CalOptima, which gives healthcare protection for Orange County, California, residents who’re eligible for Medi-Cal, is embarking on a five-year technique to take away obstacles to healthcare entry, together with a $100 million funding in expertise to enhance healthcare supply.
CalOptima serves almost 880,000 members with a community of greater than 10,400 major care medical doctors and specialists in addition to 41 acute and rehab hospitals. Its board mentioned that the brand new technique will change the supply of healthcare for these residents by implementing same-day remedy authorizations and real-time claims funds for suppliers, and yearly assessing members’ social determinants of well being.
A 2021 survey of greater than 1,000 medical doctors, administered by the American Medical Affiliation, confirmed 93 % of the treating physicians reported delayed entry to essential take care of sufferers whose remedy required prior authorization. The report additionally highlighted that physicians and their employees members spend on common nearly two enterprise days every week finishing prior authorizations.
“The adjustments articulated within the new imaginative and prescient will assist scale back delays and obstacles to take care of our members, in addition to entice extra suppliers to work with CalOptima,” mentioned Supervisor Andrew Do, chair of the CalOptima board of administrators, in a press release. “Understanding the life adjustments in our members may even permit CalOptima to assist our members handle insecurities of their day by day wants that will affect their bodily and psychological well being.”
To attain this new imaginative and prescient, a $100 million funding in expertise developments won’t solely permit CalOptima to supply same-day remedy authorizations and course of real-time supplier claims funds, however it’ll facilitate sharing crucial information with group companions by growing a state-of-the-art well being info alternate program to interrupt down silos and improve take care of members.
When the system launches, CalOptima will turn into the primary Medi-Cal plan within the state to implement real-time claims processing. CalOptima’s implementation of a “cloud-first” technique may even embody cybersecurity controls to take care of HIPAA compliance and measures to stop cyber-attacks.
“As the one largest well being plan in Orange County, CalOptima gives take care of one in 4 residents. We take that big accountability critically, and our members are relying on us to assist them entry the precise care on the proper time,” mentioned Michael Hunn, CEO of CalOptima, in a press release. “Automated expertise will permit members to obtain same-day authorizations, serving to them entry wanted remedies and specialist care on a well timed foundation.”
As well as, in response to the rising healthcare 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. At the side of this partnership, CalOptima plans to launch a 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 Medical Discipline Groups, outreach staff and cell groups to deal with the wants of this inhabitants, linking them to a medical dwelling so as to stop emergency division utilization in addition to development of untreated well being situations that will end in mortality.