Bechara Choucair, MD, is the senior vice president and chief health officer at Kaiser Permanente. He penned an op-ed in CalMatters April 19 to explain why he believes the payer-provider's proposed no-bid Medi-Cal contract with the state will benefit vulnerable Californians.
The plan, first revealed in February, would allow the Oakland, Calif.-based payer-provider to hand-pick enrollees and avoid the state's Medi-Cal contract bidding process in 32 counties, concerning other payers with being left sicker and more expensive members.
Kaiser is currently allowed to accept only previous members and their family members. Under the proposal, eight other payers would have to compete for their contracts with Medi-Cal.
The legislation cementing the Kaiser contract would take effect in 2024 if approved by the California State Legislature, which began considering the bill this week.
The proposal has garnered widespread criticism from payers, providers, counties and unions across the state.
Dr. Choucair says the proposal would allow Kaiser's 900,000 existing and future Medi-Cal members to access the company's continuity-of-care approach. Members can move between employee-sponsored coverage, Covered California and Medi-Cal within a year and avoid disruptions in care and access to physicians.
Dr. Choucair writes that Kaiser cannot participate in the state's contract procurement process because it acts as a payer and provider within a defined geographic area. He argues the proposed legislation would codify the alignment of Kaiser's delivery model with growth and quality standards set by the state.
The op-ed claims that the proposal would accomplish three central goals: increased equity, ease of access and affordability. According to Dr. Choucair, health equity would increase because more vulnerable populations would have access to the plan. Ease of access would improve by removing the layers of administration within a traditional payer-provider relationship. Finally, affordability will increase because administrative oversight fees from the state to local plans for services delegated to Kaiser could be eliminated, resulting in lower care costs.
Overall, Medi-Cal will benefit because Kaiser will be required to use its model to help federally qualified health centers and other safety-net providers improve their quality, Dr. Choucair writes. The safety net will also be strengthened by expanding the virtual care and clinical capacities of federally qualified health centers, and more specialty care will be provided by driving in-person, outpatient specialty care visits for high-need patients.
Dr. Choucair says that Kaiser operates Medi-Cal "at a significant loss" because of lower reimbursement rates while still maintaining quality care and access standards. Furthermore, he says the company will not compete with local plans, will support safety-net providers, and will work with counties on behavioral and public health initiatives.