Countywide : Cal-OPTIMA to Contract 40 Health-Care Providers

Cal-OPTIMA, Orange County’s new Medi-Cal managed-care network, will enter contracts with 40 health-care providers from throughout the county, integrating new participants and long-term Medi-Cal providers in the novel system, officials said Wednesday.

“We’re very satisfied” with the level of response from contractors and with their geographic distribution, said Mary K. Dewane, chief executive officer of Cal-OPTIMA. “We continue to enjoy participation by a whole variety.”

The new system will include long-term Medi-Cal providers as part of doctor-hospital consortia, as well as health maintenance organizations and other large networks such as UC Irvine and the Friendly Hills Health Care Network. HMO participants will include Kaiser Foundation Health Plan, FHP International Corp. and PacifiCare Health Systems.

Cal-OPTIMA is the county’s answer to problems in the state Medi-Cal program, which has been shunned by many physicians because of low reimbursement rates and red tape. Cal-OPTIMA, which will be locally run, is intended to be more cost-effective and provide patients greater access to care. The system will serve some 300,000 Medi-Cal recipients beginning in October.

Though rate negotiations with the state took months longer than expected, none of the organizations that expressed early interest in the program dropped out once rates were set, Dewane said.

In the current cost-cutting environment, Dewane said, “there is no such thing as a good deal. But we negotiated hard [for good rates] and I think we did the best we could. . . . I’m very optimistic about our financial viability or we wouldn’t have gone forward.”

Dewane said she could not discuss the rates in detail, but estimated that the payments would bring in slightly less than the estimated $400 million now drawn by the county annually in Medi-Cal funds. But Dewane said she is confident the new program will use those dollars more efficiently.