L.A. Care Health Plan - La Care Health Plan

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 six health coverage programs including Medi-Cal, L.A. Care Covered™, L.A. Care Covered Direct, L.A. Care’s Healthy Kids, PASC-SEIU Homecare Workers Health Care Plan, and L.A. Care Cal MediConnect Plan.

L.A. Care is the nation’s largest publicly-operated health plan, serving more than 2 million enrolled members, and has been accredited by the National Committee for Quality Assurance.

Company Description

L.A. Care 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.

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, California’s Medicaid plan, is a public program that provides health coverage for children, families, adults, seniors and people with disabilities who meet the income requirements. In addition to offering a direct Medi-Cal line of business, L.A. Care works 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 Coveredâ„¢. L.A. Care Coveredâ„¢ is a state-selected Qualified Health Plan by Covered California to be one of only six plans to administer health insurance to Los Angeles County residents. As a Qualified Health Plan, L.A. Care provides the opportunity for all members of a family to receive health coverage under one health plan.
• L.A. Care Covered Directâ„¢. L.A. Care Covered Directâ„¢ allows one to buy health care coverage directly with L.A. Care. L.A. Care Covered Directâ„¢ gives Los Angeles County families choices. L.A Care Covered Directâ„¢ plan helps individuals and families benefit through their commitment to the delivery of quality health coverage in Los Angeles.
• L.A. Care Cal MediConnect Plan. L.A. Care Cal MediConnect Plan provides coordinated care for Los Angeles County seniors and people with disabilities who are eligible for Medicare and Medi-Cal.
• L.A. Care’s Healthy Kids (0-5). Sponsored by First 5 LA and the Children’s Health Initiative of Greater Los Angeles, Healthy Kids (0-5) provides health coverage for children who do not qualify for Medi-Cal.
• PASC-SEIU Homecare Workers Health Care Plan. L.A. Care provides health coverage to Los Angeles County’s In-Home Supportive Services (IHSS) workers, who enable our most vulnerable community members to remain safely in their homes by providing services such as meal preparation and personal care services.

History and structure

In 1993, the State Department of Health Services produced a report entitled “Expanding Medi-Cal Managed Care: Reforming the Health System â€" 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.

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, United Health Plan (UHP), Tower Health Plan and Maxicare. By 2006, L.A. Care had established its own direct line of business in Medi-Cal.

L.A. Care has also been involved in the Healthy Families program, California’s version of the Children’s Health Insurance Plan (CHIP), from 1998 to 2013. In 2003, the agency launched L.A. Care's Healthy Kids program for children ages 0â€"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 6â€"18 in 2004; however, currently has rolled back to the 0-5 age status.

In 2008, L.A. Care launched the Medicare Advantage Special Needs Plan (SNP) for those dually eligible for both Medi-Cal and Medicare. This program was sunset in April 2014 with the launch of the L.A. Care Cal MediConnect Plan.

On October 1, 2013, L.A. Care Health Plan launched L.A. Care Coveredâ„¢, a new health plan accredited by the National Committee for Quality Assurance and selected by Covered California to administer health insurance to Los Angeles County residents.

In 2014, L.A. Care signed a three-way contract with the California Department of Health Care Services (DHCS) and the Centers for Medicare & Medicaid Services (CMS) to participate in Cal MediConnect, a pilot program for dual Medicare and Medi-Cal eligible beneficiaries to improve care coordination and health outcomes, and maximize their ability to remain in their homes and in their community.

Governance

L.A. Care is governed by a 13-member stakeholder Board of Governors representing consumers, community clinics, an expert in health plan policy, physicians, hospitals, federally qualified health centers, children’s health care providers, Los Angeles County and Los Angeles County Department of Health Services. Two of the seats are held by a consumer and a consumer advocate 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.

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 11 regional community advisory committees.

Community Grantmaking

L.A. Care launched its Community Health Investment Fund in 2001. Since then, it has awarded more than $150 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. Grant initiatives have included the Tranquada Awards, which provide infrastructure support for safety net clinics, the Oral Health Initiative, which expanded access to dental care for low-income Angelenos, and the Health Information Technology Initiative, which helped clinics purchase and implement technologies such as disease registries and electronic health records.

Family Resource Centers

L.A. Care Health Plan has four Family Resource Centers, one in Lynwood, CA, a second in Inglewood, CA, a third at The Wellness Center at the Historic General Hospital in Boyle Heights, CA, and a fourth in Pacoima, CA. These centers provide free health education, fitness and nutrition classes to all community members.

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). 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.

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. 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.