As complaints pile up, Sacramento County wants to reinvent its sprawling Medi-Cal program

Last December, Dr. Peter Beilenson disclosed a few unsettling facts about the Medi-Cal services used by some 420,000 people in Sacramento County.

Beilenson, the former director of the county’s health services department, told the Board of Supervisors that four out of five of the health organizations were ranked near the bottom for patient satisfaction and health outcomes when compared to others in the state.

The county has long relied on what’s known as geographic managed care to automatically siphon residents to different health plans based on where they live. Overseeing the quality of services took a back seat and performance slipped, officials said.

Now the county has a plan to fix it.

A new 20-member body called the Health Authority Commission is focused on improving the quality of services for Medi-Cal enrollees. Its first order of business is to cut the number of health plans down from five to two or three.

“Before we had a monitoring body which had very little ability to influence any aspect of how plans perform in the county,” said Chet Hewitt, CEO of the Sierra Health Foundation, who chairs the commission.

He said it was challenging for them to get performance data and the monitoring body was not involved in the selection of health plans. The shift will give the health authority commission a larger voice in those decisions later this year.

“The health authority is about more than simply having influence in the procurement process which results in the selection of plans who provide coverage,” Hewitt said. “The authority will also have oversight and monitoring responsibility associated with the performance of those selected plans going forward.”

Several counties have already created local governing boards like San Diego County.

Going from five health plans to two or three

The current Medi-Cal providers in Sacramento County include Kaiser Permanente, Molina, Anthem Blue Cross, Health Net and Aetna. In 2019, at least three of them 一 Anthem, Health Net and Molina 一 received performance scores below the median for the state, which was 62%, according to state Department of Health Care Services data reviewed by The Sacramento Bee.

The highest score a plan can receive is 100% and the lowest is 40%.

Anthem received a score of 55%; Health Net got a 53%; and Molina a 47%. Aetna was not included in the state’s data, and Kaiser received a single score of 100% for all of its Medi-Cal managed care plans in northern California.

“One of the goals of this procurement is really what I’ll call administrative simplification, and from a state-level not to have five plans but to whittle that down to two plans that would allow them to just have those two plans to hold accountable,” said Chevon Kothari, who replaced Beilenson as director of health services.

The changes will not happen right away. Kothari said health insurers submit proposals to the state by the end of this year. The health care services department will make a selection by spring 2022. The county’s Medi-Cal beneficiaries will not notice changes until January 2024.

Kothari said the moves will not leave enrollees with fewer services; there will just be fewer insurers.

“The more players and more plans we have the more confusing the system can be sometimes,” Kothari said. “A part of the goal for this is to simplify that for residents.”

This story was originally published July 29, 2021 at 5:00 AM.