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HOME > ABOUT > PRESS > MEDI-CAL PATIENTS TO GET NEW PLAN
Article published - August 30, 2009
Credit: PRESS DEMOCRAT
47,000 Medi-Cal patients in Sonoma County to get new health plan
by Bleys W. Rose
The 47,000 low-income residents of Sonoma County who use the state subsidized Medi-Cal program for medical coverage will be switched to an HMO-style health plan beginning Oct. 1.
The current fee-for-service model of funding medical services is being abandoned under prodding from state health officials who proposed, back in 2005, that Sonoma County become one of 13 counties that could benefit residents with little or no health coverage.
Dr. Mary Maddux-Gonzalez, the county public health director and chairwoman of a 23-member committee responsible for implementing the Medi-Cal HMO, said the group has secured acceptable reimbursement rates for medical providers at local hospitals and community clinics, where most family practice care will be delivered.
“It will have a prevention focus and provide a medical home” for Medi-Cal patients, she said.
Citing such clinics as the Southwest Community Health Center, Petaluma Health Center and Healdsburg's Alliance Medical Center, county Board of Supervisors Chairman Paul Kelley said “their participation is key here.”
County officials said health maintenance organizations reduce the costs of health care when expenses are spread over a large group of patients. But HMOs also encounter opposition from some physicians, particularly specialists, who feel reimbursements don't adequate cover cost of treatment.
In HMOs, physicians receive a negotiated amount of money for treating a set number of patients, a system that is different than one in which doctors and medical providers receive a set fee for each medical service provided.
The switch to an HMO-style system involves a county contract with Partnership Health Plan, based in Fairfield, to manage the program. Since 1994, Partnership Health Plan has operated the Solano County program and later added Napa and and Yolo counties.
“If you get patients into primary care, preventive services and specialty care, the emergency room visits go down,” said Jack Horn, executive director of Partnership Health Plan. “We have done the math and this is a better model.”
Horn said counties participating in Partnership Health have experienced a 50 percent decline in emergency department visits by Medi-Cal patients.
The managed care plan was supposed to be implemented in Sonoma County a year ago, but the state's budget problems created uncertainty over reimbursement rates to medical providers, leading many to balk at an agreement. Maddux-Gonzalez said those physician reimbursement rates were settled in June, paving the way for agreements with clinics and hospitals.
The county's Health Profile survey concluded that a problem with the current fee-for-service program is that only 60 percent of the 47,000 people on Medi-Cal maintain regular enrollment, which would be automatic under an HMO system.
The survey also found that too often care is delivered in emergency rooms where treatment is expensive and could have been better obtained in medical offices.
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