February 16, 2018
Area(s) of Interest: Payor Contracting
On December 26, 2017, the California Department of Managed Health Care (DMHC) issued a cease-and-desist order, requiring nine health plans to terminate their contracts with Employee Health Systems (EHS) Medical Group Inc. This order came after SynerMed—a company closely affiliated with EHS—was accused of blocking patient access to specialists to hold down costs.
EHS had more than 500,000 patients statewide—90 percent of whom were Medi-Cal managed care patients. As required by DMHC, health plans affected by this order were required to submit a transition plan by January 3, 2018, and transfer all EHS patients to different health care providers by February 5, 2018.
The California Medical Association (CMA) has published a guide intended to help physicians understand the impact these recent changes may have on their practices and where patients are being moved so they can determine whether to explore contract relationships with other entities.
The guide is available free to members only in the CMA resource library.