California has transitioned 2 million Medi-Cal beneficiaries from the traditional fee-for service system into managed care plans. Health Net, an IPA model HMO, under contract to the California Department of Health Services, is a major participant in this new system of care.
The issues and challenges associated with implementing a new delivery system within rural and urban communities requires approaches that demonstrate an understanding of the inherent problems with changing a health care system. Local public health agencies assist managed care health plans during implementation by providing technical assistance and sharing programmatic experience. Selected public health functions are maintained by local public health agencies, which result in a blended public/private delivery system characterized and shaped by the specific environment.
With a population of over nine million people and three public health departments, implementing Medi-Cal managed care in Los Angeles County has been a challenge. Although the county is blessed with abundant resources, the delivery of health care services is complex. On the other hand, Tulare County, a rural agricultural community with a population of 355,500, has a well defined health care delivery system that is plagued by limited resources.
The success that Health Net has experienced in these counties is due in part to the role played by local public health agencies. Utilizing the best of both worlds, Health Net is involved in the on-going development of several public/private partnerships with local public health agencies to continue eliminating health disparities.
Learning Objectives: 1) Understand the challenges facing managed care health plans in providing services in rural versus urban communities, 2) Articulate the important role local Public Health Agencies play in assisting managed care health plans in implementing services in these communities, 3) Recognize the importance of creating new public/private partnerships to eliminate health disparities
Keywords: Managed Care, Rural Health Care Delivery System
Presenting author's disclosure statement:
Organization/institution whose products or services will be discussed: None
I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.