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CalOptima Earmarks $64M for Provider Support

Analysis  |  By John Commins  
   July 12, 2022

The payer also allocated $45.2 million for digital transformation assistance to improve provider interactions.

CalOptima's board of directors has approved $64 million in supplemental funding for its contracted Orange County providers, including $58.2 million for COVID-19 expenses, and $6 million to cover Medicare funding cuts.

The CalOptima board also allocated $45.2 million for digital transformation assistance to streamline and improve interactions with providers.

The COVID-19 payment hikes of up to 7.5% will fund efforts by providers to administer COVID-19 vaccinations, cover costs for tests and treatment, and address virus variant outbreaks.

"COVID-19 cases are fluctuating, and providers are continuing to grapple with the pandemic. CalOptima wants to support our partners with the resources they need to ensure quality care for our vulnerable member population," CalOptima CEO Michael Hunn says. "The supplemental funding will provide stability for the health care system as we prepare to transition out of the Public Health Emergency."

The payments will be made for a full year, from July 1, 2022, to June 30, 2023. The board first approved supplemental payments in 2020 after noting the strain on providers. The supplemental funding also supports the healthcare safety net, as CalOptima membership has grown 23% during the pandemic to nearly 900,000.

CalOptima's Medicare programs OneCare, OneCare Connect Cal MediConnect Plan, and the Program of All-Inclusive Care for the Elderly are subject to 2% federal cuts that total $6 million a year.

The board voted to protect providers from this reduction particularly during this time as CalOptima will transition approximately 14,500 members from OneCare Connect to OneCare on Jan. 1, 2023. California is closing Cal MediConnect Plans as part of a larger initiative known as California Advancing and Innovating Medi-Cal.

CalOptima's digital transformation is part of a new three-year strategic plan to deliver efficiencies for providers, including same-day treatment authorizations and real-time claims payment. CalOptima's new budget allocates $45.2 million to this effort and signifies that the agency is moving forward with strengthening its systems on behalf of Orange County providers.

A few initiatives identified for the first year are provider portal enhancements, a provider data management system the integrates contracting and credentialling, and robotic process automation to better connect members to providers offering the services they need.   

“The supplemental funding will provide stability for the healthcare system as we prepare to transition out of the Public Health Emergency.”

John Commins is a content specialist and online news editor for HealthLeaders, a Simplify Compliance brand.


KEY TAKEAWAYS

The board first approved supplemental payments in 2020 after noting the strain on providers. The supplemental funding also supports the healthcare safety net, as CalOptima membership has grown 23% during the pandemic to nearly 900,000.

CalOptima's Medicare programs OneCare, OneCare Connect Cal MediConnect Plan, and the Program of All-Inclusive Care for the Elderly are subject to 2% federal cuts that total $6 million a year.

The board voted to protect providers from this reduction particularly during this time as CalOptima will transition approximately 14,500 members from OneCare Connect to OneCare on Jan. 1, 2023.

CalOptima's digital transformation is part of a new three-year strategic plan to deliver efficiencies for providers, including same-day treatment authorizations and real-time claims payment.


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