Health Plan for Poor Draws Criticism : Medicine: Care of low-income people may decline under an HMO called OPTIMA, leaders in the Vietnamese community say.

WESTMINSTER — The medical care of low-income Vietnamese may decline sharply under a health maintenance organization called OPTIMA that is being crafted to improve medical access for Orange County’s poor, Councilman Tony Lam and other critics warned Friday.

Lam said that he, gastroenterologist Christopher D. Bui and pharmacist Hieu Duc Tran will go on a Vietnamese radio station Sunday and urge listeners to join a campaign to make sure their interests are heard.

They said they believe that OPTIMA, or Orange Prevention Treatment Integrated Medical Assistance program, is being designed to benefit large HMOs while excluding independent physicians and pharmacists. And this prospect, they argued, bodes ill for Vietnamese patients.

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OPTIMA officials, however, have yet to settle on a health care delivery system. That decision will be made at the end of the month after a public hearing.

Bui said the new system, which will create networks of health care providers who are paid a fixed amount of money monthly to serve Medi-Cal recipients, may help indigent patients in other parts of Orange County who have had great difficulty finding physicians who will accept the low reimbursement rates offered by Medi-Cal, California’s insurance program for the poor. But he said the poor in the Little Saigon community of Westminster have access to all the medical care they need. “In the Vietnamese community, we have all kinds of specialists willing to take Medi-Cal,” Bui said.

Moreover, Bui said, it is common for Vietnamese physicians even to extend services for which they are not paid and to make themselves available to Medi-Cal patients 24 hours a day.

Bui said he is concerned that a health management organization would “tie the hands” of Vietnamese physicians by limiting the care they can provide to save money for the program.

It is important, Bui said, that these patients have the choice of keeping their doctors. “The system is working well for this community,” he said.

According to the Orange County Department of Social Services, about 9% of the county’s 286,000 Medi-Cal beneficiaries are Vietnamese.

Tran said he is concerned that OPTIMA will seek to save money by contracting with large pharmacy chains that can obtain drugs at a discount, thereby excluding some 30 independent Vietnamese pharmacies that give counseling in the Vietnamese language.

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Mary K. Dewane, chief executive officer of OPTIMA, said as yet no design has been chosen for OPTIMA’s health care delivery system. She said she has been meeting with groups of physicians throughout the county, and OPTIMA’s board of directors will have a public hearing Sept. 13 before deciding Sept. 20 on the basic structure of the organization, which is expected to begin operation next summer.

“I think the board has been very specific about its desires to include the traditional providers who have long been serving the Medi-Cal population, including the providers who are linguistically and culturally appropriate for the population, in any system that will evolve for OPTIMA,” Dewane said.

But Lam said he believes that Dewane and the OPTIMA board privately favor a plan that would require doctors and patients to become part of one of the large health maintenance organizations that already are established.

Calling it “baloney” that the OPTIMA staff hasn’t picked a model, he said, “I feel the whole thing has been railroaded for the benefit of the big HMOs.”

Bui and Tran said they have begun passing around a petition calling for OPTIMA to preserve the right for patients to choose their doctors outside an HMO. Bui said so far they have collected 2,000 signatures on the petition that they intend to submit Sept. 13 to the OPTIMA board.