Updates on Enhanced Care Management and Community Supports

Streamlining Access to Enhanced Care Management (ECM)
DHCS is streamlining and improving access to ECM by standardizing referrals and expediting the authorization process. DHCS worked extensively with stakeholders to develop statewide ECM Referral Standards and an updated ECM presumptive authorization policy included in the ECM Policy Guide (page 107). The standards and policy take effect on January 1, 2025, and Medi-Cal managed care plans (MCP) are currently operationalizing the new guidance. This adds to a series of DHCS reforms to streamline access to ECM and Community Supports outlined in the 2023 ECM/Community Supports Action Plan.
 

Stakeholders may direct questions about the new guidance to CalAIMECMILOS@dhcs.ca.gov.
 

DHCS Awards $147 Million to Help Medi-Cal ECM and Community Supports Providers Statewide
On August 30, 2024, DHCS awarded $146.6 million to 133 community providers throughout California that provide ECM and Community Supports services to Medi-Cal members. This funding is part of the Providing Access and Transforming Health (PATH) Capacity and Infrastructure, Transition, Expansion, and Development (CITED) initiative, aimed at supporting community providers’ capacity to partner with MCPs and participate in the Medi-Cal delivery system. ECM and Community Supports are essential to Medi-Cal transformation, serving the highest-need MCP members with in-person care coordination, housing assistance, and other vital services, leading to a more equitable health system that works for all Californians. For more information, visit the PATH website. 

CalAIM Background

California Advancing and Innovating Medi-Cal (CalAIM) 

Executive Summary and Summary of Changes 

READ REPORT (Pages: 25)

Date: CalAIM implementation was originally scheduled to begin in January 2021, but was delayed due the impact of the COVID-19 public health emergency. As a result, DHCS is proposing a new CalAIM start date of January 1, 2022. 

 Guiding Principles ( p 3)

• Improve the member experience. 
• Deliver person-centered care that meets the behavioral, developmental, physical, long term services and supports, and oral health needs of all members. 
• Work to align funding, data reporting, quality and infrastructure to mobilize and incentivize towards common goals. 
• Build a data-driven population health management strategy to achieve full system alignment. 
• Identify and mitigate social determinants of health and reduce disparities and inequities. 
• Drive system transformation that focuses on value and outcomes. 
• Eliminate or reduce variation across counties and plans, while recognizing the importance of local innovation. 
•  Support community activation and engagement. 
• Improve the plan and provider experience by reducing administrative burden when possible. 
• Reduce the per-capita cost over time through iterative system transformation. 

Conclusion ( p 17)

CalAIM is an ambitious but necessary proposal to positively affect Medi-Cal beneficiaries’ quality

of life by improving the entire continuum of care across Medi-Cal, and ensuring the system more appropriately manages patients over time through a comprehensive set of health and social services spanning all levels of intensity of care, from birth to end of life.

 2021-22 Governor’s May Revision Department of Health Care Services Highlights

May 14, 2021  ( 22 pages) 

(Page 6) May 14, 21

"Community Health Workers (CHWs) – DHCS proposes to add CHWs to the class of skilled and trained individuals who are able to provide clinically appropriate Medi-Cal covered benefits and services. CHWs are skilled and trained health educators who work directly with individuals and families who may have difficulty understanding and/or interacting with health care providers due to cultural and/or language barriers and can assist those individuals by helping them navigate the relationship with their health care providers, assist them in accessing health care services, provide vital health education, and connect individuals and families with other community-based resources. CHWs can bridge gaps in communication and reduce health and mental health disparities experienced by vulnerable communities in California. The budget includes costs of$16.3 million total funds ($6.2 million General Fund) in FY 2021-22 for CHWs, implementing January 1, 2022."

• 1115 Waiver Renewal - Workforce Expert Stakeholder Workgroup Meeting Resources
  Agenda
• Presentation Materials
  • Meeting #1 DHCS Presentation - Anastasia Dodson
  • Framework and Ideas for Consideration in 1115 Waiver, Sunita Mutha & Joanne Spetz - UCSF Center for Health Professions
  • Related Workforce Efforts and Issues for Consideration: OSHPD and CalSIM - Sergio Aguilar, OSHPD and Barbara Masters, CalSIM
  • Role of Workforce in Other States' 1115 Workforce, Sunita Mutha & Joanne Spetz - UCSF Center for Health Professions
• ​Reading Materials
  • ​Healthcare Workforce Development Programs - OSHPD
  • 2013-2015 Healthcare Workforce Development Work Plan - OSHPD
  • Community Health Workers
  • States Can Transform their Healthcare Workforce - ACGME
  • National Approaches to Whole Person Care in the Safety Net - John Snow, Inc., CAPH, SNI
  • Opportunities for Whole Person Care in California - John Snow, Inc., CAPH, SNI
• Meeting Summary

