The California Department of Health Care Services (DHCS) has been working to break down organizational and technological silos with a patient-centered approach to care that relies heavily on cross-agency collaboration and data sharing.
Its Whole Person Care (WPC) Pilots — in 25 jurisdictions including Shasta, San Diego and Los Angeles — coordinates Medi-Cal beneficiaries’ health, behavioral health and social services to achieve “improved beneficiary health and well-being through more efficient and effective use of resources.”
The pilots target high-risk recipients, including the homeless, individuals experiencing mental health issues or substance abuse disorder, and those who have multiple chronic conditions or are high utilizers of the emergency department. Thus far, they appear to be working.
“One of the really big successes of this work has been the relationships and the cross-sector infrastructure that has been developed across the providers and systems. Each pilot is bringing together multiple providers and systems to coordinate care,” said Amanda Clarke, associate director of programs at the California Safety Net Institute (SNI), which helps California’s public health-care systems improve care delivery and has been involved with the WPC program since its inception.
How the WPC Pilots Began
The WPC Pilots are a five-year program authorized under California’s Medi-Cal 2020 waiver. The waiver was created to test locally based initiatives that will coordinate physical health, behavioral health and social services for vulnerable Medi-Cal beneficiaries — those who are not only high users of multiple health care systems, but who continue to have poor outcomes, said Anthony Cava, spokesman for the California Department of Health Care Services.
WPC Pilots, Cava said, “identify target populations, share data between systems, coordinate care in real time, and evaluate individual and population health progress through collaborative leadership and systematic coordination among public and private entities.”
The program's first year began in January 2016 and consisted of the application and approval process. The first 17 WPC Pilots were approved for implementation on Jan. 1, 2017. The last eight got underway July 1, 2017 — the same date that some of the original 17 were approved for expansion. The five-year program ends in December 2020.
At its core, Clarke said, the pilots are about strengthening integration and coordination among different providers who are serving a lot of the same high-need individuals but aren't necessarily talking to each other or coordinating care as effectively as they might.
WPC Outcomes, Goals, Future in California
Pilot data that’s being collected shows some decreases in emergency department utilization, Clarke said, and whole-person care is allowing providers to offer services that go beyond some of the traditional medical care.
“To give some examples, there's new sobering centers being opened, new housing navigation centers to connect people who are homeless or at risk of homelessness, work around supporting people who are being released from jail,” she said. “We're also seeing new partnerships between county agencies and community-based organizations and they're really learning how to leverage one another's strengths.”
So if a county puts in place a large data sharing infrastructure, Clarke said, it may have more bandwidth to address local needs. “The key goals certainly are focused around improved integration and improved health outcomes for individuals.”
Cava said additional funding is being proposed to continue efforts begun through the pilots, adding: “We hope this becomes the new standard in how care is provided to beneficiaries in the future.”
Tech's Role in WPC Pilots
Earlier this year, the California Health Care Foundation (CHCF) released a report dedicated to technology in the WPC Pilots. "Catalyzing Coordination: Technology’s Role in California’s Whole Person Care Pilots" not only identifies key technological challenges related to WPC programs, but also opportunities for technology vendors.
CHCF identified four common challenges that pilots experienced: building consensus around a technology approach; aggregating data from many systems; ensuring technology complies with nuanced policies and agreements; and navigating partners’ skepticism of new technology tools.
These challenges vary from pilot to pilot, Cava said, and they depend upon local efforts and the strength of collaborative relationships and solutions among the pilots’ local partners. The report further mentions, he noted — and the DHCS agreed — that pilot cities “have made tremendous progress in moving toward a streamlined process where care planning is shared across multiple sectors.”
As for opportunities with technology vendors, the report states there are “myriad opportunities for technology vendors to enhance WPC pilots’ capabilities related to data sharing and care coordination.” It lists such areas as data quality monitoring and improvement, data sharing across sectors, flexible data analytics and reporting, and public data systems integration.
While the pilot counties already are contracting with multiple vendors, Clarke said, she does think there will continue to be a need and an interest given that health-care technology is constantly evolving.
“We're seeing that a single pilot might have to contract with different vendors to fulfill different needs,” she added. “So I think that as technology evolves and is able to address more and more of those needs with a single platform, we will see that continued conversation between pilots and providers or vendors along the same lines.”
