By OPEN MINDS Circle
California Medicaid beneficiaries with complex care needs at high risk of high health care utilization who participated in the “Whole Person Care” (WPC) pilot program that took place from 2017 through 2021 had fewer hospitalizations and emergency department visits than non-participants with similar care needs. WPC participants had 45 fewer hospitalizations per 1,000 and 130 fewer emergency department visits per 1,000. The WPC participants had 56 more per 1,000 addiction treatment encounters and 130 more per 1,000 than non-participating beneficiaries. Medi-Cal (California’s Medicaid program) paid $383 less per beneficiary per year for the WPC participants.
There was a greater decline in acute care use among WPC participants with serious mental illness (SMI), substance use disorder, or homelessness. The WPC pilots also resulted in lower payments for medically complex/otherwise high-risk enrollees.
During this period, lead entities launched 25 WPC pilots, representing 26 counties. The participating counties identified and enrolled eligible beneficiaries. In total, 247,887 beneficiaries participated in the WPC pilot; about 27% had three or more chronic health conditions, and 70% had SMI, substance use disorder, or homelessness.
The pilots coordinated beneficiaries’ care across health, behavioral health, and social services. A key focus of the WPC was involving relevant stakeholders and sharing real-time data. The goal was to improve health care delivery, achieve better health outcomes for the beneficiaries, and reduce overall Medicaid spending.
These findings were reported in “Final Evaluation of California’s Whole Person Care (WPC) Program” by Nadereh Pourat, Ph.D.; Emmeline Chuang, Ph.D.; Brenna O’Masta, MPH; and colleagues. The researchers analyzed the data collected by the WPC pilots and Medi-Cal data collected by the California Department of Health Care Services to determine whether WPC led to better care, better health, and lower costs. Analyses of Medi-Cal data included comparisons of selected WPC metrics as well as utilization and cost measures before and after WPC implementation for WPC enrollees and a control group of Medi-Cal enrollees with similar characteristics.
During 2022, the WPC pilots began transitioning the WPC participants to Enhanced Care Management and/or Community Supports services under the California Advancing and Innovating Medi-Cal (CalAIM) Medicaid waiver. As of February 2023, many WPC participants have transitioned to the new services.
For more information, contact: Nadereh Pourat, Ph.D., Associate Center Director, UCLA Center for Health Policy Research, Director, Health Economics and Evaluation Research Program, Professor, Department of Health Policy and Management, UCLA Fielding School of Public Health, Professor, UCLA School of Dentistry, School of Dentistry, University of California – Los Angeles, 10833 Le Conte Avenue, CHS – Box 951668, Los Angeles, California 90095-1668; Email: pourat@ucla.edu; Website: https://ph.ucla.edu/about/faculty-staff-directory?type=all&page=1