Rate increase aims to improve member access to
care, sustain the managed care network and is the largest in
CalOptima Health history
ORANGE,
Calif., June 17, 2024 /PRNewswire/ -- The
CalOptima Health Board of Directors has approved an investment of
$526.2 million to increase rates paid
to health networks, hospitals, physicians, community clinics,
behavioral health providers and ancillary services providers in
Orange County. It is the largest
provider rate increase of its kind in CalOptima Health's nearly
30-year history. This investment is intended to support timely
access to critical health care services for members and promote
longer-term financial stability of the managed care network over a
30-month period from July 2024
through December 2026.
This unprecedented provider rate increase comes at a much needed
time to counteract some of the financial uncertainty due to the
California state budget deficit
and its potential impact on health care programs, including
Medi-Cal. The complex nature of the ongoing budget negotiations
underscores why CalOptima Health's action to deliver a separate
provider rate increase is so significant. Based on prior fiscal
prudence and in accordance with its founding ordinance, CalOptima
Health is using unallocated reserve funds to expand access and
augment provider reimbursement.
CalOptima Health provides health insurance benefits to nearly
one in three Orange County
residents. It serves more than 928,000 low-income children,
adults, seniors and people with disabilities through a managed
care delivery model, including health network partners, hospitals,
physician groups, community health centers, skilled nursing
facilities, behavioral health providers and other ancillary service
providers. Together, these organizations are the health care safety
net for Orange County.
"Historically, Medi-Cal reimbursement has been a barrier to
access for patients and their families," said Michael Hunn, CEO of CalOptima Health. "We ask a
lot of our hospitals, doctors and others who provide life-saving
care to our members. During the public health emergency, CalOptima
Health supported providers with temporary, short-term supplemental
payments. These new rate increases will help ensure member access,
provider financial stability, network access and medical care for
CalOptima Health members throughout Orange County over the next two and a half
years."
About CalOptima Health
A county organized health
system, CalOptima Health provides quality health care coverage for
low-income children, adults, seniors and people with disabilities
in Orange County, California.
CalOptima Health's mission is to serve member health with
excellence and dignity, respecting the value and needs of each
person. CalOptima Health serves more than 928,000 members with a
network of 10,900 primary care doctors and specialists and 39 acute
and rehab hospitals.
WHAT THEY'RE SAYING
Reactions from health care
leaders across Orange
County
"These rate increases by CalOptima Health put members' health
care needs first and foremost. All of the hospitals, community
clinics, physicians and others who care for CalOptima Health
members appreciate the recognition and validation of our important
role in supporting the health care safety net in Orange County. We thank CalOptima Health for
its historic investment."
—Robert Braithwaite, President and CEO of Hoag Memorial Hospital
Presbyterian and Chair of the Orange
County Area for the Hospital Association of Southern California
"On behalf of the physician community, the Orange County Medical
Association applauds this important action by CalOptima Health in
making a substantial investment in the health care delivery system
in Orange County. Not only does
this help support the providers, but more importantly, it will help
to increase access to care in the network that serves one out of
every three residents in our community."
—Jim Peterson, Executive Director, Orange County Medical
Association
"This landmark decision underscores CalOptima Health's
unwavering commitment to enhancing the quality of care for the
communities we serve. The increased funding will significantly
bolster the ability of the Behavioral Health and Applied Behavior
Analysis provider community to attract and retain behavior
therapists, and ultimately provide the highest standard of care to
our patients. The increase means more comprehensive and accessible
mental health services and behavioral interventions. It will allow
us to expand our reach to underserved populations, reduce wait
times, and deliver individualized, evidence-based care that
addresses the unique needs of each patient. We are excited about
the opportunities this rate increase brings."
—Junie Lazo-Pearson, Ph.D., BCBA-D, Chief Clinical Officer,
Advanced Behavioral Health
"Orange County pediatricians
appreciate that CalOptima Health's rate increase is designed to
ensure that physicians are adequately reimbursed for the excellent
care they deliver. Also, the increase will serve to improve health
care disparities for the population served, resulting in better
health outcomes and decreased overall costs. We applaud CalOptima
Health for understanding and recognizing the importance of the
patient-centered medical home as well as assuring continuity of
care for our patients."
—Reshmi Basu, M.D., FAAP,
President, American Academy of Pediatricians–Orange County
Chapter
"As a family physician working at a training program within a
Federally Qualified Health Center, our goal is to provide
high-quality clinical care to our community while training future
physicians to dedicate their careers to caring for the underserved.
Ultimately, we aim to train physicians who expand their services to
meet the needs of the communities they serve, including services
such as medication-assisted treatment of opioid use disorder,
treatment of Hepatitis C, and complex prenatal care. Provider rate
increases represent an opportunity for us to be appropriately
compensated for the significant impact broadly trained primary care
physicians have on the health care system, and for us to continue
to focus our efforts on providing our patients timely access to the
highest standards of needs-focused care."
—Matteo Leveroni, M.D., Medical Director of Family Medicine, UCI
Family Health Center–Santa Ana
"Family Choice Health Services fully supports the provider rate
increases being implemented by CalOptima Health, starting
July 1, 2024. Family Choice expects
that the added upfront monthly capitation provided will be
sufficient to pay for the higher provider rates being implemented.
With the proper balance in increased funding between physicians,
hospitals, health networks, FQHCs and other health care providers,
quality patient care and access throughout Orange County will be improved and
ensured."
—Toan Tran, M.D., Chief Executive Officer, Family Choice Health
Services
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SOURCE CalOptima Health