The UCSF Community Living Policy Center and the UC Berkeley Health Research for Action Center recently examined the Home- and Community-Based Services (HCBS) provided through Cal MediConnect (CMC). In their research brief, the authors discuss best practices as well as challenges faced by HCBS agencies and CMC plans.
The researchers collected the data from Cal MediConnect plans about their experience working with HCBS agencies and long- term care facilities through an online survey. Researchers also conducted 20 in-depth interviews with stakeholders from independent living centers (ILC), housing providers, stakeholder associations, senior service agencies, and home-delivered meal providers.
Here are some of their key findings:
- Utilizing Interdisciplinary Care Teams and care coordinators improves access to HCBS and results in better outcomes for beneficiaries. In particular, HCBS program social workers provide valuable insight into the unmet needs of beneficiaries that can help CMC plans provide services in a more person-centered way. Care coordination efforts have also led to innovative coordination approaches within CMC health plans and HCBS programs themselves.
- CMC referrals to HCBS managed care benefits (e.g., IHSS, CBAS, or transportation) have improved access for beneficiaries. The increase in collaboration and coordination between health plans and HCBS agencies has resulted in more streamlined and efficient processes. Despite these promising outcomes, IHSS will no longer be a CMC benefit as of January 2018 so it is yet to be seen how this will impact ongoing collaboration and coordination efforts.
- Referrals to non-Medi-Cal HCBS service agencies (e.g., Meals on Wheels, ILCs, housing agencies, and home health service agencies) were mixed. Some health plans make an effort to identify and develop relationships with HCBS providers in their counties. However, some challenges remain, including lack of clarity about the scope of services provided by the HCBS agencies, inadequate information technology (IT) infrastructure, lack of clarity around CMC plans’ role in contracting and payment for non-Medi-Cal HCBS, and the need for more beneficiary and provider education about the HCBS services available through CMC health plans.
- The brokerage model was explored as a way to facilitate the partnerships between CMC health plans and HCBS agencies. In this model, one large HCBS agency assumes a “middle man” role between CMC health plans and the smaller HCBS agencies in the community. Larger and more established HCBS agencies are better equipped to overcome contracting and financial barriers. They have well established networks with smaller HCBS providers, as well as experience providing direct services. This is proving to be a promising practice that has the potential to increase access to HCBS for beneficiaries.
- Data sharing continues to be a challenge due to HIPPA regulations and lack of integrated IT. To overcome these challenges, best practices include: electronic information sharing, increased communication between HCBS providers and health plans, and in-person collaborative meetings.
For full survey findings, complete evaluation, and recommendations, visit www.TheSCANFoundation.org.
To learn more about Medicare-Medicaid integration evaluation efforts, click here.