California's Medi-Cal Plans Aim to Enhance Care Coordination

From RADAR on Medicare Advantage

Medi-Cal managed care plans are in the early stages of standing up California's new Health Homes Program (HHP), which aims to deliver comprehensive care management for qualifying Medicaid enrollees with chronic conditions. The HHP will target the highest risk 3% to 5% of Medi-Cal beneficiaries and coordinate a range of physical health, behavioral health, substance use disorder, long-term services and other supports through a network of community-based care management entities (CB-CMEs) that is established by managed care plans.

All Medi-Cal plans are required to participate in the HHP in counties where it is being offered, must build an HHP network in which a member can choose the CB-CME that they want for their care coordination, and will reimburse the CB-CMEs for the provision of HHP services. Through this enhanced care coordination and the partnership between the plan and CB-CME, the state hopes to reduce avoidable health care costs.

San Francisco Health Plan is one of the two plans in San Francisco County that kicked off the initiative on July 1. Fiona Donald, M.D., the health plan's medical director, says "the goal is really to meet the folks that are identified for the program where they're at, identify their priorities and help them utilize health care and community-based resources in the best way to achieve optimal health."

The plan estimates that "several thousand" individuals out of the 130,000 it currently serves will qualify for the HHP.

L.A. Care Health Plan, which serves 2 million Los Angeles County residents and estimates it will provide HHP services to 10,000 of those members even though as many as 100,000 may qualify, is in the early stages of considering how it will structure the benefit and its CB-CME to adequately serve that population.

John Baackes, CEO of L.A. Care, says meeting the CB-CME contracting requirement and making sure that they have qualifying entities with the capacity to take care of eligible participants is the "No. 1 challenge." 

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