The California Department of Health Care
Services (DHCS) implemented a Section 1115 Medicaid Waiver called “Medi-Cal
2020,” which started Jan. 1, 2016, and ended Dec. 31, 2021. Under this Waiver,
DHCS implemented Whole Person Care (WPC) a program for high-risk,
high-utilizing enrollees who had a complex profile, with multiple service
needs.
A total of 25 Pilots, representing the
majority of counties in California, implemented WPC starting in January 2017.
WPC required participating Pilots to identify and enroll eligible Medi-Cal
beneficiaries; coordinate care across health, behavioral health, and social
services; involve relevant stakeholders; and share data in real-time with
the goals of improved care delivery, better health, and lower costs. Nadereh
Pourat, associate center director of the UCLA Center for Health Policy
Research and director of the center’s Health Economics and Evaluation Research
Program, led a team of researchers who evaluated the WPC program.
The final report builds on the interim evaluation report. In this subsequent report,
Pourat and team evaluated WPC metric achievement and changes to healthcare utilization and estimated costs through the full six year of the program; progress in
the development of supporting partnership, data sharing, and care coordination
infrastructure and processes; and plans for the transition to California
Advancing and Innovating Medi-Cal (CalAIM).
Findings:
The WPC final evaluation report shows that WPC Pilots:
- Invested
in promoting meaningful and diverse partner engagement and buy-in through
consistent communication, consensus on strategic priorities, and/or
financial incentives.
- Acquired
and implemented innovative data sharing platforms needed to support
cross-sector care coordination and facilitate data sharing with partners.
- Were
successful in developing appropriate infrastructure (e.g., staffing,
standardized protocols) and processes (e.g., needs assessment, care plan,
referrals) to support effective care coordination.
In addition, the final evaluation report shows that WPC
enrollees:
- Use
of outpatient services increased in the first year of WPC. Comparing
trends from before to during WPC, enrollees had a reduction in primary
care, an increase in specialty care, a decline in mental health care, and
an increase in substance use treatment for enrollees overall vs. the
control group.
- Had
an overall reduction in ED visits and hospitalizations and an increase in
long-term stays relative to the control group
- Had
a reduction in overall estimated Medi-Cal costs compared to controls. The
examination of costs for relevant categories of service showed that the
decline in overall costs was likely accomplished through a decline in
hospitalizations, outpatient services, and emergency department visits.
All Pilots or partners have transitioned to providing
Enhanced Care Management (ECM) and/or Community Supports (CS) under CalAIM. The
findings of this evaluation highlight care coordination best practices and the
potential for similar programs to make impacts that result in better care,
better health and lower costs for high-risk Medicaid beneficiaries.
*This publication is currently under CMS review and subject to change.