County could face rocky road as it rolls out reforms
By Robin Urevich
Riverside County took a first step toward federal healthcare reform last month with the launch of Riverside County Healthcare, an insurance plan for poor people who don’t qualify for Medi-Cal.
Some 20,000 people—about 10 percent of the county’s uninsured population—will be covered.
Many of them are newly unemployed and without health care, said Jan Remm, Assistant Administrator of Riverside County Regional Medical Center, who oversees the program.
“We see that every day, so it just heartbreaking…and we want to provide that,” she said.
County officials report they’ve already received 16,000 applications and enrolled 2,700 people.
The new participants will be able to choose a primary doctor, and have access to specialists, and mental health and preventive care.
Like the federal Affordable Care Act, the idea behind the Riverside program is that an up-front investment in consistent care will save lives and in the long run, dollars, by reducing hospital stays and emergency room visits.
Chris Hernandez, an uninsured 58-year-old who said he’s been in constant pain for months, is one of the early enrollees.
His story highlights the rocky road Riverside County could face as it prepares for health reform.
Last November, Hernandez said he was earning good money on a Caltrans landscaping job in Cathedral City, despite two hernias, one of which is extremely painful. But, his employer let him go because he could no longer safely do the work.
“We were cutting down tamarack trees. You have to pick up the trees. They could see I was wincing. They could see I was in pain.”
Hernandez said his boss told him to come back to work after he’d had surgery.
In January, Hernandez, who also has diabetes, went to the county hospital seeking help to cover his treatment. After a daylong wait, a county worker issued him a county health care card and told him he could visit a clinic near his home in Indio in two to three weeks.
But Hernandez said he was too sick to wait.
“I said I can’t stand the pain. I can’t walk. It’s hard to urinate.”
He took his card directly to the hospital emergency room where a doctor prescribed pain pills and other medication and told him to follow up at the Indio clinic.
For Hernandez it was the beginning of a long painful quest for relief that isn’t over yet.
In fact, he said the program has been so tough to navigate that he’s visited a second ER since he signed up.
“They’ve been giving me the run around,” he said.
“To make an appointment, it’s something else,” Hernandez said. “It’s a computer you’re talking to.”
Still, Hernandez did get his clinic appointment within a week. He needed it, he said, because he was allergic to the pain meds he’d been given at the hospital and stopped taking them.
Hernandez got a new prescription at the clinic, but he had to travel more than 60 miles to Riverside to one of the three county pharmacies to fill it, wait up to 10 days for the meds to arrive by mail or pay for them out of pocket.
None of those were viable options, Hernandez said, so the next day, hurting again, he visited the emergency room at the Eisenhower Medical Center for more pain relief.
Now, he said, he has a mid-February appointment to see a surgeon who will decide whether to okay his operation.
Remm has promised to look into Hernandez’s case.
According to the county’s contract with the state, the RCHC must provide urgent primary care appointments within 48 to 96 hours.
As a non-physician, Remm said she isn’t qualified to say whether the intense pain Hernandez described qualified as urgent under the program’s rules.
She said county officials are negotiating with pharmacies to make prescriptions more easily accessible to people who live far from the city of Riverside.
While Riverside’s program is new, ten California counties, including Los Angeles, Alameda and San Diego, began to expand services to low income people in programs similar to Riverside’s in 2007.
Among their challenges was teaching people how to use health insurance, said Nadereh Pourat, head researcher at the UCLA Center for Health Policy Research
“You might not think of going to the doctor (if you’ve never had health insurance). You might continue to go to the ER,” Pourat said. She and her colleagues are evaluating the programs for the federal government. “How do you teach people you don’t have to do that anymore?”
If Hernandez’s experience is a guide, Riverside’s challenges might also include how to serve people quickly and efficiently enough to keep them out of the ER.
“It’s going to be a tall order,” said Riverside County Supervisor Bob Buster, of the county’s prospects for successful implementation of health reform.
“There ought to be additional funding and incentives provided. I don’t see those things.”
One factor is the county’s sheer geographic expanse. It’s nearly as big as New Jersey in land area, stretching from the far eastern suburbs of Los Angeles to the Arizona border.
“We can’t attract enough doctors,” Buster said. “Folks who have a heart condition might have to come from the Coachella Valley into Riverside.”
That is the same trip Hernandez and other RCHC members currently must make to pick up a prescription under the plan.
Riverside’s poorest patients who use the county’s health plan of last resort, the Medically Indigent Services Plan, and need specialists, have waited as long as a year for appointments, said Terri Vise, Director of the Riverside region for Neighborhood Health Care, which runs a network of clinics in Southern California, including one that will participate in RCHC.
“They would keep coming back to our clinic…to work through the same problems,” Vise said.
The scarcity of doctors and oversupply of needy patients is a big factor, she said.
“Reason would tell us that patient would eventually visit the ER,” Vise said.
But Remm insisted that RCHC will provide timely appointments under the terms of its contract with the state. Appointments with specialists must be made within 30 days of a request; the plan has 60 days to make gastroenterology and dermatology appointments, because specialists in those areas are particularly scarce in the county.
Eventually, Riverside’s program, like those in other counties will be tested on measures like cutting emergency room use and hospitalizations, and whether people with chronic conditions get regular tests and health screenings, Pourat said.
Chris Hernandez set a simpler criterion. “I just want to get back to work,” he said. But he said he’s worried that the job he was on might end by the time he finally gets his surgery and recovers.