Strategies for Coordinating Behavioral Health Care for California’s Dual Eligibles

By Lilly Clements, Junior Policy Consultant and Megan Thomas, Associate Director

Since 2014, the Cal MediConnect (CMC) program has coordinated care for some of the most vulnerable Californians. CMC was developed by the Department of Health Care Services (DHCS) and the Centers for Medicare & Medicaid Services (CMS) to better serve dual eligible beneficiaries – those enrolled in both Medicare and Medi-Cal (Medicaid in California).

A primary focus of CMC is to better coordinate behavioral health care service delivery for members. This week, DHCS released a report entitled “Improving Behavioral Health Integration and Coordination for Cal MediConnect (CMC) Members,” which details the complexities and nuances of CMC plans’ efforts to integrate behavioral health into the care delivery system for dual eligible beneficiaries.

Almost five years into the program, feedback from CMC plans shows that they are taking a range of approaches in identifying CMC members’ behavioral health service needs and integrating them with physical health services. CMC plans shared the following lessons learned and best practices in response to a DHCS survey and during a March 2019 convening of CMC plans:

  • Identifying Members’ Behavioral Health Service Needs – Plans use a variety of mechanisms to identify members who may be in need of behavioral health services and ensure they are referred to the appropriate level of care. These strategies include reviewing health risk assessments, analyzing hospital admission data and measures, and tracking referrals from providers, the county, and CMC members.
  • Developing Relationships and Strengthening Communication Channels – Plans refer members who need specialty mental health services to the appropriate county but continue to coordinate the members’ physical health care services. Therefore, a trusted relationship with county partners is a key factor in their ability to successfully coordinate care for CMC members. Plans develop and strengthen these relationships through plan liaisons, memorandums of understanding, educational and training opportunities, and regular meetings with county staff.
  • Promoting Data Sharing – CMC plans identified their ability to obtain timely and accurate data on members’ service utilization, medications, current providers, and assessment results as a key aspect of coordinating behavioral health services for CMC enrollees. Most plans have established data-sharing agreements with county partners to facilitate sharing of members’ information, although this continues to be a challenge in some counties.
  • Enhancing Care Coordination – Behavioral health service delivery and care coordination models vary by CMC plan. Some plans integrate resources to provide behavioral health services, while others delegate the provision of services to the county or contracted vendors with behavioral health expertise.

The CMC plans continue to explore opportunities to improve integration and coordination of behavioral health care services for their members and to overcome the remaining challenges. Harbage Consulting supports the CMC program by providing policy support to DHCS, documenting best practices and facilitating related convenings, collecting and implementing stakeholder feedback, and conducting on the ground outreach to Coordinated Care Initiative stakeholders.

To learn more about the Coordinated Care Initiative and Cal MediConnect, please visit CalDuals.org.