MEDI-CAL: Enrollees, Doctors Voice Concerns
California Health Decisions Inc. released the results of its Consumer Feedback Loop, a survey of Medi-Cal managed care beneficiaries and physicians in Alameda County. The project, conducted by the nonprofit organization in conjunction with consumer and health care organizations, was designed to identify the perceptions, issues and concerns that physicians and patients have with the Medi-Cal system. Work is now underway on phase two of the project, which involves designing solutions for the problems identified in the survey. The study found a "relatively narrow set of strong and consistent themes," and that "[b]eneficiaries and physicians agree about problems and solutions to a remarkable degree." The study found five key problems areas within Medi-Cal: prescription drug treatment, long waits for treatment, the second-class status of Medi-Cal patients, confusion about emergency and urgent-care procedures and a shortage of physicians.
Beneficiaries said that their health plans should cover all medications prescribed by physicians and expressed frustration with formulary and 30-day supply limits imposed by health plans. Doctors agreed that "dispensed amounts are too small," but noted that beneficiaries need to understand that most private health plans also place limits on prescriptions and encourage the use of generics. Medi-Cal enrollees also complained about long waits in the doctor's office and said that it can sometimes take months to get an appointment. Doctors admitted there being long waits but said they routinely overbook because of high absentee rates, which they said are as high as 50%. Medi-Cal beneficiaries also reported feeling stigmatized and said they receive "second-class" treatment from doctors. Doctors attributed some of these problems to the managed care system, and acknowledged that some doctors may unknowingly pass along their frustrations about managed care's low reimbursement rates to the patients. Regarding emergency care, enrollees said they were "in the dark about what to do when they have an emergency" and expressed fear that they would be charged for unauthorized ER visits. Doctors said Medi-Cal beneficiaries have "bad habits" related to emergencies and need to be educated about calling their doctor first before going to the ER. Beneficiaries also expressed concern regarding lack of doctors serving Medi-Cal patients, particularly specialists. Doctors said there are too few doctors because Medi-Cal reimbursement rates are too low and echoed enrollees' complaints about difficulties in finding specialists who would see Medi-Cal patients. The enrollees also mentioned other secondary problems that included: excessively long delays for referrals and authorizations, enrollment issues, eligibility, language barriers and dental issues.
As a solution to the prescription drug concern, the enrollees and doctors agreed that more prescriptions need to be covered for longer periods of time and people need to be educated about the equivalency of generics and brand-names. To reduce the complaints related to long delays, the respondents suggested having staff tell patients why there are delays and giving estimates of how much longer the wait will be, increasing the number of specialists and creating an appointment reminder system. To ease the stigma of Medi-Cal, it was recommended that physicians and staff be sensitized to the special problems of Medi-Cal beneficiaries and that a role within health plans be created for a patient advocate. Regarding the issue of emergency care, recommendations included distribution of informational material about what to do in emergency situations, implementation of a triage hotline and having the ER call the primary care physician when patients come in unauthorized. Finally, it was recommended that doctors be offered better incentives to serve the Medi-Cal population (release, March 1998).