The three-year program would give up to 10,000 of GCHP’s more than 200,000 members the option of choosing AHP, a subsidiary of Clinicas del Camino Real, Inc. (Clinicas), as the administrator of their health care benefits in the first year.
As members of AHP, Medi-Cal beneficiaries will have access to Clinicas’ network of medical, dental, optical, preventive, specialty, ancillary, and institutional providers and will benefit from having their care coordinated by one entity. Members will maintain their access to GCHP’s providers for pharmacy, transportation, and mental health services, and to its 24-hour advice nurse line.
“It’s important for our members to have choices when it comes to their health care and we are excited that they will continue to have an opportunity to choose who manages their care with an additional partner,” said Margaret Tatar, GCHP’s chief executive officer. “We are looking forward to our partnership with AmericasHealth Plan to serve Ventura County’s Medi-Cal community.”
The pilot program has been approved by the state regulatory agencies that oversee Clinicas and GCHP: The Department of Managed Health Care and the Department of Health Care Services.
“We have been working on this partnership with GCHP for a very long time and now it is finally coming,” said Christina Velasco, Clinicas’ chief financial officer. “We will continue to offer the same high level of care that all patients deserve through this pilot program.”
GCHP’s governing board, the Ventura County Medi-Cal Managed Care Commission, approved the proposal on August 26, 2019.
“On behalf of the Ventura County Medi-Cal Managed Care Commission, I am delighted to see this pilot program with AmericasHealth Plan come to fruition,” said Dee Pupa, chair of the commission and deputy director of managed care at the Ventura County Health Care Agency. “We are all invested in the success of this collaborative effort to continue meeting the needs of Medi-Cal beneficiaries in our community.”
GCHP is mailing information about the program to its members. Members who are interested in participating in the pilot must opt in by providing their written consent on the form that is included in the mailing. Members have the right to opt out of the pilot and move back to their GCHP provider at any time by contacting GCHP’s Member Services Department.
As the pilot program nears its end in 2024, GCHP’s commission will review AHP’s performance against predetermined quality measures and will decide whether to extend the program and increase the membership.
“Our proposal for this plan-to-plan arrangement was for GCHP to allow AHP and Clinicas to manage and coordinate the care of our Medi-Cal patients. We have built a very robust network of primary care, specialty, ancillary, hospital, and institutional providers to be able to handle all of the health care needs of our patients and we are very proud of this,» Velasco said.
Both AHP and GCHP have plan-to-plan partnerships with other health plans. Since 2016, AHP has worked with Central Health Medicare Plan, Anthem Blue Cross, Blue Shield, SCAN, and Imperial Health to provide care to people who are covered under Medicare Advantage and commercial plans in Ventura County and the San Fernando Valley.
GCHP currently has a plan-to-plan agreement with Kaiser Permanente to manage the care of more than 5,500 members.
“As the cost of care continues to increase, partnering with other health plans to coordinate care for members has been one way to create efficiencies. As the health care landscape evolves, forging partnerships will be the path forward for delivering high-quality care for our members,” Tatar said.