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Orange County

Since 1983, The Medical Services Initiative Program (MSI) has been a County Safety Net Program responsible for the provision of medical care to Orange County's medically indigent adults. MSI functions as a public-private partnership and contracts with a variety of private entities for the provision of medical care to eligible persons. These contracts include hospital, transportation, skilled nursing, pharmaceutical, durable medical equipment, case management and administrative services. Contracts are also in place for a variety of outpatient services including laboratory, imaging, urgent care, and surgery centers. Physicians, dentists, and community clinics are reimbursed on a fee-for-service basis. Unique to Orange County's MSI Program is the fact that prior to the Health Care Coverage Initiative (HCCI), enrollees only received episodic care for urgent or emergent services with limited primary care in a select number of community clinics. The advent of CI has allowed enrollees to take advantage of what is now a comprehensive delivery system with primary and preventive services coordinated using an established network of physicians, expanded case management, and quality improvement initiatives that will advance population health and redirect costs to more appropriate levels of care.

The cornerstone of MSI's quality improvement initiatives is the patient centered Medical Home with a focus on educating the Medical Home provider. As a part of HCCI, MSI created a Quality Assurance Program chaired by its Medical Director to oversee the quality services that are provided to MSI members through the application of clinical performance measures. Emphasis is placed on timely access to care, the use of evidence based medicine to minimize variations in care, and access to preventive care. Quality improvement is recognized as a continuous effort by all members and providers of the program with a focus on processes of care and services. The committee meets quarterly and determines quality indicators to be monitored and develops processes by which to gather, analyze, and report its findings to the MSI Program in development of interventions to improve the quality of services. The committee recommends corrective action plans when opportunities to improve care or services are identified. Oversight includes, but is not limited to, case review, the pay-for-performance initiative program, billing patterns, formulary utilization, provider credentialing, and provider and patient complaints.

Equally important however is to pursue the use and development of electronic health information technology (HIT), in addition to patient education—each enabling the patient to receive better service at the point of care and to better navigate the complex healthcare system. The HCCI program is moving towards a fully integrated delivery system using HIT. The foundation of our system is a web-based eligibility and enrollment application where patients are assigned a unique identifier. Continuity of care data is displayed from disparate systems into a single, web-based application known as MSI Connect. MSI Connect empowers Medical Home providers to use this as a tool to promote early intervention activities and further reinforce the patient about the Medical Home concept for improved continuity of care. The system may also help prevent the duplication of services as data becomes available to providers at the point of care—this will save precious health care resources to the overall healthcare system, not just MSI.

Orange County Documents
Medical Services Initiative (MSI) Provider Manual
Medical Services Initiative (MSI) Program Brochure
Medical Services Initiative (MSI) Provider News: Volume 2, Issue 1
Medical Services Initiative (MSI) Provider News: Volume 2, Issue 2
Medical Services Initiative (MSI) Provider News: Volume 2, Issue 3
Medical Services Initiative (MSI) Patient Handbook
Performance Summary: Orange County MSI Program (February 2009)
Patient Survey Results; Orange County MSI Program (February 2009)
MSI Coverage Initiative Timeline
Medical Services Initiative (MSI) Clients Within 5 Miles of Active Medical Home Provider Locations
Medical Services Initiatve (MSI) Clients Within 10 Miles of Active Medical Home Provider Locations
Locations of MSI Dental Clinics (Number of MSI Clients by Zip Code)
Locations of MSI Dental Clinics (Orange County Regions)
Pharma Utilization Program (Year 1)
Summary Provider Comments
MSI Pay for Performance
Medical Services Initiative (MSI) Provider News Volume 1-Issue 11
Medical Services Initiative (MSI) Provider News Volume 1-Issue 12