Pharmacist's Role in California Coordinated Care Initiative
Speaker: Jane D. Kerney-Ogle
former Deputy Director Health Care Delivery Systems California Department of Health Care Services
The state Medi-Cal program and the federal Medicare program are partnering to launch a three-year project to promote coordinated health care delivery to seniors and people with disabilities who are dually eligible for both of the public health insurance programs. The program is called Cal MediConnect. Cal MediConnect will be implemented on a county-by-county basis, starting April 2014, in eight counties: Alameda, San Mateo, Santa Clara, Los Angeles, Orange, San Diego, Riverside and San Bernardino. Each county will commence as it is deemed prepared.
The Cal MediConnect program aims to improve care coordination for dual eligible beneficiaries and drive high quality care that helps people stay healthy and in their homes for as long as possible. Additionally, shifting services out of institutional settings and into the home and community will help create a person-centered healthcare system that is also sustainable.
Joining a Cal MediConnect plan is optional on the part of beneficiaries, and the choices beneficiaries will be presented are somewhat complex. Dual eligible beneficiaries who are confused and concerned about their healthcare choices are expected to consult trusted health care providers for advice, and many are expected to consult their pharmacist. This is especially the case since beneficiaries will be receiving a notice that they have been disenrolled from their Medicare Part D Plan in anticipation of enrollment in a Cal MediConnect Plan.
- List the reasons why the federal Center for Medicare and Medicaid Services initiated this program of coordinated care for persons eligible for both Medicaid and Medicare benefits (dual eligible) and understand why California opted to participate by implementing what has become known as Cal MediConnect.
- Name the basic structure, operation and rationale for Cal Mediconnect.
- Explain the choices dual eligible beneficiaries will be asked to make concerning the administration of their medical care as the program is implemented over the next year.
- Specify the notices that dual eligible beneficiaries will be receiving leading up to the time they are scheduled to be enrolled in a Cal MediConnect Plan unless they opt out, including the notice they will receive of disenrollment from their Medicare Part D drug plan.
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The California Pharmacists Association (#0113) is accredited by the Accreditation Council for Pharmacy Education (ACPE) as a provider of continuing pharmacy education. Upon completing an evaluation form, participants will be awarded 1 hour (0.1 CEUs) of Continuing Pharmacy Education Credit. A statement of credit will not be issued. Participants may log onto the CPE monitor website using their individual log in to download their statement of credit. Please allow 4 weeks for processing of CPE credits to the CPE monitor. UAN: 0113-0000-14-009-L04-P.