California’s Innovative Approach to “Whole Person” Care

By Lucy Pagel, Policy Consultant
and Jennifer Ryan, Vice President

California recently launched an innovative new initiative – the Whole Person Care (WPC) Pilot program – designed to take a comprehensive approach to improving the health outcomes of Medi-Cal beneficiaries who are high utilizers of the health care system. Approved in December 2015 as part of the Medi-Cal 2020 section 1115 waiver, the WPC Pilots will receive federal Medicaid funds for coordinating health, behavioral health and social services for a targeted group of beneficiaries. Through collaboration and coordination among county agencies, health plans, providers, housing support programs, and other entities, the WPC Pilots are designing and developing the infrastructure to integrate and improve care for vulnerable populations. To date, 18 Pilots have received approval from the California Department of Health Care Services (DHCS) and are in the beginning phases of implementation.

Our team has been proud to work with the DHCS on the design and implementation of the WPC Pilot program.  Today, Harbage Consulting released an overview of the program entitled, California’s Whole Person Care Pilot Program: County Partnerships to Improve the Health of Medi-Cal Beneficiaries.

In addition to providing an overview of the key elements of the program, the Harbage Report highlights several strategies that the WPC Pilots are undertaking to address specific areas of need, including 1) supporting the homeless population; 2) enhancing care coordination; and 3) sharing patient data across providers.

Target Populations

Many of the WPC Pilots are using this opportunity to address the needs of beneficiaries who are either homeless or at-risk of becoming homeless. The Pilots are increasing the amount of care coordination and supports available to this population by providing targeted services including access to sobering centers, peer support services, housing and tenancy sustaining services, mobile outreach teams, and legal assistance.

Several of the Pilots are also using WPC to enhance the resources available to those with Serious Mental Illness (SMI), Substance Use Disorders (SUD), multiple chronic conditions, and those recently released from incarceration.

Financing

The WPC Pilot Program is financed differently than most Medi-Cal programs. Each pilot submitted a budget along with their application and will receive payment based on demonstrated achievement of the goals and metrics outlined in the budget. If the Pilot lead entity spends more than was allotted in the budget, they will not receive additional funds. Additionally, if the budget was designed with a Per Member Per Month (PMPM) cost, the Pilot will only receive funding for the number of beneficiaries actually served.

What’s Next

The WPC Pilots are in the midst of developing the infrastructure and business relationships that will enable them to fully launch their programs. DHCS is continuing to provide guidance and technical assistance to the Pilots through regular communication and support. DHCS is also in the process of launching a Learning Collaborative to help ensure their successful implementation.

DHCS opened a second opportunity for WPC Pilot applications in January 2017 because the first round of applications did not reach the full amount of funding available. Applications are due in March 2017 and the second round of Pilots are expected to be awarded in the summer of 2017.