One plan or two? Placer County weighs Medi-Cal model options

Placer County is considering a transition for the model used for its Medi-Cal managed care within the county. According to the staff report, the county is currently assigned to the regional model, in which the state contracts with two for-profit plans to administer Medi-Cal benefits. Placer has been under this model since 2013, as assigned by the California Department of Health Care Services (DHCS), with Anthem Blue Cross and California Health & Wellness as the managed care plans. The county is now exploring a county-organized health system (COHS) model with Partnership HealthPlan of California. The staff report notes the COHS model is determined to offer counties with the greatest amount of local control to be responsible for the governance of their plans. In an email to the Auburn Journal on Wednesday afternoon, Director of Health and Human Services and Interim Health Officer Dr. Rob Oldham said the county is "eager to have more of a voice at the table to ensure our Medi-Cal beneficiaries are getting appropriate access to care that is tailored to the unique needs of our county," as access to Medi-Cal providers can be a challenge due to Placer's wide-ranging geography. "Making the pivot to the county-organized health system model with Partnership would help further expand access to care for Placer's Medi-Cal population, in part because of their experience with health care delivery in rural areas and high member satisfaction," Oldham said. Les Ybarra, president of California Medicaid with Anthem Blue Cross, said moving to the COHS model would limit Placer Medi-Cal beneficiaries to one option. In comparison, Ybarra said access is already being provided through the current model, as Anthem Blue Cross has agreements with Sutter Health, Dignity Health and the UC system. Ybarra also confirmed Anthem's focus over the years has been community health investment and finding opportunities with community and faith-based organizations "in order to really reach our Medi-Cal members and the local residents where they are and where they seek services. "From a consumer standpoint, we believe it's really important for the Medi-Cal beneficiary to really pick the plan that best suits their needs from their individual and family perspective," Ybarra said. According to Ybarra, a two-plan model is the "best of both worlds," as it offers a local initiative health plan that is locally governed by a public entity and a commercial plan that would be open to bid. Ybarra also noted the COHS model could have Placer competing with other counties for resources. "Placer, in that scenario, would be part of a very large board with other counties," he said. "Although there would be a board seat, or potentially more than one, they also would still be competing with other counties for resources. So that local control, I think, is a little undefined in terms of how influential a board seat might actually be." Oldham introduced the ordinance regarding the transition during the Board of Supervisors' Aug. 31 meeting. Oldham noted DHCS is requiring counties to finalize their choice with an ordinance by early October, and confirmed all details regarding the transition process had not been received, as the transition would occur in 2024. The board approved the first reading of the ordinance in a unanimous vote. Ybarra also confirmed the transition to the COHS model would remove the current plans from the competitive bidding process. However, if Placer remains in the regional model, the state will then require plans to bid and will again select the top two plans. Ybarra noted in that scenario, the county would have the opportunity to submit a letter of support for a health plan that will be responding to the bid. "We absolutely appreciate the opportunity to be at the table, be part of the stakeholder process and really find a solution that's best for Placer County and the beneficiaries that receive Medi-Cal services," Ybarra said. The ordinance was planned to be authorized during the consent agenda of the Sept. 14 meeting. However, the item was pulled and delayed for the board's next meeting. Ybarra said Anthem applauds the board for delaying the vote to allow the county more time to look into available options. "The supervisors (have) expressed interest in a model that really would give the county more control, but they also, I think, have entertained the idea that choice for the medical beneficiaries is really important and they seem to respect the idea around the competitive bidding process," Ybarra said. Oldham confirmed if the county does not move to the COHS model, it will remain in the regional model with two managed care plans selected again by the DHCS. "In recent years, both plans have taken steps to improve access for their Medi-Cal members and have signaled an invitation to include more of a local voice in their governance structure moving forward," Oldham said. "We have recommended a transition to a County Organized Health System under Partnership HealthPlan but are continuing discussions with other health plans and some neighboring counties to ensure we have a full sense of what other options may be feasible for Placer and the pros (and) cons of each." The item is scheduled to return to the board Sept. 28.