California stumbles at shifting care for costly patients

lifornia's ambitious effort to save billions of dollars by changing how the state's costliest patients get treated is on the ropes.

The Obamacare program was designed to reduce medical costs by putting more of the nation's 11 million most challenging and expensive patients into tightly managed care.

But the rollout in California — one of the first states spearheading the effort — has been marred by widespread confusion, enrollment glitches and a revolving door of health officials. Sixty percent of eligible patients have rejected the program, and state leaders are demanding to see financial savings in a year.

Most of the patients suffer from multiple chronic conditions, such as diabetes and Alzheimer's. They range from younger, disabled adults to older Americans in nursing homes. Nationwide, some $300 billion is spent annually on these patients who qualify for both Medicare and Medicaid. 

In Long Beach, Bertha Poole, a 62-year-old quadriplegic, has been on Medicare and Medi-Cal since 1996. She likes her doctors and isn't eager to join a new program.

"Most people don't want to even consider leaving their doctor," she said.

Other patients like Daniel Caldera Jr. welcome the extra attention they say they get in managed care. The 58-year-old Chino man is a disabled veteran and has landed in the hospital twice in the last year. He's enrolled in the new state program with CareMore, a unit of insurance giant Anthem Inc.

His new doctors quickly diagnosed a blocked coronary artery after he complained about shortness of breath while taking out the trash. "I was literally a ticking time bomb," he said.