State health officials this week said that an eight-county managed health care test program for 460,000 low-income residents who receive both Medicare and Medi-Cal will begin in October.
The intent of the three-year demonstration project, which includes Orange County’s CalOptima health plan, is to cut medical costs by managing the care of these so-called “dual” patients in a way that ensures they receive timely diagnosis and treatment, ultimately reducing emergency room visits and confinement to nursing homes.
The program, named Cal MediConnect, is part of the national Affordable Care Act commonly known as Obamacare. The demonstration project is an attempt to work out problems before MediConnect law goes into full effect.
Currently more than a million Californians are eligible, and that number is expected to increase as more baby boomers qualify for Medicare. Orange County has an estimated 75,000 eligible residents.
“This is a major step forward to better integrate health services,” Diana Dooley. secretary of the state Health and Human Services Agency, told a telephone news conference Wednesday.
The program originally was to begin in June but was postponed to October while state officials sought federal approval for the test project.
Toby Douglas, director of the state Department of Health Care Services, said the management upheaval at CalOptima in the past year didn’t disqualify it from participating in the demonstration.
At least 16 top CalOptima managers, including the CEO, chief operating officer, chief financial officer and chief medical officer, have left. In January the county grand jury issued a blistering report blaming the Board of Supervisors for allowing the management turmoil at the agency, which provides health care for more than 400,000 county residents.
“We have full confidence in CalOptima,” Douglas said.
Other counties participating are Los Angeles, Riverside, San Bernardino, San Diego, Alameda, Santa Clara and San Mateo.
A key to making the project successful, health professionals have said, is ensuring enough doctors, specialists and other providers participate so patients can stay with their current medical providers.
Patients are not required to participate in the test. If the programs don’t attract enough medical professionals, administrators are concerned that the patients will drop out of the managed care program.