Priority Group: Medi-Cal reimbursements by Jamen Garcia

ambershaver — 2024-07-17 18:26:58 UTC

Data driven (snapshot)

ambershaver — 2024-07-17 18:27:53 UTC

Equity

When Medi-Cal rates are not equitable across California, medical services to the Medi-Cal members are not equitable.

Low rates perpetuates continuation of low rates

ambershaver — 2024-07-17 18:28:54 UTC

Allowing providers to care for their communities.

Quality care that they want to provide.

ambershaver — 2024-07-17 18:32:23 UTC

Quality care requires covering cost of care

ambershaver — 2024-07-17 18:32:39 UTC

Quality vs. Access

Low rates force providers to choose between providing quality care and providing access to care

ambershaver — 2024-07-17 18:33:28 UTC

Provider satisfaction

ambershaver — 2024-07-17 18:34:19 UTC

Medicine shouldn't be a numbers game.

ambershaver — 2024-07-17 18:35:25 UTC

Patient satisfaction

ambershaver — 2024-07-17 18:35:32 UTC

Access to care

ambershaver — 2024-07-17 18:36:58 UTC

Providers are paying the price

Providers are valuable / a noble profession / trusted

Putting money behind our value

Overall Values:

jameng — 2024-09-16 22:14:21 UTC

We value equity: When Medi-Cal rates are not equitable across California, medical services to the Medi-Cal members are not equitable. Low rates perpetuates continuation of low rates
We value data-driven decision making: https://drive.google.com/file/d/1Akb-BJ5AR3V_dvgNhD3HeHVmEV1gnVNe/view/.
We value quality, accessible community care: Allowing providers to care for their communities. Quality care that they want to provide. Quality care requires covering the cost of care. Low rates force providers to choose between providing quality care and providing access to care
We value provider and patient satisfaction: Providers are paying the price. Providers are valuable, a noble profession and trusted. We need to put money behind what we value. Medicine shouldn't be a numbers game.

Problem:

2024-09-18 17:27:26 UTC

This region is more dependent on Medi-Cal Reimbursement, and facilities are hard to support

Problem:

2024-09-18 17:28:08 UTC

Lower reimbursement rates; geographically-driven Medi-Cal rates do not bear out logically

Problem:

2024-09-18 17:30:23 UTC

May be a disconnect between rates and the provider's day-to-day experiences; may create unrealistic expectations re. patient load, and quality measures may be impacted

Problem:

2024-09-18 17:31:04 UTC

Pediatric practices: care is shifting to mid-level providers because rates are not high enough

Problem:

2024-09-18 17:31:36 UTC

Is there a disparity in bargaining power between large medical groups and smaller groups?

Problem:

2024-09-18 17:32:41 UTC

Parity in care: the difference in reimbursement between Medi-Cal and private pay is growing and making care unsustainable

Problem:

2024-09-18 17:33:35 UTC

OB units closing because not reimbursed enough to cover costs

Overall Problem:

jameng — 2024-10-14 21:07:38 UTC

Central California healthcare systems and providers are more dependent on Medi-Cal reimbursement rates than other regions, and receives lower rates than other regions.

Solution

2024-10-16 17:38:52 UTC

Piloting an increase in rates for Central CA, from the bottom to the top of the allowable range, and monitor impacts of the rate increase.

Solution

2024-10-16 17:39:56 UTC

Work with local MCPs to increase rates paid to providers to attract additional workforce for the Medi-cal system

Solution

2024-10-16 17:48:00 UTC

Work w/MCPs and DHCS around process that they use for determining compliance around time and distance. (consider a neutral third-party to do this monitoring)

-->this is part of establishing the access challenges (understanding access issues will help inform rates discussions)