Being a public HMO, have their enrollees had difficulties related to the number of providers who accept/don't accept Medi-Cal? I don't know what the stats are for physicians accepting Medi-Cal, but for dentists it's something like only 40 percent of them are accepting Denti-Cal patients. On a wider scale, do managed care organizations, either public or private, have any avenues of action when it comes to convincing providers to accept patients on the managed care plan in question?

It seems that L.A. Care utilizes incentive programs on multiple levels. In terms of doctor incentives, have you seen improvements in the patient pool that they serve - are they healthier as a whole? Have you found that "monetary" incentives are the only way to motivate both doctors and patients toward health?

Also, how do community providers become a "safety net provider?"

My questions for L.A. care would be:

What kind of marketing do they do outside of their website to reach Los Angeles' communities?

How do they address the barriers in health care such as language differences, immigrants, lack of transportation?

Which one of the 4 programs do most of their clients generally qualify for?

Going along with what a couple people have already posted..

I would like to know what guidelines LA Care puts on its physicians in terms of what procedures they should be doing. Are physicians directed to try more cost-effective measures first to try to solve a problem before moving to more expensive procedures, even if the more expensive procedures have a statistically-better chance of solving the problem in the first go-round? Are there any financial incentives for the physicians to use cost-effective methods/procedures? Also, since physicians are most likely salaried, what are their (financial) incentives to providing better care?

I would ask what kind of a services offered need an authorization to receive? Also, once a patient receives authorization for treatment, how long must the patient wait from the time they receive authorization to the time they receive care? If a patient is hospitalized in a facility not within LA Care's network, once the patient is stabilized, does LA Care cover the cost to transfer the patient to a LA Care facility, does their insurance cover it, or does the patient have to pay that out of pocket?

I would ask, since this HMO is a public HMO, do they drop any of their poor consumers? Also, I would ask how are their health indicators compared to other HMOs. I would think that LA care has patients who advocate less for themselves so their costs would be decreased and maybe their health indicators.

I would ask LA Care how do people qualify for this plan? Does it provide for the couples that are over 50 and does not have a job yet lives with family? Does each applicant have their own worker? What is the interview or paper process? How long will the person know that they are covered by LA Care?

I am interested in learning how they track preventative services obtained by their patients or if they track preventative services at all. Do they know which patients are overdue for their mammograms? Or do they just check when the patients come in to the clinic? In addition, I want to know what type of physicians they employ and what is their referral mechanism to specialists or when patients develop complications of their diseases.

Any difference in doctor participation?

Regarding L.A. Care's reimbursement rates, their Billing Manual says:

Reimbursements, unless otherwise stated in the Family PACT Policy, Procedures and Billing Instructions Manual, defers to Medi-Cal policies, codes, rates and claims submission procedures. All providers bill fee for service. Providers are reimbursed according to Medi-Cal policy unless otherwise stated and claims are subject to Medi-Cal time guidelines.

I'm curious what differences exist between Medi-Cal and Family Pact reimbursement policies. Also, where Medi-Cal and L.A. Care have similar reimbursement rates, how do their doctor participation rates compare? One would think they would be similar since they would be paying doctors the same but it would be interesting to find out.

Are there individuals who go to LA Care for treatment but do not qualify for one of the programs that would allow reduced or no cost? If yes, what happens to them, especially if they cannot afford any costs associated with their visit?

Are any efforts made to increase the number of people who are signed up with LA Care?

What does "community accountability" entail? Who are the stakeholders? How does LA Care encourage and facilitate primary care, based upon the challenges in dealing with underserved and vulnerable populations? What are the most successful initiatives funded by the Community Health Investment Fund?

How do they feel about the new HMO regulations limiting patient waiting times? And how will their daily operations change to meet the new criteria?

http://www.statehousecall.org/californias-new-hmo-regulations

How much funding does LA Care receive? How are they able to still exist as an organization given the likely high cost of caring for such a low-income population? What is in the fine print regarding eligibility for various procedures? Who really decides or approves of surgeries and other medical care? Are there any incentives or bonuses offered to LA Care physicians, and if so, are they based on patient outcomes or on services provided (or not provided)?

How do they differentiate between procedures that are deemed necessary versus inappropriate?

I guess I have a lot of questions.

I agree with everything that has been said but would also like to know what restrictions they have when it comes to certain procedures they can offer their patients, and if that may effect the quality of care they can offer their patients. I wonder if due to costs, care may be extremely limited.

How are low-income patients dealt with when they acquire large medical bills that which they cannot afford? In this case, how would the financial aspect of the situation be settled by L.A. Care, the patients and the physicians for the services renderred?

 How are physicians evaluated by patients? How are physicians contracted with L.A. Care?Are there strict policies?

I wonder how do managed care organizations seek out physician and hospital contracts? Do they search for specific doctors, with history of quality services? Do they look for the most prestigious hospitals? Or, do hospitals and practices contact the HMO themselves in order to guarantee a set number of patients?

patient satisfaction?

Based on what we talked about during the last class, namely how can we measure the quality of health care, I wonder whether LA Care conducts patient satisfaction surveys regularly and whether or not LA Care gives bonuses to individual physicians and other health care providers based on the kinds of reviews given by the patients that they've treated.

integrity

Seeing that managed care has such a bad reputation, how is that L.A. Care is able to carry out their mission, vision, and values to those in need? What methods have they used to present themselves to the community in a way that shows they are going to "Stick it out" with their members and not drop them the way others have in the past?