Report Finds Lack of Care Coordination for Calif.’s Vulnerable Groups
Despite the expansion of Medi-Cal under the Affordable Care Act, many of the state's most vulnerable individuals do not receive adequate health services because of a lack of care coordination among providers, according to a report by San Francisco-based John Snow Inc., Payers & Providers reports.
Medi-Cal is California's Medicaid program.
Details of Report
The report was underwritten by the Blue Shield of California Foundation (Shinkman, Payers & Providers, 10/2). It was conducted in collaboration with the California Association of Public Hospitals and Health Systems and the Safety-Net Institute (JSI report, September 2014).
For the report, researchers interviewed health care and social services officials in five counties across Northern and Southern California.
The report identified several of the most vulnerable populations across the state, including:
- Adult prisoners, of whom about 20% have a history of mental health problems;
- Homeless individuals, of whom about 50% have a mental health or substance misuse issue; and
- Juveniles in the criminal justice system, of whom about 70% have a mental health issue (Payers & Providers, 10/2).
The report found that such populations often do not receive "whole-person care," which incorporates:
- Care coordination;
- Collaborative leadership;
- Financial flexibility;
- Health data sharing; and
- Patient-centered care.
In addition, the report found that "[t]here is currently no single care plan for individuals accessing services across multiple county programs, and there is usually no primary entity responsible for patients seeking care across systems."
According to the report, "Eligibility and enrollment in Medi-Cal represent the 'essential gateway' for an individual to access whole-person care." However, researchers noted that "for the residual uninsured, there is less of a single gateway to access" to such care (JSI report, September 2014).
The report recommended that:
- Agencies, providers, insurers and other stakeholders implement infrastructure to enable data sharing;
- Counties appoint a lead individual and lead agency dedicated to coordinating care efforts for vulnerable populations;
- Designated Medi-Cal medical homes address both medical and non-medical needs;
- Medi-Cal managed care plans be in charge of coordinating health care and mental health services for beneficiaries; and
- Medi-Cal managed care plans be granted greater flexibility for capitation rates for non-medical services (Payers & Providers, 10/2).
Researchers said that Cal MediConnect -- part of the state's Coordinated Care Initiative -- "represents the paramount example of coordination of care for one vulnerable population with potential to expand the model to other populations" (JSI report, September 2014).This is part of the California Healthline Daily Edition, a summary of health policy coverage from major news organizations. Sign up for an email subscription.