Managed Care: What is it and how can I make it work for me and my family? Family Voices 14th Annual Health Summit Monday, March 14, 2016 Gregory S. Buchert, MD, MPH President & CEO, California Health & Wellness

2 From My Perspective … Healthcare Administrator PhysicianDad

3 What is managed care? A health care delivery system organized to ensure you get.. –The right care –At the right time –In the right place Characterized by: –Provider network –Utilization review process –Quality improvement programs –Emphasis on preventive care

4 What is Medi-Cal managed care? Reference: California Healthcare Foundation, Medi-Cal Facts and Figures – A Program Transforms, 2013.

5 Medi-Cal Managed Care Models ModelDescriptionCounties County Organized Health System 1 health plan available Del Norte, Humboldt, Lake, Lassen, Marin, Mendocino, Merced, Modoc, Monterey, Napa, Orange, San Luis Obispo, San Mateo, Santa Barbara, Santa Cruz, Shasta, Siskiyou, Solano, Sonoma, Trinity, Ventura, Yolo Two-Plan 1 commercial health plan and 1 Local Initiative plan to choose from Alameda, Contra Costa, Fresno, Kern, Kings, Los Angeles, Madera, Riverside, San Bernardino, San Francisco, San Joaquin, Santa Clara, Stanislaus, Tulare Geographic Managed Care More than 2 commercial health plans to choose from Sacramento, San Diego Regional 2 commercial health plans to choose from Alpine, Amador, Butte, Calaveras, Colusa, El Dorado, Glenn, Inyo, Mono, Mariposa, Mono, Nevada, Placer, Plumas, Sierra, Sutter, Tehama, Tuolumne, Yuba Imperial 2 commercial health plans to choose from (1 of which is subcontracted by the county to be the Local Initiative Plan) Imperial San Benito 1 commercial health plan available or Fee for Service San Benito

6 Advantages to Managed Care Managed care plans provide: –Help coordinating your care –Help finding primary care doctors and specialists –Help finding a pharmacy –Ongoing referrals to specialists –Telephone advice nurses –Customer service centers –Health education programs –Help getting to and from medical appointments (non-medical transportation) Reference: Disability Rights of California

7 Make the System Work for You 1.Understand what benefits your child is entitled to 2.Understand who is responsible for covering which benefits 3.Get connected to a care coordinator or case manager 4.Exercise your rights 5.Let your voice be heard

8 Questions