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Governance and Start-Up in a Public Plan Howard Kahn October 13, 2010. Experience with Two Public Plans in California. One is a public monopoly. One is competitive with private plan. California’s Public Plans. - PowerPoint PPT Presentation
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Governance and Start-Up in a Public Plan
Howard Kahn
October 13, 2010
Experience with Two Public Plans in California
• One is a public monopoly.
• One is competitive with private plan.
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California’s Public Plans
• Core attributes of public plans in CA (serve Medicaid enrollees, safety net protection, stakeholder board, lower admin costs, etc) create:– Transparency– Level playing field (more or less)– Quality and efficiency
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Managed Care Market Models – COHS, GMC, and Two Plan
• Expansion of Medi-Cal managed care models– County Organized Health System (COHS) –
locally organized for specific regions– Geographic Managed Care (GMCs) - State
contracts with several plans in a specific region
– Two Plan Model – Competition in counties with developed health systems
L.A. Care Product Lines
• Medi-Cal– Plan Partners network– Direct provider network
• Healthy Families (SCHIP)
• Healthy Kids
• Medicare Advantage Special Needs Plan (SNP)
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L.A. Care’s Mission
“To provide access to quality health care for Los Angeles County’s vulnerable and low-income communities and residents, and to support the safety net required to achieve that purpose.”
L.A. Care – Not Just an HMO
• Focus on strengthening health care safety net• Community-accountable – public advisory
committees• Community investments and leadership to
improve community health• Health policy leadership
…but is also an HMO that is performing well.
Formation and Governance
• Established by enabling legislation in 1994
• Public Agency, independent from county
• Separate Health Authority - Local Initiative- Brown Act provisions- Community/stakeholder input
• 13 member stakeholder Board
Stakeholder Board Composition
• 4 - Representing Los Angeles County (including a Board of Supervisors representative)
• 2 – Private hospitals (with and w/out Medicaid DSH)• 1 – Free and community clinics• 1 – Federally Qualified Health Centers• 1 – Physician representative• 1 – Children’s health care provider• 1 – Knox Keene licensed health plan• 2 – Health care consumers
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Advisory Groups
• Technical Advisory Committee• Children’s Health Consultant Advisory Committee• Regional Community Advisory Committee (11)• Executive Community Advisory Committee
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Licensure
• Knox Keene (HMO) licensed April 1997• Fiscal solvency/TNE requirements• Creates level playing field among
participating health plans• Oversight by Department of Managed
Health Care and Department of Health Care Services
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Health Plan of San Mateo
• Licensed as a Health Insuring Organization • Exempt from Knox-Keene licensing
requirement• Operational in 1987• Eventually was licensed• Medicare SNP that competes with private
plans
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Start-up Financing
• L.A. Care - Plan Partners, County, State, and lines of credit
• Health Plan of San Mateo - hospitals, county, HFFA, grants, loans
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Questions