February 10, 2020
CalOptima
Orange

Welcome to the Medi-Cal Managed Care 101 program resources web page. Below are information and materials you may find helpful when preparing for and attending the event.

Overview

This introductory course is designed to help participants better understand the essential concepts behind Medicaid, Medi-Cal and Medi-Cal managed care.

The course will cover:

• Medi-Cal program basics
• How Medi-Cal fits within the broader California health care landscape
• The different Medi-Cal managed care models and how they work
• How the state regulates and oversees Medi-Cal managed care plans
• Managed care principles and key plan functions
• Current and future issues in Medi-Cal managed care

Course Schedule

*May be subject to change

9:30 – 9:50 a.m. | Welcome & Introductions

9:50 – 10:15 a.m. | What is Medi-Cal?
Len Finocchio

Participants will receive a macro-level view of Medicaid and Medi-Cal, including where Medicaid/Medi-Cal fits within the larger health insurance market, program history, the role of Medi-Cal, who it covers and how it is financed.    

10:15 – 11:05 a.m. | Medi-Cal Managed Care Models
Jane Ogle

Participants will gain an understanding of the basic differences between managed care and fee-for-service, the different models of Medi-Cal managed care and services included/not included in
Medi-Cal managed care.  

11:05 – 11:20 a.m. | Break

11:20 a.m. – Noon | Program Oversight & Regulation
Jane Ogle

This session will provide an overview of the various roles and functions of the Department of Health Care Services (DHCS), including where Medi-Cal managed care fits within the Department’s larger mission. Participants will also learn about the role of the Department of Managed Health Care in regulating and overseeing Medi-Cal managed care plans.

Noon – 12:45 p.m. | Hosted Lunch

12:45 – 1:05 p.m. | Networking Exercise

1:05 – 1:40 p.m. | Managed Care Principles & Payment

This session will provide participants with an overview of managed care principles and concepts, and how they are applied in the context of operating a Medi-Cal managed care plan. The session will cover key risk mitigation and risk spreading concepts, such as provider capitation, risk sharing arrangements and other incentive structures.

1:40 – 2:50 p.m. | Key Functions of Managed Care Plans
Elizabeth Darrow

This session will build upon the managed care principles session, providing a practical overview of managed care plans’ key operational areas and functions, such as customer service/enrollment, medical management, provider contracting, compliance, claims and finance. The session will help participants understand how each of the key functions are interrelated, and how impacts or changes from one functional area can affect other areas. Case scenarios will bring concepts together for participants.

2:50 – 3:05 p.m. | Break

3:05 – 3:50 p.m. | Ask the Experts
Len Finocchio, Elizabeth Darrow, Jane Ogle

This session will facilitate an interactive discussion between faculty and participants. Participants will be able to ask questions and discuss with faculty the key challenges and issues facing local plans, and other burning questions.

3:50 – 4:00 p.m. | Wrap-Up & Adjourn

Materials

Download materials for viewing
Download materials for printing
Download materials for note-taking

Download Appendix: CHCF California Health Care Almanac: Medi-Cal Facts and Figures, 2019 

Download Glossary of Health Care Terms and Acronyms

Faculty

Elizabeth Darrow
Consultant and former CEO of Santa Clara Family Health Plan

Elizabeth Darrow is a seasoned health care executive with more than 20 years of experience in managed care, focusing exclusively on Medicare and Medicaid programs. Most recently she was the Chief Executive Officer of the largest Medi-Cal managed care plan in Santa Clara County. Among other roles, Ms. Darrow also previously served as Executive Director of Government Programs at New West Health Services in Montana and Medicare Director for Schaller Anderson in Arizona. Currently, Ms. Darrow works as a consultant with various California health plans focused on Medicare and Medi-Cal. Ms. Darrow is a graduate of the Ohio State University with a Bachelor of Science and Master of Arts.

Len Finocchio, DrPh
Principal
Blue Sky Consulting Group

Dr. Finocchio has more than 20 years of health policy research and implementation experience in government, academia, advocacy and philanthropy. Most recently he was a senior researcher at Mathematica Policy Research. Previously, Dr. Finocchio was part of the Brown Administration’s team as Associate Director at the California Department of Health Care Services leading the implementation of the Affordable Care Act. While a Senior Program Officer at the California HealthCare Foundation, Dr. Finocchio led program strategy, grantmaking, and research in the areas of health services for the uninsured, Medicaid and CHIP programs, and safety net capacity. He has also held senior health policy positions at the Institute for Health Policy Solutions, Children Now and UC San Francisco Center for the Health Professions. He has published articles in Health Affairs, Academic Medicine, the Journal of General Internal Medicine and the American Journal of Public Health.

Jane Ogle
Consultant and former Deputy Director for Healthcare Delivery Systems

Jane Ogle is the former Deputy Director for Healthcare Delivery Systems at the California Department of Health Care Services, where she was responsible for the Low Income Health Program that ultimately transitioned 640,000 childless adults into Medi-Cal in 2014; the Long Term Care division that oversees programs for the most at risk older adults in the state; California Children’s Services; and the Managed Care Division that expanded Medi-Cal managed care to all 58 counties and transitioned 900,000 children from Healthy Families into Medi-Cal. She was responsible for the Coordinated Care Initiative in seven counties that integrates Medicare and Medi-Cal services with long term services and supports through managed Medi-Cal health plans. Prior to her work at the state, Ms. Ogle was the first COO at Santa Clara Family Health Plan and spent more than 20 years in hospital administration at hospitals in Trenton and Princeton, New Jersey. Ms. Ogle is a graduate of Georgetown University, School of Foreign Service.

Site/Parking

CalOptima
505 City Parkway West
Orange, CA 92868

Meeting Room: Conference Room 109N

For attendees who will require overnight accommodations, discounted rooms are available at the ALO Hotel:

ALO Hotel by Ayres – Anaheim
3737 W Chapman Ave., Orange, CA 92868
(714) 978-9168
Note: To receive the discounted rate, mention CalOptima when booking.

Parking is available on-site.

Feedback Survey

Thank you for attending! 

At the conclusion of the program, we are kindly requesting your feedback on the course via a brief online survey, which should take only a few minutes to complete. We truly value your thoughts and opinions, and we will use the feedback we receive to shape and develop future programs.

Complete the survey

For questions or comments, please contact the LHPC Institute at institute@lhpc.org.