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L.A. Care Health Plan

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Local Initiative Health Authority of Los Angeles County
L.A. Care Health Plan
official logo
Agency overview
FormedApril 1, 1997; 27 years ago (1997-04-01)[1]
TypeLocal public authority
JurisdictionLos Angeles County[1]
Headquarters1055 W. 7th Street, 10th Floor
Los Angeles, CA 90017
Annual budgetUS$1,142,000,000 (2010)[2]
Agency executives
  • Howard A. Kahn, Chief Executive Officer
  • Gertrude “Trudi” Carter, M.D., Chief Medical Officer
  • John Wallace, Chief Operating Officer
  • Tim Reilly, Chief Financial Officer
Websitelacare.org

The Local Initiative Health Authority of Los Angeles County, doing business as L.A. Care Health Plan, is an independent, local public agency based in Los Angeles, California, that began operations as a licensed health plan in 1997. The organization serves low-income individuals in Los Angeles County through five health coverage programs including Medi-Cal, L.A. Care’s Healthy Kids,[3] L.A. Care’s Medicare Advantage Special Needs Plan, PASC-SEIU Homecare Workers Health Care Plan and L.A. Care Covered™.

L.A. Care is the nation’s largest publicly operated health plan, with more than one million enrolled members,[4] and has been accredited by the National Committee for Quality Assurance.[5]

Company Description

L.A. Care Health Plan (Local Initiative Health Authority of Los Angeles County) was created by the State of California to provide health care services for Medi-Cal managed care beneficiaries, uninsured children and other vulnerable populations in Los Angeles County.[6]

It is a tax-exempt public entity, subject to state rules and regulations governing public entities. This means that L.A. Care is subject to California’s Brown Act, mandating that all Board decision-making must take place at public meetings.

Coverage Programs

  • Medi-Cal. Medi-Cal is California’s version of Medicaid and is the only public program that covers some low-income adults (like pregnant women, seniors, and persons with disabilities) as well as children. In addition to offering a direct Medi-Cal line of business, L.A. Care contracts with three Plan Partners to provide coverage to Medi-Cal members. These Partners are Anthem Blue Cross, Care 1st Health Plan, and Kaiser Permanente.
  • L.A. Care’s Healthy Kids. Sponsored by First 5 LA and the Children’s Health Initiative of Greater Los Angeles, Healthy Kids provides health coverage for children ages 0-5 who do not qualify for Medi-Cal, up to 300% of the Federal Poverty Level.
  • L.A. Care Health Plan Medicare Advantage HMO SNP. The L.A. Care Medicare Advantage (HMO SNP) provides coordinated care for Los Angeles County seniors and people with disabilities who are eligible for Medicare and Medi-Cal.
  • PASC-SEIU Homecare Workers Health Care Plan. Negotiated by the Personal Assistance Services Council (PASC) and the Service Employees International Union (SEIU), the PASC-SEIU Homecare Workers Health Care Plan provides health coverage for in-home supportive services (IHSS) workers who work 77 or more hours per month for at least two consecutive months.
  • L.A. Care Covered™. L.A. Care Covered™, offered by L.A. Care Health Plan, gives its members access to an extensive network of doctors, specialists, hospitals, pharmacies and preventive care services, plus additional free services such as a nurse advice line, health education and exercise classes, and disease management programs.

History and structure

In 1993, the State Department of Health Services produced a report entitled “Expanding Medi-Cal Managed Care: Reforming the Health System – Protecting Vulnerable Populations” which served as a blueprint for expansion of Medi-Cal managed care. It designated L.A. County as one of the areas for the “Two-Plan Model” where a locally organized Medi-Cal managed care plan (local initiative health plan) would be formed to compete directly for Medi-Cal managed care enrollments with a “commercial plan.” After a competitive selection process, Health Net of California was chosen by the State as the “commercial plan,” L.A. Care Health Plan was formed as the Local Initiative Health Authority of Los Angeles County, and the Two-Plan Model began to operate in L.A. County.[6]

During its 1997 launch, L.A. Care contracted with seven established health plans, referred to as plan partners: Blue Cross of California (now Anthem Blue Cross), Community Health Plan (CHP), Kaiser Permanente, Care 1st, UHP, Tower Health Plan and Maxicare. By 2006, L.A. Care had established its own direct line of business in Medi-Cal.[7]

L.A. Care has also been involved in the Healthy Families program, California’s version of the Children’s Health Insurance Plan (CHIP), since 1998, and in 2003 launched L.A. Care’s Healthy Kids program for children ages 0–5, funded in partnership with First 5 LA and the Children’s Health Initiative of Greater Los Angeles. Healthy Kids was established as an insurance program for families who do not qualify for Medi-Cal or Healthy Families due to either income or immigration status. It was expanded to reach children ages 6–18 in 2004.[8]

In 2008, L.A. Care launched the Medicare Advantage Special Needs Plan (SNP) for those dually-eligible for both Medi-Cal and Medicare.

Governance

L.A. Care is governed by a 13-member stakeholder Board of Governors representing consumers, community clinics, physicians, hospitals, federally-qualified health centers, children’s health care providers, Los Angeles County and its Department of Health Services. Two of the seats are held by consumers who are elected by L.A. Care enrollees. L.A. Care is among the few public health plans to have consumer members on its governing board with full voting privileges.[9]

Several committees advise the board of governors, including a health care professionals committee, a children’s health committee and an executive community advisory committee representing eleven regional community advisory committees.[10]

Community grantmaking

L.A. Care launched its Community Health Investment Fund in 2001. Since then, it has awarded more than $132 million in grants and support for the health care safety net, to improve community and public health and expand health insurance coverage among underserved populations.[11] Grant initiatives include the Tranquada Awards,[12][13] which provide infrastructure support for safety net clinics, the Oral Health Initiative,[14] which expands access to dental care for low-income Angelenos, and the Health Information Technology Initiative,[15] which helps clinics purchase and implement technologies such as disease registries and electronic health records.

