State Department of Health Care Services Director Toby Douglas explained the reasoning behind the state's plans for the Healthy Families program during the Insure the Uninsured Project's 16th annual statewide conference in Sacramento yesterday.
Acknowledging that the proposal to shift 875,000 children out of Healthy Families and into Medi-Cal on a relatively fast timeline is a little controversial, Douglas said it's part of a bigger plan.
"It's all about delivery system reform," Douglas said. "It's about moving toward organized delivery systems."
That includes integrating Healthy Families into Medi-Cal, he said. "We believe from a consumer-friendly point of view -- and from an administrative point of view -- we think having one program makes the most sense as we move to 2014," Douglas said.
He said new data shows many providers and health plans used by Healthy Families are similar to those in Medi-Cal.
A new set of DHCS documents are expected to be sent to Healthy Families stakeholders today, in advance of tomorrow's meeting. Those documents compare the providers and health plans of the two programs and found that:
- 78% of HFP children are enrolled in a health plan that currently participates in both Medi-Cal and Healthy Families;
- Primary care provider overlap is between 79% and 89%, depending on the type of managed care model; and
- Specialist provider overlap is between 81% and 91%, depending on the type of managed care model.
So, Douglas said, the move makes sense. "From an administrative perspective, we see this as more efficient," he said. "There are many reasons for it, and yes, it saves money. The Healthy Families program pays higher [provider] rates, but not big differences over time."
Douglas said he can explain the move in more detail at tomorrow's stakeholder meeting in Sacramento. The topic will also be on the agenda next Wednesday, at the monthly meeting of the Managed Risk Medical Insurance Board, which oversees the Healthy Families program.
"We are proposing bringing all services under one accountable organization to provide more coordinated care," Douglas said. "Many people have said or think the state is abdicating its responsibilities. But really, it's just the opposite. We're trying to be more accountable, in the way we design these networks."