Ventura County Devising Own Medi-Cal Plan

When the state announced last year that the San Fernando Valley would be the site of a new Medi-Cal pilot project called Expanded Choice, health officials from Ventura County breathed a sigh of relief.

For more than two years, a coalition of physicians, hospitals and government officials in Ventura County has been quietly working to keep state-sponsored health care experiments like Expanded Choice out of their territory.

The county’s strategy involves more than just opposing Expanded Choice, which was shelved, at least for this year, after it was vigorously criticized in the Valley. Ventura County officials say they believe the best way to keep the state from tinkering with the Medi-Cal system in their county is to offer an alternative.

Consequently, members of a county-appointed task force have been busily creating the county’s own Medi-Cal experiment, which they predict will be superior to Expanded Choice.

The proposed Ventura plan differs from Expanded Choice in a key way. Under Expanded Choice, Medi-Cal beneficiaries will receive their care from health maintenance organizations. Doctors will be shut out of Expanded Choice unless they affiliate with an HMO.

Under the Ventura County plan, physicians will not have to join an HMO to continue treating their Medi-Cal patients.

Ventura County’s plan, however, shares the same goals as Expanded Choice: improving the poor’s access to health care and cutting costs.

“We feel we have the correct program for our county,” said Susan K. Lacey, a Ventura County supervisor. “We’ve designed it the way we want to for our folks.”

Expanded Choice, said Monty Clark, a task force member and regional director of the Hospital Council of Southern California, “may be thrust upon us at some point in time. At least we’d like the option of first refusal.”

Ventura County is one of a handful of counties throughout the state that are proposing to take over administrative responsibility for providing health care to the poor.

Harsh political reality is one of the motivators. There has been continuing pressure from Sacramento and Washington to slash subsidized medical costs generated by the poor, the elderly and the disabled by finding new ways to deliver and pay for the care.

Other counties that have been exploring the option include Orange, San Mateo, San Francisco, Contra Costa, Santa Clara and San Bernardino. Officials from some of these counties say that devising their own Medi-Cal delivery systems is preferable to waiting for the state to impose innovations that they might not like.

Ventura County is modeling its Medi-Cal plan on a system Santa Barbara County has used for almost three years. Under that model, the state has saved about $3 million. But equally important, officials say, the system has become more accountable to patients, physicians and hospitals because it is controlled at the local level.

Case Management System

The Santa Barbara County Special Health Care Authority operates a case management system, with local physicians acting as case managers. Each Medi-Cal recipient chooses a participating primary-care physician who is responsible for all the individual’s medical treatment.

The physicians must pre-authorize their Medi-Cal patients’ hospitalizations or visits to specialists. The county relies on the physicians to reduce unnecessary hospital stays and to stop some Medi-Cal recipients’ expensive habit of doctor shopping.

Ventura County officials believe that more physicians will participate in their system, which has been endorsed by the local medical society, than would participate in Expanded Choice, said Neal Andrews, assistant administrator at Ventura County Medical Center.

One of the chief criticisms of Expanded Choice has been that community doctors would shun the experiment and therefore force many Medi-Cal patients to find new doctors.

There is an inherent financial risk in Ventura County’s proposed project. The state will continue to pay for Medi-Cal costs, but at a reduced rate. The state will pay the health care authority an amount calculated to save the state 5% of its annual Medi-Cal costs in the county. If Medi-Cal bills exceed the state’s allocation, the health authority will have to absorb the loss.

The Ventura County program, in the planning stages for 2 1/2 years, will not be started until at least July, 1987, even if no serious bureaucratic roadblocks are encountered. Health planners say setting up a new Medi-Cal system is incredibly time-consuming.

“It’s quicker to build a nuclear power plant than to get one of these things going,” said Charles Jervis, director of San Bernardino County Medical Center. He said that San Bernardino physicians are favoring the project because “they are scared to death of Expanded Choice.”

State Sen. Gary Hart (D-Santa Barbara) recently introduced a bill that is expected to move the Ventura County project a little closer to its goal. The bill would provide the needed legislative authority for the county, which has about 42,000 Medi-Cal recipients, to proceed with its plan.

“The medical needs of a community are best understood by the members of that community and their local representatives,” Hart said. “I think the way to obtain the highest quality health care at the lowest cost is to shift administration to the local level.”

Michael W. Murray, executive director of the California Medical Assistance Commission, the state agency overseeing Expanded Choice, said the state welcomes those enterprising counties that want to come up with their own Medi-Cal innovations. “I don’t think there is one magic approach,” he said.