87,000 Patients to Participate : HMOs Picked for Pilot Medi-Cal Plan

The state selected seven health-maintenance organizations Friday to provide medical treatment for 87,000 Medi-Cal patients in the San Fernando Valley area who will participate in a controversial pilot project aimed at reducing costs and improving access to physicians.

The facilities tentatively included in the experiment range from the well-known Kaiser Foundation Health Plan to four newly created HMOs. One of the new groups has been formed by Los Angeles County and will be based at the Olive View Medical Center in Sylmar, which is scheduled to open in March.

The HMO selections, announced by the California Medical Assistance Commission, indicate that Valley Medi-Cal recipients will have access to more hospitals and physicians under the experiment, called Expanded Choice, than they now do.

The commission said the seven health plans have contracted with 20 area hospitals to admit their Medi-Cal patients. Only 14 area hospitals now accept Medi-Cal patients.

The county-formed HMO also proposes to have 1,093 physicians available to treat its Medi-Cal recipients, more than the 950 Valley-area physicians who now accept such patients.

Under Expanded Choice, most Medi-Cal beneficiaries will be required to join one of the seven HMOs sometime next year. Patients no longer will be able to see their regular physicians unless those doctors have contracted with one of the selected HMOs.

About 71% of the Medi-Cal beneficiaries in the Valley-area experiment, which includes Glendale and the Santa Clarita Valley, use physicians who will participate in Expanded Choice, according to Jim Foley, director of Valley project. Foley said the state hopes more physicians will sign up with the HMOs before the experiment begins.

Although the seven chosen facilities listed the number of physicians they propose to use to treat their Medi-Cal patients, Foley said that, because some of the physicians have signed up with more than one HMO, the exact number of doctors in the program is not yet known.

Opponents of the pilot program have complained that forcing Medi-Cal recipients to receive their care at an HMO would disrupt existing patient-physician relationships. Robert Holt, hospital relations officer for the Los Angeles County Medical Assn., predicted in October that the program would exclude almost all of the Valley doctors who now accept Medi-Cal patients.

Critics of Expanded Choice said Friday that the figures released by the state are misleading because some of the physicians have only signed letters of intent to contract with an HMO. Foley acknowledged that not all the doctors have signed contracts with health plans.

Officials with the California Medical Assistance Commission, which is overseeing the project with the state Department of Health Services, contend that Expanded Choice will increase access to doctors, since only about 25% of the Valley’s 3,800 physicians now accept Medi-Cal patients.

But Holt contended again Friday that patients’ choices will decrease.

The state commission has not yet determined how many people will be enrolled in each health plan. Kaiser, the biggest of the seven selected, wants to limit its participation to 3,000 patients, which would make it the smallest participant. In contrast, the county’s HMO has asked the state for a Medi-Cal enrollment of 40,000 patients.

According to state documents, the proposed ratio of physicians to patients varies greatly among the health plans. For instance, Kaiser expects to have at least 313 physicians available to care for 3,000 patients. Amerimed, which has proposed caring for 25,000 Medi-Cal patients, says it will have 79 physicians.

United Health Plan says it will have 238 physicians to treat 30,000 patients.

Foley said the commission has not yet examined the patient-physician ratios proposed by the plans to determine whether they are adequate.

Officials of the county medical association and the National Health Law Program said they also intend to review the seven HMOs’ proposed contracts.

“It will take an in-depth analysis to see whether the plans are doing what needs to be done,” Holt said.

The Medical Assistance Commission will hold four public hearings in the Valley area in mid-January to elicit comment about the plans before it makes the contracts final, probably in March, Foley said.

Detailed descriptions of the proposed health plans will be available for review starting Dec. 31 at libraries in the San Fernando and Santa Clarita valleys, Burbank and Glendale.

A similar Medi-Cal experiment is scheduled in San Diego.

HMOs SELECTED BY STATE

The state has tentatively selected the following health plans to participate in Expanded Choice:

Amerimed, Burbank

Amicare Advantage Plan Inc., Beverly Hills

Blue Cross of California, Van Nuys

CareAmerica Health Plan of Southern California Inc., Chatsworth

Kaiser Foundation Health Plan Inc., Oakland

Olive View Community Health Plan, Los Angeles

United Health Plan, Inglewood