Summary

Published Date: January 22, 2020

​The California Department of Health Care Services (DHCS) implemented a Section 1115 Medicaid Waiver called “Medi-Cal 2020,” which started on January 1, 2016, and is scheduled to end on December 31, 2020. Under this Waiver, DHCS implemented Whole Person Care (WPC) for high-risk, high-utilizing enrollees who have a complex profile and are high need. A total of 25 Pilots (27 Lead Entities), representing the majority of counties in California, implemented WPC starting in January 2017. WPC requires participating Pilots to identify and enroll eligible Medi-Cal beneficiaries; coordinate care across health, behavioral health, and social services; involve relevant stakeholders; and share data in real-time with the goals of improved care delivery, better health, and lower costs. 

The interim evaluation of WPC, led by UCLA Center for Health Policy Research Associate Director Nadereh Pourat, used qualitative data sources to examine the infrastructure developed, implementation processes, and services delivered by Pilots in WPC, as well as challenges encountered and promising strategies used to overcome them. UCLA used Pilot-reported metrics and Medi-Cal data to determine whether WPC led to better care and better health within the first three years of WPC. 

Overall, the results indicated significant progress in the establishment of needed infrastructure and processes to support effective care coordination, including the development health information technology and the establishment of partnerships for managing care. Examples of better care outcomes included improved rates of follow-up after hospitalization for mental illness, initiation and engagement in alcohol and other drug dependence treatment, and timely provision of comprehensive care plans. Examples of better health outcomes included improved beneficiary self-reported overall and emotional health, controlled blood pressure, and diabetes control.

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