Getting a Grip on Health Care for Poor : OPTIMA Is a Step Toward Reducing Costs, Improving Service for Medi-Cal Recipients

It’s frustrating to see how Orange County’s health system for the poor delivers so little care at such a high cost. One problem is that poor people covered by Medi-Cal have such limited access to primary care that they end up going to emergency rooms--at a much higher cost to taxpayers.

There must be a better way--and now it appears that there may be one. On Tuesday, the Board of Supervisors is expected to approve a state-sponsored plan to develop a so-called County Organized Health System in Orange County. Its aim is to reduce costs and deliver better care to the 225,000 poor people in the county who are eligible for Medi-Cal.

That is good news--as far as it goes. Too bad that a COHS, at least initially, won’t address the larger problem of the 400,000 or so Orange County residents who have virtually no access to health care. About half those are working poor who don’t get health insurance on the job.

Still, the creation of a COHS in Orange County would be a positive step. Similar systems are off to a good start in San Mateo and Santa Barbara counties. Orange County is among three counties--also including Solano and Santa Cruz--chosen by the California Medical Assistance Commission for a COHS. Orange County’s would be called OPTIMA--Orange Prevention, Treatment and Intervention Medical Assistance program.

It would work like this: The state would provide OPTIMA with a set amount for each Medi-Cal-eligible person, and OPTIMA would contract with hospitals, community clinics, physicians and other health care providers to provide primary care. Currently, about a half a billion dollars a year is spent on Medi-Cal in Orange County. But much is wasted. For example, one emergency room visit costs as much as five or six physician office visits.

It will take many months--and much hard work--to put OPTIMA into effect. The state has made it clear that much will depend on how willing physicians are to participate. Certainly, doctors have legitimate gripes about the current Medi-Cal system--bureaucratic hassles, slow payments and lower-than-normal fees. But OPTIMA should simplify procedures by bringing them under local control.

If successful, OPTIMA might expand to include other health programs for the poor, including the county’s Indigent Medical Services. That would be welcome.

Though limited to Medi-Cal, OPTIMA should be a good start at delivering better health care to at least some of the county’s poor--as well as better using public health dollars.