Adventist taking over Medi-Cal benefit administration for Health Net in Kings County

About 13,000 Medi-Cal members in Kings County will have their health care coordinated by Adventist Health beginning next year.

The health system will take over the service in Kings County for Health Net, which has been administering health benefits in Kings, Fresno and Madera counties under a contract with CalViva Health, the locally governed Medi-Cal managed care plan.

Kings County patients will keep their primary-care doctors and specialists and use the same hospitals, but Adventist Health Plan, the licensed health plan for Adventist Health, will oversee consumer health benefits.

Medi-Cal enrollees who belong to Anthem Blue Cross will not be affected. A total of about 44,000 people in Kings County are enrolled in Medi-Cal, the state-federal insurance for people with low incomes.

Health Net will continue to administer benefits for CalViva members in Fresno and Madera counties. But under the new arrangement, Health Net will pay Adventist Health Plan a per-patient rate to coordinate care for CalViva’s managed-care members in Kings County.

By paying a lump sum per patient rather than a fee for each service, Health Net can better predict health-care costs, said Tom Hamilton, regional health plan officer. And Adventist can be more involved in the care of patients, he said.

Adventist Health/Central Valley Network, which operates four hospitals and 32 community clinics in the central San Joaquin Valley, is taking on some risk by venturing into the health insurance market.

“If a lot of patients have not seen care in the past and are now seeking care, that’s the risk that we take,” said Jeff Conklin, president and chief executive officer for Adventist Health Plan.

Adventist Health is not the first hospital-based health system to have a health plan, but it’s more common to administer benefits for Medicare managed care patients rather than for Medi-Cal patients. Medicare is the federal health insurance for the elderly and disabled; Medi-Cal is the state-federal insurance program for low-income elderly, adults and children.

Managing Medi-Cal patient benefits makes sense for Adventist and the community, Conklin said. Adventist has been providing health care to Medi-Cal patients for a long time, he added.

Medi-Cal members won’t have to change doctors or hospitals.

“We want patients to know it doesn’t change anything about their access to care,” Conklin said.

Letters were sent to Medi-Cal members to explain the switch from Health Net to Adventist Health Plan. Members will get new health cards to use. People with questions about the new health plan can call CalViva’s Member Service Department at 888-893-1569.

This story was originally published December 8, 2015 at 4:15 PM with the headline "Adventist taking over Medi-Cal benefit administration for Health Net in Kings County."