SONOMA COUNTY ? Sonoma County will finally be annexed into an efficiency-driven, ?medical home-modeled? managed Medi-Cal system this fall after more than three years of planning and delays.
?We are extremely, extremely excited about it coming into Sonoma,? said Redwood Regional Health Coalition Executive Director Nancy Oswald, who leads coordinated projects across more than a dozen North Bay community clinics.
?We know that it rewards the kind of work that needs to be done to keep people healthy and out of the hospital and really aligns with our vision and that of health care leaders in Sonoma County.?
In 2005, the California Department of Health Services recommended that 13 counties, including Sonoma, switch from a fee-for-service program to a managed system as a way to increase the number of providers that accept Medi-Cal patients in underserved areas.
About a year later, the Sonoma County Board of Supervisors agreed to investigate the model, forming a 23-member Medi-Cal Managed Care Planning Group that ultimately resolved to join an existing network called the Partnership HealthPlan of California based in Fairfield.
The partnership, launched in 1994, is a public-private Medi-Cal pool, which currently connects about 94,000 public health recipients in Napa, Yolo and Solano counties. Providers contract directly with the plan for payment, and the organization handles all of the administrative work and provides quality-of-care incentives.
After preparing for the Sonoma County launch for about two years with an expected go-live date last October, the roll-out was unexpectedly delayed after the state attempted to reduce the partnership?s core funding, making it impossible for it to add another county while facing a budget shortfall.
Now with new funding approved, the group has set a tentative implementation date of Oct. 1 this year, pending a vote from the partnership?s board this Wednesday.
Health Plan Deputy Executive Director Liz Gibboney said patients will begin receiving notices about the change this summer. Once the recipients select a primary care provider, they receive an enrollment packet and medical card. Partnership will open a small office in Santa Rosa to help administrate the plan as well as add about 50 staff to its headquarters office.
Although the Solano plan is reimbursed at rates similar to fee-for-service providers, it is able to offer private physicians higher rates through savings made by reduced emergency room visits. By giving patients a ?medical home? it prevents them from letting conditions worsen to the point of needing hospitalization.
Also, with the higher rates for private doctors, between 30 percent and 50 percent more than in the traditional system, additional physicians will likely accept Medi-Cal recipients. This is especially important for those needing specialist care in Sonoma, which currently is extremely limited.
Federally qualified health centers in Sonoma, which cover about 85 percent of Medi-Cal recipients in the county, will actually be reimbursed at lower rates under the plan, but officials can recoup the difference by applying with the state.
Although the plan might result in additional paperwork for the health centers, they are eligible for regular bonuses by implementing programs aimed at increasing quality of care. ?It does add some paperwork for us, but the benefits far outweigh any negatives,? said Petaluma Health Center Chief Executive Officer Kathryn Powell.
?Patients really do respond to having an official medical home. They aren?t hopping around from health center to health center or in the hospital, and we expect it to make more specialists available to us, which is something we desperately need.?