California Endowment Funds Program to Improve Farm Workers’ Healthcare
PacifiCare Health Systems Inc., the Santa Ana-based managed care company, has been identified with its core health maintenance organization products for many years. But PacifiCare, which is attempting to work its way out of a difficult stretch, is looking at a new preferred provider organization as one of the cures for what ails it.
“This is absolutely part of the overall revenue diversification strategy,” said Dr. Ace Hodgin, PacifiCare’s Phoenix-based senior vice president of PPO plans. Having a PPO, according to Hodgin, will allow PacifiCare eventually to move into hybrid healthcare service products.
PacifiCare recently received regulators’ OK to market the PPOs in California, Texas and Oklahoma. The company said that the PPO will allow more consumer choice among doctors and specialists, along with a simpler administrative design.
On the reimbursement issue, Hodgin said the PPO would reimburse hospitals on a discounted fee-for-service basis, and physicians via a fee schedule. PacifiCare, mainly in its core California market, has had to make some adjustments in its contracting practices because of “provider pushback,” or demands for more money from doctors and hospitals.
PacifiCare plans to begin enrolling PPO members in California, Texas and Oklahoma in October, with effective dates starting in January. At the outset, Hodgin said, PacifiCare is looking to market the product to groups with as few as 50 and as many as 2,000 employees.
“This would work nicely with our national accounts, but their sales are already done for the year,” Hodgin said. PacifiCare anticipates that the PPO will be part of national account packages in 2003, he said.
PacifiCare, meanwhile, is awaiting approval in Arizona, Colorado, Nevada, Oregon and Washington to market the PPOs in those states.
Preferred provider organizations are gaining favor as employers grow weary of worker complaints about restrictions placed on them by health maintenance organizations. Figures from the American Association of Preferred Provider Organizations, an Indiana-based industry group, showed that in 1999, 106.8 million Americans were eligible for such organizations, an 8.6% hike from 1998. The data also showed that PPO eligible-enrollment topped HMO enrollment, which totaled 104.5 million in 1999. HMO numbers include Medicare, MediCal/Medicaid, point-of-service plans, self-funded and the Federal Employee Health Benefit Program. Other findings included a 70% growth in the number of large employers offering PPO products.
Farm Workers’ Health Targeted
The California Endowment, Woodland Hills, along with government representatives from California and Mexico, are planning to put together an initiative to address the healthcare needs of California’s agricultural workers. July preliminary figures from the state Employment Development Department showed that Orange County’s farm employment totaled around 8,200 people.
Endowment officials said more than $16 million in grants would be made to several organizations to provide better health education, more health coverage and better access to services for agricultural workers and their families. A report and series of recommendations developed by a task force is the framework for the funding program.
Among other things, findings from the report showed that fewer than one-third of California’s farm workers have any form of medical insurance, and only one in seven is in a government-sponsored healthcare program for low-income people. The report also concluded that the risks for conditions such as heart disease, stroke, asthma and diabetes “are startlingly high for a group comprising mostly young men who would normally be in peak physical condition.”
The California Endowment was established by Blue Cross of California in 1996. It makes grants to organizations and institutions that are dedicated to benefiting the health and well being of state residents.
Bits and Pieces:
Huntington Reproductive Center, which has offices in Fullerton and Laguna Hills, was selected as one of 24 locations to participate in an infertility treatment trial conducted by Ferring Pharmaceuticals Inc., Tarrytown, N.Y. Mission Hospital Regional Medical Center, Mission Viejo, introduced a treatment for gastroesophageal reflux disease. The treatment involves tying sutures together near the “valve” between the stomach and esophagus to create a pleat that reduces or eliminates reliance on acid-controlling medication Faculty and students at Vanguard University, Costa Mesa, recently participated in an evaluation of rapid testing technology used in AIDS assessments. Vincent Gil, a Vanguard professor, received a grant from MedMira Laboratories Inc., Halifax, Nova Scotia, to test the technology Ninety-two first-year medical students at the University of California, Irvine, College of Medicine participated in a “white coat” ritual intended to emphasize compassion in the doctor-patient relationship Children’s Hospital of Orange County, Orange, received a video system from the Elf Foundation, Corona del Mar. The Elf Foundation was formed to design and install entertainment and Internet-based educational systems in children’s hospitals and ancillary facilities around the country St. Mary Medical Center, Long Beach, opened a new clinic for people with the AIDS virus.
