Status update on California’s Whole Person Care pilot programs

With a year and a half remaining in California’s Whole Person Care (WPC) pilot program, the California Health Care Foundation (CHCF) announced the release of two studies providing a midway status update.

WPC programs — created as part of the state’s 1115 waiver — aim to coordinate resources and care to treat Medi-Cal beneficiaries’ physical, behavioral health, and social needs. The pilots specifically target high-risk Medi-Cal beneficiaries, such as individuals who are homeless, experiencing mental health issues or substance abuse disorder, have multiple chronic conditions, or are high emergency department utilizers.

The pilots encourage the coordination of counties, cities, Medi-Cal Managed Care Plans, providers, community organizations, and hospitals to treat the whole person.

 

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There are 25 WPC pilots across California. As of December 2018, 108,000 individuals were enrolled. Program implementation began in 2017, and the programs are set to expire December 2020.

The reports outline some of the key initiatives adopted by the WPC pilots, highlight innovative accomplishments, and detail some of the challenges and difficulties the programs have encountered.

One of the released reports, “Whole Person Care: A Mid-Point Check-In,” was written by Harbage Consulting and published by the California Department of Health Care Services. The report is based on information learned in one-on-one interviews with all 25 programs.

“With two years of implementation behind them, the 25 WPC pilots have met with many challenges and discovered new opportunities to improve access to health and social services for Medi-Cal beneficiaries,” said Lucy Pagel, Senior Policy Consultant at Harbage Consulting.

According to the report, common elements have emerged across many of the WPC programs. They include: the utilization of community health workers to improve outreach and care coordination with WPC enrollees, navigation centers that serve as information hubs for enrollees to connect to services, housing supportive services, and respite/recuperative care for homeless enrollees who need a safe space to recuperate from illness.

Representatives from the programs report that building partnerships, both internally and externally, has been a major benefit of the WPC pilot.

The cooperation has allowed “partners to come together in regular planning and operations meetings to discuss workflows and conduct case conferences. These meetings increase cross-agency awareness and understanding, improve working relationships, and result in better coordination for beneficiaries,” reads the report.

An example of external partnership-building highlighted in the report is in Placer County. There, the county partners with Sutter Health Hospitals. Through data sharing, when a WPC enrollee enters a Sutter ER, the hospital is able to notify the Placer WPC team, which can then dispatch a care coordinator to arrange follow-up care and services for that individual.

The report also highlights efforts related to providing coordinated care, which it describes as “the heart of WPC.”

Examples of care coordination across the state include a multidisciplinary team in San Mateo County that works with the county’s highest health care service utilizers, and the hiring of new case management staff in Santa Cruz to improve behavioral health integration.

Another example of successful care coordination included in the report is in San Bernardino County, where nurses visit enrollees’ homes to prevent hospital readmissions.

One of the most important, but challenging, priorities identified by WPC teams is providing housing services for WPC enrollees. While Medicaid funding can’t be used for purchasing or renting housing, it can be used for tenant and landlord training, funding security deposits, and individual outreach.

WPC teams are also exploring other, innovative approaches. Marin County has partnered with the local housing authority to ensure that a certain number of Section 8 vouchers go to WPC enrollees every year. Other programs are developing housing pools to combine resources to pay for housing services and supports.

“Despite examples of success, lack of affordable housing stock in California and the length of time it can take to house members is by far one of the biggest ongoing challenges in WPC,” reads the report.

The second CHCF-supported report focuses on the importance of data-sharing for the WPC pilots. The report, “Catalyzing Coordination: Technology’s Role in California’s Whole Person Care Pilots,” identifies key technological challenges and opportunities related to WPC programs.

“While integrated care requires an array of capabilities, one of the most fundamental is an organization’s ability to share data. If entities cannot effectively exchange information about the patients they share, then they cannot effectively coordinate care for those patients,” reads the report’s executive summary.

Shared platforms for care coordination and case management, cross-sector data sharing, patient identity matching, and automated data integration are all identified as technological capabilities critical to WPC pilots.

However, despite the importance of these tech capabilities, the report describes these data-sharing necessities as complex.

“Integrating care across sectors is no easy task. The breadth and depth of new partnerships and systemic changes required to truly integrate services across the continuum of care can be dauntingly complex,” reads the report.

Some of the key data-sharing challenges identified in the report include the aggregation of huge volumes of diverse data from multiple systems, building consensus around an individual WPC program’s technological approach, and navigating external partners’ skepticism of new technological tools.