The California Improvement Network (CIN), which is a project of the California Health Care Foundation and administered by Healthforce Center at UCSF, is a community of health care professionals dedicated to driving improvements in patient and provider experience and population health, while lowering the cost of care. As part of its efforts to spread better ideas for care delivery, the network finds, documents and shares innovative quality improvement projects throughout the state.
The Q&A below highlights CIN partner organization, the California Safety Net Institute (SNI) and their work to improve care for the state’s high-needs patients by breaking data-sharing barriers, leveraging community health workers and peer navigators, and delivering care outside clinic walls. SNI’s Amanda Clarke, associate director of programs, describes the challenges, lessons and opportunities of the state’s Whole Person Care Pilots (WPC).
Q: What is the WPC?
A: This program, in the 1115 Medi-Cal waiver, brings together public health care systems, county behavioral health, managed care plans and community organizations to improve care for their highest need patients. These patients are often bouncing between the emergency department, psychiatric inpatient care, jail and the street.
To help stabilize patients, service providers need to collaborate more effectively across systems. WPC provides funds to develop infrastructure and deliver care across systems, so that providers can share information and improve care coordination. WPC also funds services that are not covered by Medi-Cal, such as medical respite, sobering centers, jail reentry support and housing navigation.
Q: What is the Safety Net Institute’s role in the Whole Person Care Pilots?
A: The California Health Care Safety Net Institute (SNI) supports California’s public health care systems by informing and shaping statewide and national health care policy. We provide performance measurements and reporting expertise, while supporting decision-making and learning for our members by facilitating learning groups and other convenings. For WPC, SNI regularly convenes the 25 pilot sites across the state to share lessons learned and tackle implementation challenges. We listen to their concerns and communicate with the state so that program policies reflect what is going on in the field. We are also a partner in the state’s learning collaborative, which is another venue for providing technical assistance to the pilots.
Q: How do the Whole Person Pilots tie to substance use disorders?
A: Many of the highest utilizers served by WPC have mental illnesses and co-occurring substance use disorders (SUD), so behavioral health is a key partner in the program. Traditionally, providers have operated in siloes, but WPC has created a pathway for new partnerships, which is leading to better coordinated care. For example, in Alameda County, the WPC called Care Connect operates a 24/7 sobering center to care for individuals who are under the influence and a SUD diversion program for people facing criminal charges for drug use. These programs help provide alternatives to prison, such as inpatient residential treatment. WPC also runs a hotline that providers can contact when seeking SUD treatment for a patient.
Q: What have been the major lessons from the pilots?
A: We’re still early in the pilots and learning what works — and what doesn’t. Data sharing has been a challenge across pilots and an area ripe for learning. A lot of WPC partners were either unclear about what data is allowed to be shared or had the perception that they couldn’t share data when it was actually permissible, particularly SUD and eligibility data. Pilots also learned the technical aspects of cross-sector data sharing, such as implementing new care management platforms and developing workflows to facilitate data exchange across disparate electronic health records. One of the most valuable lessons learned is the need to engage local counsel and IT teams early, and not under-estimate the amount of resources and support it takes to share data effectively. We also learned how much time it takes to launch a large-scale, multi-stakeholder program like WPC.
At the start, it was challenging for pilots to develop infrastructure while also enrolling clients and delivering services at the same time. The experience helped us realize the importance of a ramp-up period prior to enrolling clients, so pilots can build infrastructure, hire teams and develop partnerships necessary to support change over the long term. It took more than a year for pilots to overcome the initial start-up challenges of WPC, but now they’re really hitting their stride.
Q: From SNI’s perspective why are community health workers and peer navigators so critical? Patient engagement has been a common challenge for many WPC pilots, in part because the program serves patients who are dealing with serious issues like severe mental illness, jail involvement and chronic homelessness. The pilots found that community health workers (CHWs) and peer navigators with lived experience can connect with and relate to these individuals in a different way than traditional providers.
A lot of the work in WPC happens outside clinic walls, in places like homeless encampments or probation offices. Trained peer navigators and community health workers are often comfortable working in these community settings and can more easily build trust with clients over time. WPC is facilitating the development of a strong workforce of CHWs and peer navigators, which is critical for supporting complex patients.
Q: How is WPC creating change in counties throughout the state? A: Whole Person Care takes a more holistic approach to care — the program recognizes that patients have a range of needs that include medical, behavioral, socio-economic and others. In order to provide high quality care in this context, multiple service providers from different sectors need to work together to coordinate services. For example, the public health care system, behavioral health, managed care plans, housing providers and others are sitting on the same steering committees. Some of these groups are coming together for the first time, even though they’re working in the same county and serving the same individuals.
This collaboration is changing data-sharing practices among agencies and organizations — they now look at how the data flows and how to improve these processes to better serve patients. It’s also developing a culture change around delivering care outside the clinic walls. The funding for WPC provided a helpful lever so counties could build the infrastructure needed to provide better care for the most vulnerable patients. We hope the investments made will continue to improve care coordination in communities long after the waiver ends in 2020.
About Amanda Clarke
Amanda Clarke joined SNI in 2014. As associate director of programs, Clarke develops programs, policies and trainings that promote integration across public health systems and strengthen care in the safety net. Prior to joining SNI, Clarke worked with the Robert Wood Johnson Foundation on a national program to reduce racial and ethnic disparities and spread best practices in minority health. Clarke has lived on four continents; previously she managed community health programs in West Africa with the United Nations Population Fund. She holds a master of public health from University of California, Berkeley and a bachelor of arts degree from George Washington University.
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