Whole Person Care Interim Evaluation

Interim Evaluation of California's Whole Person Care (WPC) Program

DRAFT

Prepared for: California Department of Health Care Services

September 2019

September, 2019

UCLA Center for Health Policy Research Health Economics and Evaluation Research Program

Interim Evaluation of California's Whole Person Care (WPC) Program

Nadereh Pourat, PhD Emmeline Chuang, PhD Xiao Chen, PhD Brenna O'Masta, MPH Leigh Ann Haley, MPP Connie Lu, MPH Michael P. Huynh, MPH Elaine Albertson, MPH Denisse M. Huerta

UCLA Center for Health Policy Research Health Economics and Evaluation Research Program

September 2019

This interim evaluation was supported by funds received from the California Department of Health Care Services (contract number 17-94448). The analyses, interpretations, and conclusions contained within this evaluation are the sole responsibility of the authors. This report contains analysis of data available up to the end of Program Year 3 (December 2018).

Acknowledgments

The authors would like to thank Azeem Banatwala, Brendon Chau, Kimberly de Dios, Maria Ditter, Catly Do, Chingyi (Ethan) Ie, Corey Ly, Ana Martinez, Tarek Meah, Nicole Pereira, Wafeeq Ridhuan, Kylie Vines, Kong Xin, Ziming Yang, Dahai Yue, and Weihao Zhou for their hard work and support of WPC program evaluation activities.

Suggested Citation

Pourat N, Chuang E, Chen X, O'Masta B, Haley LA, Lu C, Huynh MP, Albertson E, and Huerta DM. Interim Evaluation of California's Whole Person Care (WPC) Program. Los Angeles, CA: UCLA Center for Health Policy Research, September 2019.

2 Interim Evaluation of California's Whole Person Care (WPC) Program | Whole Person Care Interim Evaluation Report

UCLA Center for Health Policy Research Health Economics and Evaluation Research Program

September, 2019

Contents

Interim Evaluation of California's Whole Person Care (WPC) Program ....................................... 1 Chapter 1: Executive Summary..................................................................................................... 22

WPC Program Overview............................................................................................................ 22 Evaluation Methods .................................................................................................................. 22 Results ....................................................................................................................................... 23

Motivation for WPC Participation..................................................................................... 23 Structure of WPC Pilots..................................................................................................... 23 Health Information Technology and Data Sharing Infrastructure.................................... 24 Identification, Enrollment, and Engagement of Eligible Medi-Cal Beneficiaries.............. 25 WPC Services Offered and Delivered................................................................................ 26 WPC Care Coordination .................................................................................................... 27 WPC Performance Improvement and Program Monitoring............................................. 28 Enrollee Demographics, Health Status, and Prior Health Care Utilization ....................... 28 Better Care ........................................................................................................................ 29 Better Health..................................................................................................................... 30 Homeless WPC Enrollee Services and Outcomes ............................................................. 31 Sustainability..................................................................................................................... 33 Conclusions and Next Steps ...................................................................................................... 33 Chapter 2: Introduction ................................................................................................................ 35 WPC Program ............................................................................................................................ 35 WPC Goals......................................................................................................................... 35 WPC Lead Entities ............................................................................................................. 38 Target Populations, Services, and Reporting.................................................................... 39 WPC Funding and Pilot Payment Methodology ............................................................... 40 UCLA Evaluation ........................................................................................................................ 42 Conceptual Framework..................................................................................................... 42 Evaluation Questions ........................................................................................................ 44 Data Sources ..................................................................................................................... 45

Whole Person Care Interim Evaluation Report |Interim Evaluation of California's Whole Person Care 3 (WPC) Program

September, 2019

UCLA Center for Health Policy Research Health Economics and Evaluation Research Program

Analytic Methods .............................................................................................................. 46 Limitations......................................................................................................................... 46 Chapter 3: Motivation for WPC Pilot Participation ...................................................................... 48 Fit with Strategic Priorities........................................................................................................ 48 Synergies with Other Programs and Initiatives ........................................................................ 50 Specific Goals ............................................................................................................................ 54 Chapter 4: Structure of WPC Pilots............................................................................................... 58 Organizational Structure........................................................................................................... 58 Target Populations .................................................................................................................... 60 Partnerships .............................................................................................................................. 64 Partner Selection and Decision to Participate .................................................................. 64 Partners' Level of Involvement ......................................................................................... 67 Pilots' Perception of Partner's Buy-in............................................................................... 71 Perceived Impact of WPC on Cross-Sector Collaboration and Integration of Care.......... 74 Chapter 5: Health Information Technology and Data Sharing Infrastructure .............................. 78 Data Sharing Infrastructure ...................................................................................................... 79 Data Sharing Agreements and Enrollee Consents .................................................................... 79 Availability of Case Management Tools.................................................................................... 81 Health Information Exchanges.................................................................................................. 83 Data Sharing Processes ............................................................................................................. 87 Performance Monitoring .......................................................................................................... 89 Challenges and Solutions .......................................................................................................... 92 Chapter 6: Identification, Enrollment, and Engagement of Eligible Medi-Cal Beneficiaries........ 99 Identifying Prospective Enrollees ............................................................................................. 99 Enrollee Engagement and Retention ...................................................................................... 101 Challenges and Solutions ........................................................................................................ 102 WPC Enrollment Size and Patterns ......................................................................................... 110 Enrollment Size ............................................................................................................... 111 Disenrollment.................................................................................................................. 115

4 Interim Evaluation of California's Whole Person Care (WPC) Program | Whole Person Care Interim Evaluation Report

UCLA Center for Health Policy Research Health Economics and Evaluation Research Program

September, 2019

Services without Enrollment........................................................................................... 118 Enrollment Patterns by Target Population ..................................................................... 119 Chapter 7: WPC Services Offered and Delivered........................................................................ 124 WPC Services Offered ............................................................................................................. 125 WPC Estimated Service Delivery............................................................................................. 126 Outreach ......................................................................................................................... 127 Care Coordination ........................................................................................................... 128 Housing Support ............................................................................................................. 129 Peer Support ................................................................................................................... 131 Benefit Support ............................................................................................................... 132 Employment Assistance .................................................................................................. 134 Sobering Centers............................................................................................................. 135 Medical Respite............................................................................................................... 136 Estimated Payment for Service Category per Enrollee........................................................... 138 Chapter 8: Care Coordination ..................................................................................................... 139 A Conceptual Framework for Assessment of WPC Care Coordination .................................. 139 Progress in Implementing Care Coordination......................................................................... 141 Care Coordination Infrastructure ................................................................................... 141 Care Coordination Processes .......................................................................................... 146 Challenges and Solutions ........................................................................................................ 153 Chapter 9: WPC Performance Improvement and Program Monitoring..................................... 159 Pilot-Initiated Quality Improvement....................................................................................... 159 PDSA Types...................................................................................................................... 159 Volume and Length of PDSAs Conducted by WPC Pilots................................................ 162 Monitoring of PDSA Activities......................................................................................... 163 Internal Assessment Activities ........................................................................................ 165 Chapter 10: Enrollee Demographics, Health Status, and Prior Health Care Utilization ............. 167 WPC Enrollee Characteristics.................................................................................................. 167 Demographics ................................................................................................................. 168

Whole Person Care Interim Evaluation Report |Interim Evaluation of California's Whole Person Care 5 (WPC) Program

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