​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.