Panel Offers Plan to Cure Health Care for the Poor : Medi-Cal: County health and government officials propose HMO-like program that would ease access to physicians. It must be approved by supervisors and state medical commission.

Orange County health and governmental officials on Wednesday unveiled a plan for better, quicker and perhaps less expensive medical care for 225,000 poor people in the county.

The plan, which is something like a health maintenance organization (HMO), would cover all current Medi-Cal patients in the county. It would go into effect in about two years.

People who have Medi-Cal cards would be able to pick a doctor from a pool of Orange County physicians who take part in the plan. That doctor then would be their primary-care physician--responsible for all health care. County officials said poor people no longer would have to flock to hospital emergency rooms for non-emergency health problems.

“This (plan) is a potential benchmark for other counties in California,” said County Supervisor Gaddi H. Vasquez. He and Supervisor Harriett M. Wieder were among those presenting the plan at a press conference at the county Hall of Administration.

Wieder said: “We all know that access and financing of health care has become a national concern. In Orange County, health care issues pose a particular challenge since we do not own or operate a county hospital. . . . (Indigent) patient groups have difficulty accessing adequate health care.”

The root of the problem, the various officials said, is that since Medi-Cal pays considerably less than private physicians charge, few doctors in the past have wanted to take Medi-Cal patients. Burdensome paperwork required by existing Medi-Cal has also added to the doctors’ dislike, the officials said.

The result for poor people has been no family doctors, officials said. These poor people then go to hospital emergency rooms to seek a doctor even if they do not have an emergency. Since emergency rooms are expensive to operate, much Medi-Cal money is wasted on this type of patient “referral,” the officials added.

The plan proposed for Orange County would lump all 225,000 Medi-Cal patients in the county into one system, to be called OPTIMA (Orange Prevention, Treatment and Intervention Medical Assistance program).

OPTIMA would pool all the Medi-Cal funding for Orange County patients. It would then use that money to pay private doctors who agree to participate. Medi-Cal, which is jointly funded by the state and federal government, spent almost half a billion dollars for treatment for poor people in Orange County last year--much of it needlessly spent at emergency rooms, according to a report given to the county task force.

Under OPTIMA, the pool of Medi-Cal funds would be locally administered. Payments to doctors would be quicker and would require less paperwork, county officials said.

OPTIMA evolved from five months of study by a government-health industry task force headed by Wieder. The plan still has two hurdles to pass before it can be put into effect. It must be approved by a majority of the five-member County Board of Supervisors later this month, and it must win approval of the California Medical Assistance Commission.

Wieder and Vasquez predicted that their fellow supervisors would support the plan. They also expressed optimism that the state agency would give OPTIMA the green light. If so, no additional approval or state legislation is needed, the two supervisors said.

Dr. Richard F. Kammerman, immediate past president of the Orange County Medical Assn., was among those on the task force that created the OPTIMA plan.

“In many ways, today is an historic day for anyone concerned with resolving the chronic access-to-health-care crisis--a problem faced by thousands of Orange County residents,” Kammerman said. He said doctors in Orange County are working “to enable maximum physician participation and support for such a future system.”

Wieder said the plan possibly will save money. If so, she said, the health program might be expanded to cover some of the so-called “working poor,” those who cannot afford health insurance but are ineligible for Medi-Cal.