CalAIM’s Population Health Management (PHM) Program Launch is scheduled for January 2023. The Department of Health Services (DHCS) says the program will be a statewide approach that ensures Medi-Cal members lead “longer, healthier lives and happier, better health outcomes and health equity”.
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The MPS program will focus on proactively assessing and responding to the care needs of Medi-Cal beneficiaries with tailored interventions.
The program will require Medi-Cal managed care plans to implement person-centered strategies focused on wellness and prevention. According to the DHCS, the general requirements for Medi-Cal managed care plans under the PHM program are as follows:
- “Build trust and engage meaningfully with members;
- Collect, share and assess timely and accurate data on member preferences and needs to identify efficient and effective intervention opportunities through data-driven risk stratification processes, predictive analytics, identification gaps in care and standardized assessment processes;
- Focus on upstream approaches related to public health and social services and help members stay healthy through wellness and prevention services;
- Ensure care management, care coordination and care transitions across delivery systems, settings and life circumstances; and
- Identify and mitigate social drivers of health to reduce disparities.
To support DHCS’s vision for PHM, the department is also developing a statewide PHM service designed to collect and integrate data for improved data sharing between Medi-Cal enrollees, their providers, and health professionals. social service programs. According to the DHCS, the PHM service:
- “Provide plans, providers, counties, Medi-Cal members, and other authorized users with access to more timely, accurate, and complete data about members’ health histories and needs, to help improve care.” and avoid duplicate processes.
- Support risk stratification and segmentation and risk prioritization functions.
- Promote trusting relationships between members and their care team by making it easy to update their information and providing access to health education, their applicable rights and benefits, and information about the use of their data, among other features.
- Improve the ability of DHCS to understand population health trends and support surveillance. »
DHCS notes that in 2023, health plans will be required to meet the National Committee for Quality Assurance standards for PHM as well as the statewide DHCS Supplemental Standards for PHM.
The PHM program involves the DHCS establishing various new requirements for Medi-Cal managed care plans. Two notable components of the program include improving processes related to gathering information on members and improving the MPS strategy and population needs assessment (PNA).
To improve the existing PHM strategy and NAP, The DHCS says the NAP process will require less frequent data collection and greater engagement with communities, including local stakeholders such as members and families, Medi-Cal providers, local health departments and government agencies, and county mental health plans.
In early 2023, DHCS announces that it will release guidance and a template for the new comprehensive PHM strategy and new PNA structure to help Medi-Cal managed care plans work with their community partners to develop a strategy. targeted for their MHP programs and to improve decision-making. -making and monitoring progress towards the objectives of the MPS.
According to the DHCS, Medi-Cal managed care plans will be required to submit this full PHM strategy annually beginning in October 2023. The PHM strategy must include details about the plan’s PHM program, including prevention and prevention strategies and interventions. of well-being.
In July 2025, Medi-Cal managed care plans will be required to submit their NAP and produce a publicly available report.
To collect member information, DHCS expects each Medi-Cal managed care plan to collect and use a wide variety of data, including data collected as part of the managed care plan as well as information from provider referrals and member selection and evaluations.
The DHCS notes that existing data collection mechanisms in Medi-Cal managed care plans do not always maintain member trust, lack timeliness and accuracy, do not effectively share data across the care team limb and often lack data on the social determinants of health.
“An effective approach to MPS begins with collecting accurate and robust information to understand the health and social needs of each member to ensure they receive the right services at the right time and in the right place,” the department states. in its MPS strategy document.
DHCS also notes that it will remove existing requirements that Medi-Cal managed care plans ensure members complete the Individual Health Education and Behavioral Assessment/Assessment to Stay Healthy in Early Life. primary care visits, due to stakeholder feedback that prescribing the exact health status and behavioral questions to ask patients during visits is cumbersome, not evidence-based, and unnecessary.
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