Commitment to care coordination: Finishing what we've started
When California launched Cal MediConnect, its landmark dual eligible demonstration project, its architects knew the challenge they were accepting. Their plans rested on a simple premise: The need to improve care coordination and leverage community supports for Medicare-Medicaid beneficiaries most at risk. Their goals were to improve care outcomes, help beneficiaries remain in their homes, and reduce avoidable hospitalization and emergency room visits.
Nearly two years later, we can see that vision becoming a reality. Cal MediConnect beneficiaries express greater satisfaction with their plans and are having improved access to care.
At the same time, all parties involved need to do more – especially in expanding access to care coordination services – to meet the needs of California's dual-eligible individuals and complete a blueprint for other states to follow. Unprecedented in the boldness of its ambition as it is in the scale and complexity of its implementation, Cal MediConnect must be done right. As part of The SCAN Foundation's bedrock commitment to older adults, particularly those who are low income and in need of care, we have monitored Cal MediConnect's progress, researched its impact, and engaged its architects every step of the way.
Working with our partners – including the University of California-San Francisco, the University of California-Berkeley, and Field Research Corporation – we have assembled a rich body of research that draws in perspectives from beneficiaries, providers, payers, and policymakers. Results were shared last week at the release of the Bipartisan Policy Center (BPC) recommendations to improve care delivery across Medicare and Medicaid for beneficiaries nationwide.
Taken together, the research findings show where the program's strengths lie, and where the work remains.
Cal MediConnect's coordinated care has shown a positive impact:
- Participants have high levels of satisfaction.
- Access to care is improving.
- Medical and supportive services are making it safer and/or easier for participants to live in their homes.
- Having an individual plan of care and a care coordinator makes a difference for individuals with complex needs.
Additionally, we pinpointed areas for program improvement:
- Informing dual-eligible individuals about options for, and the value of, participating.
- Helping doctors and providers engage their patients about their full range of needs.
- Continually assessing participants' emerging needs in order to refine their plan of care.
- Pairing the most high-risk participants with a care coordinator.
- Coordinating with community-based services to maintain individuals' safety and wellbeing in the place they call home.
We're not finished yet – in California or at the national level. BPC's event shows that enormous progress has been made, but “getting this right” will require more work and collaboration from participants, health plans, providers, and other stakeholders.
By capitalizing on these early successes and overcoming the known challenges, well-coordinated care can make an impact on people's lives. All of us who care about this population must do what we can to facilitate meaningful collaborations, monitor the progress, and identify best practices that will advance care coordination across the country. We have no doubt that the goal of person-centered care for adults with complex care needs can, and will, be reached together.
Bruce Chernof, M.D., is the President and CEO of The SCAN Foundation.