The UCSF Community Living Policy Center and the UC Berkeley Health Research for Action Center conducted an evaluation of Cal MediConnect (CMC), part of California’s Coordinated Care Initiative (CCI). The evaluation uses focus groups and a representative telephone survey to assess beneficiaries’ experiences with care, including access, quality, and coordination. The evaluation also examines service delivery system response to the initiative in several sectors, including health plans, medical care providers, behavioral health, skilled nursing, and home and community-based services.
As part of this three-year evaluation, in early 2016 researchers conducted a representative telephone survey with 2,139 beneficiaries who were dually eligible to examine their experiences with Cal MediConnect. Researchers compared the experiences of CMC beneficiaries with those who opted out and those who reside in non-CCI counties to identify areas where experiences are significantly better or worse than those who did not participate.
Key findings from the telephone survey include:
- Most Cal MediConnect beneficiaries are satisfied with their benefits.
- Continuity of care is important to beneficiaries.
- Access to care improved for about a quarter of beneficiaries in CMC, with the most significant improvements seen in the areas of prescription medication, equipment or supplies, vision, and dental benefits.
- Care coordination from Cal MediConnect plans is working well and having a care coordinator helped ease the transition into Cal MediConnect.
- Cal MediConnect plans are coordinating LTSS, but more needs to be done to reduce unmet needs for those needing personal care assistance.
- Cal MediConnect notifications showed room for improvement.
- Beneficiaries had many reasons for opting out of Cal MediConnect that reach beyond “fear of change.”
For full details of the telephone survey findings and the complete evaluation, including comments from the California Department of Health Care Services, click here or visit www.thescanfoundation.org.
UC Berkeley Health Research should also include patients that speak only foreign languages, ie. Armenian, etc. Those members that were enrolled in Cal-Medi Connect suffered the most because they couldn’t communicate with anyone, including: health plans, IPA, care coordinators, or unknown specialists that they were referred to. Also majority of researched members must include members that have multiple problems, like cancer, heart condition; & find out how happy these members are with new physicians. Those individuals only rely on their PCP to take care of them with everything, including their personal paperwork. Very sick patients’ entire life changes once they enroll, including Laboratory, radiology, unknown doctors, etc. & to deal with all these with limited or no English at all. You need 1 family member to stay by you all day to handle all these changes & communications & appointments.
As a PCP – With IPA’s it takes forever to get referrals or things approved. A simple ? turns into a maze to untangle. Patients are added to IPA system 30-90 days late, so it takes longer to get any referrals. Also the capitation payments are not always paid for retro enrollment months. They pay 1 month, next month they take the same amount out. Multiply this by 3-5 members a month. It adds up to hundreds of dollars of loss per month for PCP & gain to IPA. It is impossible to keep track of IPA monthly capitation payments at all. Some IPA’s (like HealthCare Partners) does not provide written details with capitation payment, just a 1/2 page summary. They always go back several months & dis-enroll a member & take the fee out for all those months. So it becomes a massive burden on our staff to verify each member on several sites, including Medicare/Medi-Cal, Health Plan; & for each month separate to determine if it is accurate. It is impossible to keep truck of any payments.
UC Berkeley Health Research should also include patients that speak only foreign languages, ie. Armenian, etc. Those members that were enrolled in Cal-Medi Connect suffered the most because they couldn’t communicate with anyone, including: health plans, IPA, care coordinators, or unknown specialists that they were referred to. Also majority of researched members must include members that have multiple problems, like cancer, heart condition; & find out how happy these members are with new physicians. Those individuals only rely on their PCP to take care of them with everything, including their personal paperwork. Very sick patients’ entire life changes once they enroll, including Laboratory, radiology, unknown doctors, etc. & to deal with all these with limited or no English at all. You need 1 family member to stay by you all day to handle all these changes & communications & appointments.
As a PCP – With IPA’s it takes forever to get referrals or things approved. A simple ? turns into a maze to untangle. Patients are added to IPA system 30-90 days late, so it takes longer to get any referrals. Also the capitation payments are not always paid for retro enrollment months. They pay 1 month, next month they take the same amount out. Multiply this by 3-5 members a month. It adds up to hundreds of dollars of loss per month for PCP & gain to IPA. It is impossible to keep track of IPA monthly capitation payments at all. Some IPA’s (like HealthCare Partners) does not provide written details with capitation payment, just a 1/2 page summary. They always go back several months & dis-enroll a member & take the fee out for all those months. So it becomes a massive burden on our staff to verify each member on several sites, including Medicare/Medi-Cal, Health Plan; & for each month separate to determine if it is accurate. It is impossible to keep truck of any payments.