The Latest News from CalOptima

January 29, 2021

The Latest News from CalOptima: Serving Orange County's Older Adults

Amid Pandemic, CalOptima Extends Financial Support, Provides Vaccines at PACE

On January 7, the CalOptima Board of Directors approved $45.6 million in funding and programs in response to the ongoing COVID-19 pandemic. CalOptima will increase funding for health networks, incentivize vaccination for members and pay for expanded infection prevention training in nursing homes. Meanwhile, in a collaborative effort with the Orange County Health Care Agency, CalOptima has administered vaccines to more than 280 frail seniors who participate in the Program of All-Inclusive Care for the Elderly (PACE).

Health networks will receive approximately $9 million in additional funding to help cover COVID-19-related costs through June 2021. Up to $35.4 million is approved for a gift card incentive program that aims to directly motivate large numbers of members to seek vaccination. Plus, $1.2 million in funding for the nursing home program is designed to boost training resources and vaccine uptake by staff.

Offering vaccines to CalOptima’s PACE participants was a top priority given their high-risk medical conditions. At vaccine events held on January 23 and 28, participants expressed appreciation and emotions of joy and relief. Second doses will be administered in late February.

For details on the programs and financial support, please see CalOptima’s press release.

CalAIM Proposal Relaunched, Enhances Care Coordination for High-Risk Members

Concurrent with the release of Gov. Newsom’s FY 2021–22 proposed budget, the Department of Health Care Services (DHCS) released a revised CalAIM proposal. CalAIM is a multiyear initiative to improve Medi-Cal beneficiaries’ quality of life and health outcomes by implementing delivery system, program and payment reforms. The proposal was initially released in late 2019 but put on hold due to the pandemic. The new proposal revitalizes the Enhanced Care Management and In Lieu of Services initiatives and calls for implementation on January 1, 2022. CalAIM’s relaunch also brings the restart of state-sponsored workgroups this month, with a plan to finalize requirements in the spring. CalOptima will participate in the state’s stakeholder-feedback process and has begun local coordination efforts. Soon, CalOptima will engage our advisory groups, health networks, provider associations, community collaboratives and others to ensure awareness of the significant elements in CalAIM. Click here for CalOptima’s Legislative Update on CalAIM.

2021 CalOptima Member Health Rewards Program

CalOptima offers adult health rewards to eligible members for taking an active role in their health. Visit www.caloptima.org/he althrewards to view or print current incentive forms.

To learn more, call CalOptima’s Health Management department at 1-714-246-8895. We are here to help you Monday through Friday, from 8 a.m. to 5 p.m. We have staff who speak your language.

Important: Kaiser members are excluded from all CalOptima health reward and incentive offers. Health rewards can be discontinued at any time.

Disclaimer: You must meet all health reward eligibility requirements to qualify for the gift card. Kaiser members are excluded. It takes at least 8 weeks after we receive the completed form to process your gift card. The gift card cannot be used to purchase alcohol, tobacco or firearms. Gift card has no cash value, and CalOptima is not responsible if it is lost or stolen. You may only receive 1 gift card per calendar year for this health reward. Gift cards are available while supplies last. This health reward may be discontinued at any time without notice. OneCare (HMO SNP) is a Medicare Advantage Organization with a Medicare contract. Enrollment in OneCare depends on contract renewal. OneCare Connect Cal MediConnect Plan (Medicare-Medicaid Plan) is a health plan that contracts with both Medicare and Medi-Cal to provide benefits of both programs to enrollees. OneCare and OneCare Connect comply with applicable Federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, or sex.

From CalOptima's PACE

Seven Years of Success at CalOptima PACE

CalOptima launched the first Program of All-Inclusive Care for the Elderly (PACE) Center in Orange County to serve local vulnerable seniors seven years ago, on October 1, 2013. PACE enables nursing home-eligible individuals to live in the community as long as possible.

In 2019, CalOptima PACE was successful in keeping 99% of enrollees in the community and out of nursing homes. This achievement was echoed in CalOptima PACE’s ability to keep participants safe during the COVID-19 pandemic.

The coronavirus pandemic only intensified PACE’s commitment. In the spring of 2020, the program transitioned to a “PACE without Walls” model of community-based care, delivering quality care for participants from the comfort of their homes using the latest methods of virtual engagement, telehealth and delivery of wellness packages.

CalOptima PACE is rated first in California for participant satisfaction. Also, in 2019 a program survey showed that 92% of participants said they would recommend CalOptima PACE to a friend or relative in need of care.

Recently, a PACE participant fell at home on a Friday afternoon, and imaging results revealed that a hand fracture was sustained. The ongoing pandemic and the participant’s cognitive impairment rendered the emergency room an improbable option. PACE arranged transportation for the participant to visit the PACE clinic where, upon arrival, the participant’s hand was stabilized. An orthopedic appointment was scheduled for the following Monday. PACE was able to divert an ER visit and coordinate care for the participant. PACE Director Elizabeth Lee shares: “When we see and hear situations like this play out, that’s when we know exactly ‘why CalOptima PACE’.”

For more information about CalOptima PACE, call 714-468-1100, or visit us at www.caloptima.org.

From CalOptima's OneCare Connect Cal MediConnect Plan (Medicare-Medicaid Plan)

What is OneCare Connect?

