Sunday, December 10, 2017

OCMA Blog

Paul B. Yost, M.D. Elected Chair of CalOptima Board of Directors

During its March 2, 2017 meeting, the CalOptima Board of Directors elected Paul B. Yost, M.D. to serve the remainder of Mark Refowitz’s term as chair of the CalOptima Board of Directors.  Mr. Refowitz previously announced his retirement as Director of the Orange County Health Care Agency, effective March 30, 2017.  He also announced he would be stepping down from the CalOptima Board subsequent to the March 2 regular meeting.  Dr. Yost’s current term as chair will conclude at the end of 4 months, when the next election is scheduled.

Congratulations to Dr. Yost on this tremendous accomplishment.


CalOptima Honors Orange County Pioneers Who Created Better Health Care System Two Decades Ago

For two decades, CalOptima has served Orange County’s low-income population with access to quality health care and on April 21, the agency honored 10 industry leaders at the center of CalOptima’s creation as a county organized health system. In a ceremony at Santa Ana’s Bowers Museum, honorees received Legacy Awards for their leadership and partnership in laying the foundation for CalOptima, which has been repeatedly recognized as the top Medi-Cal plan in California for quality care.

The Legacy Awards were developed specifically for CalOptima’s 20th anniversary and reflect the honorees’ contributions and the agency’s successful operation since October 1995.

CalOptima Legacy Award honorees include:

Mary Dewane, Founding Chief Executive Officer, now a resident of Phoenix

Kenneth E. Bell, M.D., Former Chief Medical Officer, a resident of Long Beach, California

Jean Forbath, Former Board member and Founder of Share Our Selves, a resident of Costa Mesa, California

Founding members of the CalOptima Board of Directors

John R. Cochran III, chairman of the Board and then a hospital CEO, from Portland, Oregon

Peter G. Anderson, M.D., emergency medicine specialist and physician leader, from Newport Beach, California

Art Birtcher, commercial real estate developer, from San Juan Capistrano, California

Richard Frankenstein, M.D., specialist and physician leader, from Valencia, California

Claire Heaney, then a nurse and health educator, from Tustin, California

Joyce Munsell, then a nurse and health care executive, from Santa Rosa, California

Harriett Wieder, former Orange County Supervisor (posthumous). The late Supervisor Wieder’s award was accepted by daughter Gayle Wieder-Tauber of La Jolla, California.

“Our Legacy Award recipients can be credited with helping to transform Orange County’s health care delivery system for Medi-Cal members,” said CalOptima Chief Executive Officer Michael Schrader. “Through innovation and collaboration, these leaders tackled a crisis in access to health care, overcrowded emergency rooms and unnecessary costs. They were essential in the broad community effort that launched CalOptima to fix those problems, and their legacy is alive in CalOptima’s ongoing impact of improved health for vulnerable children, adults, seniors and people with disabilities.”

Since inception, CalOptima has collaborated with myriad partners and providers to fulfill its mission of providing access to quality care. The Legacy Awards event also brought together more than 200 leaders from local health networks, hospitals, community-based organizations and government agencies to celebrate the success they share as partners in CalOptima programs.

To learn more about CalOptima, visit www.caloptima.org.

Webinar: Coordinated Care Initiative: Key Information for O.C. Physicians

The Coordinated Care Initiative:  Key Information for Orange County Physicians occurs several times:

Wednesday, April 27, 2016, 12:00 noon - 1:00 p.m.

Wednesday, May 25, 2016, 12:00 noon - 1:00 p.m.

Wednesday, June 22, 2016, 12:00 noon - 1:00 p.m.

Please register for the date and time that works best for you:  https://attendee.gotowebinar.com/rt/6054087317243662596

Program Description:  This webinar is designed for physicians and will cover the Coordinated Care Initiative (CCI) and the programs within the initiative including Cal MediConnect, known as OneCare Connect in Orange County.

The CCI is a new program designed to help provide extra support for low-income seniors and people with disabilities in California, including those who are dually eligible for Medicare and Medi-Cal.

Webinar topics include:  

1.  Overview:  How the CCI is changing health care for dual eligible patients;

2. Continuity of Care:  How to keep seeing your patients if they join OneCare Connect;

3. Care Coordination:  How OneCare Connect can help support physicians in coordinating care for patients, including in-home and community based services;

4. Billing Processes: How billing works under the CCI for patients who join OneCare Connect and for those who remain in  fee-for-service Medicare and join the CCI for Medi-Cal services.

