Program Overview:
L.A. Care’s Population Health Management (PHM) Program strives to address health needs at all points along the continuum of health and well-being, through participation engagement and targeted interventions for the member population across all lines of business. The integration of population health management consolidates and coordinates multiple program and service offerings into one seamless system, producing efficiencies that drive improved health outcomes, addressing social determinants of health, decrease disparities and reduce overall health care spending. L.A. Care’s population health management services are provided by a team that includes medical, care management, social services, behavioral health and community resources together whose goal is to coordinate and ensure the right service at the right level for any sub-population. Rather than providing specific service categories into which individuals must fit, L.A. Care’s population health management revolves around the individual’s needs and adapts to their health status—providing support, access and education all along the continuum.
Through a high-tech, high-touch, highly efficient workflow we can use the widest breadth of data sources with optimal process flow to achieve a holistic view of members and providers for ideal customer relationship management.
The Population Health Management Program is conducted through coordination and collaboration with the following programs:
The major components of the program are:
1) Population identification
2) Assessment and risk stratification and segmentation through whole-person care approaches addressing social determinants of health in addition to clinical indicators
3) Member enrollment, health appraisal (HA) and engagement
4) Interventions focused on: monitoring, health promotion and basic population health management, early detection, condition management, enhanced care management, complex care management, transition care services, community support programs and patient safety
5) Evaluating program outcomes. L.A. Care’s PHM Program’s foundation is built upon meeting the National Committee for Quality Assurance (NCQA) PHM Standards, L.A. Care’s Enterprise-wide goals and objectives as well as meeting the California Department of Health Care Services (DHCS) California Advancing and Innovating Medi-Cal Program (CalAIM, which launched in 2022).
CalAIM
CalAIM is a multi-year initiative by the California Department of Health Care Services (DHCS) to improve the quality of life and health outcomes of Medi-Cal members. Population Health Management (PHM) serves as one of the key cornerstones for the CalAIM initiative. In alignment with the CalAIM PHM Program, L.A. Care has implemented, enhanced, and expanded on the following programs:
- Basic Population Health Management
- Enhanced Care Management
- Complex Care Management
- Transition of Care Services for high and low risk members including birthing population.
Additionally, L.A. Care continues to partner collaboratively with the Local Health Jurisdictions (LHJ) (Long Beach, Los Angeles, Pasadena) and all the Managed Care Plans in Los Angeles County to foster a deeper understanding of the health and social needs of members and the community through participation in the LHJ’s Community Health Assessment (CHA) and Community Health Improvement Plan(CHIP) with the ultimate goal of reducing siloed approaches and more effectively improving the health and lives of members.