Caring for Communities in Need Across Los Angeles County, With Community Centers as One Anchor

Two of the largest and most influential health plans in Southern California announced on Sep. 4 a plan to improve the quality of life of residents across Los Angeles County.

As announced in a press release posted to the Blue Shield of California website on Tuesday, Sep. 4, “L.A. Care Health Plan and Blue Shield of California Promise Health Plan announced today that they will invest a combined $146 million as part of a five-year commitment to expand Community Resource Centers across Los Angeles County. This unique collaboration will help improve health outcomes in local communities and the total quality of life for members of the two health plans. Improved health outcomes will also reduce health care costs over time,” the press release stated.

As noted in our report September 5 on the September 4 announcement, L.A. Care Health Plan serves nearly 2.2 million members in Los Angeles County, making it the largest publicly operated health plan in the country; it is focused mainly on caring for Medicaid (called Medi-Cal in California) and workers’ compensation recipients. Blue Shield of California, based in San Francisco, is a nonprofit, independent member of the Blue Cross Blue Shield Association with 6,800 employees, more than $20 billion in annual revenue and 4.3 million members. The two health plans have a long history of working together, the press release noted, as Blue Shield Promise is one of the Plan Partners that L.A. Care contracts with to serve Medi-Cal members in Los Angeles County, and this resource center effort greatly expands their ongoing collaboration.

Following the announcement, John Backes, president and CEO of L.A. Care, and Greg Buchert, M.D., president and CEO of Blue Shield Health Plan Promise, spoke individually to Editor-in-Chief Mark Hagland. Below is a composite set of excerpts from their interviews.

Can you share about the origins of this initiative?

Greg Buchert, M.D.: It’s interesting, because both L.A. Care and Blue Shield Promise had community resource centers, but as we recognized the importance of being present in the community, we also considered that if we really wanted to make an impact on individuals’ health, beyond paying for care, we needed to get more involved directly. And with two organizations that had already been collaborating for a long time, we came together and said, why don’t we do things on a grander scale? So this just made a really nice marriage, if you will.

John Baackes: With regard to the broader context around this initiative, it’s important to go way back to the beginning of MediCal managed care in California; when L.A. Care was created 22 years ago to be the public health plan for MediCal managed care in L.A. County, HealthNet was already a commercial plan in the space. And we built the company from scratch. Originally, we were a broker representing seven plans. One of those was CareFirst, which BlueShield acquired in 2013. Twenty-two years ago, those seven plans were plan partners. Today, we only have BlueShield, Kaiser Permanente, and Anthem. So if you join L.A. Care, you can stick with us or pick one of those three.

For our part, we’ve got 2.2 million members overall in the county—that’s every fifth person. And our collaboration with Blue Shield of California has a longstanding one, going back to what had been CareFirst, which became Blue Shield Promise. And the Blue Shield Promise leaders came to us and said, we want to be strong partners with you. So we put together a work group; I appointed four people and Paul Markovitch [the Blue Shield of California CEO] appointed four people. And they came back with the idea of investing in and super-sizing our resource centers. We already had six, and BlueShield had one. We said, if we expand it enough, we can bring many people into those sites. Our goal is to have 14 centers in communities where any of the partners’ plan members live. Originally, these were going to be health education community centers. From 2007 when the first one opened, we’ve had six days of classes a week in nutrition, maternal and child health, tai chi and other subjects, and about half were not our members. Now, with the partnership with BlueShield, we can expand our program of services, and will be able to bring member services into those sites.

Can you share your perspectives on the broader context of the long-term health status of populations and communities?

Buchert: One that that we’re doing is that we are going to where the member is. Two is that we need to be culturally competent in those communities, and understand the individuals, and the issues they’re dealing with. And being organizations that already believe in recruiting from the community… As a physician and as a healthcare executive, I’m acutely aware that I do play only a small part in someone’s overall health. So if we provide services that people want to use, like to use, and are likely to use, we will improve people’s health, and ultimately also will lower costs.

And you’re all serving multiple communities within Los Angeles County.

Yes, it’s plural; each community has its own characteristics. It’s not just language, ethnicity, identity; it’s also different needs. For example, we recently embarked in an art therapy program in South L.A. in memory of Nipsey Hussle [the rap artist who was shot to death in South L.A. in March]. Members of the community were devastated by the death of someone who had been so committed to their community. And their needs would be different from in, say, Pomona, or even further south in South L.A. And in places where there are food deserts, maybe we could do something about food insecurity. And to explore issues like public charge. Wherever we are, we want to help to advocate for themselves.

What kind of traffic do you expect on the part of residents making use of the community centers?

Baackes: Per traffic, we expect it will more than double the 130,000 people we’ve had in the six centers, to 250,000 to 300,000 people a year in the 14 sites.

How do you see this program in the broader context of what you’re trying to achieve in LA County?

We and the people at Blue Shield Promise believe that because the people on MediCal are living in poverty, they deserve a whole host of services. And the Department of Social Services has regularly scheduled hours at our sites. We’ll also have CalFresh workers for people to enroll in food stamps, or SNAP, as it’s now called. So we’ll be able to provide locations for social services to have locations to make it easier for people to sign up for the social services they’re eligible for. So we believe this will give them opportunities to overcome some of the barriers they’re experiencing.

How do you see the social needs of your population evolving over the next several years?

Buchert: The most immediate issue will be what happens in the whole area of the public charge, and how it’s implemented and interpreted  by individuals. We’re already seeing individuals leaving the MediCal program, withdrawing their children from school, no longer participating in WIC. And if individuals flee knowingly or ignorantly from using public services, that will be the first thing that will impact their lives. Second, if and when a recession comes, a lot of people who’ve been able to leave the program, will need to re-enroll; we’ll have more pressures of poverty and joblessness. And in a challenged population, more issues will be associated with food insecurity, housing instability, and domestic violence; as well as more use of emergency departments, etc. The whole economic and political dynamic will be one of the most important areas of challenge. On the flipside, there’s a realization that everyone isn’t Caucasian and speaks English, and there’s a realization that we need to deliver culturally competent care. So in terms of the care we provide, including preventive screenings, it will have to be with a nod to our very diverse population. What’s more, all of our populations are fully immersed in technology, and there’s a real opportunity to leverage consumer-facing technology in these areas.

How will this landscape look five years from now?

I’d say five years from now, it will be a benchmark for other organizations that can step up, who have been serving communities. I think it will be something that Blue Shield will be propagating in other areas. And there I think there will be more mobile resource centers. And if we can go to communities and mornings in one community and afternoons in other communities… and we need to spend more time listening to our communities, to find out what they want and need.

Is there anything you’d like to add?

We’re really excited to have this collaboration, to provide local community support across the county. And my LinkedIn has just been on fire from my colleagues across the country, who have been marveling at what we’ve been able to do.