Saturday, December 16, 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. 

 


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.


State Offering Webinar on Coordinated Care Initiative

The California Department of Health Services is offering two more educational webinars on the Coordinated Care Initiative (CCI) in July. It is important to note that these webinars will NOT be recorded or available for on-demand playback.


Physicians and their staff in affected counties are encouraged to participate in one of the live webinars, Tuesday, July 23 or Tuesday, July 30.

 

The initiative, also known as "CalMediConnect," was authorized by the Assembly in July 2012 in an effort to save money and better coordinate care for the state's low-income seniors and persons with disabilities. The program begins with a three-year demonstration project that will transition more than 450,000 of the state's dual eligible beneficiaries - those eligible for both Medicare and Medi-Cal - into managed care plans.

 

Enrollment begins no sooner than January 2014 in 8 counties (Alameda, San Mateo, Santa Clara, Los Angeles, Orange, San Diego, Riverside and San Bernardino).

 

Physicians, other providers and their staff are invited to participate in one of the July webinars:

  • Tuesday, July 23 at 6:00pm (Click here to register)
  • Tuesday, July 30 at 5:00pm (Click here to register)

Each webinar will include a 30 minute overview of the program, including continuity of care provisions, and 30 minutes of Q&A. Note that the content of the overview will be the same on both dates. Additional webinars will be scheduled as enrollment nears.

For more information on the initiative, please visit http://www.CalDuals.org


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