Innovative Approaches to Providing “Whole Person Care” in California

California’s Whole Person Care (WPC) pilots – a key component of the state’s Medi-Cal 2020 Section 1115 waiver – have been operational since 2017. With two years of implementation behind them, the 25 WPC pilots have met with many challenges and discovered new opportunities to improve access to health and social services for Medi-Cal beneficiaries.

Exhibit 1: Map of WPC Pilots

This week, the Department of Health Care Services published a paper Whole Person Care: A Mid-Point Check-in, written by Lucy Pagel, Carol Backstrom, and Hilary Haycock of Harbage Consulting (funded by the California Health Care Foundation). This blog explores the key components of success, as well as some challenges, based on Harbage Consulting’s experience with the pilots through our work leading the Whole Person Care Learning Collaborative.The WPC program is the nation’s first comprehensive effort provide federal Medicaid funding to encourage counties, cities, hospital authorities, health plans, providers and community-based organizations (CBOs) to harness their collective resources to identify and provide essential care coordination and other wrap-around services to Medi-Cal beneficiaries. Many of these individuals are homeless, justice-involved, and/or are high-utilizers of emergency medical care. WPC not only provides funding for the delivery of wrap-around services, but acts as a catalyst for systemic change at the local level by giving pilots the flexibility to meet beneficiary needs in creative ways, rather than through a set menu of covered services. WPC also provides key funding to allow the pilots to investment in care coordination infrastructure and workflows, which have the potential to extend beyond the five-year waiver timeframe.With such an important role to play in the health and well-being of Medi-Cal beneficiaries, the WPC pilots have worked diligently over the past two years to develop the partnerships necessary to effectively provide coordinated physical health, behavioral health, and social services for WPC enrollees. Essential to the success of these efforts has been developing strong partnerships both internally, within and among county departments, and externally with providers and CBOs. These partnerships require consistent communication, as well as the sharing of WPC enrollee data, which has proven to be a significant challenge for WPC pilots. Specifically, pilots have struggled with the legal and technical sides of data sharing. Legally, the complex web of data-sharing regulations has led to confusion and different interpretations among county counsels, health plans, and other partners. Technologically, different partners often use separate information technology platforms and implementing new or interoperable platforms among all partners is often prohibitively expensive.The WPC pilots have worked to address these many challenges creatively by building strong partnerships, developing and replicating data-sharing agreements, and implementing innovative technology solutions to facilitate effective data sharing. These innovations enable pilots to provide wrap-around services to WPC enrollees that have the potential to keep them out of the emergency room and to improve health outcomes. Some of the program elements that have been implemented under the WPC pilots are outlined below:

• Sobering Centers: Many pilots are using WPC funding to build sobering centers that provide a safe space for intoxicated individuals experiencing homelessness to recover.

• Medical Respite/Recuperative Care: Pilots are using WPC funding to develop medical respite or recuperative care centers to care for homeless enrollees who are too sick to be on the streets, but not sick enough to be admitted to the hospital or need a safe place to stay post-discharge.

• Community Health Workers: Many of the pilots are integrating community health workers (CHWs) into their workforce in order to improve outreach and provide care coordination services to WPC enrollees.

• Service Navigation Centers/Support: Some pilots are creating hubs of information for enrollees to help them efficiently learn about and connect to services. CHWs or other outreach workers and peer support staff help enrollees fill out applications for social services including food assistance, General Assistance, Meals on Wheels and more.

• Re-entry Transitions: Pilots focusing on the re-entry population are working closely with corrections departments, including probation, courts, and the local county jail system to improve transitions once individuals are released from jail.

• Housing Services: A majority of pilots are using WPC to offer housing services including housing navigation and tenancy supports, in an effort to help WPC enrollees find housing placements and stay in those placements for the long-term.

With two more years of funding available, the WPC pilots have the opportunity to expand and refine their efforts and to continue identifying innovative ways to meet people where they are. Harbage Consulting is proud to support the WPC pilots through the WPC Learning Collaborative and other technical assistance efforts.

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Authors

Lucy Pagel [Director]