Report Details Progress, Challenges of California’s ‘Whole Person Care’ Pilots
A recently published report describes the progress being made by 25 pilot implementations of California’s Whole Person Care program to address social determinants of health for Medicaid patients, as well as the challenges pilot counties face with data sharing across sectors.
The paper, written by Harbage Consulting and funded by the California Health Care Foundation, details the history and setup of Whole Person Care (WPC). Recognizing that medical services only address part of a person’s overall healthcare status, the California Department of Health Care Services designed the WPC program to address the health, behavioral health and social needs of high-need, high-cost Medi-Cal beneficiaries, and negotiated the program as part of its Medi-Cal 2020 Section 1115 waiver renewal with the Centers for Medicare & Medicaid Services.
The WPC pilots are testing whether local initiatives coordinating physical health, behavioral health, and social services can improve health outcomes and reduce medical costs. Up to $1.5 billion in federal funds are available over the five years of the demonstration, matched by $1.5 billion in local funds from the pilots. Program elements that are common across many pilots include:
• Community Health Workers: These key team members improve outreach and provide care coordination to WPC enrollees.
• Service Navigation Centers/Support: Some pilots are creating information hubs to help enrollees connect to services.
• Reentry Transitions: Pilots focusing on the reentry population work closely with corrections departments, probation, courts, and the local county jail system to improve transitions when people are released from jail.
• Housing Supportive Services: Providing tenancy support to help WPC enrollees find housing placements and stay in their new homes for the long term.
• Medical Respite/Recuperative: Helping homeless enrollees who are too sick to be on the street, but not sick enough to be admitted to the hospital.
• Sobering Centers: Providing a safe recovery space for intoxicated people who are homeless.
The report notes that the pilot projects described relationship-building and “silo-busting” as some of the biggest accomplishments so far and the ones most likely to be sustained once the program concludes.
“Because local governments serve as a hub for the pilots, they have the influence and resources necessary to convene partners, both internally within government systems and externally with community-based partners, both of which are essential to supporting Medi-Cal beneficiaries with new services and a person-centered approach to care,” it notes. Yet early on, many pilots described intra-governmental silos and fragmentation as challenges. Although they serve the same county residents, they often have not communicated and coordinated with each other effectively.
The ability to share and act on enrollee health data was described as a “game changer” for those pilots that successfully navigated the creation of data-sharing agreements. But it is not an easy process. “Not only did pilots need to work through the legal requirements around how to share beneficiary data, they also had to invest in developing data infrastructure and help partners recognize opportunities created by more expansive data sharing,” the report says. “Pilots reported that it takes a significant investment of time and persistence for various legal departments to be comfortable moving forward with data-sharing agreements that align with the vision of WPC.”
The report notes that confusion around data sharing led to significant delays in pilot implementation, hindering the ability to coordinate care. Even two years into implementation, many pilots are still working through these issues. However, pilots with finalized data-sharing agreements have been able to move forward in setting up the infrastructure for securely and legally sharing enrollee information between partners.
As far as technology platforms, the report notes that pilots have implemented a range of data-sharing approaches, from sophisticated care management platforms that can match data access to an individual provider’s permission settings to simple cloud-based forms and shared documents. “Some pilots have achieved data sharing at scale, allowing population health approaches to data use, while others continue to work on ensuring case-by-case data sharing and release of information forms,” the report says.
Pilot projects also are struggling to get the necessary data from partners to meet reporting requirements, the report concluded. “Many of these pilots believe WPC is positively impacting their communities, but worry that without good data, this will progress will not be recognized.”
