Most vulnerable people benefit from health contract proposal – Marin Independent Journal
The Legislature will begin this week to consider a proposal by the California Department of Health Services to place Kaiser Permanente under a single, direct contract for medical services in the counties where we operate.
The change is significant, as are the benefits for the most vulnerable participants.
Medi-Cal is the state and federally funded program that provides healthcare to low-income residents. Kaiser Permanente proudly provides the highest quality medical care and assistance in the state to more than 900,000 people in 22 counties. We are a direct contract with the state in five counties including Sacramento and San Diego. We work with local Medi-Cal health plans in the other counties.
The health status and demographics of our Medi-Cal membership 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. For example, this approach allows a single mother affiliated with Kaiser Permanente to switch between employee-sponsored insurance, Covered California, and Medi-Cal over the course of a year without disrupting her health insurance and access to doctors.
The change being considered this week will allow more people like you to enjoy a similarly seamless approach across the other areas we serve. It also allows us to do the same for foster children and seniors who are enrolled in Medicare and Medi-Cal at the same time.
The state is entering into new standard contracts with Medi-Cal Managed Care health plans to ensure greater quality, transparency and accountability. Because Kaiser Permanente, unlike other healthcare plans, provides both care and coverage within a select geographic footprint, we cannot participate in the state’s established procurement process. The Department of Health Care Services Direct Individual Contract Proposal, drafted in the language of the Budget Trailer Bill and in Assembly Bill 2724 by Assembly Member Dr. Joaquin Arambula, aims to align our supply model with the government’s growth and quality goals for Kaiser Permanente.
The proposed agreement, which would begin in 2024, is consistent with the state’s mission to provide medical services through a holistic approach to care. Most importantly, it provides significant benefits to the Californians who rely on Medi-Cal for care and services. It also:
• Promotes equity by committing Kaiser Permanente over time to serving more vulnerable populations with complex needs in all areas where we serve our members and patients in California, thereby providing more equitable access to the state’s highest quality plan . This will help further expand our existing commitment to providing quality care and coverage for those with limited income and resources.
• Eases access by removing confusing layers of administration, resulting in a single, direct contract that offers less fragmented care and improves the patient experience.
• Increases affordability as the state does not have to pay management fees to local plans for services they delegate to Kaiser Permanente, resulting in savings that are used to reduce costs and invest in care.
• does more for Medi-Cal overall by encouraging Kaiser Permanente to use its model to help federally qualified health centers and other safety net providers improve quality; Strengthening the safety net by supporting the expansion of virtual care and clinical capacity at these qualified health centers and our other clinical partners; and provide more specialist care by exploring in-person, outpatient specialist visits for patients with the greatest need.
Participation in Medi-Cal is part of Kaiser Permanente’s mission as a nonprofit organization.
We offer Medi-Cal members equal access to our care and coverage, but receive lower reimbursements and operate at significant losses at Medi-Cal.
We will not compete with local plans and will continue to support the core functions of safety net providers. We will work with districts on various issues such as: B. Behavioral health, public health and more.
Overall, the single treaty 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 higher quality, more affordable health care to 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 long-term care provider. Distributed by CalMatters.org.