Celebrating their 50th anniversary this year, the Medicare and Medicaid programs have become part of the fabric of healthcare in the United States. That fabric for Medicaid is actually more of a safety net for those living below the poverty line. Medicaid pays for the delivery of half of all babies born in the United States and fills the gaps in health coverage that sometimes occur in people’s lives.

Since 1997, L.A. Care Health Plan has been administering Medi-Cal (which is the name for the Medicaid program in California) to eligible Los Angeles County residents. L.A. Care Health Plan is a public entity created by the state of California. Medi-Cal provides healthcare to nearly 2.4 million county residents, of whom more than 1.8 million are enrolled in Medi-Cal with L.A. Care, which is the largest publicly operated health plan in the United States. The remaining residents are covered by a for-profit company named HealthNet. 

L.A. Care Health Plan is larger than healthcare plans in 43 states. “Every sixth person in LA County comes through L.A. Care for their health insurance,” CEO John Baackes maintains. “We have a very complex and diverse risk pool with not only moms and kids but also much higher-risk, higher-cost patients.” These include aged, poor and disabled individuals.

Many of the L.A. Care members in this high-risk population have not been in a managed care program before. They are more accustomed to fee-for-service care, so a period of adjustment for the members as well as the providers is necessary when they join. 

More Facilities

A goal of L.A. Care Health Plan is to increase its number of member-facing locations throughout Los Angeles County, which measures 4,752 square miles. Currently, it has two headquarters buildings a block apart in downtown Los Angeles – one with a member-facing office – and four family resource centers located in the Boyle Heights and Pacoima neighborhoods of Los Angeles and in Inglewood and Lynwood, Calif.

The centers provide a range of free wellness classes and activities, including health screenings and classes in weight management, early childhood development, parenting, healthy cooking and exercise not just to members in each area but also to the surrounding community. L.A. Care members also receive assistance in picking a doctor and making appointments. But Baackes wants to expand this outreach.

“Our mission is not just to serve safety net and vulnerable populations, but also to improve the health of the community we live and work in,” he emphasizes. “What we cover is barely a dent in the county. I could envision us having as many as a dozen of those family resource centers some day, hopefully during my tenure.”

To be responsive to the community, L.A. Care Health Plan has 11 regional community advisory committees (RCACs) that allow health plan members to have their voice heard on the plan’s activities. 

Members join the RCAC in the region where they live. Community-based organizations and advocate groups are also able to participate. 

Marketing Healthcare

L.A. Care Health Plan had not marketed or advertised its services extensively in the past. However, L.A. Care Health Plan offers L.A. Care Covered, a commercial plan available through Covered California, the state’s health exchange created under the Affordable Care Act. The L.A. Care Covered plan is voluntary, so marketing it is important.

“We’re building a brand identity and doing more promotional activities in mainstream media,” Baackes says. “We can’t afford the L.A. Times or television, but we can be at bus stops with transit ads and on local radio stations. The amount we’ve been spending on that for the last three years is not huge, but it is going up a little every year.”

Several levels of coverage are available through the L.A. Care Covered plan, including bronze, silver, gold and platinum. “Most people went into the bronze level who joined our program,” Baackes says. “The program can be characterized as attractive to young invincibles who think, ‘I’m never going to get sick.’ They get bare-bones coverage. We’ve got a significant number of those in the plan.”

This attitude along with the coverage of high-risk individuals can create challenges for L.A. Care. “We’ve added about a half-million members in the last four years,” Baackes says. “So the main challenge is keeping up with the growth and adjusting the organizational structure so that we can meet the demands of these different population groups, since it’s not all moms and kids.”

L.A. Care Health Plan was converting to a new operating platform from TriZetto Corp., Naperville, Ill., called QNXT when Baackes arrived, and he anticipates completing the conversion by third-quarter next year.  The use of electronic health records (EHRs) is also being promoted by L.A. Care. Although management and medical technology continues to improve, Baackes emphasizes that the human touch is still necessary. “You can have all the technology in the world, but if you want to improve the care, it’s a person-to-person thing – patient to healthcare manager,” Baackes stresses. “There has to be a human contact.”  

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