The State of California Department of Health Care Services (DHCS) announced today that Los Angeles County was chosen as one of four sites for an integrated care initiative for individuals who are eligible for both Medicare and Medi-Cal. L.A. Care is one of two health plans in the county who will participate. The new pilot program is set to start in January, 2013.
In coordination with the federal government, DHCS has developed a new demonstration pilot that, beginning next year, will provide comprehensive health services to individuals eligible for both Medicare and Medi-Cal (“Dual Eligibles” or “Duals”). The three-year pilot will test how aligning financial incentives can drive patient-centered care and rebalance the current health care system away from institutionalization and toward keeping patients at home. Four counties have initially been selected to participate in the pilot program, including the County of Los Angeles.
Howard Kahn, Chief Executive Officer of L.A. Care Health Plan said, “The L.A. Care team is excited about participating in the Dual Eligibles pilot program. We have a proven track record in the delivery of high quality care to our members, and an extraordinary knowledge of Medi-Cal in Los Angeles County. L.A. Care recognizes the need for strong consumer protections and that cost-effective high quality care benefits the patients, the government, and the public.
“By competing with Health Net in the Two-Plan Model, we can improve continuity of care and services, and maximize the ability of Dual Eligibles to remain in their homes and in their community. This can be achieved by providing appropriate services and supports in lieu of institutional care. In doing so, we can increase the availability and access to home-and community-based alternatives. We are very pleased that DHCS has selected Los Angeles County and L.A. Care, and are committed to making this pilot project a success,” Kahn added.
As California’s Legislature continues to face an unprecedented fiscal crisis, managed care is seen as a promising solution to improve the currently fragmented system of care for Dual Eligibles. Over the last few years, the DHCS has moved groups of Medi-Cal beneficiaries from the traditional fee for service Medi-Cal program into Medi-Cal managed care, with the goal of improving the quality and efficiency of care delivered to beneficiaries (e.g., mandatory enrollment of seniors and people with disabilities or SPDs).
L.A. County is home to approximately 374,000 Duals (the largest concentration in the country), with an annual combined Medi-Cal and Medicare expense of over $10 billion in 2009. Currently, the care system for Dual Eligibles is fragmented, uncoordinated, complicated, difficult to navigate, not focused on an individual’s medical care, lacking continuity of care, and largely unmonitored for access, language and cultural barriers. The benefits of integrated care provide significant opportunities to improve healthcare access and quality, and reduce cost of care for this high-cost and high-need population.
L.A. Care is well-positioned to take on this additional membership, having served for 15 years as the local intiative health plan for Medi-Cal in Los Angeles County competing with Health Net, the commercial health plan in the Two-Plan model. The Two-Plan model is a system of care that brings together two experienced organizations serving L.A.’s low-income beneficiaries. Through contracted “Plan Partners,” the model fosters broad choice of health plan options and enables a systemic approach to delivery reform while delivering proven savings that can be shared with the Federal and State governments.
The other counties selected for the pilot program are Orange, San Diego and San Mateo. Now that the demonstration counties and health plans have been selected, DHCS will release the proposals for a 30-day public comment period. Following that comment period, the proposals will be submitted to the Centers for Medicare and Medicaid Services (CMS), the federal regulatory agency that administers the Medicate program, and a 30-day federal public comment period will commence.
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