OPTIMA Picks ‘Hybrid Plan’ Mixing HMOs, Consortiums : Health: Most agree with vote on the system’s format. However, a group of Vietnamese doctors and pharmacists say it will hurt individuals who have traditionally helped the indigent.

Officials building a new system to serve Orange County’s 300,000 Medi-Cal recipients adopted a plan Tuesday that broadens access to medicine while preserving the “safety net” of doctors, hospitals and clinics that have served the county’s poor.

This so-called “hybrid plan” will allow OPTIMA, the agency forming the new health care delivery system, to contract with new consortiums of physicians and hospitals and with existing health maintenance organizations.

“I believe the hybrid option offers the most opportunity for the inclusion of individual physicians and the least chance of disruption of patient care,” said John R. Cochran III, chief executive officer of Martin Luther Hospital in Anaheim and OPTIMA’s board chairman.

The board adopted the plan 5 to 0, with members Harriett M. Wieder and Art Birtcher absent. Wieder, a county supervisor who spearheaded the formation of OPTIMA, sent a message that she favored the approach.

The board also instructed its staff to start making plans to fold into the managed-care system as soon as possible an additional 17,000 to 20,000 low-income people who are ineligible for Medi-Cal but whom the county serves through its Medical Services to Indigents program.

Most representatives of Orange County’s medical community Tuesday spoke in favor of the plan the board adopted.

Mary A. Piccione, executive director of the UCI Medical Center in Orange, told the board that UCI, which historically has served a large portion of Orange County’s indigents, already was working with the Orange County Medical Assn. to help form a group of traditional Medi-Cal providers that will contract with OPTIMA.

Samuel Roth, assistant director of the Orange County Medical Assn., said his group received many calls from physicians and hospitals who wanted help in forming a consortium that would meet OPTIMA’s criteria.

But not everyone was satisfied. A petition signed by 75 Vietnamese physicians and 12 Vietnamese pharmacists demanded that OPTIMA keep open the option of contracting with individual doctors rather than requiring them to join or form groups.

“We think the present designs proposed by OPTIMA are grossly unfair, disregarding our medical, cultural and psychological needs,” said Duc Trong Do, vice chairman of the Advisory and Supervisory Council of the Vietnamese Community of Southern California.

OPTIMA officials said one of their most important concerns in adopting a new managed-care plan was not to destroy the “safety net” of clinics, hospitals and physicians that already serve the county’s indigent population but are not aligned with HMOs or other health networks.

However, they rejected the option of contracting directly with individual clinics or private practitioners, arguing that it would be more convenient and cost-effective to contract instead with networks that include family doctors, specialists and hospitals.

Those networks will be similar to HMOs but won’t have to meet the same licensing requirements.

OPTIMA’s goals in taking over the operation of Medi-Cal in Orange County from the state are to improve access to medical care and curb Medi-Cal’s burgeoning costs.

In the past, only a relatively small number of physicians in the county have participated in the state Medi-Cal program, which was criticized for its red tape and low reimbursement; Medi-Cal patients often were forced to go to hospital emergency rooms where they received their routine medical care at a much higher cost.

More physicians and hospitals are showing interest in OPTIMA, in part because declining reimbursements offered by commercial health plans are making Medi-Cal more attractive, and because there is hope that a locally designed and operated Medi-Cal system will be more responsive to local needs than the state system.

But Dr. Melvyn L. Sterling, immediate past president of the Orange County Medical Assn., told the OPTIMA board that the association is supporting their plan “with some caution because the devil is indeed in the details. Local physicians and their patients are justifiably concerned about the impending changes in health care that will be brought about by OPTIMA.”

The plan still must be approved by the federal Health Care Insurance Finance Administration.