1. ORANGE COUNTY WHOLE PERSON CARE (WPC) PILOT PROPOSAL
Liz Amantine-Taylor
Strategic Projects Administrator
Orange County Health Care Agency

2. Medi-Cal 2020
Medi-Cal waivers are programs under Medi-Cal that provide additional services to specific groups of individuals, limit services to specific geographic areas of the state, and / or provide medical coverage to individuals who may not otherwise be eligible under Medicaid rules
Medi-Cal 2020, the current wavier which in effect January 2016 through December 2020, focuses on the way Medi-Cal provides services to improve the quality of care, access and efficiency
One of the programs in Medi-Cal 2020 is Whole Person Care

3. Whole Person Care
WPC Pilot Program is the coordination of health, behavioral health, and social services, as applicable, in a patient-centered manner with the goals of improved beneficiary health and wellbeing through more efficient and effective use of resources
The WPC Pilot is primarily for infrastructure development and data sharing, as well as other costs not currently covered by Medi-Cal
The WPC Pilot focuses on those more vulnerable populations of Medi-Cal beneficiaries that have high instances of emergency room and inpatient utilization

4. TARGET POPULATIONS Persons who are Homeless
Persons who are Homeless & Living with Serious Mental Illness

5. OBJECTIVES
Reduce inappropriate or unnecessary ER/Inpatient Utilization
Meet needs in real-time – social, medical, and emotional
Increase readiness for Coordinated Entry Process
Improve/Increase success in housing placement

6. WPC SERVICES TO ALL POPULATIONS
Emergency Room Notification System
Community Based Organization Referral System
Recuperative/Respite Care
Hospital and Clinic Based Care Navigation/Coordination
Managed Care Personal Services Coordinator (CalOptima)

7. ADDITIONAL WPC SERVICES TO THE HOMELESS AND SMI POPULATIONS
Dedicated resource(s) to seek out and secure housing opportunities
Housing sustainability services, including peer support

8. PARTNERS CalOptima Health Care Agency’s Behavioral Health Services
Orange County Community Resources (Housing)
2-1-1 Orange County
Illumination Foundation
Safety Net Connect
Community Clinics: Share Our Selves, Lestonnac, Buena Park, Hurtt Family Medical, Serve the People, & Korean Community Services
Hospitals: St Jude, St. Joseph, Hoag, Mission, UCI, Saddleback Memorial, and Orange Coast Memorial

9. WPC Expansion Opportunity
$300 million per year available of which Orange County received $4.7 million per year
After funding all applicants in the initial round, $61 million remained
Orange County submitted an application for an additional $2.1 million per year
Expect to be notified by July 2017, if additional funds are approved

10. WPC Expansion Overview
Incorporates the outreach, engagement, and supportive services provided in the drop-in and multi-service centers into the WPC. (Courtyard and Kramer sites)
Expands the number of Recuperative Care Bed days from 12,612 to 27,320 over the term of the WPC Pilot.
Dedicates Recuperative Care Bed resources to clients identified in the Courtyard as having a high medical acuity
Funds four additional community clinics to add homeless outreach and coordination services (Livingstone, Families Together, North Orange County Regional and VNCOC)
Funds the administrative resources needed to implement, monitor and report on expanded WPC activities

11. QUESTIONS ??????

12. Whole Person Care (WPC): CalOptima’s Role
Covered OC Collaborative
May 5, 2017
Debra Kegel
Manager, Business Integration

13. Background
Medi-Cal 2020 authorized WPC and requires Medi-Cal Managed Care Plan (MCP) to partner with the lead entity when pilot is specific to Medi-Cal managed care beneficiaries
As the only Medi-Cal MCP in Orange County, CalOptima is participating in the pilot
CalOptima will provide:
Administrative support
Enhanced care coordination for homeless WPC beneficiaries and the community providers serving them
Financial support for respite services
Participating entities must include a minimum of one Medi-Cal managed care health plan (MCP) operating in the geographic area of the WPC Pilot to work in partnership with the Lead Entity when implementing the Pilot specific to Medi-Cal managed care beneficiaries.

14. Administrative Support
CalOptima provides project management support
Hosted WPC Collaborative meetings (in person and web-based)
Conducting other project management activities
Data coordination and sharing to facilitate coordination among entities caring for CalOptima members will include:
Providing MCP enrollment data to Safety Net Connect (WPC Connect)
Ensuring care management staff receive ER notifications
Increasing access to available MCP care plans
Receiving and sharing WPC care plans to MCP staff and providers
A significant part of the WPC is data coordination and sharing, and a coordinated care plan for all providers working with WPC beneficiaries. WPC Connect will be implemented to provide both the real-time ER notification of homeless persons accessing care through the emergency rooms and will include the Care Plan module for WPC beneficiaries.

