The Landscape for Improving Medi-Cal Managed Care Beneficiary Care in Sacramento County
This brief, The Landscape for Improving Medi-Cal Managed Care Beneficiary Care in Sacramento County, provides an overview of the six Medi-Cal managed care (MCMC) models and the current MCMC landscape in Sacramento, a rapid evidence review of comparative effectiveness studies on model performance and quality of care outcomes, and an overview of the political and administrative context.
Sacramento is one of two counties that use the Geographic Managed Care (GMC) model -- a state experiment in building a competitive public health insurance marketplace similar to the private insurance market. The other five models (Two-Plan, County Organized Health System, Regional, Imperial and San Benito) limit competition to one or two plans as compared with the GMC model, which provides four to seven plans.
According to the Sacramento County Medi-Cal Managed Care Advisory Committee county beneficiaries and providers face significant challenges due to a complex, confusing system with access problems and performance concerns. Most Sacramento MCMC plans rank near the bottom on quality metrics. Work by CHPR investigators suggests that access to primary care for beneficiaries is significantly worse in Sacramento County than in seven regional counties. These challenges are compounded by pervasive instability among GMC health plan participants, independent practice associations and contracted providers, which has impacted beneficiaries’ access to care. This brief is intended to inform a robust community discussion about the need and options for Medi-Cal managed care policy changes in Sacramento County.