Special Notice / Hearing: None__
Vote Required: Majority
To: Honorable Board of Supervisors
From: Louise F. Rogers, Chief, San Mateo County Health
Marc Meulman, Director, Public Health, Policy and Planning
Subject: Agreement for Public Health, Policy and Planning to Provide Enhanced Care Management Services for Health Plan of San Mateo Clients
RECOMMENDATION:
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Adopt a resolution authorizing an agreement for Public Health, Policy and Planning to provide Enhanced Care Management services for clients of the San Mateo Health Commission dba Health Plan of San Mateo for the term of January 1, 2022 through December 31, 2022, in an amount not to exceed $1,549,110.
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BACKGROUND:
The California Department of Health Care Services (DHCS), through the California Advancing and Innovating Medi-Cal (CalAIM) initiative, seeks to move Medi-Cal services toward a population health approach that prioritizes prevention and whole person care. The program is designed to extend supports and services beyond hospitals and health care settings directly into California communities.
As part of CalAIM, based in part, upon the successes of the Whole Person Care (WPC) pilots, DHCS established a new statewide benefit entitled Enhanced Care Management (ECM). ECM provides a whole-person approach to care that addresses the clinical and non-clinical circumstances of high-need Medi-Cal recipients. The goals of ECM are: 1) improving care coordination; 2) integrating services; 3) facilitating community resources; 4) improving health outcomes; 5) addressing social determinants of health; and 6) decreasing inappropriate utilization. ECM is intended for the highest risk, highest-cost Medi-Cal managed care members with the most complex medical and social needs. ECM targets specific populations including adult high utilizers, individuals experiencing homelessness, adults with Serious Mental Illness/Substance Use Disorders, adults/youth transitioning from incarceration, and adults at risk of institutionalization and eligible for Long Term Care, and nursing facility residents who want to transition to community. ECM will provide these clients with long-term help coordinating their services across delivery systems to address their needs.
WPC is a pilot program funded under the Section 1115 Medicaid Waiver, through a contract with the DHCS. San Mateo County Health participated in the WPC pilot from 2016 to 2021 to provide a coordinated, efficient, and effective delivery of medical, behavioral health, and social services to the County’s highest-risk and vulnerable populations. The WPC pilot established the Bridges to Wellness program in the Public Health, Policy and Planning (PHPP) division of County Health to provide intensive care management services. The Bridges to Wellness program serves individuals who are high utilizers of emergency services, are often homeless and whose health and/or behavioral health conditions place them at high risk for poor health outcomes.
DISCUSSION:
The Health Plan of San Mateo (HPSM) seeks to contract with PHPP to engage Bridges to Wellness as a provider of ECM services effective January 1, 2022. Under this agreement, the Bridges to Wellness program will provide direct services for HPSM’s members eligible for ECM. HPSM will pay the County a fixed monthly rate of $520 per enrolled and engaged client for these services. In addition to the monthly rate, HPSM will pay for outreach services to its members to engage them in ECM services at a rate of up to $50 per month for three months in a 12-month period.
The agreement and resolution have been reviewed and approved by County Attorney as to form. This agreement is late due to delayed contract negotiations between PHPP and the HPSM.
The resolution contains the County’s standard provisions allowing amendment of the County fiscal obligations by a maximum of $25,000 (in aggregate)
It is anticipated that 90% of Bridges to Wellness clients enrolled in ECM services will have a comprehensive assessment completed within 30 days of enrollment.
PERFORMANCE MEASURE:
|
Measure |
FY 2021-22 Estimated |
FY 2022-23 Estimated |
|
Percentage of Bridges to Wellness clients enrolled in ECM services who have a comprehensive assessment completed within 30 days of enrollment |
90% 160 clients |
90% 270 clients |
FISCAL IMPACT:
The term of the agreement is January 1, 2022 through December 31, 2022. The amount of the agreement is not to exceed $1,549,110 for the one-year term. This amount is included in the PHPP FY 2021-22 Adopted Budget and FY 2022-23 Recommended Budget. There is no Net County Cost associated with this agreement.