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CalOptima Unveils Transformative 5-Year Strategic Plan for 880,000 Low-Income Orange County Residents

(March 18, 2022) - CalOptima unveils a transformative 5-year strategic plan to bring unprecedented levels of services to Medi-Cal patients.

At a press conference this morning, CalOptima presented the new vision for member services, which is designed to bring new, standard-setting levels of care to patients under its care. CalOptima is the single largest health insurer in Orange County, which provides health care coverage for 880,000 low-income residents under the State Medi-Cal Program.

The new vision, proposed by Orange County Supervisor Andrew Do who also serves as Chairman of the CalOptima Board of Directors, was unanimously supported by the Board.

Joined by CEO Michael Hunn and CalOptima’s Board of Directors, Supervisor Do announced three goals over the next 5 years:

   • Same day treatment authorizations.

   • Real-time claims payments for providers.

   • Annual assessment of each member’s social determinants of health.

“We believe these goals are a game changer; they will set the standard for healthcare in the U.S.,” said Supervisor Andrew Do.

A 2021 survey of over 1,000 doctors, administered by the American Medical Association, showed 93% of the treating physicians reporting delayed access to necessary care for patients whose treatment required prior authorization. The report also highlighted that on average physicians and their staff spend almost two business days each week completing prior authorizations.

“The changes articulated in the new vision will help reduce delays and barriers to care for our members, as well as attract more providers to work with CalOptima,” said Supervisor Do. “Understanding the life changes in our members will also allow CalOptima to help our members address insecurities in their daily needs that may impact their physical and mental health.”

“Slow authorization approval not only delays necessary access to treatment, which may exacerbate medical conditions, but also adds stress and anxiety to patients already concerned about their health. CalOptima provides health coverage for 1 in every 4 people, and 1 in every 3 children in Orange County. These are our friends and neighbors, and the kids who go to school with our children. It’s important to get things right and keep driving forward with actions that make a difference,” Supervisor Do added.

$100 Million for a Full Digital Transformation Strategy

To achieve this new vision, CalOptima’s Board of Directors approved a three-year investment of $100 million to fund a digital system transformation and workplace modernization strategy during yesterday’s board of directors meeting.

Technology is an essential part of delivering optimized health care. The approved funding will restructure existing infrastructure that will help CalOptima meet expedited turnaround times, claims and process automation, data sharing with partners, and expedited treatment authorizations.

When the system launches, CalOptima will become the first Medi-Cal plan in the state to implement real-time claims processing.

Another element of the transformation is developing a Health Information Exchange program to break down silos and improve collaboration with local community partners. And developing the program across County agencies will allow CalOptima to address health care disparities and social determinants of health. 

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Orange County Supervisor Andrew Do represents the First District communities of Cypress, Fountain Valley, Garden Grove, Huntington Beach, Los Alamitos, La Palma, Seal Beach, Westminster, and the Unincorporated Communities of Midway City and Rossmoor. As Supervisor, Andrew Do has reformed Orange County’s mental health services, expanded access to health care, and led efforts to combat homelessness.