs) or Certified Public Expenditures (CPEo).

Training Details

This training will be held LIVE in Los Angeles (location TBA) in Tuesday, May 10 from 1 – 3 p.m. and simultaneously webcast for those who are unable to attend in person. For more details, contact Kim Lewis at

Additional Background

For more, be sure to read our comprehensive summary of the new 1115 waiver and our suggestions to counties on maximizing CPEs.

Time for an All-Payer Claims Database in CA?

[The following post was written by Erica Brode, ITUP intern.]

Recently, one of my health policy professors complained to her primary care physician about serious discomfort in her knee. Her doctor referred her to an in-network orthopedic surgeon who performed a MRI and then referred her to the in-network hospital for surgery earlier this week (which was successful).

Fortunately, my professor is covered by an HMO through her employer, UC Berkeley. Because she had no co-payments or other out-of-pocket expenses, my professor never thought to ask about the prices associated with these services. And even if she had asked, she probably would never find out since that sort of information is not available to the public and it is doubtful that even her physicians know.

Such lack of transparency is a common occurrence in our health care system. However this could all change if California invests in an All-Payers Claims Database (APCD). An APCD is a database created by state mandate that typically includes claims data derived from medical, eligibility, provider, pharmacy and or dental files from private and public payers.

Benefits of an APCD

With access to such information, public health workers could allocate resources based on the geographical distribution of disease. Employers could use the data to further their health promotion programs. And, consumers can see who provides a certain service in their area and how much it would cost.

Although originally developed for policymakers and academics, such a database allows transparency to all levels of the healthcare system from the payer to the consumer. Already implemented in other states, information in APCDs has been used in price negotiations between payers and providers without any impact on overall healthcare costs.

Opportunities & Challenges

On March 24th, Patrick Miller from the University of New Hampshire Health Policy Institute and Jonah Frohlich from Manatt Health Solutions Consulting Firm gave a briefing on APCD implementation in other states and spoke to the feasibility of launching this type of database in California.

Miller and Frohlich noted California’s unique challenges and its differences compared to the other states currently implementing APCD. California is much larger and has 300+ medical groups that would all have to provide separate claims data. There are also questions of whether the APCD would be governed by the state or a non-profit organization, whether the reporting would be mandatory (like most states) or voluntary (like Washington and Wisconsin), and whether an APCD would conflict with any California-specific privacy legislation.

One of the biggest roadblocks in California is money. Given our current economic environment, it is unlikely that our state would be able to fund this kind of project. However, other states have had success raising the necessary funding by assessing a fees on plans or providers based on market share, imposing fines for not reporting, creating data access fees, or working with the federal government to gain a grant or Medicaid match.

Although many states have already implemented similar APCDs, California is squarely in the “strong interest” category. While not currently on the legislative agenda, this type of transparent, consolidated database might just be what the doctor ordered for California’s healthcare system. An APCD would supply important information for Pay‐4‐Performance reimbursement systems and quality reporting initiatives, as well as efforts to establish medical and health homes. One particularly interesting opportunity for California would be the potential for an APCD to help the very important risk adjustment efforts in the California Health Benefit Exchange come 2014.

For more, you can view a video of Miller’s and Frohlich’s March 24th discussion, and download PDF versions of their presentations.

Federal Aid for States to Invest in Health IT

Also today, CMS issued this final regulation that will help states develop and upgrade their Medicaid internet technology (IT) enrollment systems.

The new rule implements Section 1903(a)(3)(A)(i) of the ACA which increases Medicaid’s federal match — to 90 percent! — of the cost for states to develop systems to help people enroll in Medicaid or the Children’s Health Insurance Program (CHIP). States can use the money to design, develop, or install mechanized claims processing and information retrieval systems as the “Secretary [of HHS] determines are likely to provide more efficient, economical and effective administration of the plan and to be compatible with the claims processing and information retrieval systems utilized in the administration of title XVIII [Medicare].”

The rule also increases to 75-percent federal match for ongoing operational costs and establishes performance standards for improved eligibility systems to promote greater efficiency and a more consumer-friendly enrollment process.

The previous federal match had been the traditional Medicaid rate of 50 percent. By shouldering considerably more of costs related to enrollment technology, the federal government hopes that states will be better able to prepare for the improvements and the Medicaid/Exchange expansions that will come in 2014.

Because California did not apply for an “Early Innovator” grant, implementation of this new rule offers our state the opportunity to invest in a new, IT-based enrollment systems that will hopefully make it easy, come 2014, for anyone to understand their health coverage options, enroll in Medi-Cal or the Exchange, renew their coverage, and stay covered while transitioning between coverage sources.