California Bringing Public Health, Managed Care Together on Community Health Assessments
The State of California has launched a collaborative model to align local public health jurisdictions’ community health assessments (CHAs) and community health improvements plans (CHIPs) with Medicaid managed care plans’ population needs assessment.
This model is informed by Oregon’s approach, which requires its Coordinated Care Organizations to collaborate with local public health entities and hospitals to develop a single community assessment in the jurisdictions where they operate.
During a recent webinar put on by Manatt Health, Palav Babaria, chief quality officer and deputy director of quality and population health management at the California Department of Health Care Services, noted that until now, the needs assessments done by local jurisdictions and Medicaid managed care plans “have been happening in the same communities, and they've been largely siloed."
She said policy guidance that went into effect in January requires that instead of doing their own separate population needs assessments, all 22 MediCal managed care plans, which span the state and cover 15 million members, must partner with and meaningfully participate in the local health jurisdictions’ community health assessment and community health implementation plan process.
“We recognize that's a big lift because there are 61 local health jurisdictions. Some of our plans operate in multiple counties and in some cases, there may be multiple plans operating in a single county, so that local health jurisdiction and public health department really is the backbone of this process and managed care plans are coming to their table to do this in a more meaningful, integrated way,” Babaria said. They are also required to provide funding or in-kind staffing support, whether that is analytics support, event coordination, engagement support, in all of the services, all of the areas in which they operate, and they also have data-sharing requirements to support the analytic part of the process.
“The other huge lift for our state is when we looked at the current cycles, every single local health jurisdiction, for the most part is on a different cycle, as are most of the nonprofit hospitals because their cycles are tied to their tax-exempt status and when they go through their financial reviews with the IRS,” Babaria explained. “Obviously for our plans, especially those operating in multiple counties, managing all those different timelines is really hard. So through partnership with our state colleagues, we've actually been able to issue policy that by 2028, every single local health jurisdiction will be on the same every-three-year cadence and timeline. And we have a glide path from now until 2027 for everyone to adjust their processes and get on that single timeline. We think this will really allow the state to be able to predict when these processes are going to happen and then also flow into state-level decisions and policymaking as well.”
Trudy Raymundo, who is with the Office of Policy & Planning in the California Department of Public Health, said, “COVID taught us a really great lesson that traditionally siloed healthcare and public health systems really needed to come together. We needed to start aligning, we needed to start collaborating in order to really tackle the complex problems within our communities. We did not want to lose the momentum that had been built.” This idea of aligning and integrating these two traditionally siloed approaches has multiple benefits, including more effective and efficient use of all of our resources, she added. “We really can start to think about how we integrate previously siloed data streams.”
“From the healthcare perspective and the public health perspective, we all have a myriad of data, but how do we bring those data sets together so that we can actually have one collective vision of what is needed in our communities and what is truly the health of our communities and our residents,” Raymundo said. “One of the results of COVID is a loss of credibility for some of our local health departments, and coming together in this collective fashion starts to provide our communities greater clarity.”
Babaria did note that California has tried this before. “There have been multiple efforts over, frankly, years and decades to try to bring these entities together, to try to align and coordinate on the community health assessment specifically, and for a host of reasons that have not moved forward,” she said. “For us, coming out of the public health emergency, and leveraging those lessons learned is sort of the tipping point of what made this effort successful when previous efforts to do the same thing hadn't really gained as much traction, because there really was a collective understanding that these siloed systems are not serving the health interests of the community members that they're set up to serve.”
From the Department of Health Care Services perspective, it required the department to have faith and trust in their partners, she added. “As we started to regularly meet with public health and our other colleagues at both the state and local level, the reality is we all have tunnel vision. We look at problems through the healthcare lens or through the public health lens or through the hospital lens. And that tunnel vision doesn't serve the interests of our communities or get us to whole-person care. So I think bringing people together in this integrated way is the only way we will ever solve the right problems.”
Babaria also noted that assessments don't matter if you don't actually do something with that data and the goals that you've set. “On the California Department of Health Care Services side, we also have a new contract requirement for all of our managed care plans for community reinvestment, where all plans that make a profit will be required to reinvest some of that profit back into the community,” she said. “We're still working on that policy design. It will go into effect in the next year or so. We definitely see a linkage where this joint community health assessment process will absolutely inform what those investments need to be focused on so that we are really responding to the needs of the community and not making assumptions about what people need from our own tunnel vision vantage point.”
