Central California Alliance
for Health
Main Office:
1600 Green Hills Road, Suite 101
Scotts Valley, California 95066-4981
(800) 700-3874 Toll Free
(831) 430-5500
339 Pajaro Street, Suite E,
Salinas, CA 93901-3400
(831) 755-6000
530 West 16th Street, Suite B,
Merced, CA 95340-4710Website: www.ccah-alliance.org
Established: January 1,1996
Membership: 190,000
Central California Alliance for Health (the Alliance) is an award-winning, non-profit public health plan that was developed to improve access to health care for lower income residents who lacked a "medical home," and so relied on emergency rooms for primary care. Through its five lines of business (Medi-Cal, Healthy Families, Healthy Kids, Alliance Care IHSS and Alliance Care AIM), the Alliance serves 190,000 beneficiaries in Santa Cruz, Monterey and Merced counties.
The Alliance’s mission is to:
· Ensure appropriate access to publicly financed health care for residents of Santa Cruz, Monterey and Merced counties, using a cost-effective, non-profit health plan.
· Improve medical outcomes, minimize unnecessary suffering and cost, and promote self-care and wellness among health plan members.
· Increase health care providers’ satisfaction and participation in serving health plan members’ needs.
The Alliance has pursued this mission by linking members to primary care physicians and clinics that deliver services with a focus on preventive care and management of chronic illness, and arrange referrals to specialty care. As a result, the Alliance helps its members to enjoy the benefits of a positive, ongoing, doctor/patient relationship and streamlined approach to medical care. The Alliance’s programs for uninsured children and families are an investment in local communities, and their chronic disease management programs connect patients with the services they need.
To assist both its providers and members navigate the complicated health care environment, the Alliance developed a user-friendly managed care health plan. Key areas of service include:
- Ease of claims processing, and the ability to access local resources to ask questions or discuss specific claims.
- Local approval of treatment authorizations for care, access to local nurses, social workers, health educators, pharmacists and physician Medical Directors, to discuss specific care management issues.
- Local Member Services and Provider Services representatives that assist members and providers respectively with questions about the Alliance’s benefits, member health programs, provider network, health education needs, or questions about access.
The Alliance has achieved the following:
- State recognition for the highest rates of quality preventive services to members among all Medi-Cal plans in California for the past three years. The Alliance won the 2006, 2007 and 2008 HEDIS Gold Award for providing an exceptional level of chronic disease and preventive care services, such as childhood immunizations, prenatal care and diabetic eye exams, to its members.
- Reduced both suffering and cost compared to the State-operated Medi-Cal fee-for-service system through an innovative restructure of access and case management, allowing members access to care when they need it.
- Developed member health programs for diabetes management, pediatric asthma management, and breast-feeding promotion for its members.
- Established a network of over 1,300 health care providers that deliver high quality and cost-effective care to Alliance members in Santa Cruz, Monterey and Merced counties.
- Increased provider satisfaction, improved payment and participation in the Medi-Cal program.
- As a risk-sharing non-profit health plan, shared over $60 million in budget surplus with contracted physicians since the Alliance’s inception.
- Maintained administrative expenses at consistently lower than 6%.
Through its governing body, the Santa Cruz - Monterey - Merced Managed Medical Care Commission, the Alliance is continuing to develop its plan in the following areas:
- Further linking plan members with primary care physicians or practices.
- Conducting member and provider education programs that promote "best use" practices and help Alliance members and providers understand and optimize services.
- Increasing quality-related activities, including further promotion of health education, preventive care and early detection, and case management services.
The Alliance works together with its many partners to improve member access to quality health care. The Alliance also provides its members with reliable and affordable access to the care when they need it. With the support of their communities, the Alliance is shaping a healthier future by creating locally responsive health care solutions.
