Magazine article Drug Topics

Managed Care Goes West - to Calif. Medicaid Program

Magazine article Drug Topics

Managed Care Goes West - to Calif. Medicaid Program

Article excerpt

California pharmacists have become unwilling guinea pigs in a state experiment to control spiraling Medi-Cal costs. Because the problem of expanding demands and rising costs is nationwide, this experiment could spread to other parts of the country.

California, like other states, has traditionally based Medicaid programs on fee-for-service, the standard of care when Medicaid was enacted. Today, half of the general population in California, but only 10% of the Medi-Cal population, is enrolled in a managed care program. A bill rushed into law last year directs the Department of Health Services to move Medi-Cal into the mainstream of managed care.

"Managed care is here," warned Joseph Kelly, chief of DHS' Medi-Cal Managed Care Programs Branch. "It is growing, it will continue to grow."

What managed care will do to pharmacists isn't clear. "In the short run," Kelly told the California Pharmacists Association's annual meeting in Palm Springs, "the managed care (program) should have no impact on pharmacists, whether or not they serve Medi-Cal patients."

For the long term, the news isn't as rosy. As patients move out of fee-for-service and into managed care programs, Rx volume for many stores will drop.

DHS is trying to meet two demands--providing equal access to health care and providing cost-effective health care, Kelly told CPhA. "This is the challenge of the '90s, the challenge by which this generation of public leaders will be judged. Partners are needed if cost-effective solutions are to be obtained. We can't succeed without your help."

The state will set up five county-organized health systems (COHSs), up from the current two, and two geographic managed care pilot projects. Pharmacists like the existing COHS programs; both are run by pharmacists, feature open enrollment, and offer above-standard professional fees designed to encourage pharmacy participation. …

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