Multi-Silo Care Coordination in California’s Safety Net

By Hilary Haycock

Last week, I gave a presentation at the Northern California State of Reform Conference on what multi-silo care coordination looks like in California’s safety net. The good news? California is investing in innovative programs designed to break down those silos and help providers deliver person-centered care. The bad news? We still have a long way to go!

What’s the Challenge?

The health care safety net in California – like safety nets across the nation – was developed from a patchwork of solutions designed to solve the needs of specific populations and to leverage available funding streams.

The result: Multiple, fragmented public programs serving overlapping populations.

Let’s look at an example: A Medi-Cal beneficiary with depression, hypertension, and diabetes, who is chronically falling behind on their rent. Best case scenario, this person has a team of teams that is trying to help them address each of those problems. Including:

  • A team of behavioral health providers – including a psychiatrist, a therapist and a case manager/care coordinator.
  • A team of physical health providers – including a nutritionist, cardiologist, endocrinologist, and a case manager/care coordinator.
  • A team of social supports – including family members, friends, and community members and organizations – potentially including a county or community-based case manager.


Here’s the problem – who’s coordinating the care coordinators across these teams? How are we investing in the system so the beneficiary doesn’t have to manage all these teams? How can we ensure that the teams work together to make it easy for the beneficiary to seamlessly get the care and supports they need to achieve their goals in life?

The solution is two-fold. First, we need to break down the structural barriers between those silos.  Then, we have to build the communication infrastructure and partnerships across silos that are necessary for actual person-centered care coordination.

How Are We Breaking Down Those Silos?

California has several initiatives underway to try to help break down the structural barriers between silos and promote better, more coordinated care across health and social programs.  Harbage Consulting is proud to be supporting California’s Department of Health Care Services in each of these efforts:

    • Coordinated Care Initiative: This program is tackling two of the biggest public healthcare programs: Medicare and Medicaid (called Medi-Cal in California). People who are eligible for both of these programs must navigate two sets of health and supportive services and at least two sets of providers – many of which don’t work together.  Now, new Cal MediConnect health plans combine both sets of benefits into one managed care plan with extra care coordination services to help provide person-centered care.  This financial alignment of the Medicare and Medi-Cal benefits is the first step to get providers working together across the silos.  Read more about our work in our CCI Case Study.


    • Whole Person Care Pilots: One of the most innovative state pilot programs in Medicaid today, California’s Whole Person Care pilots are a $1.5 billion federal investment in building community partnerships between county health departments, Medi-Cal plans, social service agencies, and community partners. This program will help build the infrastructure that will allow providers across the silos to communicate and fund care coordination services and supportive housing services.  Read more about these innovative pilots here.


  • Health Homes Program: Targeted at Medi-Cal enrollees who have multiple chronic health conditions, including behavioral health conditions, this program provides extra care coordination services that are grounded in the community. Medi-Cal managed care plans will partner with clinics and community-based organizations to provide their members with dedicated care coordinators who can help connect them not just to the medical and behavioral health services they need, but also to social services – particularly housing supports. California’s program is targeted for implementation in 2018.


While each of these programs was developed in true safety net style – to target a specific population and/or capture a specific funding stream – they are leading the way in showing us how to start breaking down the structural barriers that have historically prevented multi-silo care coordination.  By improving financial alignment, building communication mechanisms, and funding health plan-community partnerships, California is again leading the way toward a system that better supports care coordination across programs and values whole-person care.