Family Resource Centers

L.A. Care Health Plan has two Family Resource Centers, one in Lynwood, CA, and one in Inglewood, CA. These centers provide free health education, fitness and nutrition classes to all community members.[16][17][18]

Promotion of health information technology

In April 2010, L.A. Care was awarded a federal grant to establish a Health Information Technology Regional Extension Center (REC), called HITEC-LA, to help doctors in L.A. County adopt and use Electronic Health Records (EHRs).[19] HITEC-LA is the sole REC in L.A. County, under the terms of the grant. The grant was awarded by the U.S. Department of Health and Human Services through the Health Information Technology for Economic and Clinical Health Act (HITECH Act), of the American Recovery and Reinvestment Act of 2009.[20][21]

In August 2012, L.A. Care announced the launch of eConsult, a $1.5 million Web-based consultation system that allows primary care and specialty physicians to communicate remotely with one another, share clinical information and documentation, send photos of patients’ conditions, and consult electronically to better coordinate patient care and cut down on costs associated with unnecessary referrals. Pilot project testing of the eConsult platform revealed reductions in referral visits by up to 46% in some specialty categories.[22] The consultation system can also directly process referral requests and authorizations if a face-to-face, patient-to-specialist visit is required, reducing the specialty physician referral process to a few days and increasing the speed with which patients’ care is delivered.[23]

See also

References

  1. ^ a b "About L.A. Care Health Plan" (PDF). L.A. Care Health Plan. Retrieved 10 September 2013.
  2. ^ "2009-2010 Annual Report" (PDF). L.A. Care Health Plan. 2010. Retrieved 10 September 2013.
  3. ^ Dubay, Lisa; Howell, Embry M. (2006), Los Angeles Healthy Kids Improves Access to Care for Young Children: Early Results from the Healthy Kids Evaluation (report), Health Policy Briefs, Washington, D.C.: Urban Institute (published July 12, 2006), OCLC 71199318
  4. ^ "L.A. Care The Nation's Largest Public Health Plan With 1 Million Members". CBS News. Los Angeles, California. 29 February 2012.
  5. ^ "Health Plan Report Card". National Committee for Quality Assurance. 2008. Retrieved 17 September 2012.
  6. ^ a b Expanding Medi-Cal Managed Care: Reforming the Health System, Protecting Vulnerable Populations (PDF) (Report). California Department of Health Services. 1993.
  7. ^ California Department of Health Services Directory
  8. ^ "Healthy Kids for Parents - English" (PDF), Children's Health Initiative of Greater Los Angeles, L.A. Care Health Plan
  9. ^ "HMO Members Elect Own Representatives to Governing Board of L.A. Care Health Plan". Business Wire. 13 September 1999.
  10. ^ "LA Care Health Plan (aka Local Initiative Health Authority Governing Board)", Commissions: Membership Rosters (website), County of Los Angeles, archived from the original on July 26, 2011
  11. ^ 15 Years and One Million Members Strong: 15th Anniversary Report (PDF) (Report). L.A. Care Health Plan. 1956. {{cite report}}: Check |url= value (help)
  12. ^ "L.A. Care Awards $795,000 to Five Health Clinics for Infrastructure Improvement Projects" (Press release). L.A. Care Health Plan. May 12, 2010. Retrieved September 18, 2012.
  13. ^ Ledue, Chelsey (May 20, 2010), "L.A. Care awards $795,000 to five health clinics for infrastructure improvements", Healthcare Finance News, New Gloucester, Maine: MedTech Media
  14. ^ "L.A. Care Awards $635,000 to Increase Free and Affordable Dental Services for the Underserved Residents of Los Angeles County" (Press release). L.A. Care Health Plan. September 7, 2011. Retrieved September 18, 2012.
  15. ^ "L.A. Care Grants Over $500,000 to Support Meaningful Use of Health Information Technology" (Press release). L.A. Care Health Plan. August 10, 2010. Retrieved September 18, 2012.
  16. ^ Lewis, Jason (July 23, 2009), "Family Resource Center Opens in Inglewood", Los Angeles Sentinel
  17. ^ Staff (July 8, 2010), "L.A. Care to Celebrate Anniversary of Resource Center", LA Watts Times, The Pulse, Rancho Cucamonga, California: MediaStretch
  18. ^ "L.A. Care Celebrates the 1st Anniversary of its Inglewood Family Resource Center", Los Angeles Wave, Los Angeles, California: Los Angeles Wave Publications Group, July 17, 2010[dead link]
  19. ^ Ledue, Chelsey (July 28, 2010), "Grant Will Connect Los Angeles County Clinics to HIE", Healthcare IT News, New Gloucester, Maine: MedTech Media
  20. ^ Ledue, Chelsey (April 9, 2010), "L.A. Care Health Plan receives $15.6M grant to advance use of health IT", Healthcare Finance News, New Gloucester, Maine: MedTech Media
  21. ^ REC Program (website), Office of the National Coordinator for Health Information Technology HITECH Extension Program (published December 9, 2011), 2011
  22. ^ "Electronic Specialist Consultations Reduce Unnecessary Referrals and Wait Times for Specialty Appointments for Uninsured and Underinsured Patients". Agency for Healthcare Research and Quality. 2013-07-17. Retrieved 2013-07-29.
  23. ^ "More E-Savvy for Medi-Cal Plans: L.A. Care, IEHP Roll Out Systems to Cut Costs" (PDF). Payers and Providers, California Edition. 16 August 2012.
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