15. Enhanced Care Coordination
Funded through WPC, designated representative(s) will:
Assist WPC partners working with MCP WPC homeless beneficiaries
Recuperative care agencies
Community-based organizations
Outreach workers and navigators working
Facilitate connections for immediate, non-emergent and non-urgent medical needs
Primary care providers for appointments, prescription refills, care planning, etc.
Authorizations and referrals for other needs, such as specialists, transportation and DME
CalOptima Direct, CalOptima Care Network and Health Network assigned members
Designated representative(s), funded through the WPC, to assist WPC partners (e.g. recuperative care, outreach workers and navigators) working with WPC homeless beneficiaries with immediate, non-emergent or non-urgent medical needs who are experiencing MCP benefit and provider access issues. This representative will then coordinate the necessary authorizations and referrals.
Access to available care plans that may exist for the MCP homeless beneficiaries participating in WPC. If one does not exist then the beneficiary can be connected with their primary care provider and/or CalOptima case managers to develop a care plan.

16. Recuperative Care Funding
Leverages existing CalOptima initiative
For MCP WPC homeless beneficiaries, discharging hospitals refer to participating recuperative care agency
CalOptima may reimburse up to 15 days of recuperative care
Recuperative care agency participating in WPC per contract with and directly bills Orange County Health Care Agency
Member is discharging from designated hospital directly to recuperative care
Member has post-discharge medical needs meeting CalOptima program requirements

17. Other CalOptima Impacts
WPC Connect is expected to:
Provide real-time notice of ED and inpatient hospital stays
Enhance care coordination among various providers and agencies serving members
Assist in identifying homeless members
Leverage other CalOptima programs, such as Health Homes Program
Enhanced services expected to improve health outcomes for CalOptima members who are homeless or at risk of homelessness
Increased access to and support from community organizations serving homeless and/or Serious Mental Illness (SMI) populations
Assistance with finding and sustaining housing

18. Questions and Contacts
Debra Kegel, Manager, Business Integration ,
Poorva Gaur, Analyst, Business Integration ,

19. CalOptima’s Mission
To provide members with access to quality health care services delivered in a cost-effective and compassionate manner

23. Contact Information: Amy Davis-Pacheco Sr. Program Manager – CES

24. Community Referral Network Overview

25. (This slide show focuses on the Social Service component only)
Agencies Create Social Service Referrals
(This slide show focuses on the Social Service component only)
Minimal Patient Demographics are Required
A verbal client consent field will be added to this section confirming that the client is aware they are being entered into the referral system and may be contacted by agencies to help them.

26. Create Multiple Social Service Referrals

27. Client Receives Resource List for all Services Available in their area
Agencies providing the particular service in the designated area receive notification that a patient has entered their queue

28. Clients are Added to the Social Service Queues
Agencies providing the particular service in the designated service area will have access to view and contact the clients in their service pool (queue)

29. Referrals are Accepted by Different Agencies
Agencies “take ownership” to begin assisting a client. That client is then removed from the queue. If for any reason the agency is unable to assist the client, they may “return ownership” therefore sending the client back into the queue for another agency to help.

31. The Initiative and Health Creation
Decrease Health Disparities
Establish a Patient-Centered Medical Home Network
Improve Health Equity/ Access to Quality Care
Create an Integrative Healthcare Delivery System

32. Integrative Health Initiative Overview - Vision
To transform community health centers from a disease-focused health delivery model to one that focuses on prevention and health creation through the implementation of Integrative Health practices.

33. LiveHealthy OC Initiative – Cohorts 1 and 2

34. LiveHealthy OC Initiative Overview
The Process
Clinics participate in a three-step process:
Step 1: Education and Learning - participation in a planned learning program with a focus on educating physicians, mid-level providers and selected medical assistants
Step 2: Transformational Change in Culture, Practice and Service Delivery - project implementation and testing
Step 3: Cultivation of a Professional Learning Community - building and participating in a peer-based professional learning community (Community of Practice – COP).
Evaluation and Metrics – change in behavior and outcomes at the organizational level, provider/clinician level, and patient level

35. LiveHealthy OC Initiative – Project Overview
Key Indicators and Benchmarks of Success
Knowledge Attainment (Provider/Staff)
Attitudes
Clinical Skills
Behaviors
Satisfaction (Provider/Patient)
Infrastructure/Clinic Resources
Health Outcomes

36. Contact
Rhonda Smith, Project Manager LiveHealthy OC Initiative (305)