Will Lightbourne on health equity and the legislative session in California

Will Lightbourne, Director of the Department of Health Care Services (DHCS), joined us as the morning keynote speaker at the 2020 Southern California State of Reform Health Policy Conference on Tuesday. In his keynote, the director discussed his thoughts on the biggest issues facing California over the next few years. 

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First on Lightbourne’s mind is addressing the current health equity issues that have been exacerbated by the COVID-19 pandemic. The director pointed to current mortality rates for adults, where the death rate for Latinos is 42 people per 1000, Blacks is 48 people per 1000, and Pacific Islanders is 41 per 1000. By comparison, white and Asian populations of the same age demographics are dying at a rate of 27 per 1000.

“This is not just a factor of exposure, it’s a result of underlying health conditions and treatments [available to these groups],” said Lightbourne.

While these disparities were put under a magnifying glass due to the pandemic, the director acknowledged that there are huge issues related to health care access, system fragmentation, provider demographic makeup, and a narrow clinical definition of what is health care.He says he has no doubt that the majority of what affects people’s wellness occurs outside the setting of a clinic.

“There’s a weakness in our part to hold our managed care delivery system fully accountable for addressing disparities,” said Lightbourne.  

Lightbourne also addressed the Medi-Cal system, and the upcoming reprocurement of all the commercial managed care plans. DHCS plans to finalize the request for proposals (RFP) by the third quarter of 2021.

Some of the main focuses of these RFPs will be incentives for plans to employ enhanced care management, requirements for measured progress in closing disparities in health outcomes, and emphasizing value-based payment over volume-based payment. According to the director, COVID has also highlighted the need for the expansion of telehealth.

“That’s an area we need to work very closely with the provider systems and a lot of other stakeholders as well to ensure that it never takes the place of consumer choice, but that we can find good ways of embedding it in the delivery system,” said Lightbourne.

Director Lightbourne also touched on how these RFPs will include the embedding of CalAIM goals, and how the pandemic has forcedDHCS to be more sensitive to the long-term effects to the state budget. But he reiterated that the key elements of CalAIM remain at the core of the goals at the department. 

“What I anticipate we’ll be seeing is a phase-staged implementation of the CalAIM goals,” said Lightbourne.

DHCS also remains committed to the goal of deliberate and focused integration of physical, behavioral, and dental health care. While continuing to build on the success of whole-person care and the Health Homes program.

“Expanding [the] enhanced care management [pilots] for high-acuity, high-risk target populations as a state-wide service, not a county-by-county pilot,” said Lightbourne.

Lightbourne says the COVID-19 pandemic changed how DHCS thought about re-procurement. He described the need for both close local collaboration as well as cross-system engagement of all health care silos. And he reiterated the need for home and community-based care which will be carried through to the next contracts.

“We have a large aging, disability population, and as we’ve seen from the pandemic, the institutional settings have been the most dangerous place for people,” added Lightbourne.

Director Lightbourne lastly acknowledged that the innovation this year has not only put forth the need for continued growth and innovations in the Medi-Cal program but also in technology. 

“We will definitely be working with stakeholders to identify those innovations that came about during the pandemic, that people are interested in seeing continue.”