State Names Four Counties for Duals Project

by David Gorn

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California took a big step yesterday, officially unveiling the four counties that will kick off the three-year project to eventually shift 1.1 million dual eligibles -- Californians eligible for both Medi-Cal and Medicare -- to a Medi-Cal managed care program.

The first four participants in the Coordinated Care Initiative are Los Angeles, Orange, San Diego and San Mateo counties. The Department of Health Care Services currently has authority to start the program in those counties, but legislation is pending in Sacramento that would expand authority for the number of participating counties -- up to 10 of them by 2013.

The trailer bill language for that legislation has been finalized. The trailer bill is expected to be included in the budget package in June, DHCS officials said.

The other six counties DHCS hopes to include in the duals demonstration project by 2013, pending legislative approval, are Alameda, Contra Costa, Riverside, Sacramento, San Bernardino and Santa Clara counties.

The new model of care in the project has been designed to provide better care at a lower cost, by integrating and coordinating all of the many medications, conditions, providers and payments for this fragile population of duals, according to Toby Douglas, director of the Department of Health Care Services.

Douglas said gaining accessing to all of those services can be confusing and counter-productive, as patients can get fragmented care. "We believe now is the time to change that," Douglas said.

"Between now and 2013, we have a  lot of work to do," he said. "We are going to learn from our efforts to date [in the past year's conversion of the SPD population to Medi-Cal managed care]. We have been working on this for a long time."

Will Lightbourne of the Department of Social Services said that a big part of this new model of care is to integrate services such as Community Based Adult Services and In-Home Supportive Services into patients' overall care.

"IHSS is at the heart of our state's safety net," Lightbourne said. "It's a cost-effective part of the care continuum, and now for the first time we'll be able to coordinate overall care with IHSS care."

To Lora Connolly of the Department of Aging, the unveiling of the duals project was a big moment. "This is a historic time, really," Connolly said. "We're moving [away] from acute care and a more institutional focus. It's a unique opportunity to better design care for patients with chronic and multiple needs."

Douglas said the state hopes to save about $678 million next year through coordination of care, and $1 billion the year after that.

robert alboney
Auto assigning duals biggest problem in co-ordinating care onto a HMO vrs A fee for service program.. Duals are acustom to going to doctors without a referral.This is the main reason Duals have not joined a Medicare Special needs program and if they had they disenrolled. When notified they must join a plan they are given the plans names in their Area and phone numbers.When called it is the obligation of the enroller to get them to enroll into their plan.The alternative is to seek out independant enrollers who represents all the plans who are not bias and co-ordinate their care and benefits.

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