GEOGRAPHIC MANAGED CARE: Degree of Success Unclear
According to a Sacramento Bee editorial, it remains "agonizingly unclear" whether the five-year-old Geographic Managed Care (GMC) experiment is a success. The Sacramento-based program "is part of part of a massive migration of California welfare families into the private managed care system." Today, more than two million California women and children on welfare are in managed care, but the information on their care is so poorly collected and disseminated that the system remains somewhat of a "medical mystery." The editors state that the "uncertainty is a symptom of a larger problem facing health care. Techniques for measuring and improving the quality of care are too primitive and too few to give the consuming public -- or the taxpayers underwriting GMC -- answers about whether they are getting their money's worth."
'Overwhelmed by Its Mission'
"The California Department of Health Services, which oversees the GMC and similar initiatives in 25 other counties, shows all the symptoms of an agency overwhelmed by its mission," the editorial states. The department has only 25 employees -- "only a handful" of whom were around when the GMC was launched -- to "keep track of" 35 contracts, 24 full-service health plans and 2.5 million enrollees. And the overload shows. "Snippets of data suggest that the program is generally working": Four years ago, audits showed that "Sacramento plans were failing to see most of their new enrollees within 120 days. The department says the next audits will show precisely the opposite trend. That's encouraging, but hardly adequate information." The piece concludes the state must implement a more efficient information gathering and reporting system -- or turn to the free market and contract with groups such as the Pacific Business Group on Health, which "are demonstrably better at negotiating contracts, measuring quality and disseminating information" (10/5).