Although San Benito County supervisors have signed a letter of intent for the county to join the Central California Alliance for Health, two local stakeholders still need to work out their differences before the partnership can move forward.
Originally, the state set a deadline of June 1 for 28 counties that have “fee for service” Medi-Cal programs to move to a managed care program, but the deadline was recently extended to Sept. 1.
County stakeholders, including representatives from Hazel Hawkins Memorial Hospital and the San Benito Health Foundation met in November with representatives from CCAH and the California Department of Health Care Services to discuss a potential partnership, with a second meeting taking place in February when local stakeholders agreed to support the alliance.
But since that meeting both local agencies have expressed concerns about the partnership. Hazel Hawkins representatives are worried it would send patients out of the county for treatment while San Benito Health Foundation staff members are upset that their patients may not be allowed to seek treatment out of the county, most often at Saint Louise Regional Hospital, in Gilroy.
“It is our experience that it is better to refer to a local hospital provider than one further away,” said Alan McKay, the executive director of CCAH at the recent board meeting. “The care concentrated in the county is primary care. We do pay attention to traditional preferred providers, but we do stop what we call doctor shopping or referrals out of the area.”
McKay prepared a report included in the supervisors’ agenda packets that summarized the issue at the heart of the disagreement.
According to McKay, Rosa Vivian Fernandez, the executive director of San Benito Health Foundation, said she referred patients to Saint Louise out of “concerns regarding quality of care and patient dissatisfaction at (Hazel Hawkins.)” McKay’s report noted that Fernandez said if she was not able to continue referring patients to Saint Louise, she would refer her patients to other hospitals within the alliance’s network, which includes Monterey, Merced and Santa Cruz counties, rather than Hazel Hawkins.
According to McKay’s report, Underwood said his primary concern was in keeping Medi-Cal payments in the county, especially since the new Women’s Center will be opening soon.
“He suggested that the Alliance might require use of (Hazel Hawkins) for a period of time in order to assess patient satisfaction with the soon-to-open Women’s Center,” the report reads.
Though McKay acknowledged the alliance has made exceptions in the past for use of out-of-area providers – specifically in allowing Merced patients who live near the county line to continue to receive hospital services in Turlock, which is in Stanislaus County – he said the situation in San Benito did not necessarily apply in the same way.
“First, SBC’s two most significant (and nearby each other) Medi-Cal providers are not working together, due to apparently long-standing and perhaps intractable concerns that have been recently amplified,” McKay wrote in his report. “Second, (the Health Foundation) refers to St. Louise Hospital not primarily for patient convenience, but rather out of concerns regarding quality of care at the closer-by (Hazel Hawkins) where local services are available.”
McKay recommended the stakeholders work together to resolve their issues before the partnership goes into effect.
“The Alliance’s success in SBC would require a local Medi-Cal system of care where providers work effectively together,” he said.
Underwood wrote a letter to McKay in late March in which he refuted Fernandez’ claims about quality of care. In it he noted the hospital is a Joint Commission accredited facility, with similar or better ratings than Saint Louise in major categories on industry comparisons such as Healthgrades, Hospital Compare and Leapfrog.
“Currently, as you noted, patients in Monterey and Santa Cruz require prior authorization for services available within the County,” Underwood wrote in his letter to McKay. “It is unfair and disparate treatment to the community-owned public hospital, our physicians, and our residents to allow funding intended for this County to go out of the area for services provided locally.”
Fernandez, the executive director of the San Benito Health Foundation, spoke at the board meeting and contended that her reasons for referring patients out of the area for treatment are quality of care as well as timeliness of referral appointments.
“This is not just about broken relationships,” Fernandez said. “It is about patients. At San Benito Health Foundation, 55 percent of patients are residents of our county who live in poverty. We are concerned not just with those insured who have Medi-Cal – we are concerned with uninsured or partially insured patients.”
She said 36 percent of the referrals made to Hazel Hawkins Memorial Hospital were unattended.
“We want to see the true data of where people are getting access and the timeline of when they are getting access,” she said, referring to Hazel Hawkins services. “Many of the rest of us who have insurance choose other places in the system and we’d like Medi-Cal patients to have a choice.”
Supervisor Robert Rivas said he thought the heart of the issue was the relationship between the hospital and the foundation, rather than any concrete evidence of poor treatment.
“The Health Foundation has a lot of strong statements … they talk about patients, access to care,” he said. “Is this really about patients or is it about personalities? … I think the problem is this relationship.”
Supervisor Anthony Botelho said he would support the alliance as well as making Hazel Hawkins the primary referral agency.
“It really is dependent on the whole community to be utilizing those services,” he said. “It’s one way we all grow together.”
Several speakers, including two board members from the San Benito Health Foundation and an employee, argued that the supervisors and the alliance should allow the referrals to Saint Louise to continue, reiterating the same concerns about quality of care expressed by Fernandez.
Maria Corona, the interim director of San Benito County’s Health and Human Services Agency, said if San Benito County does not join the alliance, state officials have said they will select a commercial contract to oversee the managed care system. With the Alliance, San Benito is guaranteed two representatives on the board, but Corona said that would be unlikely if a for-profit entity decided to provide care.
“I am going to support joining the alliance,” said Supervisor Margie Barrios. “What I do expect is that we do support each other moving forward. You have expressed your concerns. Help us provide the very best care.”
The supervisors approved signing the letter of intent unanimously with direction for the partners to continue resolving their issues.
