CalOPTIMA Proves a Learning Experience

Your article (“CalOPTIMA’s Rocky First Year Offers Lessons for Other Counties,” July 21) was a pleasant surprise and a fairly good report of a topic that deserves more coverage than it gets.

Since its inception, CalOPTIMA has truly disrupted health care in Orange County. As a consultant managing several medical groups and practices within Orange County, I have witnessed firsthand the hardship it has cost--to physicians and their staffs, and patients too.

The examples in your article are a tip of the iceberg and do not do the problem justice. There are dozens of physicians and providers who are really experiencing economic hardship--even disaster--from the result of the CalOPTIMA implementation. Ironically, these are the providers who did accept Medi-Cal patients before CalOPTIMA.

“Chaotic” is an appropriate description for the first year. It also could be a word to describe the CalOPTIMA “management” style.

Your article quotes Mary Dewane as saying, “We know that 240,000 people have a doctor and a health plan and a system in place for them.” Regarding that “system in place,” your article did touch on a huge and severe problem--calling or contacting CalOPTIMA to ascertain patient eligibility. The answer takes forever.

The pediatrics practice that I manage has chosen to often just treat sick patients, knowing that it may or may not be reimbursed for this service.

As a short-term member of one of the steering committees to launch CalOPTIMA, I was amused when confronted with a potential problem. The answer from one of the CalOPTIMA bureaucrats would often be something like, “The devil is in the details.”

CalOPTIMA, its founders and its managerial bureaucracy have really created a devil of a time for Orange County.

CHARLES M. DENNY

Laguna Beach

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The article on CalOPTIMA’s rocky start points out that all of the problems noted were solved by CalOPTIMA’s staff. It does not stress that the responsiveness of the staff has been incredible, considering the awesome task of starting a new program for Orange County’s Medi-Cal recipients. The fact is the communication to and training of the new managed care organizations has been better than anyone could have expected.

Further, you question the appropriateness of the administrative costs. That ignores the information you have published about the Medical Risk Ratios (administrative costs) of all the state’s managed care plans. The fact is, the combined costs of CalOPTIMA and its contractees are right in line with the administrative costs of almost all of California’s HMOs, with the notable exception of Kaiser.

CalOPTIMA is an experiment with national implications: If it can continue to organize better care to poor people at lower costs, it will set the standard for the rest of the country to follow. In truth, the CEO of CalOPTIMA, Mary Dewane, and her staff deserve kudos for the excellent work they have done over the past nine months.

KENNETH E. BELL, M.D.

Area associate medical director

Kaiser Permanente, Orange County

Chairman, CalOPTIMA Provider Advisory Committee