Health Care Agenda
Former Assemblyman Martin Gallegos steps into new state position as head of Patient Advocate office.
By LAURENCE DARMIENTO
Staff Reporter
Martin Gallegos’ new role as the state’s Patient Advocate was, in a sense, tailor made for him, since it was legislation he authored in 1999 that created the job. At the time, Gallegos probably never imagined he would serve in this position. The Baldwin Park Democrat was an up-and-coming chiropractor-turned-legislator who chaired the Assembly Committee on Health. Among his other legislative accomplishments was creation of the state Department of Managed Health Care, the chief HMO regulator. Last year, he seemed a shoo-in for state Senate, replacing Hilda Solis. Instead, Gallegos was defeated by Assemblywoman Gloria Romero in a bitter election that pitted two liberal Latinos against each other. After some health care consulting work, Gov. Gray Davis offered Gallegos the new job at a salary of $112,656. His office’s primary responsibility is educating Californians about their rights under managed care.
Question: What do you do in your new job?
Answer: The Office of the Patient Advocate is the only one in the nation. This is an office whose sole purpose is to be an advocate for HMO consumers. To be their voice.
Q: What exactly does that mean?
A: We do an HMO report card. We have run a media campaign to create awareness for the consumer that there is help available. We have a working group where we bring health plans, consumer advocates and other stakeholders together. We go to health fairs and other events. If a medical group or HMO closes we have what I like to call a SWAT team that goes into communities and tells consumers what their options are.
Q: So If I have a specific complaint about my HMO concerning coverage would I call your office?
A: No, you would call the Help Center operated by the Department of Managed Health Care (888-HMO-2219).
Q: So do you have any enforcement authority if you discover some problem?
A: We have no enforcement or regulatory authority.
Q: Isn’t that frustrating?
A: No. We really didn’t intend for there to be any regulatory or enforcement authority. The governor thought that would be redundant and confusing (with the State Department of Managed Health Care.)
Q: Can you cite some accomplishments?
A: Probably the major accomplishment in the time I have been here has been the production and release of the first California HMO report card, which compares the quality of the 15 major health plans serving 95 percent of the HMO population in California.
Q: What did it find?
A: The results in general showed that no plans are necessarily providing excellent care but no plans are providing poor care either. Most of them are providing fair to good care. And though there is no rating system, Kaiser is the plan that performed best overall.
Q: Are there some specific performance issues that stood out?
A: When we were looking at preventive care for health plans, we looked at childhood immunization rates. There were certain plans doing very poorly 30 to 40 percent immunization rates for the children enrolled. Others were doing much better, 65 to 75 percent. So obviously there is an example of action that needs to be taken.
Q: Is anything going to be done about those rates, aside from informing consumers?
A: We gave the data to the Department of Managed Health Care, which they then can use as tools for enforcement or regulation to get health plans to improve quality of care. One of the subcommittees of the advisory committee to the department proceeded to do a study on preventive services. I think a draft of that report has gone to the advisory committee, so it’s still in the public hearing stage.
Q: What good is all this information to consumers, if in response to the recent round of stiff health care premium hikes businesses offer only one HMO?
A: It gives them an opportunity to look for the best value for their dollar, the most bang for their buck.
Q: But how many employers or employees even know your office exists?
A: One of the things I did find out when I assumed office is that there was very little public knowledge about the Office of the Patient Advocate and the services that were available to consumers.
Q: What have you done about that?
A: We spent about $1.5 million last year to do an eight-week statewide television and radio media campaign to get the word out (about the office). We launched the TV campaign in Sacramento, San Diego and Fresno. Obviously we stayed out of the big markets like Los Angeles and San Francisco because we just couldn’t afford to run a television campaign in those large markets. But we did the radio campaign statewide.
Q: It seems a shame you couldn’t hit the largest market in the state with the television campaign.
A: Obviously Los Angeles has a large population, but we hired a contractor to help advise us on the media camp. Their suggestion was for the money we had to spend and for what we were trying to accomplish we were best served going into these markets, and if we ever were to get more resources available we could continue the campaign.
Q: Are you going to get any more resources?
A: We didn’t get any more resources in the existing budget (the Patient Advocate budget is $4 million and the office has a staff of 14). We have the same we had in year one, but we will have additional resources in the ’02 and ’03 budget (starting July 1), which the governor has approved. But we are looking right now as to whether a media strategy is the most effective way to get the word out.
Q: What other means are there?
A: We also can contract with community-based organizations and consumer advocate groups that serve HMO enrollees and utilize their contacts. We are also doing a statewide pharmacy campaign, where we have hooked up with independent pharmacies to get out information.
Q: Critics might say that all you are doing is putting a Band Aid on a sore. Is that too harsh?
A: This is not a Band Aid on a sore. This is one of the cures of the sore. Information is a valuable component to improving the health care system. Lack of that is one of the causes of the public feeling that they are not comfortable with the system.
Q: So how would you rate the improvement made in the last few years under the 1999 HMO reform package signed by Gov. Davis that created your office?
A: We have made very meaningful strides towards improving health care. You have a Department of Managed Health Care, a regulator totally focused on this huge $25 billion a year HMO industry. You have independent medical review. You have a right to direct access to a second opinion. You have improved internal grievance procedures. You have the availability of court retribution if the consumer suffers serious damage. You have all of these major reforms that were not in place.
Q: There are proposals floating around the state for drastic measures, such as a single payer system. What do you think of them?
A: No system of health care is perfect. The reason we went to managed care is that before, the fee-for-service system was not perfect.
Q: How did you get this job? Did you lobby for it?
A: I had been approached by the Administration (and asked) if I was interested in an appointment. It just worked out there was a resignation of my predecessor. I was very excited and definitely interested. As a legislator I had worked extensively in HMO reform and had pretty solid credentials as a consumer advocate, so this position just seemed like a natural for me to assume.
Q: Do you still have your chiropractic practice in Baldwin Park?
A: I sold the practice back in 1999.
Q: Would you ever like to serve again in elective office?
A: I would not rule out ever running again for public office. But it is not something that is high priority for me. Right now I am very fortunate. The governor found me deserving of this position.
INTERVIEW:
Martin Gallegos
Title: Patient Advocate
Organization: Office of the Patient Advocate, State of California
Born: 1956, Los Angeles
Education: Bachelor of Science, Occidental; Doctor of Chiropractic, Los Angeles College of Chropractic
Career Turning Point: 1990 election to the Baldwin Park City Council
Most Admired People: John F. Kennedy, for his dedication to public service
Personal: Single
