ORANGE, Calif. (March 21, 2022) — The CalOptima Board of Directors unanimously approved a new vision for Medi-Cal member services that will change the delivery of health care for nearly 880,000 Orange County residents. The five-year strategic vision aims to remove barriers to health care access for members by implementing same-day treatment authorizations and real-time claims payments for providers, and annually assessing members’ social determinants of health.

A 2021 survey of more than 1,000 doctors, administered by the American Medical Association, showed 93% of the treating physicians reported delayed access to necessary care for patients whose treatment required prior authorization. The report also highlighted that physicians and their staff spend on average almost two business days each week completing prior authorizations.

“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 Supervisor Andrew Do, Chair of the CalOptima Board of Directors. “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.”

To achieve this new vision, a $100 million investment in technology advancements will not only allow CalOptima to provide same-day treatment authorizations and process real-time provider claims payments, but it will facilitate sharing critical data with community partners by developing a state-of-the-art Health Information Exchange program to break down silos and enhance care for members. When the system launches, CalOptima will become the first Medi-Cal plan in the state to implement real-time claims processing. CalOptima’s implementation of a “cloud-first” strategy will also include cyber-security controls to maintain HIPAA compliance and measures to prevent cyber-attacks.

“As the single largest health plan in Orange County, CalOptima provides care for one in four residents. We take that enormous responsibility seriously, and our members are counting on us to help them access the right care at the right time,” said Michael Hunn, Chief Executive Officer of CalOptima.

“Automated technology will allow members to receive same-day authorizations, helping them access needed treatments and specialist care on a timely basis.”

In response to the growing health care crisis among the homeless population, CalOptima and other agencies joined to form the Orange County Interagency Council on Homeless Health Care (OCICHHC) in December 2021. In conjunction with this partnership, CalOptima plans to launch the Street Medicine Program to support Medi-Cal members who are experiencing homelessness. Street Medicine will include health and social services designed to meet individuals where they are to reduce or eliminate barriers to care and follow-up services.

Street Medicine providers will work with CalOptima’s current Clinical Field Teams, outreach workers and mobile teams to address the needs of this population, linking them to a medical home in order to prevent emergency department utilization as well as progression of untreated health conditions that may result in mortality.

In recognition of the growth and evolution of CalOptima, the Board-approved new mission and five-year vision statement are as follows:

• Mission: To serve member health with excellence and dignity, respecting the value and needs of each person.
• Vision: By 2027, remove barriers to health care access for our members, implement same day treatment authorizations and real-time claims payments for our providers, and annually assess members’ social determinants of health.

Contact:
Janis Rizzuto
Director, Communications
(714) 246-8837
jrizzuto@caloptima.org

About CalOptima

A county organized health system, CalOptima provides publicly funded health care coverage for low-income children, adults, seniors and people with disabilities in Orange County, California. CalOptima’s mission is to serve member health with excellence and dignity, respecting the value and needs of each person. In total, CalOptima serves nearly 880,000 members with a network of more than 10,400 primary care doctors and specialists as well as 41 acute and rehab hospitals.

Additional Quotes From CalOptima Board Members

“I commend CalOptima for being a leader in Orange County health care by making this transformational investment in technology. Hundreds of thousands of our most vulnerable members will be able to access the follow-up care they need without delays, and that will be a game-changer for the health of our community as a whole.”
—Clayton Corwin, Vice Chair, CalOptima Board of Directors, and President, StoneCreek Company

“The health care crisis among our homeless population has been a significant challenge. However, we are moving in a proactive direction by forming the Street Medicine team, which will assist our Medi-Cal members who are experiencing homelessness. A vast majority of our homeless Medi-Cal members lack access to medical care, and this team will help address the need by eliminating barriers and linking them to much needed medical care and social services. My hope is that this initiative will help reduce the number of mortalities among the homeless population.” —Supervisor Doug Chaffee, Chairman, Orange County Board of Supervisors, and CalOptima Board Member

“CalOptima has already done significant work over the past two years to serve members experiencing homelessness with Clinical Field Teams and shelter-based services. The new Street Medicine Program is the next level of care, with clinicians out in the field attending to immediate primary care needs. Orange County Health Care Agency looks forward to collaborating with CalOptima to ensure the success of this life-changing program.”
—Clayton Chau, M.D., Ph.D., Director, Orange County Health Care Agency, and CalOptima Board Member

“The Board action is a huge win for Medi-Cal members in Orange County. The new technology strategy will support better member care by eliminating the delays in getting authorizations approved. This will allow patients to access the care they need much sooner.”
—José Mayorga, M.D., Executive Medical Director, UCI Health, and CalOptima Board Member

“Street Medicine is a proven model for delivering primary care to people experiencing homelessness. By leveraging existing efforts such as the Clinical Field Teams with Street Medicine, Orange County will now provide robust and compassionate care to those who need it most and improve our communities’ health.” —Isabel Becerra, President and CEO, Coalition of Orange County Community Health Centers, and CalOptima Board Member

“This is a historic moment for the health of Orange County’s Medi-Cal members. The impact of this technology investment will be evident for years to come as CalOptima removes barriers to care.”
—J. Scott Schoeffel, Health Care Attorney and CalOptima Board Member

“I commend CalOptima’s new mission and vision statement for putting members’ needs first by prioritizing the social determinants of health that impact and pose barriers to health.”
—Blair Contratto, President and CEO, Mount Carmel Health Ministries, and CalOptima Board Member

“I applaud CalOptima for prioritizing the needs of those who are among the most vulnerable and underserved in Orange County, and I am proud to be a part of it. This five-year strategic plan will transform health care.”
—Trieu Tran, M.D., Orthopedic Surgeon and CalOptima Board Member

“All of our members deserve to be served with excellence and dignity. The Board’s action reflects a renewed commitment to our members’ care and needs.”
—Nancy Shivers, MSN, RN, CCM, CalOptima Board Member