Slowing on Medi-Cal Managed Care Urged

Just as Los Angeles County is poised to adopt managed care for Medi-Cal patients on an unprecedented scale, a coalition of consumer groups Thursday made a last-ditch plea to suspend automatic enrollment in the program statewide because of “ongoing deficiencies” and “mass confusion.”

Days before 1.2 million low-income county residents--mostly women and children on welfare--are scheduled to start signing up, the coalition issued a blistering report accusing state health officials of grossly inadequate preparation throughout California.

“This is the largest and most rapid transition in the country to managed care,” said Bruce Livingston of Health Access Foundation, a San Francisco-based consumer group that is part of the coalition. “We want the state to slow down and do it right the first time.”

The report comes only a month after the Los Angeles County Medical Assn. called for halting the county’s Medi-Cal managed care efforts, saying the program was “headed for disaster” and could bring “sickness, suffering and death.”

The state has no plans to hit the brakes.

“We don’t view the bringing up of the [system] in L.A. as a portent of disaster. It’s a step in the right direction,” said Joseph Kelly, the state Department of Health Services official overseeing the transition.

Consumer groups and the medical association have been included in discussions of the Los Angeles County model from the outset, he said. Their outcries now are largely a reflection of “anxiety and concern” over the impending change, he said,

Ultimately, the so-called two-plan model is expected to be implemented in 12 California counties, but Los Angeles County accounts for more than a third of the patients and would be the largest managed care project of its kind in the nation.

Enrollment is to start April 1 in Blue Cross, one of the participants in the Los Angeles County model. In general, plan sign-ups are to be phased in over the next six to 12 months.

Patients will have the option of sticking with the old form of Medi-Cal until the managed care model is fully implemented. But patients who do not make a choice will be automatically assigned to managed care.

The two-plan approach includes a new, locally organized health plan (called L.A. Care in Los Angeles) and an existing commercial plan called Foundation Health. L.A. Care is actually a partnership of seven health plans, six commercial and one public.

The model is intended to increase patient access to care while containing costs. Health care providers are paid set monthly fees for each patient assigned to them, whether or not the patient seeks care.

The idea is to keep patients as healthy as possible and avoid expensive emergency care. It is also to enhance patient choice and boost the often-shunned Medi-Cal program’s allure to providers.

Based on the experience thus far in Alameda and other California counties, the consumer coalition deemed the two-plan model a failure.

“This program, which should be providing better access to health care for patients who desperately need it, instead is creating confusion, disruption, incontinuity of care and, sometimes, medical disaster and death,” said Jeanne Finberg, an attorney with Consumers Union, publisher of Consumer Reports.

The 71-page coalition report concludes that the state Department of Health Services did not adequately plan for the program and has not sufficiently monitored Medi-Cal managed care in general. It has set unrealistically low payment rates, provided inadequate patient education and allowed “massive errors in processing enrollments,” the report states.

State and health plan officials acknowledge that there have been glitches in enrollment, but they attribute them to a former enrollment contractor that was recently replaced. In addition, they say, they have taken pains to develop educational materials and do community outreach.

“I think it’s irresponsible” for these groups to go public with their concerns so late in the game, said Anthony Rodgers, chief executive officer of L.A. Care. He said there has been enormous investment of time and resources in the new program and that delays could be costly.

“The train has left the station,” he said. “This kind of effort [by the coalition] I really think does more harm than good.”

Foundation Health also expressed some surprise and dismay at the late-stage critique.

“It always kind of floors me when [critics] say the state is doing this so quickly, when they’ve spent the last five years [planning] this,” said Sean O’Brien, director of Medi-Cal operations for Foundation.

“They’ve been getting input from providers, plans and work groups. It’s been slow in getting off the ground, if anything. . . . It’s almost two years behind schedule. The state has been taking its time.”