This discussion paper prepared by John Snow, Inc., in collaboration with the California Association of Public Hospitals and California Health Care Safety Net Institute, defines whole-person care as the coordination of health, behavioral health, and social services in a patient-centered manner with the goals of improved health outcomes and more efficient and effective use of resources. The paper uses a conceptual framework of six elements of whole-person care: identify the target population, provide patient-centered care, coordinate services across sectors, share data, create financial flexibility, and engage collaborative leadership.
The paper analyzes findings regarding whole-person care related activities, opportunities, and challenges based on interviews in five California counties (Los Angeles, San Diego, San Mateo, Santa Clara, and Sonoma). It identifies opportunities for county-level safety-net stakeholders, state-level organizations and foundations, and California state policymakers to consider for implementing whole-person care strategies for California’s vulnerable populations.
Among the report’s key findings:
- Stakeholders agreed that pairing whole-person care initiatives for the highest-cost sub-populations with broader population health efforts is a wise investment of public funds for both quality and cost outcomes
- Aligned eligibility standards for Medi-Cal and other social service programs was noted as an area for better patient-centered care and system efficiency
- There is currently no single care plan for individuals accessing services across multiple county programs, and there is usually no primary entity responsible for patients seeking care across systems
- Patient-centered health home (PCHH) transformation and behavioral health/primary care integration represent two key steps counties are taking toward whole-person care
- Cal MediConnect (California’s dual eligibles demonstration) represents the paramount example of coordination of care for one vulnerable population with potential to expand the model to other populations
- Service delivery integration lags behind eligibility and enrollment integration
- Data infrastructure that allows for health, behavioral health and other social services information exchange is an important, yet underdeveloped, building block of whole-person care
- Medi-Cal managed care organizations are able to use the flexibility of their managed care capitation rate (a form of blended funding) to meet whole-person needs, but have not done so systematically for a variety of other reasons
- Aligning the financing for Medi-Cal health, severe mental health, and substance use disorder services is a key facilitator of whole-person care in the future
- Leadership at multiple levels of organizations is required for effective implementation
- Collaborative leadership can originate from a variety of entities
- Relationships between people ultimately form the substance of coordination of services, and relationships take time and energy to foster
- Political will plays a pivotal role in creating traction for cross-sector collaboration
The paper was funded by the Blue Shield of California Foundation.