Population Health Management workgroup meets to discuss Medi-Cal Healthier California for All

The California Department of Health Care Services (DHCS) held a Population Health Management Strategy Workgroup meeting on Tuesday as part of its planning for the Medi-Cal Healthier California for All initiative. The initiative aims to implement broad reforms to the Medi-Cal program in anticipation of the upcoming 1115 and 1915(b) waiver renewals.

The Population Health Management (PHM) Strategy Workgroup is one of 5 topic-specific groups dedicated to exploring specific components of the new proposal. The PHM workgroup is charged with establishing standardized population health management requirements for Medi-Cal managed care plans (MCPs).

 

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During the February 11 meeting, participants discussed the revised Population Health Management Program proposal.

According to the proposal, MCPs will be required to maintain a PHM program that addresses “the full spectrum of care coordination” including creating prevention, wellness, and case management programs, data collection and monitoring, and developing predictive analytics to identify high risk patients, communities, or populations.

The 19-page proposal outlines the specific details, goals, and requirements for the program.

A PowerPoint presentation from the meeting outlines the most recent DHCS-adopted recommendations that are now included in the proposal.

Among these recommendations are requirements for the risk stratification and segmentation component of the PHM plan.

“Risk stratification or segmentation will enable the Medi-Cal managed care plan to identify specific members who may benefit from wellness, prevention, and disease management activities; members who can benefit from case management; and members who are at risk for developing complex health issues,” reads the proposal.

According to the presentation, MCPs will be required to assign members to four categories based on risk: low, medium/rising, high, or unknown. MCPs may use their own algorithms to segment the individual members, but must describe how their algorithm will identify individuals in need of Enhanced Care Management, In Lieu of Services, and other programs.

Other newly-adopted recommendations would require DHCS to create an Individual Risk Assessment survey tool for MCPs to confirm their risk tier assignments.

MCPs are also encouraged to partner with providers, Tribal and Indian Health program providers, Community Based Organizations, and local health departments to help in care coordination and addressing social care needs. MCPs will need to coordinate with behavioral health plans for members with substance use disorder or serious mental illness.

The presentation also outlines learning collaborative activities including establishing measures to assess PHM program impact, tailoring PHM to specific population such as children, women, or rural members, and coordinating with external entities providing carved-out services.

In terms of timeline, the new PHM programs would be implemented as part of the new Medi-Cal managed care plan contracts, effective January 1, 2022.

DHCS plans to submit the new 1115 waiver and consolidated 1915(b) to CMS in June 2020, with public comment taking place in May 2020.