OneCare Connect is an insurance plan for people who have both Medicare and Medi-Cal coverage, also known as “Medi-Medis” or “Dual Eligible” members. Members are mostly low-income seniors and people with disabilities. OneCare Connect members retain their Medicare and Medi-Cal benefits, but receive more services and support at no extra cost with no deductibles, premiums or membership fees.

Instead of having multiple ID cards and multiple plans managing their services, OneCare Connect members have one ID card to access professional services, hospital stays, and purchase their medications.

OCC has a dedicated Customer Service department with multilingual staff available 24 hours a day, 7 days a week at 1-855-705-8823 (TTY 711). As of January 1, 2021, the OneCare Connect plan serves 14,938 members across Orange County.

Enrolling into OneCare Connect is simple. To learn more about OneCare Connect or to enroll, call toll-free at 1-800-960-9070 to speak to an enrollment specialist Monday through Friday, from 8 a.m. to 5 p.m.

Watch the video explaining the 2021 benefits of OneCare Connects, and how to enroll on our website at www.caloptima.org/onecareconnect.

From Community Partner: Council on Aging Southern California

Helping Seniors Remain Healthy, Connected and Protected During COVID-19

The Council on Aging — Southern California (COASC) has been a trusted nonprofit organization since 1973. COASC provides unbiased information, services, and programs to more than 290,000 seniors and disabled adults annually across Orange, Riverside, San Bernardino, Inyo and Mono counties.

Whether assistance is needed to navigate the aging experience or face a crisis with a parent or loved one, the Council on Aging can help. COASC promotes the independence, health, and dignity of older adults in-need through compassion, education and advocacy.

COASC provides a range of no-cost programs to older adults and their families:

Long-Term Care Ombudsman Program: Support and advocacy for residents in long-term care facilities
Health Insurance Counseling & Advocacy Program (HICAP): Free, unbiased Medicare counseling
ReConnect Early Intervention Services: Assists adults ages 60+ to improve their emotional health and overall well-being
Friendly Visitor Program: Support and friendship for isolated adults
Senior Protection Program & Financial Abuse Specialist Team: Knowledge and protection to avoid financial predators
SmileMakers Holiday Gift Program: Provides holiday gifts to lonely seniors
Answers Resource Guide: Trusted resource for seniors and their families

People often forget that aging impacts us all. That is why the Council is so important to the community. COASC offers a helping hand when people do not know where to turn. Learn more and get involved at coasc.org or call

714-479-0107.

From CalOptima's Population Health Management department

Impact of Isolation Among Older Adults

and Ways to Stay Connected

Most of us have been faced with isolation due to safety orders to help stop the spread of COVID-19. Older adults are one of the high-risk groups cautioned to stay home and limit contact with others outside their homes, when possible. Many older adults either do not have access to technology or know how to use it. This can increase their chances of isolation. Older adults who cannot find new ways of staying connected with others are likely to be most affected. Isolation is a public health concern that can increase health risks.

Health risks of isolation include:

High blood pressure
Heart disease
Mental health including depression, anxiety or suicide
Memory problems
Practicing unhealthy habits such as smoking, not being physically active and not eating healthy
Early death

You may be at risk if you are:

Living alone or cannot leave the home
Feeling alone or separated from others
Facing a major loss or change
Lacking a sense of purpose
A caregiver

Ways to stay connected:

Find activities or learn something new. Start a fun project such as working on an adult coloring book.
Stay active! Exercise boosts your mood. Do at-home workouts or walk around your neighborhood.
Volunteer in person or online. Helping others can help ease loneliness.
Stay in touch with family and friends in person, online or by phone.
Send a handwritten letter or call using video chat.
Adopt a pet. Animals can make a great friend and may also reduce stress.

To learn more, call CalOptima’s Health Management department at 714-246-8895 (TTY 711).

Resources for Older Adults

Council on Aging Southern California: Calendar of events. Classes offered on meditation, painting, balance and mobility and more. https://www.coasc.org/events/calendar/

Tech Boomers: Websites and apps-based resource. Provides information on how to access and use various common internet applications for socialization, entertainment, ordering services (food, products, etc.): https://techboomers.com/courses

Laguna Beach Seniors: Zoom trainings and various resources. https://www.thesusiq.org/zoom-class-catalog.html

The California Master Plan for Aging: Various resources and local playbook with information about COVID-19. https://mpa.aging.ca.gov/

Aging 2.0: Website supporting older adults through technology. https://www.aging2.com/chapters/about/

Click here for a list of internet options for low-income seniors. List published by the Family Caregiver Alliance.

Get Your Flu Shot

Participate in CalOptima's Survey

Please provide feedback on our weekly COVID-19 e-newsletter. Your feedback will help us explore ways to enhance our communication efforts. Please take three minutes to complete this brief survey by January 31, 2021 for an opportunity drawing for a Starbucks gift card.

Click here to access the survey

From CalOptima's Community Relations Department

Upcoming Meetings and Events

CalOptima is committed to collaborating with our community partners to provide access to health care services, educational resources and social services to our members. In collaboration with diverse community organizations, this list of events and meetings below is a resource for providers and stakeholders, and it reflects our commitment to participation in community activities regularly.

To view the entire month of January, click here.

How to Contact CalOptima During the COVID-19 Pandemic

Our buildings are closed to members, but we continue to serve our members through our Customer Service phone lines, as we adhere to guidelines to reduce the possibility of transmission.