A week after San Benito County supervisors approved a letter stating their intent to join the Central California Alliance for Health as its managed care Medi-Cal provider – a state requirement to change to a managed care system goes into effect on Sept. 1 – the board of directors of the Central California Alliance for Health voted against expanding into San Benito.
A letter from Alan McKay, the CEO of the Central California Alliance for Health, which oversees Medi-Cal managed care systems in Monterey, Santa Cruz and Merced counties, largely cited unresolved issues between the public Hazel Hawkins Memorial Hospital and the federally funded nonprofit San Benito Health Foundation.
California is moving to a managed healthcare system for Medi-Cal patients as part of the nationwide healthcare reform. San Benito County is one of a handful of rural counties that have been excluded from a statewide managed health system because the county is not contiguous to other participating counties. Last year, state officials encouraged San Benito to join the alliance.
In managed care, providers are encouraged to keep the cost of healthcare low. Some of the staples of managed care systems include incentives for patients and physicians to seek the lowest-cost appropriate treatment, an emphasis on preventative care and sometimes even requiring prior approval needed lab tests or referrals to specialists.
Rosa Vivian Fernandez, president and CEO of the San Benito Health Foundation, expressed concerns at the April 16 board of supervisors meeting that the alliance partnership would force her to refer patients to Hazel Hawkins Memorial Hospital rather than to Saint Louise Regional Hospital in Gilroy. Ken Underwood, the CEO of Hazel Hawkins Memorial Hospital, said he was concerned the alliance would allow the foundation to continue a referral pattern of sending patients out of the county for services that are available in Hollister.
“At the conclusion of a thoughtful and lengthy discussion of issues and a full review of related communications and correspondence, it was clear to the Alliance board that these two essential Medi-Cal providers in San Benito County remain far apart on any resolution to their concerns regarding access and referrals for San Benito County Medi-Cal beneficiaries,” McKay wrote in a letter addressed to Maria Corona, the interim director of San Benito’s Health and Human Services Agency.
The alliance board of directors met April 24, with representatives from the hospital and health foundation present.
McKay said in the letter that the two parties had been “unable to make any significant progress towards resolving this long-standing conflict.”
He said without the collaboration of the two largest Medi-Cal providers in the county, it was unlikely the model promoted by the alliance would be successful.
In correspondence with the alliance and in public meetings, Fernandez contends that she did not want to refer patients from the federally-qualified health center to Hazel Hawkins over issues of quality of care. Underwood expressed concern that the publicly-funded hospital was losing money as patients are sent out of town. He also in letters to McKay cited the hospital’s performance on industry evaluations, noting that the Hollister hospital performed as well or higher than Saint Louise Regional Hospital in many areas.
The alliance board of directors voted unanimously not to move forward with expanding into San Benito County. They also included in the resolution that they would not consider a partnership in San Benito sooner than mid-2015.
San Benito supervisors are expected to discuss the creation of a subcommittee to help the two local agencies move forward on a resolution with a plan to join the Alliance in 2015.
Corona was not immediately available to comment on the next steps the county will need to take to join a managed care program by Sept. 1. At the April 16 meeting, she said if the county did not join the Alliance the state would select a commercial entity to provide the service and the county would not likely have representation as they would have with the Alliance’s board of directors.
