As San Benito County prepares to move Medi-Cal patients to a managed care system by June 1 as part of the state reform of the healthcare system, representatives of the San Benito Health Care District expressed some concerns to government officials about a potential partnership with the Central California Alliance for Health.
Maria Corona, the interim director of the San Benito County Health and Human Services Agency, had requested that county supervisors sign a letter of interest to be sent to state officials and approve the partnership with the alliance, which has established partnerships with Monterey, Santa Cruz and Merced counties. But supervisors put the brakes on any decision at their special meeting last week when Ken Underwood, CEO of Hazel Hawkins Memorial Hospital, and Gordon Machado, a hospital trustee, expressed worries that the contract contained language that they felt might send patients to healthcare providers outside the county.
“They did a review of the provider network,” Corona said, of the alliance organization. “They are going to be reviewing it to develop a network of access that will include San Benito County, Monterey and Santa Clara. They are not able to approve any contract until it is approved by the state.”
Underwood and Machado contended they were still open to a partnership with the outside group but they wanted to ensure language in the contract that would require patients to see providers in San Benito County when providers are available. They said in Monterey and Santa Cruz counties, patients must be seen within the county in which they reside unless there is not a provider available. For instance, if patients need the care of a specialist, they can be referred to providers in other counties.
“We did a $30 million renovation on our hospital and it is necessary to protect it,” Machado said. “We need to keep the tax dollars here. People complain about leakage of sales tax and we have them doing the same thing with the hospital.”
Underwood said the alliance services 250,000 Medi-Cal patients in the counties with which they currently partner. San Benito County has 8,000 Medi-Cal patients.
“They have an excellent reputation and have been recognized with state awards,” Underwood said. “They offer good, quality services.”
He said he is open to a partnership if the contract can be amended to require patients to seek services in the county – unless the services are not available from county providers.
“We want the same gatekeeper approach to be maintained as in Monterey and Santa Cruz counties,” he said.
Underwood also noted that the alliance board has seven representatives from each of the three counties that are now partners, but would have just two representatives from San Benito if the partnership is approved. He said because of the lower number of Medi-Cal patients in San Benito County, the representation would be adequate.
Corona said at the last meeting between the alliance and stakeholders, they had all agreed to move forward in requesting a letter of interest from the board of supervisors. She said she became aware of concerns about the contract from local partners last Tuesday morning.
San Benito is one of 28 rural counties in which low-income residents who qualified used the state-operated Medi-Cal fee-for-service program, but changes to the state program are requiring these counties to move to a manage-care system. While 26 of the contiguous counties will have their services provided by the Department of Health Care Services, San Benito and Imperials counties were not included. State officials anticipated that San Benito could partner with the Alliance. The goal of moving counties to managed care is “to improve access and quality of care for low-income residents of their communities, using a cost-effective health plan that leverages local innovation,” according to a letter in the supervisor’s agenda from Tuesday.
Corona said San Benito County could try to provide managed care without joining the partnership but in looking at that option she said there were a lot of potential liabilities for the county.
Supervisor Margie Barrios asked Underwood to continue to work with representatives from the Alliance to come to an agreement. The supervisors delayed a decision on the letter of interest and instead asked to move the item to a future board meeting when representatives from each agency will be available to answer questions.
Corona stressed the importance of moving quickly on the letter to the state due to the June 2013 deadline to roll out managed care.
