At the Woodland Hills, California-based Health Net health plan, leaders have been working to innovate around care management for their plan members. Leaders at that health plan conceived an initiative in 2023, in concert with leaders from the Dignity Health integrated health system and from the Vivant Health medical group–that is bearing fruit, and importantly, has created a sustained collaboration between and among health plan managers, hospital clinicians, and medical group clinicians, to improve plan member/patient outcomes in patient care organizations across California, on behalf of Medicaid (in California, MediCal) beneficiaries.
The groundbreaking partnership — between California’s Health Net, Dignity Health, and Vivant Health —has averted unnecessary hospital inpatient days, freeing up crucial resources for emergency room care and leading to a substantial enhancement in valued-based care coordination for higher-risk Medicaid members.
Notable achievements from the first year of the value-based care partnership include:
• Avoided more than 400 unnecessary inpatient days in the hospital, freeing up critical emergency room resources.
• A 20-percentage point increase in patients that had a primary care provider or specialist follow-up appointment made after discharge, from 76 percent to 96 percent.
• First year results show a potential $1.7 million in avoided costs.
With regard to those results, Healthcare Innovation Editor-in-Chief Mark Hagland spoke recently with Anshul Dixit, M.D., supervisory medical director at Health Net, regarding how the program was developed, and its results so far. Below are excerpts from that interview.
When did this program go live, and what are the basic components?
It evolved out of a contract signed in February 2023 among these parties. The initiative began in 2023, and is running for three years. One of the key components is having onsite nurses from Vivant Health, the medical group, at the hospital itself. Those nurses work very closely with the care management staff at Dignity Health, are able to get them discharged in a timely fashion, and make sure that the medical groups, health plan’s, and hospital’s perspective, are taken into account. And they’re able to create access under CalAIM.
[CalAIM is a statewide initiative in California that, as the California Department of Health Care Services notes on its website, is providing “access to new and improved services to get well-rounded care that goes beyond the doctor’s office or hospital and addresses all of their physical and mental health needs. These changes are part of a broad transformation of Medi-Cal to create a more coordinated, person-centered, and equitable health system that works for all Californians.”]
They’re able to support our members not just through clinical services, but also through services that bridge the social drivers of health, ambulatory access to behavioral health, and substance abuse resources. Having nurses from the medical group onsite at the hospital, is a key component. The other component is holding weekly interdisciplinary care team rounds. These rounds involve physicians, nurses, case mangers, behavioral health colleagues called substance abuse navigators, and social workers; all those individuals are involved in the interdisciplinary care team meetings. We’re able to prioritize high-value clinical interventions and social-issue interventions. At the same time, this interdisciplinary team is able to deprioritize interventions that add to the care burden and do not add value. Those are two of the innovations that the initiative has been able to put in place. The other two elements are the cultural piece and the care transitions piece.
What have you been able to do on the cultural front?
With respect to the culture, these teams have created an atmosphere in which all points of view are respected and considered. The clinical piece is part of it, but there’s a social work piece and behavioral health piece, and connections to ambulatory care. So we’ve been able to give staff across the spectrum an important voice in the members’ care plan; that’s resulted in averting unnecessary hospital stays, improved care transitions; it’s a shifting of the care paradigm, so to speak.
Hospitals have been challenged to shift paradigms; that’s where the health plan has been able to intervene, for example, with recuperative services. Those are available to members with an unstable housing situation. They are ready to be discharged from the hospital, but don’t have a place to go to. So we’re able to put them into boarded services—short-term transitional care for members who are ready to leave the hospital. It’s a facility where they can stay for a few days to weeks. They are provided basic management, making sure they’re taking their medications and are progressing; and boarding and meals.
Have there been any challenges along the way you’ve hard to overcome?
The challenges involved getting everyone in the same room, and aligning in a new way to serve our members. Our clinical partners are very, very busy, so it took some creativity to approach this, being mindful of the pressures on their time. We’ve been able to help them look at all these new care paradigms that are available.
How has that worked to make sure the patient gets the follow-up?
The credit there goes to our partners at the hospital and the medical group. They will make sure the follow-up appointments are made and kept.
Reducing hospital stays comes out of the care management overall, correct?
We’re able to get members out of the hospital faster. And even on holidays and weekends, we’re able to coordinate in a way that allows members to be discharged to the next level of care. That tends to be a barrier in many cases. They’re able to make those transitions happen.
What have been the biggest lessons learned around getting the health plan, hospital, and medical group people together productively?
The resources are there; it means getting everyone in the same room, sitting around the table, and dismantling the barriers to care. Once you have that clarity, that it doesn’t matter where the member’s experience comes from, that we’re all aligned, the rest becomes easy. That was indeed the biggest “aha” moment in this.
How should our readers across the country think about this?
Value-based care in Medicaid can be accomplished; you just need strong partners and the willingness to take on the status quo. Medicaid members are not well-served in the traditional paradigm of care; they have barriers to access, significant social issues, and need a coordinated approach to treatment options for not only physical health, but behavioral health and addiction treatment options. Then when you have all those elements, it becomes a virtuous cycle.
