CalOPTIMA Gets Word of Thanks

Your Oct. 25 article (“O.C. Largely Healing Service to Poor Patients”) presented a well-balanced perspective.

HMO-type health systems are, by virtue of economics, designed to best serve individuals who are well. And having ready access to health care is a cost-effective and, of course, preventive approach.

The glitch for people who are disabled and who may have chronic, unique and/or complex needs is that they do not “fit” into the fundamental cost-capped structure upon which managed care is based. A quick fix or ignoring the problem simply doesn’t work. Inattention to the health-related needs of individuals who are disabled can result in serious regression and/or expensive reaction to an emergency that was preventable at great cost to the child or adult as well as the system.

CalOPTIMA has worked closely with the Area Board XI Task Force since mandatory enrollment of all Medi-Cal beneficiaries began. We have been grateful for CalOPTIMA’s responsiveness and desire to remedy many of the barriers encountered by individuals having disabilities. This includes publication of a consumer handbook that we believe will assist consumers to navigate the managed health care systems.

What has amazed me from the beginning is the absolute lack of required documentation that could truly measure success outcomes from the perspective of the human beings who we hoped were the reason this, and other, managed health care pilot projects exist throughout the state and nation.

RHYS BURCHILL

Executive Director

Area Board XI

Developmental Disabilities Board

Tustin