Sacramento County supervisors establish commission to monitor Medi-Cal managed care plans
After years of complaints about the quality of care provided to Medi-Cal recipients, the Sacramento County Board of Supervisors voted unanimously Tuesday to create a health authority to oversee, assess and make recommendations on the companies that the state hires to serve local residents.
Dr. Peter Beilenson, who will leave his post as head of the Sacramento County Department of Health Services on Dec. 22, appealed to the board at a Dec. 8 meeting, telling them that, if the authority was instituted, it would be one of his proudest accomplishments.
In a report to the board, he noted that Sacramento and San Diego counties in 1994 began participating in a geographic managed care program that allowed the state Department of Health Care Services to contract with Medi-Cal managed care plans to serve county residents. San Diego County, however, benefited from legislative language that gave its leaders a greater ability than Sacramento County in holding those managed care organizations accountable.
“This has resulted in a situation where four out of the five managed care organizations participating in Sacramento County are in the bottom quartile in terms of patient satisfaction and health outcomes in the state of California,” Beilenson said when he submitted the ordinance to create the health authority at the Dec. 8 meeting. “This ordinance gives the county teeth in the following ways: It sets up a Sacramento County Medi-Cal oversight authority and empowers that authority to hold ... managed care organizations accountable for achieving certain goals, as well as giving the county power to determine whether a managed care organization will be allowed to bid on future managed care organization (contracts).”
Over the past 18 months, Beilenson said, he joined with state Sen. Dr. Richard Pan, D-Sacramento, and Sierra Health Foundation President Chet Hewitt to hold a half-dozen stakeholder meetings where they did fact-finding and debating how best to improve care for Medi-Cal enrollees.
In the end, Beilenson’s recommended ordinance received letters of support from Medi-Cal providers, hospitals, federally qualified health centers, physicians, nurses, health advocates and administrators, medical students, researchers and medical societies, among others.
In one such letter, Dr. Melody Tran-Reina wrote: “One of my patients suffered a catastrophic stroke in his 30s due to a rare condition, and could not access rehab services for nearly six months following the stroke. This resulted in lost days of employment, as well as significant delay in his recovery. The Managed Medi-Cal system in Sacramento is not equitable, and disproportionately impacts communities of color. Furthermore, the broken system causes health care providers to become frustrated and seek employment elsewhere.”
Anne Sunderland, senior communications officer at the California Health Care Foundation, noted that managed care plans cover about 80% of all of California’s Medi-Cal enrollees. An October 2019 report from CHCF explained that managed care plans in geographic managed care counties was worse on most measures compared to quality in other similar counties that use other models of Medi-Cal managed care.
Pan said to supervisors on Dec. 8: “It’s better that we empower the people of Sacramento ... and that means all of you here, as supervisors as well as your constituents, have to be able to have a say in our Medi-Cal plans not only for the selection of the plans or the procurement that’s happening next year.”
By approving the ordinance, the county will be able to get the commission up and running in time for the DHCS procurement at the end of 2021.
Phil Serna, who represents District 1 and is the board chair, said: “What we’re all trying to achieve here are two things: enhancement of accountability and making sure that we are maximizing service delivery for those that need these services the most in our community. ... It remains very frustrating to hear time and time again that the folks in our community who needs these health care services the most are not getting them.”
