90 Health Groups Signal Their Intent to Join County Plan

Ninety Orange County health-care organizations have sent notice that they intend to apply for participation in the county’s reformed Medi-Cal system known as OPTIMA--a response one official described as overwhelming.

“It’s more than I expected, and . . . we’re real pleased so many have come through,” said Mary Dewane, chief executive officer of OPTIMA, a unique system that will bring the county’s 300,000 Medi-Cal recipients into managed-care networks beginning in July.

The response came in the form of “letters of intent,” which Dewane cautioned do not guarantee participation. The letters, due last week, were required of any potential participant--and some may have sent them as a “place-holder,” she said.

Some organizations may decide to combine forces, reducing the overall number of providers, and others may drop out if they find the compensation unsatisfactory, Dewane said. Rates have yet to be announced. Still, Dewane characterized the initial level of interest in OPTIMA as “very encouraging.” The list of potential providers--from traditional physician groups to established health maintenance organizations--seems to assure Medi-Cal patients in the county increased access to care and expanded choice, she said.

Applications are due Feb. 15 and contracts are scheduled to be awarded the following month. Dewane said it is unknown whether the county’s financial crisis will have any substantial effect on OPTIMA’s timetable. If county money for the program is withheld for a prolonged period it could delay hiring of staff, she said.

OPTIMA, an experimental approach to Medi-Cal that state officials are watching with interest, already has changed the health-care landscape in Orange County. Dewane said many physicians who are longtime Medi-Cal providers have formed networks with other physicians and hospitals just to qualify for participation in OPTIMA. One example, she said, is the Assn. of Traditional Providers, formed with the help of the Orange County Medical Assn.

Larger organizations with long-term experience in managed care--such as FHP Health Care and Kaiser Permanente--also sent letters of intent to apply.

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The OPTIMA program, which would guarantee providers set fees per patient instead of fees for each service, has renewed interest in a Medi-Cal system often shunned because of its bureaucratic red tape and low reimbursement levels.

“We’re just itching to see what we can do for this population,” said Jim Gonzalez, director of government affairs in California for Fountain-Valley based FHP Health Care, which stopped serving Medi-Cal patients in Orange County a few years ago.

Gonzalez said he did not know why FHP ended its Medi-Cal participation here, but pointed out that the organization has continued to serve a small number of patients in Los Angeles County.

“We know that we can do a good job and provide quality health-care services to the poor,” he said.

But some OPTIMA applicants are not satisfied that the new system and all of its new participants will serve their communities as well as the traditional Medi-Cal program.

Dr. Christopher Bui, a Westminster gastroenterologist and member of an applicant group called United Care Medical Group, said he and other Vietnamese physicians applied to participate in OPTIMA because they want to continue serving Medi-Cal patients who have come to rely upon them. But many of these doctors fear that OPTIMA will disrupt these long-standing relationships, Bui said.

“Those HMO types, they smell money,” Bui said. “It is more advantageous for the administrators (of the companies) than for the patients themselves.”