Sunday, December 10, 2017

OCMA Blog

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. 

 


ALERT: You May have Automatically been Contracted into an Exchange Plan

Open enrollment began October 1st for Covered California (California's Health Benefits Exchange). The OCMA has received many calls from members confused as to whether they are contracted to see these patients. 
  

Many doctors were automatically put into contracts, and are unaware that they are on the plan directory for exchange plans with payers. These physicians have to opt out of that part of their contract if they do not wish to participate in the Exchange. The easiest way to confirm your participation is by calling the provider relationship department of the three plans in Orange County who are contracted to see Exchange patients.  

  • Anthem Blue Cross:  (855) 238-0095
  • Blue Shield Of California:  (800) 258-3091
  • HealthNet:  (800) 641-7761

For additional questions about Covered California or any practice management issue, OCMA / CMA members may call OCMA Physician Advocate Mitzi Young directly at (888) 236-0267 or myoung@cmanet.org.


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