LOS ANGELES COUNTY: L.A. Care Launches Managed CCS Pilot
Los Angeles County's Medi-Cal managed care plan, L.A. Care Health Plan, is set to launch a managed care California Children's Services (CCS) pilot project. The federal government mandated about 60 years ago that states form children's services programs to provide services for children with serious medical problems such as polio, cerebral palsy, heart conditions and cancer. Today, each county in California has its own CCS program.
While L.A. County has shifted most of its Medi-Cal recipients into managed care, CCS children were "carved out" of this process because health officials "thought they had such serious illnesses that they should not be in a managed care environment," according to Barbara Rosen, director of CCS Care. Former state Sen. Marian Bergeson (R-Newport Beach), however, sponsored a law in 1994 mandating the state to study whether these children could receive quality care through managed care. While lawmakers planned to establish five pilots, CCS Care is the only pilot currently going forward. A three-year program that will serve as many as 6,000 enrollees, CCS Care will be jointly run by the county health department and L.A. Care.
While traditional CCS programs only cover CCS-eligible conditions, CCS Care will break away from that model and provide both primary and specialist care for children. "We are going to integrate the entire child and family into this program," said Rosen, adding that "the concept here is to develop a much better-coordinated care to that the family isn't going to different places to get different kinds of care." Under the program, families can choose a pediatric subspecialist as their child's primary care physician, and that doctor will serve as a "case manager" by taking responsibility for coordinating all the child's care needs. Pilot organizers believe they can improve care without increasing costs. Better-coordinated care, said Rosen, should "decrease the fragmentation and the multiple orderings of the same kinds of tests that frequently go on with children whose care isn't well coordinated." She added, however, that "this is not a program that is meant to demonstrate that we can save money," but rather "to demonstrate that we can improve the quality of care and the service to the families and providers."
CCS Care is in the process of formalizing contracts with its network of providers, and has already signed on nine hospitals including Miller Children's, University of California-Los Angeles, Cedars-Sinai, Orthopedic, White Memorial, Rancho Los Amigos, King-Drew Medical Center, Harbor-UCLA and UC Medical Center. Rosen said the goal for starting the enrollment process is May 1 (Rachel Kennedy, California Healthline).