The investment will fund technology that allows CalOptima to provide same-day authorizations and timely claims payments.
CalOptima has launched a $100 million, five-year "strategic vision" to assess the social needs of its nearly 880,000 Medi-Cal members in Orange County, provide them with same-day care authorizations and pay claims to providers in "real time."
"The changes articulated in the new vision will help reduce delays and barriers to care for our members, as well as attract more providers to work with CalOptima," said Andrew Do, board chair for Orange-based CalOptima. "Understanding the life changes in our members will also allow CalOptima to help our members address insecurities in their daily needs that may impact their physical and mental health."
An recent American Medical Association survey of more than 1,000 doctors found that 93% of physicians reported delayed access to care for patients whose treatment required prior authorization. The survey also noted that physicians and their staff average almost two business days each week completing prior authorizations.
The $100 million earmarked for the initiative will fund technology that allows CalOptima to provide same-day authorizations and timely claims payments will also facilitate data sharing with providers and stakeholders through a health information exchange.
When the system launches, CalOptima will be the first Medi-Cal plan to use real-time claims processing. CalOptima's "cloud-first" strategy will also include cyber-security controls to maintain HIPAA compliance and measures to prevent cyber-attacks, the payer said.
To address care needs for the county's homeless population, CalOptima in December 2021 joined the Orange County Interagency Council on Homeless Health Care and will launch a joint Street Medicine Program to support homeless Medi-Cal members.
Street Medicine will provide health and social services "designed to meet individuals where they are" and will work with CalOptima's Clinical Field Teams, outreach workers and mobile teams, linking homeless people to a medical home to reduce emergency department use and manage chronic conditions.
“The changes articulated in the new vision will help reduce delays and barriers to care for our members, as well as attract more providers to work with CalOptima.”
Andrew Do, board chair, CalOptima
John Commins is a content specialist and online news editor for HealthLeaders, a Simplify Compliance brand.
KEY TAKEAWAYS
When the system launches, CalOptima will be the first Medi-Cal plan to use real-time claims processing. CalOptima's "cloud-first" strategy will also include cyber-security controls to maintain HIPAA compliance and measures to prevent cyber-attacks.
To address care needs for the county's homeless population, CalOptima in December 2021 joined the Orange County Interagency Council on Homeless Health Care and will launch a joint Street Medicine Program to support homeless Medi-Cal members.