Executive Summary

While California and the rest of the nation prepare to implement the many complex pieces of health reform, Orange County is prepared to take a leadership role by implementing a managed system of care (MSC) for the uninsured. Characteristics of a MSC include:

• Enrollees have a medical home
• Care is not episodic (i.e., crisis-based) in nature
• General agreement exists on use of community resources
• Providers follow established procedures for referrals, etc.
• All levels of care (i.e., primary, specialty, inpatient, behavioral, long term care) are effectively utilized and coordinated
• Services are developed based on the needs of a population
• There is a commitment to enhance and a mechanism to evaluate quality of care and health status of the population

In terms of the benefit to Orange County, this system of care will serve three important functions beyond delivering needed health services to low-income uninsured individuals during the interim period before health insurance exchanges and the Medicaid expansion take effect.

First, by coordinating existing programs and leveraging additional federal dollars, the County will receive a much-needed infusion of funding that will aid in developing the medical homes that will be needed to provide services to the many thousands of individuals who will carry new health insurance cards four years from now. Second, given that many of those to be served through this network will be expected to transition into Medicaid and the health insurance exchanges, they will be better prepared by virtue of learning how to receive their care through a managed model sooner rather than later. Third, because they will be receiving care during this interim period, they will be in better health and there should be less pent-up demand when health reform takes full effect.

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