University Of California, Los Angeles Study Shows Pilot Program’s Efforts In Improving Health Care For High-risk Medi-Cal Patients
California’s Whole Person Care pilot program, launched in 2016 to address the multiple health needs of some of the state’s highest-risk Medi-Cal patients, helped improve coordination of care and reduced Medi-Cal costs, according to a report published today by the UCLA Center for Health Policy Research.
The report found that under Whole Person Care, the number of Medi-Cal beneficiaries who received help for substance use issues and specialty-care services increased, and the number who were hospitalized or treated in emergency departments decreased.
The program, which ended in 2021, focused on people who frequently utilized health services, often at disproportionately high rates, including those involved with the criminal justice system, those who were homeless or at risk of homelessness, and those with multiple chronic conditions or serious mental illness or substance use disorders. Overall, the program enrolled 247,887 Medi-Cal beneficiaries statewide.
Through its 25 local pilot programs, covering 26 California counties, Whole Person Care sought to integrate physical health, mental health and social services by contracting with more than 500 local partners — social service organizations, housing support groups, behavioral health departments and others — that provided services ranging from outreach to specialized medical care.
Among the key findings from the study:
The program promoted engagement with Whole Person Care partners through consistent communication, consensus on strategic priorities and, at times, state-provided financial incentives.
The program developed appropriate infrastructure and processes to support effective care coordination.
Compared to similar high-risk Medi-Cal beneficiaries who weren’t enrolled in the Whole Person Care program, enrollees had 45 fewer hospitalizations and 130 fewer emergency department visits per 1,000 beneficiaries per year, and their estimated Medi-Cal payments were, on average, $383 less per beneficiary per year.
“The Whole Person Care program aimed to promote access to care for the most vulnerable Medi-Cal beneficiaries, and evidence suggests that the program was successful in developing needed infrastructure and delivering services needed to support effective care,” said the report’s lead author, Nadereh Pourat, associate director of the center and head of its Health Economics and Evaluation Research Program. “Patients received more care and had improved outcomes.”
The Center for Health Policy Research was selected by the California Department of Health Care Services to evaluate the $3 billion program. Important aspects of the pilot program, such as care coordination and housing support, are now available to Medi-Cal beneficiaries under a multiyear Department of Health Care Services statewide initiative called California Advancing and Innovating Medi-Cal, or CalAIM, which launched in January 2022.
This latest analysis — the second of two — follows a May 2021 report by the center.
“The results show that such programs help complex patients in different ways, depending on their needs,” Pourat said. “Most importantly, our findings highlight the overall success of the Whole Person Care program and its potential for improving the lives of high-risk patients.”