Saturday, December 16, 2017

OCMA Blog

Upcoming CalOptima Provider Forum on Duals Demonstration

On July 10, the OCMA, CalOptima and the Health Networks in the CalOptima health care delivery system co-hosted a forum for physicians to learn about the contracting options for the upcoming "duals demonstration."  The demonstration will entail enrolling the dual-eligible (Medicare/Medi-Cal) beneficiaries in Orange County into CalOptima. OCMA has been advocating that physicians and their dual-eligible patients have multiple options for participating in the demonstration, including an option that allows physicians to contract directly with CalOptima. 

 

On Wednesday, August 14, CalOptima will host another forum which will include the Health Networks to once again reach out to physicians and educate them on the various contracting options the CalOptima board of directors will consider at their next board meeting.  If you missed the July 10th forum, OCMA strongly encourages you to attend the forum on August 14.  It is imperative that CalOptima and the Health Networks hear from the physicians that are caring for the dual-eligible patients in Orange County. The invitation to the August 14 forum is attached.

 

Note: this forum will be held at CalOptima. See invitation for full details.

 

Thank you for your attention to this matter.


2013 CalOptima Circle of Care Award Request for Nominations

About CalOptima and the Circle of Care Award

CalOptima’s mission is to provide members with access to quality health care services delivered in a cost-effective and compassionate manner.

The CalOptima Circle of Care Award recognizes health care professionals, community groups and individuals who demonstrate excellence in the delivery of accessible and high-quality health care services to CalOptima members. The award honors those who go above and beyond in serving their profession, patients or clients. Since the award’s inception in 2000, CalOptima has recognized more than 230 distinguished people or groups whose dedication to our members and community is extraordinary.  

Nomination Criteria and Deadline

Please join CalOptima in recognizing outstanding health care professionals, community groups and individuals who, in the past 12 months, went above and beyond to serve our members by submitting the attached Nomination Form. Award recipients will be selected based on:

  • The nominee’s service to CalOptima members
  • The nominee’s accomplishments during the past 12 months

Nominators, please note the following criteria:


  • A nominee may only be a Circle of Care Award recipient a total of five times
  • Only one Nomination Form per nominee is needed
  • Self-nominations are welcome
  • Completed Nomination Forms must be submitted by: Friday, June 7, 2013

Mail, deliver, fax or email Nomination Forms to:   

CalOptima: Network Management Department

Attention: Maria Wahab

505 City Parkway West, Orange, CA 92868

Email: mwahab@caloptima.org

Fax: 714-796-6679   

Award recipients will be invited to attend the Circle of Care Award luncheon on Friday, September 20, 2013. 

 

 

If you have any questions, please contact Maria Wahab at 714-796-6143. Please allow adequate time before the nomination deadline for CalOptima to respond to any inquiry.

 

Please click here for the nomination form


OCMA Member Update on Dual Eligibles Demonstration Project

February 25, 2013

 

Over the last 8 months as CalOptima has been building the foundation for the duals demonstration in Orange County, the OCMA has worked consistently and diligently to represent the interests of physicians and their patients.  The critical decision during this early stage of the demonstration was CalOptima board approval of a health care delivery system to serve the duals patients.

Click here for detailed background information.

 

The OCMA strongly advocated that individual physicians, currently serving the duals patients, be included in the delivery system.  A number of these physicians see their duals patients through Medicare Fee-for-Service, and it is important that duals patients continue to have access to their current physicians.

 

OCMA sent a letter to the CalOptima CEO outlining the reasons for the individual contract option.  This letter is the culmination of months of work and summarizes the many points we carried to individual CalOptima board members and their senior staff.  

Click here for the letter to sent to the CalOptima CEO on behalf of OCMA. 

 

We are very pleased to inform our members that the CalOptima board approved a health care delivery system that will include the individual physicians.  At the February meeting of the board, they considered a number of options and, in the end, agreed to develop a network model that will offer an individual contract option to physicians.  

Click here for the approved actions that were passed by the CalOptima board.

 

There remain a number of other important decisions relative to the duals demonstration, but we have achieved the major milestone noted above.  The OCMA will continue to be an active participant in the duals demonstration, decision-making processes and will continue to update the membership as we reach other critical decision points.


OCMA Needs Your Help with an Important Survey Regarding Dual Eligibles

Your participation is needed! Please consider taking a short, 10 question survey regarding the dual eligibles demonstration project.

Those who participate in this survey may enter to win one of three $100 Visa gift cards. By leaving your name at the end of the survey, you will be entered in the drawing! OCMA staff will contact the winners on or before February 7, 2013. 

The CalOptima board of directors is scheduled to make a critical decision regarding dual eligible patients (eligible for both Medicare and Medi-Cal) in Orange County at their February 7 board meeting. The decision could impact many physicians and their dual eligible patients. Your immediate input is necessary.

 

The OCMA has been working with CalOptima to advocate that the board adopt a very open health care delivery model for the duals patients; a delivery model that includes contracted health plans and individual physicians, via individual contracts. The broad health care delivery model will allow for patients to continue seeing their individual physician even if that physician is not affiliated with a CalOptima health plan for the purposes of Medicare managed care.

 

In order to effectively advocate for the physicians providing Medicare services, we need accurate and current information to share with the CalOptima staff and board members. This survey will enable us to provide a substantial portion of the important information that we need. The CalOptima board is uncertain, at this time, on the type of health care delivery model they will utilize for the duals patients in Orange County, so your immediate response is requested and will be of great value. Thank you for your time and participation.


For a more detailed update on the duals demonstration in Orange County, please go to the OCMA web site under the Local Advocacy section.

 

To continue to the survey, click the link below.


Survey Link: 

https://www.surveymonkey.com/s/CB9QHJR


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