SACRAMENTO: Benefits of Medi-Cal Managed Care Plan Are Anyone’s Guess
Five years after its inception, "no one can be sure" how well the program that places Medi-Cal recipients into managed care is working in Sacramento County, the Sacramento Bee reports. Sacramento is one of 13 counties participating in Geographic Managed Care, but it is the only one with "no local control over the program or its participants." That is because the county did not provide "a lot of care to Medi-Cal patients and did not have a big financial stake in losing that business," according to state health officials. Over the past 64 months, the state has paid about $15.7 million per month to health and dental plans in the county, in addition to $115,000 per month in administrative costs, for a total of more than $1 billion. Alan Stolmack, acting assistant division chief of the state's Medi-Cal Managed Care Division, "said the state does not spend more on managed care programs than it did under the old system." Some providers and public officials, however, question how well the program is serving beneficiaries. Normal Label, president of Emergency Physicians Medical Group, which covers six area ERs, said visits to his ERs dropped during GMC's first year, but have since risen to a level 5% higher than they were in 1993. A spokesperson for UC-Davis Medical Center says that hospital has observed the same trend. The Sacramento-based Health Rights Hotline, which handles GMC patient complaints, has seen an upsurge in complaints.
The state Department of Finance "could not assess whether GMC has been cost-effective, one criterion used by the federal government to reauthorize the program." Nevertheless, HCFA has approved extensions of the program every two years. Nor could finance department evaluators "find no evidence that Department of Health Services is able to monitor or assess health plan performance." County Supervisor Roger Dickinson said, "The county, which has a significant interest in making sure that all people have access to adequate health care, has very little ability to affect how that health care is being delivered, and that is very frustrating." County GMC Commission Chair Joseph Sanchez said the commission needs more accurate data to assess the quality of care. But Paul Cerles, an state official responsible for the county program, said, "I could take boatloads of data to them, but I don't think they have the ability to deal with it" (Griffith, 8/18).