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Expanding substance use care: health plan teams up with seven California counties
Expanding substance use care: health plan teams up with seven California counties
- Collection:
- Health Policy and Services Research
- Series Title(s):
- Issue brief (California HealthCare Foundation)
- Author(s):
- Newman, Matthew, (Of Blue Sky Consulting Group), author
- Contributor(s):
- California HealthCare Foundation, issuing body.
- Publication:
- [Oakland, California] : California Health Care Foundation, March 2022
- Language(s):
- English
- Format:
- Text
- Subject(s):
- Delivery of Health Care, Integrated
Medicaid
Mental Health Services
Substance-Related Disorders -- therapy
California - Genre(s):
- Technical Report
- Abstract:
- Many Californians experiencing substance use disorders have co-occurring mental or physical health conditions. For Californians insured through Medi-Cal, receiving comprehensive care can be extremely challenging because they must navigate different systems of care. Counties finance and administer substance use disorder (SUD) services and specialty mental health services--often through separate programs--while Medi-Cal managed care plans finance and administer physical health services and nonspecialty mental health services. To overcome these obstacles, seven mostly rural Northern California counties (Humboldt, Lassen, Mendocino, Modoc, Shasta, Siskiyou, and Solano) worked with Partnership HealthPlan of California (“Partnership”), a County Organized Health System and the sole Medi-Cal managed care plan in these counties, to create an integrated, regional pilot program. This effort, called the Wellness and Recovery Program, is part of the state’s Drug Medi-Cal Organized Delivery System (DMC-ODS) and regionalizes SUD services across these seven counties, with the counties providing financial resources, Partnership providing centralized program administration, and county and non-county providers under contract with Partnership delivering services for enrollees. Participating counties remain financially responsible for the cost of DMC-ODS services. Rather than paying providers directly, however, the counties pay Partnership for each Medi-Cal enrollee who uses SUD services in a given month (a “per-user per-month,” or PUPM, payment). Partnership, in turn, contracts with and pays participating providers. With Partnership as a single entity administering all the physical health and SUD services provided to a Medi-Cal enrollee, the program has the potential to more readily identify and address gaps in care and ensure that services are coordinated across providers. Unlike both traditional Drug Medi-Cal services as well as SUD services provided under DMC-ODS programs elsewhere in the state, eligible enrollees in counties participating in the regional pilot can receive most services from any participating provider, no matter which of the seven counties the provider practices in. This regionalization relieves individual counties of the responsibility of developing individual comprehensive provider networks and a full spectrum of services. It is the only instance in the state in which a Medi-Cal managed care plan partners with a county or counties in DMC-ODS.
- Copyright:
- Reproduced with permission of the copyright holder. Further use of the material is subject to CC BY-NC-ND license. (More information)
- Extent:
- 1 online resource (1 PDF file (6 pages)).
- NLM Unique ID:
- 9918573685806676 (See catalog record)
- Permanent Link:
- http://resource.nlm.nih.gov/9918573685806676