This month, UCSF Institute for Health and Aging and UC Berkeley Health Research for Action and released a research brief examining providers’ experience with Cal MediConnect (CMC). Generally, providers found the program’s benefits added value for their patients, but identified challenges and areas of opportunity to improve the program.
This evaluation was supported by The SCAN Foundation as part of their ongoing evaluation of Cal MediConnect, a demonstration to test Medicare-Medicaid integration in California. The data collected for this brief builds upon the results found in Phase 1 of the evaluation (released July 2016).
Researchers conducted interviews with providers and other stakeholders, including: physician providers, provider groups, Federally Qualified Health Centers (FQHCs), hospitals, CMC plan directors of provider networks, management services organizations (MSOs), and long-term care (LTC) providers.
Some of the key findings are:
- Providers perceived CMC to be part of a positive trend toward more integrated systems of care and wished to see the program sustained and improved.
- CMC’s additional benefits added value, particularly the care coordination, transportation, durable medical equipment, vision, and pharmacy benefits, though awareness of them could be improved and access more consistent.
- Providers unaccustomed to serving dual eligible members, such as FQHCs, reported being unprepared for the complexity of medical care required by many duals, presenting challenges with time and resource management.
- Many providers experienced challenges navigating member eligibility data, as well as CMC referral and authorization processes.
- Providers struggled with care transitions when they were not able to work CMC plans.
The brief also outlined recommendations for strengthening the CMC program and improving provider experience.