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Coordinated Care for Molina Healthcare Members Right Care. Right Place. Right Time.

The healthcare system can be very complicated. When you are elderly or disabled, the system can be even more daunting. If you are in the traditional fee for service (FFS) Medicaid programs, health care services are uncoordinated and fragmented. Beneficiaries have minimal access to preventive care (such as immunizations and mammograms) and limited access to physicians. As a result, treatment is often postponed until medical conditions become more severe, leading to costly emergency room visits.

Now consider how care is delivered through a Medicaid managed care program. Coordination is the key. For seniors or individuals with disabilities, managed care companies like Molina Healthcare help members navigate the healthcare system through a care coordination model—sending diabetic testing kits to the home, scheduling a doctor’s visit after hospital discharge for the patient and providing asthma medications and equipment to prevent an asthma attack. In addition, physicians provide routine and preventive care by coordinating referrals to specialists and assessing the need for hospitalization. Molina also invests in patient education and develops specialized disease management programs for members such as Breath with Ease, Heart Health and Living with Congestive Heart Failure. By integrating preventive care, medical services, behavioral health and psycho-social services, Molina helps members attain an independent lifestyle with minimal restrictions.

Quality is also one of the pillars of Molina Healthcare. Molina Healthcare of California earned a three-year renewal on its accreditation status and received a “Commendable” ratingfrom the National Committee for Quality Assurance (NCQA). NCQA is an independent, not-for-profit organization dedicated to measuring the quality of America’s health care. And our medical group, Molina Medical, received a Standards of Excellence awardfor achieving meritorious status from the California Association of Physician Groups (CAPG). CAPG is the nation’s largest professional association representing physician groups practicing in the managed care model.

Whether our care managers are calling members to make sure they remembered to take their insulin, ensuring that a member’s wheelchair was delivered or scheduling transportation for a member’s doctor appointment, Molina is helping make sure members receive the right care at the right time in the right place.

Coordinated Care Facts

In 2007, Medicare Advantage saved seniors nearly $90 per month or $1000 per year in out of pocket costs. An estimated savings of approximately $7 billion annually. Additionally, compared to traditional Medicare, Medicare Advantage plans can reduce out-of-pocket costs by up to $4,000 annually for patients with the highest healthcare needs.

  • Comprehensive Care: Patients receive integrated treatment plans, and expert case management and disease prevention strategies for the chronically ill.
  • Cost-Effective Care: Integrated medical groups are able to support investments in advanced healthcare information technology, tracking patient follow-through on treatment plans and patient outcomes, and helping to uncover health problems before they become catastrophic.
  • Accessible Care: Efficiencies within the coordinated care delivery model mean better healthcare for more seniors, including:
    • lower out-of-pocket costs
    • increased health services such as dental care, vision care and preventive care
    • reduced hospitalizations
    • increased prescription coverage
    • higher overall satisfaction rates
    • greater value for the premium dollar than any other healthcare delivery system

What’s At Risk

If Medicare reforms dismantle incentives for coordinated care, seniors will experience significant increases in out of pocket costs - at a time when many seniors have seen their retirement account’s decline by over 40 percent in value — and decreased quality of healthcare.

Downloadable Resources

California Association of Physician Groups Report: From the Point of Care - The Experience of California Physicians in the Medicare Advantage and Traditional Medicare Programs

The Organized Health Care Delivery System

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Please do not cut Medicare Advantage plans

“Please do not cut Medicare Advantage plans. I live on Social Security with a Medicare Advantage plan Senior Dimensions. If you cut my plan, where is that going to leave me and others like me? Please oppose all cuts to Medicare Advantage plans. I beg of you.”

~ Paul, Las Vegas NV

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