Sep 24, 2018
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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Abstract
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