Speakers:  Rita Cruz Gallegos & Joe Garbanzos, Provider Outreach Specialists, Harbage Consulting; and Laura Grigoruk, Director of Direct Networks - CalOptima.

 


Autism Spectrum Disorder — The Importance of Early Identification and Behavior Intervention

By Donald Sharps, M.D.
CalOptima Behavioral Health Medical Director

 

Early identification of children with delays in development or those at risk of delays provides primary care providers with a critical opportunity to pinpoint special health care needs. 

The main path to the early identification is a developmental screening in the primary care setting. In particular, early identification of autism spectrum disorder (ASD) can help a child significantly. According to the Centers for Disease Control and Prevention (CDC), early treatment services can improve a child’s development by helping the child talk, walk and interact with others. Therefore, it is important to screen children for ASD or any other developmental problems in their early years. 


The CDC and CalOptima recommend that all children be screened for developmental delays and disabilities during regular well-child doctor visits at: 
  • 9 months
  • 18 months
  • 24 or 30 months

If a child is at high risk for developmental problems due to preterm birth, low birth weight or other reasons, additional screenings might be required.

Additionally, all children should be screened specifically for ASD during regular well-child doctor visits at:

  • 18 months
  • 24 motnhs

Further screenings might be needed if a child is at high risk for ASD (e.g., having a sibling or other family member with ASD) or if behaviors sometimes associated with ASD are present.

Identifying a child as having a special health care need is only the first step. Once developmental delays are identified then an appropriate diagnostic work-up and follow-up must occur. It is in this next step that the relationship between the primary care provider and an early behavior intervention service becomes critical.

Effective September 15, 2014, CalOptima covers behavioral health treatment for ASD. This treatment includes Applied Behavior Analysis and other behavior intervention services. The services help develop or restore, as much as possible, the daily functioning of a member with ASD.

If the developmental screening is positive for signs of developmental delays associated with ASD, you may be able to conduct the additional assessment for ASD, or you may refer the patient to a specialist for a comprehensive diagnostic evaluation. Alternatively, Medi-Cal members can call the Orange County Mental Health Plan Access Line at 1-800-723-8641 to request the evaluation or to access other mental health services.

Resources:

http://www.cdc.gov/ncbddd/autism/screening.html

http://www.cdc.gov/ncbddd/autism/facts.html

 


OCMA Collaboration with CalOptima Secures Reimbursement Increase for ER Physicians

Emergency room physicians in Orange County will see an increase in reimbursement by CalOptima due to successful efforts by the Orange County Medical Association (OCMA).

OCMA worked in close collaboration with CalOptima to address the issue of ER physician payments. Since January 1, the full implementation of federal health reform and resulting increase in health insurance coverage has led to increased use of emergency rooms throughout the county as the system faces a growing demand for services.

Although there has been significant growth in utilization, emergency room physicians had not seen an increase in their payment rates for a number of years. This is despite the fact that Orange County ER physicians have seen a greater percentage of high-acuity cases in ERs after the implementation of health reform and the expansion of Medi-Cal and CalOptima coverage to OC residents.

ER physicians initially attempted to secure an increase from the Medi-Cal plan, but were unsuccessful. “At that point we saw that we needed help. The funding was critical to our specialty, but we realized we couldn’t get it alone, so we reached out to the OCMA,” said Dr. Peter G. Anderson, head of the ER physician team at Fountain Valley Regional Medical Center.

OCMA worked closely with executives and staff at CalOptima to develop a proposal that addressed the physicians’ needs and was financially prudent for the plan.

“We have a great relationship with the Orange County Medical Association, and work closely with them on initiatives directly impacting our physician provider partners,” stated Javier Sanchez, chief network officer for CalOptima. “The solution we put together with them on the ER rate issue is just the most recent example of that.”

The increase applies to services rendered to CalOptima patients on and after Sept. 1, 2014. The case rate was increased from $85 to $95, and physician critical care services outside of the case rate will now be reimbursed at 133% of the Medi-Cal fee schedule, up from the previous 123%.

These increases will be provided to both CalOptima Direct as well as Shared Risk Groups (SRGs) and Physician-Hospital Consortia (PHCs) working through the health networks.

The proposal was adopted by the CalOptima Board of Directors at their regular monthly meeting on Sept. 4.

