Orange County Doctors Voice Concerns About CalOPTIMA HMO for Dual Eligibles
Orange County physicians on Wednesday said a proposal by CalOPTIMA, the county's Medi-Cal agency, to move as many as 50,000 beneficiaries into an HMO would diminish patient care and damage their medical practices' finances, the Orange County Register reports.
CalOPTIMA's proposed HMO, called OneCare, would be aimed exclusively at county residents dually eligible for Medi-Cal and Medicaid.
CalOPTIMA CEO Richard Chambers said OneCare was designed to simplify complicated health care options for the beneficiaries, particularly after the new Medicare drug benefit starts on Jan. 1, 2006. He said OneCare would provide all benefits from one organization.
Kenneth Bell, CalOPTIMA's chief medical officer, said patients could choose to stay with their doctor in a fee-for-service arrangement instead of joining OneCare or they could select a separate commercial Medicare HMO. "The bottom line is that it's the patient's choice," Bell said.
Doctors learned about OneCare from Talbert Medical Group, which is one of three physician groups awarded a contract to provide services for OneCare patients. A letter from Talbert "was interpreted by many doctors" to mean that all of their dual-eligible patients would be moved into managed care plans, an "impression reinforced by another letter sent by a second medical group," the Register reports.
Doctors said assurance from CalOPTIMA that patients would have a choice was misleading because patients who do not specify a choice by Oct. 31 will be enrolled in OneCare automatically. They also said that the three medical groups contracting with OneCare would run a costly marketing campaign aimed at dual eligibles (Wolfson, Orange County Register, 6/30).
Additional information on the Medicare drug benefit is available online.