Lowering the Cost of Care / Increasing Health Care in an Integrated System

Receiving Care in an Integrated System2021-03-26T00:53:58+00:00

Many Californians receive care in a fragmented system.1

Many Californians receive care in a fragmented system that does not emphasize coordination of care or take into account the higher costs of care received outside of the primary care setting. One form of an integrated health care system is managed care which refers to health care coverage that organizes doctors, hospitals and other providers into groups in order to enhance the quality and cost effectiveness of medical treatment.

Indicator Progress

In 2013 (baseline year), 50.9% of Californians received care in an integrated system. The most recent data available show 59.8% (2018). We hope to reach a target of 63.9% or higher by 2022.

Read More

More Data

Integrated System

Caution: The data source has changed from the original LGHC 2012 Task Force Report as the original data source is no longer available.

Baseline

50.9%

Current Rate

59.8%

Target

63.9%

Indicator Highlights

An estimated 17.4 million Californians (46%) receive their care from low-integration systems.

In the Coordinated Care Initiative (CCI), the state Medi-Cal program and the federal Medicare program have partnered on a project to improve care for California’s seniors and people with disabilities who are dually eligible for both of these public health insurance programs.

Santa Rosa Community Health Centers (SRCHC)

This innovation seeks to lower health care costs at Santa Rosa Community Health Centers. The program uses a nurse practitioner care team and care coordinators who manage patient care in a number of ways, including health center treatments, home visits, and phone appointments. Patients receive personalized care plans and work closely with care teams in order to achieve improved health outcomes while reducing hospitalization and treatment costs. Read more »

Percentage of Californians Who Receive Care in an Integrated System, Over Time

Download the Data Visualization Help

Percentage of Californians Who Receive Care in an Integrated System, by County

Download the Data Visualization Help

|

Indicator Description: Percentage of Californians who receive care in an integrated system, defined as a Health Maintenance Organization that is tracked by the Department of Managed Health Care. Managed care refers to health care coverage that organizes doctors, hospitals and other providers into groups in order to enhance the quality and cost effectiveness of medical treatment. Today, 58 California counties receive their health care through six main models of managed care: Two-Plan, County Organized Health Systems (COHS), Geographic Managed Care (GMC), Regional Model (RM), Imperial, and San Benito.2

Data Limitations: County enrollment information is compiled by Department of Managed Health Care Licensed Full-Service Health Plans. This enrollment information is not standardized and may be designated by the member’s place of employment or home resulting in reporting inaccuracies.

Indicator Source: Department of Managed Health Care – Office of Plan Monitoring.

Indicator Calculation Methodology: Numerator is number of enrollees in a Health Maintenance Organization by county. Denominator is the county population from the Department of Finance. Percentage is numerator divided by denominator.

Data Collection Methodology: Department of Managed Health Care Licensed Full Service Health Plans compile member enrollment information by county. These Plans submit this enrollment information on a standardized template to the DMHC website on an annual basis.

Program URL Link: http://www.dmhc.ca.gov/LicensingReporting/HealthPlanComplianceMedicalSurvey.aspx#.WJIZNk2Qzc

1. Scheffler, R. M., & Bowers, G. L. (2013). A New Vision for California’s Healthcare System: Integrated Care with Aligned Financial Incentives. Berkeley: University of California, Berkeley.

2. MEDI-CAL MANAGED CARE PROGRAM FACT SHEET – Managed Care Models. (2014, November). Retrieved December 16, 2015, from www.dhcs.ca.gov: http://www.dhcs.ca.gov/provgovpart/Documents/MMCDModelFactSheet.pdf

Stories & Solutions

Share Your Story

Want to engage in moving the dial on the Lowering the Cost of Care goal? Share your impact story!

Submit Your Story