L.A. Care Health Plan, a health plan with 2.1 million members, 1.9 million of whom are MediCal (the California Medicaid program) recipients, is based in downtown Los Angeles. Founded 20 years ago in 1997, L.A. Care Health Plan has been moving forward to optimize care management for its MediCal members, particularly those with complex needs and challenging living circumstances. The plan’s chief medical information executive, Katrina Miller, M.D., has been with the organization for two years. Dr. Miller is boarded in both family medicine and in clinical informatics, and continues to practice occasionally, in free-clinic settings.
On May 2, at the World Health Care Congress, held at the Marriott Wardman Park Hotel in Washington, D.C., Dr. Miller and Frances Martini, R.N., director of integrated population health at BlueCare, the Medicaid division of the Chattanooga-based Blue Cross Blue Shield of Tennessee, presented a session entitled, “Consumer-Centric Care: Member Engagement and Retention Strategies for Complex Populations,” as part of the Medicaid & Health Policy Summit and Behavioral Health Summit tracks, at the Congress. Healthcare Informatics Editor-in-Chief Mark Hagland caught up with Ms. Martini last month; and below are excerpts from his recent interview with Dr. Miller.
The kinds of progress that you and your colleagues have been making at L.A. Care Health Plan really speak to the general direction in which the U.S. healthcare system is beginning to move more generally, around data-facilitated population health management and care management, don’t you think?
Yes. What we need to do for the future of any sort of efficient healthcare delivery to be able to exist, we need to care for the entire population. And in terms of the health plan and care coordination side, we need to be the most efficient and effective stewards of the public money. We also need to be running at the most optimized levels, including through technology, that we can, based on our understanding of the need to use resources most efficiently. And you were mentioning the high-cost, high-needs population. And we have to understand really what that population needs as a whole, and the unique categories within that population, so we can be most efficient in getting them the care and services that they need. And it comes down to people, processes, and technology.
We have to use the technology and data to identify those folks and present them to the care coordination staff, and make sure they have an efficient process, with good handoffs, good documentation, and make sure we have the right number of people to provide the services needed. At L.A. Care, we’re trying for a high-tech, high-touch model. So we have to understand who needs what kind of direct care—medical, social worker, dietician, etc., and identify that as precisely as possible to make sure they’re interacted in the way they need to be interacted with. For instance, we have behavioral health members who yell at us and say to get away, when they really need shoes. And we need to understand where they need the help, not what we think their needs are.
And, once you’ve used data and analytics processes to identify members in need of immediate and near-term intervention, there is actually an element of “shoe-leather” work, in terms of making direct in-person connections with those members in need, correct?
Yes, we first have to identify the whole population, to address the lower-needs populations, to make sure they have access to preventive and primary care, so that we can then also focus on the higher-needs populations. So we stratify into a complex case management program, and a behavioral health program, a social work program, and a disease management program; we have a variety of programs in order to place the right members into the right programs. And we have to prioritize to make sure they’re in the right first program. So if they have complex needs, we put them into the complex care program rather than the disease management program, because they’re covered. And we need to connect them with their PCP [primary care physician], and with our internal people. And we do that through our interdisciplinary care team; we do calls to make sure we’re on the same page. And we’re working with the County on a program called Whole Person Care—it was granted last year, and the actual program hasn’t gone live yet, it should start in July, next month, for the first enrollees. That’s going to be about social services connections with community health workers. It goes beyond L.A. Care, it’s going to be the community—L.A. Care, with our competitor plan, HealthNet, and the County Department of Health Services, and then the jail program, so when folks are getting out of jail, and the Department of Mental Health Services, etc.; it involves ten sub-programs in four areas, addressing the social-services needs in the county.
What has been most challenging and surprising in drilling down to these levels of care?
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