State to Use HMOs to Serve County Medi-Cal Recipients

State officials announced Thursday that they are negotiating with 12 San Diego County health maintenance organizations about serving Medi-Cal recipients at a substantial savings to the state.

Richard Silberman, chairman of the California Medical Assistance Commission (CMAC), said the 12 were chosen from 16 health groups that submitted proposals to the commission. State officials are still talking to representatives of the 12 groups and hope to negotiate contracts with them by next month.

Silberman said the state might not reach agreements with all 12 organizations, but it is hoped that the state-supervised plan will be in effect as early as June. The commission hopes to notify the 160,000 Medi-Cal patients in the county by April of the plans available in their area and allow them to choose one.

Commission officials say that all Medi-Cal patients will be directed to join one of the prepaid plans, forcing the 2,248 doctors in the county who want to continue treating Medi-Cal patients to affiliate with one of the organizations.

According to Silberman, the prepaid plan would save about $8 million annually in county Medi-Cal costs. As outlined by Silberman, state officials want to steer the Medi-Cal program away from the current--and, they say, more costly--fee-for-service practice in favor of a fixed annual payment per patient.

The payment would be made in monthly installments to the health group, which would then pay participating doctors, hospitals, pharmacists and other providers who serve the patient.

“We will pay them a fixed dollar amount per beneficiary per month . . . it’s then up to the health plan to make arrangements with the doctors and other providers. We think this plan will encourage the medical industry to cut costs,” said Jim Ringrose, a CMAC official who helped organize the prepaid plan in San Diego County.

Silberman said the state would pay the plans $600 to $4,000 per year per patient. He said the commission is proposing to contract with each group for a three-year period.

About 70% of the county doctors who take Medi-Cal patients have signed up with one of the 12 plans, said Silberman. State officials hope that eventually 90% of the doctors will agree to participate in one of the prepaid plans.

San Diego County is one of three areas in the state that are participating in a pilot program to assess the feasibility of a state-supervised, prepaid health plan. Silberman said the California experiment is the first of its kind in the nation.

The other areas that will try the pilot program are the San Fernando Valley, with 90,000 Medi-Cal patients, and Stanislaus County in Central California, with 20,000 patients.

CMAC officials have scheduled four public meetings later this month to receive input from health industry officials, Medi-Cal patients, welfare rights groups and other organizations.

The first meeting is scheduled for 10 a.m. to 2 p.m. Nov. 25 at Holy Trinity Catholic Church in El Cajon. That will be followed by a meeting at the Balderrama Community Center in Oceanside from 5 p.m. to 8 p.m.

On Nov. 26, the commission will hold a meeting at the Pan American Plaza Recital Hall in Balboa Park from 10 a.m. to 2 p.m. The last meeting will be held later that day at the main library in Chula Vista from 5 p.m. to 6 p.m.