“OCMA was pleased to have been able to help secure this rate increase for our ER physician members,” said Robert McCann, CEO of the Orange County Medical Association. “OCMA is proud of our advocacy on behalf of all of our physician members. We will continue to strive to do all we can to assist them in their efforts to serve the healthcare needs of the Orange County community.”

Specialty physicians received a reimbursement increase from CalOptima in December 2013, but ER physicians were exempted and did not get an increase. ER physicians are also not eligible for the reimbursement increase to primary care physicians included in federal health reform, so the recent increase was a great win for ER physicians.

Read full article in Physicians News Network - Orange County.


CalOptima Ranked Top Medi-Cal Plan in California

National Committee for Quality Assurance (NCQA) honor recognizes CalOptima’s overall quality of care for more than 600,000 Orange County residents

ORANGE, Calif. (September 18, 2014) — CalOptima is California’s top-ranked Medi-Cal health plan, according to the NCQA’s Medicaid Health Insurance Plan Rankings 2014–2015.

CalOptima is 1st in the state and 29th nationwide among the 136 Medicaid plans that were ranked. The NCQA rankings are based on standardized, third-party-audited data regarding health care quality and customer satisfaction, as well as NCQA accreditation scores. CalOptima’s ranking is due to a Board of Directors and executive leadership decision last year to collect and share the full set of NCQA measures so nationwide comparison would be possible in 2014.

“CalOptima’s commitment to quality for our members is reflected in the NCQA recognition,” said Mark Refowitz, Chairman of the CalOptima Board of Directors. “Our ranking is confirmation that Orange County’s most vulnerable residents are healthier because of CalOptima and our provider partners. We share this honor with the thousands of dedicated doctors, health care providers, hospitals and other facilities that deliver care to our members daily.” 

CalOptima CEO Michael Schrader said that the 2014–2015 NCQA rankings of Medicaid plans come at an important time of expanded access to such plans for low-income people across the nation. In Orange County through CalOptima, nearly 200,000 people have gained health coverage since January 2014, he said. “Our new members can rely on CalOptima and feel confident that the care they receive is among the best in the state,” Schrader said. “CalOptima is a mission-driven organization focused on providing all members with access to quality health care delivered in a cost-effective and compassionate manner. The NCQA ranking affirms that we are truly living our mission.”

NCQA assesses plan quality based on 46 clinical measures related to both preventive care and treatments. Preventive measures report whether members are getting services to keep them healthy, such as well-child visits, immunizations, nutrition counseling and breast cancer screenings. Treatment measures gauge whether members are receiving appropriate care and medications in response to acute illnesses and chronic diseases, including diabetes and high blood pressure. NCQA also evaluates plan quality based on 11 customer satisfaction dimensions, such as getting care quickly and how well doctors communicate. Further, CalOptima is NCQA accredited with “commendable” status through 2015, which also contributes to the agency’s new high ranking in California.  

Orange County Supervisor and CalOptima Board Member Janet Nguyen, whose supervisorial district has the highest concentration of Medi-Cal members in the county, said: “All of the efforts we have engaged in are paying off, resulting in better services for members. I am proud of our staff, nurses and doctors for the fine work they have done to earn CalOptima the distinction of being the top-ranked Medi-Cal plan in California.” 

CalOptima is nearing its 20th anniversary, with the first members served in October 1995.  Founding Board Member Peter Anderson, M.D., an emergency physician in Fountain Valley, sees the NCQA ranking as reward for the efforts invested by the community at the beginning and still today. “CalOptima was founded in response to difficulties in providing local Medi-Cal members with consistent access to quality care,” Dr. Anderson said. “The NCQA ranking proves that CalOptima has more than met that challenge. It has risen to new heights in serving our community. I congratulate all the CalOptima team members for achieving this lofty goal.”
                                                                                                ###

About CalOptima
A county organized health system, CalOptima provides publicly funded health care coverage for low-income children, adults, seniors and people with disabilities in Orange County, Calif. CalOptima’s mission is to provide members with access to quality health care services delivered in a cost-effective and compassionate manner. In total, CalOptima serves more than 600,000 members with a network of more than 6,600 primary care doctors and specialists, as well as 30 hospitals. Learn more about CalOptima in this video here.

About NCQA
NCQA is a private, nonprofit organization dedicated to improving health care quality. NCQA accredits and certifies a wide range of health care organizations. It also recognizes clinicians and practices in key areas of performance. NCQA’s Healthcare Effectiveness Data and Information Set (HEDIS®) is the most widely used performance measurement tool in health care. Learn more about the NCQA rankings here.


