Amid the many unknowns about the future of health care, coordinated health care programs that show they improve care, lower costs and enhance the patient experience are worth further exploration and development.
Gov. Jerry Brown’s proposed state budget for Fiscal Year 2017–18 reinforced this by extending the coordinated care pilot program known as Cal MediConnect. Cal MediConnect plans, including CalOptima’s OneCare Connect in Orange County, have demonstrated positive results based on independent research from groups such as The Scan Foundation.
For public health plans like CalOptima, this extension is a welcome move. Why? At its core, coordinated care streamlines patient care to provide appropriate services in an effective manner. This is particularly important for health plans that serve low-income seniors and people with disabilities. These vulnerable community members often face health care systems that are disjointed, confusing and expensive.
For instance, processes vary among doctors, pharmacists, specialists and other care providers. Even straightforward information-sharing about diagnoses, tests, conditions, referrals and medications can easily get miscommunicated or lost.
However, smart, coordinated care programs can make a difference. As part of the state’s Cal MediConnect program, OneCare Connect is a prime example. This program serves people who are eligible for both Medicare and Medi-Cal. Before this program, these Medicare and Medi-Cal “dual eligibles” had to access services through disconnected programs funded by different government entities. This fragmentation often led to patient stress, delayed care, inappropriate utilization or unnecessary costs.
The Cal MediConnect concept changes this. The program creates an all-in-one health plan that covers medical services, prescription drugs, behavioral health, long-term care services and more benefits in a single delivery system. This coordination can improve beneficiary health (and satisfaction) while also whittling down costs.
One key example of success is a reduction in emergency room visits. The California Association of Health Plans recently reported that emergency room visits across more than 113,000 Cal MediConnect enrollees have decreased by 11 percent in the past two years. ERs are an expensive option people use when they don’t know where to go or have limited access to primary care. A double-digit drop in enrollees’ ER visits saves money and reduces the burden on our emergency care system.
A similar decline is happening right here in Orange County. Among OneCare Connect members, there has been a 9 percent drop in ER visits in the past year alone.
There are other positive indicators as well. Since 2014, inpatient days at hospitals declined by 24 percent for Cal MediConnect enrollees, according to health plan reports. In Orange County, it’s a solid 15 percent decline. There has also been a significant reduction in the number of days spent in long-term care facilities such as nursing homes. The data show 28 percent and 24 percent decreases in California and Orange County, respectively.
While questions loom regarding the future of the U.S. health system, the hope is that state and federal administrations continue to recognize the value of health plans pursuing care coordination.
This is especially true for programs like OneCare Connect that show strong promise for driving higher quality, more cost-efficient care that provides our most vulnerable community members with care in the right way and at the right time and place.
Michael Schrader is the CEO of CalOptima, a county organized health system that provides publicly funded health care coverage for low-income children, adults, seniors and people with disabilities in Orange County. In total, CalOptima serves more than 800,000 members via a private-sector network of contracted primary care doctors, specialists and hospitals. For additional information, visit www.caloptima.org.
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