Most vulnerable could benefit from healthcare contract proposal – Marin Independent Journal
The Legislative Assembly this week will begin considering a proposal from the California Department of Health Services to engage Kaiser Permanente in a single direct contract for Medi-Cal services in the counties where we operate.
The change is significant, as are the benefits for the most vulnerable enrollees.
Medi-Cal is the state and federally funded program that provides health care to low-income residents. Kaiser Permanente proudly provides the highest quality Medi-Cal coverage and care in the state to more than 900,000 people in 22 counties. We are a direct contractor with the state in five counties, including Sacramento and San Diego. We contract with local Medi-Cal health plans in other counties.
The health conditions and demographic makeup of our Medi-Cal members are comparable to other Medi-Cal managed care plans, as measured by the Department of Health Care Services.
We base our Medi-Cal services on our continuity of care approach. This approach, for example, allows a single mother covered by Kaiser Permanente to switch from employee-sponsored coverage to Covered California and Medi-Cal over the course of a year without interrupting her health insurance and access to doctors.
The change being considered this week allows more people like her in the other areas we serve to benefit from a similar and seamless approach. It also allows us to do the same for foster children and for seniors who are dual-enrolled in Medicare and Medi-Cal.
The state is entering into new standard contracts with Medi-Cal managed health care plans to ensure better quality, transparency and accountability. Because Kaiser Permanente provides both care and coverage in a select geographic area, unlike other health plans, we cannot participate in the state-established procurement process. The Department of Health Services’ single direct contract proposal, set out in the language of the budget bill and in Assembly Bill 2724 by Assemblyman Dr. Joaquin Arambula, seeks to align our delivery model on the growth and quality objectives that the State has defined. for Kaiser Permanente.
The proposed agreement, which would begin in 2024, is consistent with the state’s mission to provide Medi-Cal services through a holistic care approach. Most importantly, it provides significant benefits to Californians who depend on Medi-Cal for care and services. This too:
• Advances equity by requiring Kaiser Permanente, over time, to serve even more vulnerable populations with complex needs in all areas where we serve our members and patients in California, creating more equitable access to the most high quality of the state. This will help further extend our current commitment to providing high quality care and coverage to people with limited income and resources.
• Facilitates access by removing confusing layers of administration, resulting in a single, direct contract that provides less fragmented care and improves the patient experience.
• Increases affordability by eliminating the need for the state to pay administrative oversight fees to local plans for the services they delegate to Kaiser Permanente, resulting in savings that will be used to reduce costs and invest in care.
• Do more for Medi-Cal as a whole by asking Kaiser Permanente to leverage its model to help federally licensed health centers and other safety net providers improve quality; strengthen the safety net by helping to expand the virtual care and clinical capabilities of these qualified health centers and our other partner clinics; and provide more specialist care by piloting in-person outpatient specialist care visits for patients who need it most.
Participating in Medi-Cal is part of Kaiser Permanente’s mission as a nonprofit organization.
We offer Medi-Cal enrollees the same access to our care and coverage while receiving lower reimbursements, operating Medi-Cal at a significant loss.
We will not compete with local plans and will continue to support the essential functions of safety net providers. We will collaborate with counties on several topics, such as behavioral health, public health and more.
In total, the single contract proposal requires Kaiser Permanente to work with local health plans, counties, and the Safety Net to determine enrollment growth, implement Medi-Cal reforms, and ultimately provide better and more affordable health care for all who depend on it. on Medi-Cal.
Dr. Bechara Choucair is Senior Vice President and Chief Health Officer of Kaiser Permanente, a health insurance and care provider. Distributed by CalMatters.org.