Photo: Dao Nguyen, 78, shown left, described her hope for better-coordinated care through the OneCare Connect program. Tyree (TuYet) Ngo, right, Orange County HICAP's Vietnamese Outreach Coordinator, was her interpreter.
IRVINE, Calif. – Dao Nguyen, 78, was relieved to learn her new health plan would not only coordinate her complicated coverage, but she’d be able to keep the doctor she’s relied on for the past 15 years.
Nguyen, of Garden Grove, is widely respected for her lifetime of service to her family and community. In the wake of the Vietnam War, she opened an orphanage to care for over 100 children.
Today, she says she is relieved to know that she is able to access the care she needs.
Speaking through a Vietnamese interpreter at a media briefing in early September, Nguyen told reporters about the new Cal MediConnect program aimed at better managing the care of low-income seniors and people with disabilities who receive both Medicare and MediCal (California’s name for Medicaid). The meeting was organized by New America Media in partnership with the State Department of Health Care Services.
Part of National Obamacare Project
Orange County is the last of seven counties in California to roll out the program, part of a three-year pilot project.
California is one of about 20 states that under the Affordable Care Act are testing out new ways to coordinate the complexities of Medicare and Medicaid to improve care. The innovation aims to minimize cases where good care becomes lost in the health care system’s maze of restrictions and burdensome paperwork--particularly for ill and vulnerable people.
Now many older and disabled adults eligible for the two programs must decide whether or not to sign up for the new program.
Those who ignore the state’s notices--usually mailed in special blue envelopes--are being automatically enrolled in the plan.
Called OneCare Connect in Orange County and operated by the CalOptima health plan, the program gives beneficiaries the right to opt out at any time and remain with their existing health plan. And many seniors are doing so, frequently due to confusion about it.
Javier Sanchez, Cal Optima’s Chief Network Officer, explained that the program address fragmentation that has long plagued efforts by health providers to keep patient services from falling through the cracks and “help seniors manage the benefits that they’re entitled to receive.”
He continued, “Plus we also provide additional services that help improve the health care coordination for recipients. Not only does OneCare Connect (Orange County’s name for Cal MediConnect) add vision care, but mainly, the program assigns a personal care coordinator to handle often-stressful bureaucratic problems for each beneficiary.
‘Huge Fragmentation’ Before
For Kristine Loomis, a member of OneCare Connect’s community advisory board, the new program is a welcome change from the “huge fragmentation” she experienced in the past.
“I had to get things like a wheelchair, rehabilitation, in-home support services, transportation, and every one of those things,” said Loomis, stressing that the paperwork “just about killed me, the workload.”
Loomis said she had to fight her old insurance plan for four years just to get the right kind of power wheelchair. When it broke down, it took another year to get it repaired.
Loomis, 57, enrolled in the closely related MediCal Coordinated Care Initiative last year. It only took her six months to get her new, more functional chair. She hopes the new coordinated care service will assist her in doing that kind of energy-draining work.
“The thing that is somewhat frustrating as a physician,” stated CalOptima’s Chief Medical Officer Richard Helmer, M.D., “[is that] you can write the right prescription, but if that person is living alone, or maybe has a spouse that has problems, has trouble with communication, can’t read the prescription -- all those other things that impact them,” then medical care isn’t enough to secure the patient’s well being.
Most doctors’ offices don’t have the capacity to provide the range of services available to patients that OneCare Connect’s team of doctors, nurses, social workers and other professionals can provide.
Under OneCare Connect and the other Cal MediConnect projects, each beneficiary choosing to join is assigned a care coordinator.
Every health-plan member receives a 50-item assessment, such as how many medications they are taking, to determine whether there might be adverse drug reactions triggered by different medications.
“If people have diabetes or heart problems,” Helmer added, “they are enrolled in our programs to help with that.”
If a program member can remain in their home, the health care plan might provide him or her home care, case management or visits to a community adult day health center.
Free Legal Advocacy and Counseling
Those who receive blue envelopes from the state of California will be automatically enrolled in OneCare Connect if they do not reply. They are able to opt out or re-join at anytime.
But many consumers are “confused as to how it’s going to make it better for them,” said Sara Lee, supervising attorney at the Legal Aid Society of Orange County’s (LASOC).
Lee, who serves on the OneCare Connect’s Member Advisory Committee as the ombudsman, is targeting monolingual beneficiaries in Orange County’s leading ethnic populations, especially Latino, Vietnamese and Korean communities.
“We find that when they get the notices [from the state], especially for the monolingual-speaking consumers, they have no idea what this about,” Lee said.
To better understand their options, consumers can get free counseling through the Health Insurance Counseling and Advocacy Program (HICAP), funded by the federal and state government. Counselors explain program choices relevant to each person’s needs in the five most common languages in Orange Country.
“We assure them of their Medicare rights and abilities and things they can do with the program,” said Orange County HICAP manager Linda Walton, RN. “They can choose to participate in it or not.”
Making Her Choice--At 91
One recent HICAP caller was a 91-year-old woman wanting to know what the blue envelope was all about.
The nonagenarian learned she had been automatically enrolled in OneCare Connect. After meeting with a HICAP counselor, she decided to opt out and stick with her existing Medicare and Medicare plans. Living alone and having just renewed her driver’s license for another five years, the caller said she was “perfectly capable of managing own health care decisions.”
HICAP called Cal Optima, which helped the woman opt out. When the Medicare drug plan didn’t get the message, Walton helped get the paperwork straightened out so that she could get her prescriptions.
“As she’s getting ready to hang up the phone,” Walston recalls, “she says, ‘I think I’ve changed by mind. I want to enroll in OneCare Connect.’”
After having a laugh over the sudden switch, Walton said she and her staff understood. What was important, though, Walton said, was that she understood her options before making the decision that was right for her. “She had gone through the process, knew her benefits would be protected and she made her decision to do that.”
New America Media’s series of Cal MediConnect roundtables for ethnic media were supported by the California Department of Health Care Services. Additional reporting provided by Michael Navarro.
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