We chatted with Mike Odeh, Director, Health and Kelly Hardy, Senior Managing Director, Health & Research at Children Now about the effect of COVID-19 on a research analysis project. The California-based children’s advocacy organization, focused on doing what’s best for kids through research and policy, had to adjust the timeline of the project’s release and manage shifting priorities of the state Legislature.
Can you tell us about Children Now?
Mike: Children Now is a statewide advocacy organization that does research and policy work in California to transform children’s advocacy and make sure kids are the top public policy priority. We spearhead The Children’s Movement of California, which pulls together the power of thousands of Pro-Kid organizations across the state.
Tell us about your children’s health care analysis. What are your goals for the project?
Mike: Over a number of years, we’ve been looking to see if kids who have Medi-Cal as their health insurance (about half the kids in the state) are getting the services they should be getting. The services are contracted out to health insurance plans, so we had to look at how the plans are performing and how the state is overseeing that performance and holding the plans accountable.
Our goal with this analysis is to highlight the status of children’s care in Medi-Cal. As we’ve seen in official state audits and other research, Medi-Cal managed care performance is low, and has been for a while. We’re hoping to highlight that it’s a problem, and part of the problem stems from the way plans are paid—compensation isn’t tied to quality of performance. Plans can get away with not giving health care to kids but still get paid.
What were your initial plans to release the analysis?
Mike: We aimed for a late March release, which was always very ambitious even in a non-pandemic time period. The project probably would have gotten pushed back anyway, but we’ve run into some delays in getting data we requested from the state and are expecting for the analysis.
How close were you to releasing the analysis prior to the outbreak of COVID-19?
Mike: Not at all close! The pandemic relieved a little bit of pressure, but I think in some ways the pandemic has also highlighted the need for this analysis and this conversation to be happening.
How has the pandemic affected the California Legislature? Your team? Other projects?
Kelly: The Legislature shut down for a while and just recently opened up. The Assembly reopened May 4, and the Senate May 12. We basically faced two months of nothing happening, but there was still stuff to do.
Mike: The Legislature took a pause, and as it’s trying to reengage, it’s taking on a lot. They’ve been trying to squeeze two months’ worth of bill and budget hearings into a span of a couple weeks. And at the same time, they’re trying to assert and maintain their authority and oversight with some of the changes the governor has made and proposed. It’s created an interesting dynamic coming back. Worth nothing is the June 15 deadline requirement to pass the state budget. There was a lot of work to make that happen in a short time frame, and practical considerations like how to comply with social distancing in hearings, how to address members in high-risk categories, etc.
Kelly: Most critically, the budget has forced us to be very aggressive and reactive to all the cuts proposed to kids’ programs across the board. It was a pretty rosy-looking budget in January, and now it’s not, and the cuts that are being proposed are across the board—Medi-Cal, childcare, education, child welfare—rather than being targeted. We’re concerned. Kids were in crisis before and now even more so. The Legislature was finally close to passing a bill that would have required coverage of hearing aids for kids, but it didn’t move forward to the governor’s desk because he decided he would take care of it in the next (2021) budget. That’s exciting to think about doing that kind of stuff for kids because that could be a life-changing thing for them, but it’s no longer in the budget. The governor promised this in the budget, and it was there, but now it’s getting pulled back. It’s heartbreaking to think about the change in priority. That’s where we’ve been: we were in a very optimistic place to address systematic inequities, and now we’re back to deep cuts.
What about journalists? How have you seen the pandemic affect your ability to “break through” with the press?
Mike: It’s all pandemic all the time. If something is not pandemic related, it’s not going to get their attention.
Kelly: And if it’s not, you better make it pandemic-related in order to get the coverage–content has to be somehow tied to COVID-19.
Mike: It’s seductive to tie everything to COVID-19 and make everything exacerbated. I feel that may be short-sighted in some instances. Part of this project has been focused on how we look at longer term Medi-Cal payment reform and contract changes in the next few years, and now there’s a rush to address the pandemic and budget proposal. I don’t know that doing payment reform in response and reaction to the pandemic is the wisest way to go. What the budget proposal has highlighted is the lack of connection between payment and performance (which we’re saying isn’t there), and is more clearly shown by how the state is proposing to cut managed care rates across the board. The proposal is showing a greater need to have this payment reform discussion, but it needs to be thoughtful versus reactive.
What did you decide to do about releasing the analysis?
Mike: Despite our best planning, we had to be flexible and respond to the reality. One reality: now’s not the time because of quarantine. We’re still waiting for this data. And no one’s paying attention because of the budget. We had to be strategic in putting all the pieces together.
We have pushed the release date very smartly because of the reality under consideration. Often that’s the way we work; this has just forced us to do it even more.
How did you make that decision?
Mike: We’ve been optimistic but realistic about the turnaround in terms of when the department can reasonably get us the data we’re looking for. What are reasonable timelines to set for ourselves and capacity of the team? It’s been a lot of internal coordination to make sure we’re keeping on track but not being overly aggressive–communicating timeline extensions internally, asking if colleagues in other departments have time on their plates. Because of the pandemic, the shift to working from home has also played into how we care for our team and make sure people are managing.
What’s happening now?
Mike: We’re looking at another delay and aiming for a post-July 4 release date. Some data was supposed to be released a few months ago; we were finally told it would come in early June, but was under final review. Then, we got word that because of COVID-19, they are putting the assignment on hold. This required us to submit a public records request. We’re hoping it doesn’t take too long, but assuming we get data in time, a post-July 4 target date is feasible for us to finalize and incorporate the data into the report. It didn’t make sense to do it before the holiday, and the Legislature reconvenes the week after that.
What will you do next?
Mike: We have a robust plan for getting it out to a bunch of different stakeholders. The localized angle of the analysis will be really important to promote. We’ll talk about low performance and managed care contracting being an issue–having that be our mantra as conversation and debate unfolds. We don’t expect reform will happen in this budget; in fact, I’m pretty sure it won’t. But we have a long view and we’ll be prepared to engage in those conversations next year. The problem is going to get worse, and what we do next will set the stage for what we’ll do next year. I expect there will be a difficult budget conversation next year.
Kelly: Mike’s long-term vision has been so important to see this is evolving over several years, and it’s the key lever that we need to make sure people understand. It’s tough to push that boulder up the hill, and it’s not easy to explain to reporters, but it will make the biggest difference in actual care for kids.
What did you learn from this experience, and what advice would you give to someone else?
Mike: Flexibility and focus. We had to adapt because of a lot of different things. It’s easy to get sidetracked, get diverted, lost in the moment or the crisis of the week. There have been several times when I’ve wanted to just give this whole thing up. Having a team that can help bounce back some good questions and make sure you stay targeted toward the long-term goal has been really valuable to me. There’s a vision other people also see, and it helps me stay focused on the advocacy and how the work fits together even as the environment is changing.
I think this shows that we’re in this work for the long haul. This project actually started years ago, so even though the pandemic and budget are changing, the advocacy and outcomes we’re looking for are not.
