OF SAN MATEO
701 Gateway Blvd.,
Established: December 1,1987
If Santa Barbara Health Authority is an indication of the COHS models long-term success, the Health Plan of San Mateo (HPSM) is proof positive that the COHS model can also withstand the test of growth.
Between 1988 and 1995 San Mateos population grew roughly 11 percent per year, causing HPSM membership to increase more than 65 percent, from 28,000 to 47,000 members. With only two private practice obstetricians, the countys Health Services Agency and 20 PCPs accepting new Medi-Cal patients around the mid-1980s, San Mateos traditional fee-for-service Medi-Cal program would have buckled from the future influx of new Medi-Cal beneficiaries.
Fortunately, the efforts of local medical representatives, county leaders and active citizens led to the establishment of the San Mateo Health Commission by the County Board of Supervisors. One year later, the commission opened a COHS structured Health Insuring Organization (HlO) called the Health Plan of San Mateo. Since its opening in 1987, HPSM has established contracts with 90 percent of the physicians in active practice within the county, as well as 12 regional hospitals, more than 100 pharmacies and roughly 250 non-physician providers (such as durable medical equipment providers, home health and hospice agencies, physical therapists and chiropractors).
In recent years, HPSM and members of its thriving provider network have worked closely to develop programs and services that make it easier for plan members to stay healthy, and easier for providers to effectively deliver care. HPSMs success has not only resulted in a healthier member population, but a more positive outlook among doctors toward Medi-Cal managed care. Milestone improvements include:
- A 44 percent decrease in hospital days per 1,000 members.
- Improved birth outcomes, resulting in a 63 percent reduction in hospital days due to premature births; a 46 percent reduction in hospital days in cases with delivery complications; and a 58 percent reduction (from 5.2 to 2.2 days) in the average length of stay for normal deliveries.
- Distribution of enhancement funds (program savings) to a variety of community health projects.
- Selected programs that further improve the delivery and quality of health care services to HPSM members include:
- A Prenatal Care Program which focuses on minimizing the barriers that keep women from maintaining a suitable care schedule during pregnancy and offers members incentives for getting into care early and keeping appointments.
- A HealthRide program that provides transportation to medical appointments when a members scheduled or usual form of transportation is not available. With funding provided through the San Mateo Health Commission, this "enhancement fund project" provides door-to-door member transportation through contracts with local taxi and shuttle companies.
- An Ombudsman program designed to augment HPSMs existing problem-solving systems with an independent legal counselor who identifies and responds to member problems prior to initiating HPSMs formal complaint and grievance process.
Looking ahead, HPSM will continue to further its work with the county Health Services Agency and Hospital Consortium in an effort to establish an integrated long-term supportive services program. Objectives will focus on continuing to meet the needs of frail, elderly and disabled members, securing a Knox-Keene license, continuing to develop HPSMs enhancement fund program and participation in the Healthy Families Childrens Health Initiative.
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