MANAGED CARE: OMBUDSMAN PROJECT AIMS TO HELP ENROLLEES
Three leading health care foundations announced today thatThis is part of the California Healthline Daily Edition, a summary of health policy coverage from major news organizations. Sign up for an email subscription.
they are backing a four-year, $4 million project to provide
information and assistance to managed care enrollees in the
Sacramento area. Through the project, which is expected to be
operating by March 1997, the Los Angeles-based Center for Health
Care Rights (CHCR) will administer "hotline and in-person
services" that will inform the public about managed care "as well
as help resolve specific problems" with health plans. The Henry
J. Kaiser Family Foundation, the Sierra Health Foundation and the
California Wellness Foundation are contributing a total of $1.6
million to back the first two years of the project.
HELPING HANDS: CHCR will contract with Legal Services of
Northern California to provide ombudsman services to individual
managed care enrollees. Such services could involve helping
patients obtain out-of-network care not covered by a health plan
or assisting patients who believe their health plans are not
providing covered services. "Individual consumers often have no
place to turn for independent information and assistance. This
project will be the first major test of a large-scale ombudsman
program designed to serve all enrollees in managed care," Kaiser
Family Foundation President Drew Altman said. The project will
also focus on educating consumers about their "rights and
responsibilities as well as provide feedback to managed care
plans, regulators and others."
OF NATIONAL SIGNIFICANCE: The three foundations said in
their announcement that the Sacramento project is intended to be
a model for states and the nation. The Sacramento area was
selected because it has one of the highest managed care
enrollment levels in the nation, with 75% to 90% of residents
covered by some form of managed care. In addition, the city's
"demographic profile closely resembles that of California and the
nation." According to California Wellness Foundation President
Gary Yates, "The value of the Ombudsman Program lies not only in
its ability to help individuals, but also in its capacity to
collect information that will provide consumers, health plans,
purchasers and other with a better picture of what works and what
needs improvement in the current system" (joint release, 7/15).