Who do you see when you need a physical exam or medical advice from someone you know and trust? Chances are, you visit and confide in a doctor you have been seeing on an ongoing basis; someone familiar with your health background. Now, just imagine how you would feel if each time you needed to visit a doctor, you could not find one who accepted Medi-Cal patients. Or, you had to see a doctor you did not know — maybe after a long wait in the emergency room? How often would you want to go to the doctor?

This was a problem millions of Medi-Cal beneficiaries faced under the old fee-for-service Medi-Cal system. As a result, Medi-Cal beneficiaries were more prone to only seeing a doctor when they absolutely needed to, a problem that not only led to higher rates of emergency room care, but also made it impossible for the Medi-Cal program to effectively track and monitor the health of its members.

A primary care physician-based system enables each COHS plan to provide better, more effective care to Medi-Cal beneficiaries on an ongoing basis. It helps both the COHS and the provider ensure that each plan member receives quality care from a physician with a vested interest in his or her wellbeing. Most of all, it provides Medi-Cal beneficiaries with the security and peace of mind that comes with having a personal doctor who cares about their health.

Each COHS provides doctors with effective and efficient administrative support. By improving physician satisfaction with support services, the COHS plans are able to attract more physicians, thus increasing access for their members. Through their involvement in committees, the board of directors and other channels, COHS contracted providers play a central role in tailoring the process through which optimal patient care is provided as efficiently as possible and with the best possible medical outcomes. The COHS plans are able to manage the delivery of local Medi-Cal care within their finite budget resources. Savings achieved through the efficient dispensing of medical services are shared with providers. Savings are also a primary source of funding for many of the enhanced community and special care programs and services each COHS plan develops individually in response to the needs of its member community.

County Organized Health Systems are not only able to create and manage the best mechanisms for the financing and delivery of health care services, they are able to assemble the brightest minds from the local public and private sectors to ensure that their policies and activities are developed and executed in the best possible manner. While each County Organized Health System is a public agency, it is governed by an independent commission or board of directors comprised of local government representatives, provider representatives, Medi-Cal members or their advocates and representatives of the community at large.

The County Organized Health Systems benefit tremendously by their ability to assemble a board whose members are active in the local community and catalysts in furthering the programs and policies that achieve the best results for the county as a whole. Special committees also play a key role in each COHS plan, ensuring that the plan stays in constant touch with the needs of the local medical community and the Medi-Cal members it is contracted to serve.

California’s five COHS plans strive to develop value-added benefits and programs geared toward the specific needs of their members and communities at large. You can find examples of these innovative programs listed in each COHS plan’s individual section within this guide.

Through an ombudsman, member advisory committees, grievance procedures, patient advocates or other "customer support" mechanisms, each COHS plan provides its members with multiple channels of recourse, should a member have a problem or grievance about a provider or any aspect of his or her health care services. Member input is highly valued in the COHS model and regarded as a key component in the ongoing development and refinement of services.