CalAIM and recent Whole Person Care pilot programs are redesigning how care is offered to people with complex needs in the MediCal system. Housing First models have demonstrated the importance of housing for client well-being, stability, and health outcomes, yet most communities lack adequate temporary and permanent housing options. Efforts thus far have failed to demonstrate compelling outcomes due to a combination of the small sample size and the complexity inherent in interventions for people who are unhoused and often have severe mental illness with co-occurring substance use disorder.

As behavioral health needs skyrocketed when the COVID-19 pandemic took hold, specialty behavioral health organizations which provide services to people with serious mental illness and/or substance use disorder pivoted to delivering significantly more care via telehealth. While behavioral telehealth access may be a point of pride, racial inequity is also evident in telehealth access. It is disproportionately inaccessible to people of color, in particular those from the Black and Latinx communities, people with limited English proficiency, people facing poverty, and older adults.

Permanent vision loss is prevalent among the aging and will continue to rise. There are gaps and barriers resulting from fragmented care locally and globally. The health inequity among the aging, visually impaired population is also a public health issue with an economic burden on state and federal resources. The CDC reports that 4.5M over age 40 report that they are blind. This number is expected double to 9M by 2050. There are 21M more who reports having “vision problems” not correctable with conventional glasses, contact lenses, or refractive laser surgery.

The California Advancing and Innovating Medi-Cal initiative created a once-in-a-generation opportunity to reform Behavioral Health documentation. As the Chief of Medi-Cal Behavioral Health with the California Department of Health Care Services, my CHIP focused first on removing complex and cumbersome documentation standards that far exceed the standards of other healthcare delivery systems and replacing them with efficient, effective, and impactful policies to improve the lives of those we serve.

When someone experiences a crisis – a fire, crime, or medical emergency – they call 911 with the expectation of getting immediate emergency services. However, when that emergency is a behavioral health crisis, there is currently no timely and clinically appropriate response, which too often results in unnecessary suffering, loss of life, criminalization, or incarceration. A3 addresses this enormous need by making behavioral health part of the emergency response system throughout Contra Costa County.

In the United States, 25% of adults are living with a behavioral health concern, yet more than half do not receive treatment. For those seeking out services, their Primary Care Providers deliver about 70% of all behavioral health treatments. Integrated care models provide primary care and behavioral health management in the same setting, making it easier for patients to access and for providers to communicate.

We face an escalating addiction epidemic, with more than 100,000 people dying of drug-related overdoses in the US in 2021—the highest number of deaths ever recorded. San Francisco has the highest overdose death rate in California. At SFGH, more than 1/3 of hospitalized patients have a substance use disorder (SUD). Our patients with SUD have longer lengths of stay (3 v 5 days), 1.5x higher 30-day readmission rates, and 5x higher self-discharges than those without SUD.

Due to the aftermath of COVID-19 and the global pandemic, we are experiencing an unprecedented demand for behavioral health (BH) services. As a Federally Qualified Health Center (FQHC), whole-person care has only been available to patients within the mild to moderate level of impairment, resulting in referrals to county and other specialty mental health clinics for patients that are in crisis, require psychiatry and/or a higher level of care. Unfortunately, current wait times for patients seeking psychiatry and a higher level of care are reportedly between 6-8 months.

Patients with Mental Health (MH) conditions have poorer quality outcomes and experience persistent barriers in accessing care than those without MH conditions. Individuals with a Serious Mental Illness (SMI) or Substance Use Disorder (SUD) die over 20 years earlier than individuals without such a diagnosis. People with MH diagnoses incur costs more than those without MH disease. While the current health delivery system is shifting, it often separates Physical and Mental Health care.

My project aims to provide access to Countywide therapy groups for adults suffering from severe mental illness. Monterey County Behavioral Health (MCBH) Adult System functions within regional silos composed of 4 different regional clinics in Salinas, Marina, Soledad, and King City. Currently, a behavioral health client can only obtain therapy group services offered by a regional clinic actively serving the client.