Healthy San Diego Health Care Options Medi Cal Managed Healthcare in - - PowerPoint PPT Presentation

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Healthy San Diego Health Care Options Medi Cal Managed Healthcare in - - PowerPoint PPT Presentation

Healthy San Diego Health Care Options Medi Cal Managed Healthcare in San Diego County Presentation to Health Services Advisory Board February 18, 2016 By: Gregory E. Knoll Healthy San Diego Co Chair 1 Why Healthy San Diego (HSD) Why


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Healthy San Diego Health Care Options

Medi‐Cal Managed Healthcare in San Diego County

Presentation to Health Services Advisory Board

February 18, 2016 By: Gregory E. Knoll Healthy San Diego Co‐Chair

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 State mandate

  • Coordinate Public Health and Managed

Care

 San Diego – Geographic Managed

Care (GMC) county

  • Approved local managed care health

plans

 Coordination of care with

community partners

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Why Healthy San Diego (HSD) Why Healthy San Diego (HSD)

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 Consumers  Providers  Health Plans  State Department of Health Care

Services/Managed Care Operations Division

 County of San Diego Health and

Human Services Agency

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 Patient choice

  • Selecting health plans

 “Value added”

  • Local involvement in assuring quality and access

 Community defined local standards

  • Participation of traditional and safety net

providers

  • Integration of public health services

 Local oversight

  • Problem solving and continuous quality

improvement of the delivery system

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Enrollment of new and renewing beneficiaries

  • Health Care Options Orientations

 Educate customers on health care  Identify health plan choices  Refer to resources

Problem-solving w/members

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 Consumer Center coordination

  • Health plan issues
  • Complex medical needs
  • Problem-resolution
  • Cal MediConnect Ombudsman
  • Covered California

 Coordinate with HP member

services, physicians

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  • Hotline: 1-877-734-3258
  • Community education and outreach
  • Improving the system and protecting rights

The Consumer Center helps low-income health care consumers get health care

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  • Care1st
  • Community Health

Group

  • Health Net
  • Kaiser Permanente
  • Molina Healthcare
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As of August 2015

 More than 700,000 Medi-Cal

beneficiaries in San Diego County.

 89% enrolled in a Medi-Cal managed

care plan (only 54% in 2011)

 Overall managed care beneficiary

increase > 35% in past year

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11 30 300 35 350 40 400 45 450 50 500 55 550 60 600 65 650 Jul Jul 14 14 Sep 14 Sep 14 No Nov 14 v 14 Jan Jan 15 Mar 15 Mar 15 May 15 May 15 Jul Jul 15 15 Th Thousands

Managed Care Enro Managed Care Enrollment llment

San Diego San Diego Count County

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Healthy San Diego