What You Ought to Know:
– CalOptima would be the first well being plan to introduce ‘real-time claims funds’ completely for suppliers as a part of this historic $100+ million funding within the security internet in Southern California.
– Board additionally approves $100 million in expertise to enhance well being care supply and $8 million to launch a Avenue Drugs Program.
CalOptima, a publicly funded well being care protection for low-income youngsters, adults, seniors and folks with disabilities in Orange County, California, at the moment introduced that its CalOptima Board of Administrators unanimously authorized a brand new imaginative and prescient for Medi-Cal member companies that can change the supply of well being look after practically 880,000 Orange County residents. The five-year strategic imaginative and prescient goals to take away obstacles to well being care entry for members by implementing same-day therapy authorizations and real-time claims funds for suppliers, and yearly assessing members’ social determinants of well being.
Groundbreaking 5-12 months Strategic Imaginative and prescient
To realize this new imaginative and prescient, a $100M funding in expertise developments is not going to solely permit CalOptima to supply same-day therapy authorizations and course of real-time supplier claims funds, however it can facilitate sharing crucial information with neighborhood companions by creating a state-of-the-art Well being Info Trade program to interrupt down silos and improve look after members. When the system launches, CalOptima will change into the primary Medi-Cal plan within the state to implement real-time claims processing. CalOptima’s implementation of a “cloud-first” technique may also embody cyber-security controls to take care of HIPAA compliance and measures to stop cyber-attacks.
Avenue Drugs Program
In response to the rising well being care disaster among the many homeless inhabitants, CalOptima and different businesses joined to kind the Orange County Interagency Council on Homeless Well being Care (OCICHHC) in December 2021. Along with this partnership, CalOptima plans to launch the Avenue Drugs Program to assist Medi-Cal members who’re experiencing homelessness. Avenue Drugs will embody well being and social companies designed to satisfy people the place they’re to cut back or get rid of obstacles to care and follow-up companies.
Avenue Drugs suppliers will work with CalOptima’s present Scientific Subject Groups, outreach staff and cell groups to deal with the wants of this inhabitants, linking them to a medical dwelling to be able to forestall emergency division utilization in addition to the development of untreated well being situations that will end in mortality.
“As the one largest well being plan in Orange County, CalOptima offers look after one in 4 residents. We take that giant duty severely, and our members are relying on us to assist them entry the correct care on the proper time,” mentioned Michael Hunn, Chief Govt Officer of CalOptima. “Automated expertise will permit members to obtain same-day authorizations, serving to them entry wanted therapies and specialist care on a well timed foundation.”