Medi-Cal Managed Care Practice

A San Diego physician recently asked why Molina Healthcare, a publicly-traded health plan, would be involved in the care of underserved populations in California.

That is a great question, considering that California ranks next to last in the nation in reimbursement for Medicaid (in California, Medi-Cal). However, once you understand our roots, the company’s mission becomes clear.

My father, the late Dr. C. David Molina, founded the company in 1980 with a single clinic and a commitment to provide quality healthcare to Medi-Cal patients. As an emergency room doctor, he saw Medi-Cal patients seeking primary care in the emergency room as a measure of last resort. My father recognized that if he took the time to understand the needs of Medi-Cal patients he could provide the care efficiently.

The concept behind the clinics was a natural one: Medi-Cal patients need a medical home. The clinics were located close to the patients, offered a multilingual staff and waiting rooms that accommodated large families. We have grown from a single clinic to a health plan devoted to delivering healthcare services to over one million Medicaid members in seven states. We still operate 19 clinics, but most of our members see contracted doctors. We are committed to quality and, for the past two years, we have been named to the list of America’s best health plans by U.S. News and World Report.

To be profitable in the Medicaid, it is essential to minimize overhead costs. The only way to do that is to take advantage of the economies of scale from serving large numbers of patients.

California spends nearly 30% less per Medi-Cal member than the national average and the least per member in the ten largest states.

With this in mind, it is easy to see how Sharp Healthcare and Rady Children’s Hospital had difficulty in balancing the needs and managing the costs of the Medi-Cal population under Sharp Advantage. Without the economies of scale that come with serving large populations, we would not be able to sustain the infrastructure required to meet our member’s special needs.

Our network of 486 primary care providers and 863 specialists in San Diego work with social service networks, pharmacists, and community organizations to provide healthcare to our members, many of whom don’t speak English and have difficulty with written material. We have ongoing dialogue with the Council of Community Clinics in San Diego and their 70 clinics throughout the county, and we are committed to collaborating with physicians through our participation in the San Diego County Medical Society and CMA.

Healthcare in California is poised for a change. There are several proposals to extend coverage to the uninsured. It is hard to know which direction the winds of change will take us. However, I believe managed care is here to stay.

I want to extend an olive branch to my fellow physicians. I used to think I knew it all, now I am convinced I still have much to learn. We would truly like to engage you in a dialogue about what the health plan of the future should look like. You may have heard this before from others, but at Molina Healthcare we truly want to engage physicians in building a better health plan that meets your needs and helps us to meet the needs of our members. I hope you will take up my offer.