Swot Analysis Of California

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MediCal refers to California Medicaid system for their low income population; eligible participants must fall under the established poverty line to qualify for the program. Across the country Medicaid and Medicare payments usually underpay the provider, and make up this lost for cost the commercial health insurers have a higher reimbursement rate. However, to also fill in the payment gap Mr. Lassiter helped to obtain Measure A, which was a local county sales tax, that generates capital to reimburse the facilities that provided care to indigent, low income, and the uninsured populations, with Alameda Health System obtaining about 75% of the $100 million annually generated. Recognizing Alamedas contribution to indigent, low income, and the uninsured …show more content…
With the ACA, California choose to expand MediCal (Medicaid) and was able to insure more low income patients. The the low income market will now have more access to health coverage, which can be seen in Exhibit 7, in the 2013-2014 payer mix MediCal policy went up 5%, from 43% to 48%, and county indigent and other payers went from 29% to 19% and 12% to 4% respectively. According to Exhibit 8 traditional MediCal policy also provide higher full cost revenue ( > 1.88) in comparison to other payers. One issue that was noted in Alameda Health System was the lack of Medicare Advantage plans, and when participants on MediCal became eligible for Medicare they were then lost to Kaiser as Alameda Health System did not have any advantage plans. But this market did not seem to be profitable with a lower average ratio in inpatient payment to cost and similarly with outpatient payment to cost. Tradition Medicare and managed Medicare were significantly lower than 1.88 at 0.54 and 0.96 tradition and 1.10 and 1.38 managed between inpatient and outpatient payments to cost. The focus of Alameda Health System should be on expanding traditional MediCal patients as managed MediCal payments are under full cost with 0.83 inpatient payments and 1.05 outpatient payments. In traditional MediCal Alameda Health System gets 2.73 inpatient payment and 3.17 outpatient payments to cost. Along with the increase ratio of full
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