ORANGE COUNTY: MSI Program Courts CalOPTIMA
Orange County health officials will soon begin wrangling over the details of a new 1,000 person pilot project to move the county's indigent into a managed care program that would assign a physician "to oversee the care of each patient." The Los Angeles Times reports that officials for Medical Services for Indigents aim to "restrain costs" by turning over their program, which pays for "critical medical care for the uninsured," to CalOPTIMA, the county's Medi-Cal managed care program. "Widely considered costly and inefficient," MSI is expected to spend nearly $43 million in FY 1998-99, mostly because those eligible for the program only seek care when they are critically injured or very sick. "We have a system that is emergency-room based, where a majority of MSI people are seen first in an ER, and that is the most expensive setting," said Jackie Cherewick, president of the Orange County Coalition of Community Clinics.
The Times reports, however, that "CalOPTIMA officials and health care professionals have grown increasingly wary of the idea," worrying that "the success of CalOPTIMA in vastly improving Medi-Cal in Orange County could be put at risk by trying to swallow the MSI program whole." CalOPTIMA spokesperson Kathleen Crowley said, "We want an incremental approach. We do not think it would be responsible to move (all the MSI patients) wholesale into managed care." The Times reports that "tricky negotiations" will begin soon, as MSI and CalOPTIMA hash out how to handle payments, "how long it should run and when it would start, as well as a host of other items ranging from how to select the pilot patients to which hospitals and doctors will participate." An even "thornier problem," the Times reports, will be seeing if managed care works for a population which temporarily qualifies for a service "because of an injury or surprise illness." Jon Gilwee, spokesperson for the Healthcare Association of Orange County, said, "Using the managed care setting for this part of the MSI population is very much like trying to put a square peg in a round hole" (Warren, 2/5). Click here for past CHL coverage of CalOPTIMA's success in Orange County.