Well being leaders talk about 2024 Medi-Cal Managed Care Contracts – State of Reform

To advance well being fairness, high quality, entry, accountability, and transparency, new Medi-Cal Managed Care Plan (MCPs) Contracts will take impact throughout the state of California beginning in January 2024. MCPs play an important function in CalAIMwhich stands for California Advancing and Innovating Medi-Cal, and can prioritize prevention and whole-person care.

Below the new contractsBlue Cross of California Partnership Plan, referred to as Anthem, will serve 14 counties, together with Fresno and Inyo. Blue Defend of California Promise Well being Plan, and CHG Basis’s Neighborhood Well being Group Partnership Plan will each be serving San Diego County. Well being Web will serve ten counties and can subcontract to Molina County for 50% of its membership. Molina Healthcare of California will serve 4 counties, and can act as a subcontractor for Well being Web in Los Angeles County for 50% of its membership.

A various panel of specialists spoke concerning the significance of the brand new contracts on the 2023 Northern California State of Reform Well being Coverage Convention. Susan Phillip, deputy director of Well being Care Supply Programs for California’s Division of Well being Care Companies spoke on the matter.

“By 2024, 99% of Medi-Cal beneficiaries can be on a managed care plan, so managed care is de facto how we ship companies in California to our Medi-Cal beneficiaries,” Phillip stated.

Phillips defined how all MCPs are required to undergo rigorous readiness processes, which have been going down since 2022. The aim of the readiness assessment is to make sure plans are ready to adjust to new contract necessities.

One main change focuses on transparency, and requires plans to publicly and routinely report on entry, high quality, and well being fairness, stated Phillip. She added that plans can be required to put up their group funding plans, which present how plans are taking extra income and reinserting it into the group.

DHCS states that MCPs and their totally delegated subcontractors with optimistic internet revenue must allocate 5 to seven-and-a-half p.c of income to local people efforts that construct group infrastructure to assist Medi-Cal beneficiaries. Plan companions should additionally submit a Neighborhood Reinvestment Plan and Report which particulars how the reinvestment actions will profit communities, and outcomes of the investments. Extra transparency measures embody annual surveys associated to shopper satisfaction, amongst others.

One other key provision focuses on native presence and engagement. Phillip stated there’s a brand new part within the contract that requires group engagement with members and households and partnership with native community-based organizations to convey their views into the dialog.

“We’re actually working with our plan companions to suppose via all of the totally different shifting items, and I say, there’s sort of 4 totally different work streams,” Phillip stated. “First, there’s a contract deliverable assessment. There’s steering, growth and vetting. There’s one thing that we’re calling a go-live evaluation, after which there’s a 2024 transition coverage.”

Phillip stated DHCS is working onerous with plan companions on information alternate so plans which are coming into or exiting the contract perceive who their members are, and might preserve that continuity of care. As a part of their communication efforts, DHCS will contact members 90 days, 60 days, and 30 days previous to the transition to supply clear schooling and communication to members.

The 2024 transition policy guidewhich reveals what steps plans coming into and exiting contracts must take, is beneath growth; the primary chapter of the coverage information, which focuses on the continuity of care, was launched a number of weeks in the past, Phillip stated, and extra chapters can be launched in coming weeks.

Rebecca Sullivan, authorities affairs director for Native Well being Plans of California (LHPC), was additionally a panelist on the convention, and offered enter from a neighborhood well being plan perspective. LHPC operates in 36 of the 58 California counties, and by 2024, she stated 51 out of the 58 counties can have a neighborhood plan presence.

“For these enlargement plans specifically, operational readiness takes on a bit of little bit of a distinct that means,” Sullivan stated. “It’s essential to the success of this transition to develop native connections and relationships with our suppliers, our counties, and our communities we serve.”

Sullivan talked about how lots of the new necessities within the 2024 Medi-Cal MCP contract would require further assets, together with workers. Current workers can be requested to tackle extra workload, and new people will must be employed. Given the healthcare workforce shortagesSullivan added that hiring further workers creates time constraints.

“There’s nonetheless rather a lot to be carried out to know the insurance policies which are popping out—a few of these coverage information paperwork which are popping out—and we simply need to make certain that we’re deliberate within the roll-out in order that we don’t disrupt these current initiatives, and the prevailing work that’s being carried out that’s actually essential,” Sullivan stated.

In line with DHCS, the brand new contracts will permit for extra culturally competent care, as beneficiaries will obtain care and companies that take their tradition, sexual orientation, gender id, and most popular languages into consideration.

Beneficiaries also can anticipate to obtain improved integration of behavioral and bodily well being as DHCS prioritizes closing the hole between the 2, in addition to enhancing entry to psychological well being and substance use dysfunction companies. MCPs can be required to assessment stories to determine members who usually are not accessing main care, which suggests that they won’t be present process screenings or preventative care.

“As a system, we have to make sure that there’s coordination throughout the system to streamline processes by leveraging current work that’s being carried out,” Sullivan stated.