Rural Health Clinics

1
STATE HEALTH PROGRAMS
Rural Health Clinics Medi-Cal Managed Care
and
Janice Milligan, Director Public Health
Programs Eric Villegas, Senior Public Health
Administrator December 5, 2007
2
STATE/LOCAL SPONSORED HEALTH COVERAGE

• MEDI-CAL FEE FOR SERVICE
• INDIGENT CARE
• CHDP
• FAMILY PACT
• MANAGED CARE (GMC/2 PLAN)
• HEALTHY FAMILIES
• HEALTHY KIDS

3
RURAL HEALTH CLINIC SCOPE OF SERVICES

• MENTAL HEALTH
• DENTAL
• WIC SERVICES
• GATEWAY
• FAMILY PLANNING
• TARGETED CASE MANAGEMENT
• INDIGENT CARE

• LAB
• RADIOLOGY
• HEALTH EDUCATION
• TRANSPORTATION
• IMMUNIZATION
• PHARMACY
• PRIMARY CARE

4
CONTRACT ISSUES / MANAGED CARE
PRIMARY CARE (HCFA 1500)

• PM 160 PROCESS
• DENTAL SERVICES
• HEALTH EDUCATION

• MENTAL HEALTH
• TRANSPORTATION
• SPECIALTY ACCESS
• WIC SITES

5
CONTRACT DEVELOPMENT
Health Nets goal is to create/provide a medical
home for our members.

• Primary Care Provider (PCP) Directs all care
• Medical Home
• A Medical Home is not a building, house or a
  doctors office. It is a health care
  provider that knows their patients and the
  community in which they live.
• PCP Standard Contract Model
• Needs re-design
• Needs out-of-the-box thinking and creative
  solutions
• Commitment to change

6
RURAL HEALTH SPECIALTY ACCESS

• Lack of Specialty Providers in rural areas
• Access is further limited by plan/networks
• Specialists limiting access based on
  referral/payer source mix
• Health Plan referral management practices/prior
  authorization
• Further complicated by specialty-ancillary
  relationships (i.e. lab, radiology, etc.)

7
GETTING OUT OF THE BOX
Health Nets Next Steps
8
CONTRACTING

• Would a different contracting methodology be
  better?
• Examples Capitation, Budget Contracting, Fee
  for Service w/ quality bonus, per diem,
  utilization?
• Does it make sense to develop a contract
  methodology with incentives for wrap-around
  services provided by your facility, including
  dental, mental health, health education, etc?
• Would a contract arrangement around primary care
  services that involves care management of
  patients/member make sense?

9
HEALTH NET CONTACTS

• Northern San Joaquin Valley/Sac Sierra
• Ellen Brown [phone]
• Terri Howell [phone]
• Merced, Madera, Fresno, Tulare County
• Eric Villegas [phone]
• Eloisa Estrada [phone]
• Kern, Kings County
• Alexis Esparza [phone]
• Heather West [phone]
• Southern California
• Rogelio Lopez [phone]