The landscape of healthcare is constantly evolving, seeking innovative approaches to better serve individuals with complex needs. In California, a significant initiative known as the Whole Person Care (WPC) program emerged to address the challenges faced by high-risk, high-utilizing enrollees within the Medi-Cal system. While initially a statewide program, the principles and successes of WPC hold particular relevance for regions like Los Angeles, grappling with diverse populations and intricate healthcare demands.
The California Department of Health Care Services (DHCS) launched the WPC program under the “Medi-Cal 2020” Section 1115 Medicaid Waiver, operating from January 1, 2016, to December 31, 2021. This ambitious program was designed to provide comprehensive care coordination for Medi-Cal beneficiaries with complex health and social needs. These individuals often require services across various sectors, including health, behavioral health, and social support systems. The WPC program aimed to bridge these gaps, fostering collaboration among stakeholders and facilitating real-time data sharing to enhance care delivery, improve health outcomes, and ultimately reduce healthcare costs.
To evaluate the effectiveness of this statewide initiative, a team of researchers led by Nadereh Pourat, Associate Center Director of the UCLA Center for Health Policy Research, conducted a thorough assessment. Their final evaluation report provides valuable insights into the WPC program’s impact and offers lessons applicable to healthcare delivery in areas like Los Angeles.
The findings of the WPC evaluation highlight several key achievements. Participating pilot programs demonstrated a strong commitment to building meaningful partnerships by fostering open communication, establishing shared strategic priorities, and, in some instances, utilizing financial incentives. Furthermore, the WPC program spurred the adoption of advanced data-sharing platforms, essential for seamless cross-sector care coordination. These technological advancements enabled efficient data exchange among diverse partners, a critical component for delivering integrated care. Beyond technology, WPC pilots successfully developed robust infrastructure, including dedicated staffing and standardized protocols. These structural improvements facilitated effective care coordination processes, encompassing needs assessments, personalized care plans, and streamlined referral systems.
The impact of the WPC program extended to the enrollees themselves. The evaluation revealed a notable increase in the utilization of outpatient services within the first year of enrollment. Analyzing trends before and during WPC participation, researchers observed shifts in service utilization patterns. While primary care visits decreased, there was a corresponding rise in specialty care, a nuanced change suggesting more targeted and appropriate care delivery. Interestingly, mental health care utilization saw a slight decline, while substance use treatment experienced an increase, indicating a potential shift towards addressing specific substance use needs within this high-risk population. Crucially, WPC enrollees experienced a reduction in emergency department (ED) visits and hospitalizations, key indicators of improved healthcare management and preventative care. There was an increase in long-term care stays relative to the control group which warrants further investigation to understand the context and drivers behind this change. From a financial perspective, the WPC program demonstrated significant cost-effectiveness. Compared to a control group, enrollees in the WPC program exhibited a reduction in overall estimated Medi-Cal costs. This cost reduction was attributed to decreased utilization of hospitalizations, outpatient services, and emergency department visits, underscoring the program’s success in optimizing healthcare resource allocation.
As the Medi-Cal 2020 waiver concluded, the successful elements of the WPC program have transitioned into California Advancing and Innovating Medi-Cal (CalAIM). All WPC pilots and partners have now adopted Enhanced Care Management (ECM) and/or Community Supports (CS) under CalAIM, ensuring the continuation of coordinated care principles. The evaluation of the Whole Person Care program offers valuable best practices for care coordination and demonstrates the potential of such programs to achieve the triple aim of healthcare improvement: better care, better health, and lower costs for vulnerable Medicaid populations. For regions like Los Angeles, embracing these lessons and adapting whole-person care approaches can be instrumental in building a more effective, equitable, and patient-centered healthcare system.