2014 CalOptima Circle of Care Award: Requesting 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 250 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 20, 2014.

Click here for the Nomination Form

Mail, deliver, fax or email Nomination Forms to:         

CalOptima Provider Relations Department 
Attention: Maria Wahab
505 City Parkway West, Orange, CA 92868
Email: mwahab@caloptima.org 
Fax: 714-796-6679  

Award recipients will receive an invitation to attend the Circle of Care Awards luncheon on Friday, September 12, 2014.  
 
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.


CalOptima Seeks Candidates to Participate on its Provider Advisory Committee (PAC) 2014-2016

The CalOptima Board of Directors welcomes input and recommendations from the provider community regarding issues concerning CalOptima programs. For this reason, the CalOptima Board encourages providers to become involved through an advisory group known as the Provider Advisory Committee (PAC).

The Provider Advisory Committee advises the CalOptima Board of Directors and staff. The CalOptima PAC is composed of 14 members representing diverse provider constituencies. These include but are not limited to health plans, hospitals, physicians, nurses, allied health professionals, long-term care services and community health centers. The charge of the committee is to:
 
  • Provide advice and recommendations to the CalOptima Board on issues concerning CalOptima programs as directed by the CalOptima Board;
  • Engage in study, research and analysis of issues assigned by the Board or generated by thecommittee;
  • Serve as a liaison between interested parties and the Board;
  • Assist the Board in obtaining public opinion on issues relating to CalOptima programs;
  • Initiate recommendations on issues for study to the CalOptima Board for their approval and consideration; and
  • Facilitate community outreach for CalOptima and the Board.

At this time, CalOptima is seeking candidates to participate on its Provider Advisory Committee (PAC). Service on the PAC is voluntary and with no salary. You need to be available to attend monthly meetings and serve on subcommittees. The following two-year seats are available:
 

  • Long Term Care Services Representative (two seats) 
  • Non-Physician Medical Practitioner Representative 
  • Pharmacy Representative 
  • Physician Representative (two seats)

The committee encourages interested individuals with knowledge and support of Medi-Cal and Medicare to apply. To apply or to nominate an individual for the Provider Advisory Committee, please mail, fax, or email the attached candidate application by Friday, April 11, 2014, along with a biography or resume plus two letters of reference to:

CalOptima
Attn: Maria Wahab
505 City Parkway West
Orange, CA 92868
 
Office: 714-796-6143 
Fax: 714-796-6679 
Email: mwahab@caloptima.org
 
If you have any questions, please call Maria Wahab at 714-796-6143.  


Call to Action from CalOptima Regarding Duals Demonstration

Dear Orange County Physicians:

CalOptima is measuring physician interest in a direct contract model for the dual-eligible demonstration that will launch in Orange County in April, 2014.  If there are not enough physicians interested in the direct contract model, it may be difficult for the CalOptima board of directors to support the model.  See the "Call to Action" below that CalOptima issued to the physician community.  As always, if you have any questions or comments, please contact us.

 

Thomas C. Kockinis, MD                                                   Robert McCann, MHA

President                                                                           CEO / Executive Director


 


Thinking About the Duals Demonstration? 
We Want to Hear From You!


The time for you to respond is now! The CalOptima Board of Directors is exploring the interest level of a direct contracting option with CalOptima for Cal MediConnect (also called the Duals Demonstration). Based on the interest level of the Orange County physician community, the CalOptima Board may grant authority to make this new option available.
 
If approved, the direct network will be based on managed care principles, providing support for your patients who may be difficult to manage through: coordinated care, case management, physical and mental health coordination, as well as home and community-based support services.
 
We need to hear from physicians who are interested in contracting directly with CalOptima, as the window for measuring interest is narrowing. In order for the model to be viable, a substantial number of physicians need to indicate their desire to participate. Currently, we do not have enough physicians displaying an interest to proceed with this option.
 
Orange County is one of eight California counties selected to participate in Cal  MediConnect. With Cal MediConnect, Medicare patients who are 21 years of age or older receiving full Medi-Cal benefits will have the option to transition from fee-for-service Medicare to this Duals Demonstration no sooner than April 1, 2014.
 
If you are a provider interested in directly contracting with CalOptima for this demonstration, please contact our Provider Relations department at 714-246-8600 or providerservices@caloptima.org to let your voice be heard and receive additional information about your contracting options. 

 


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