• ​Agenda
  
• Presentation Materials
  • 1115 Waiver Workforce Strategies and Options
  • OSHPD Workforce Development Program Outcomes - Sergio Aguilar, OSHPD
  • California's 1115 Waiver Renewal: Demographics and Workforce Projections - Sunita Mutha and Janet Coffman, UCSF
  • California's 1115 Waiver Renewal: New York Waiver Workforce Ideas - Sunita Mutha and Janet Coffman, UCSF
  • California's 1115 Waiver Renewal: Evidence of Effectiveness - Sunita Mutha and Janet Coffman, UCSF
• Reading Materials
  • Health Professions Education Foundation, 2011-2013 Annual Report - OSHPD [External - Not DHCS]
  • MHSUDS Integration Task Force Meeting Summary
  • St. John's Enhanced Home Care Pilot Program - SEIU [External - Not DHCS]
  • Policy Evidence Assessment Report: Community Health Worker Policy Components - CDC [External - Not DHCS]
  • Certification of Consumer, Youth, Family, and Parent Providers: A Review of the Research - WWT [External - Not DHCS]
  • Primary Care Pipeline Objectives - CAPCI
  • CHW Best Practices and Cost Effectiveness Information: Safety Net Systems in Medicaid - WERC
  • Integrating Community Based Health Workers into Team Based Care - WERC
  • Min et al. (may require login/purchase) [External - Not DHCS]
  • Chinman et al. (may require login) [External - not DHCS]
  • Huffman et al. 2014 (may require login/purchase) [External - not DHCS]
  • Sandburg et al. 2014 - (may require login/purchase) [External - not DHCS]
  • CLTCEC Homecare Integration training Program (may require login) [External - not DHCS]
• Meeting Summary​

• ​Agenda
• Presentation Materi​als
  • Meeting #3 DHCS Presentation - Efrat Eilat
  • Workforce Options - UCSF
  • Matrix of Workforce Strategies and Options - UCSF
• Reading Materials​
  • MHSUDS Integration Task Force Meeting Summary​
  • States Can Transform their Healthcare Workforce - ACGME
  • Medicaid Payments and Access to Care - Sara Rosenbaum
  • Bringing Community Health Workers into the Mainstream of U.S. Health Care - Pittman, Sunderland, Broderick, and Barnett [External - Not DHCS]

IHSS Provider Voluntary Training Proposal Stakeholder Meeting

CHW/P Policy Coalition 

California Health Care Foundation funded a coalition of partners to focus on CHW policy in California
The CHW/P policy coalition is comprised of seven lead entities:

1. Asian and Pacific Islander Forward Movement,
2. California Consortium for Urban Indian Health (CCUIH),
3. California Pan-Ethnic Health Network, (Coalition Lead Organization)
4. Latino Coalition for Healthy California (LCHC)
5. The Children’s Partnership (TCP)
6. Transitions Clinic Network 
7. Visión y Compromiso. (VYC)

Goals

1. Convene CHW/Ps and advocates for CHW/Ps from diverse communities across the state 
2. Develop a shared policy agenda to advance the integration and sustainability of CHW/Ps  
3. Engage stakeholders in public education and policy advocacy  

Workgroups

1. CHW/P Voice  (VYC)  -> Goal 1
2. Policy Agenda (LCHC) -> Goal 2 
3. Education( TCP) -> Goal 3 

 Join Here: https://www.surveymonkey.com/r/DKGVPDK 

 Community Health Worker /Promotores  Action Plan (2012 ) ( 5 pages) 

https://cwdb.ca.gov/wp-content/uploads/sites/43/2016/08/Community-Health-Worker-Promotores-Action-Plan.pdf

Tim Rainey: Executive Director 

Aida Cardenas: Deputy Director, Equity and Jobs

Statewide Healthcare Worker Minimum Wage Is Now a Law in California

Workers covered

SB 525 covers all healthcare workers who provide services that directly or indirectly support patient care, including contracted workers. This includes clinicians, nurses, certified nursing assistants, aides, technicians, maintenance workers, janitorial or housekeeping staff, groundskeepers, guards, food service workers, laundry workers, and pharmacists, but does not include managers or supervisors.

Four groups with timelines to $25 wage

Group 1 — Large health systems and hospitals and all dialysis clinics

Group 2 — Smaller health facilities

Group 3 — Truly financially distressed

Group 4 — Community clinics

Learn More

RESOURCE PAGE

2020:

• https://www.chcs.org/resource/training-and-supporting-community-health-workers-and-promotores-lessons-for-states/

• https://www.chcs.org/resource/recognizing-and-sustaining-the-value-of-community-health-workers-and-promotores/

1. Resource Package #1: The Role of CHW/Ps in Health Care Delivery for Medi-Cal Members (PDF, 26 pages)
2. Resource Package #2: Training Approaches for Community Health Workers and Promotores to Support Medi-Cal Members (PDF, 29 pages)
3. Resource Package #3: The CHW/P Role in Data Collection and Outcome Measurement (Draft PDF, 21 pages)
4. Resource Package #4: Financing and Sustaining CHW/P Roles in Medi-Cal Services         (Draft PDF,  22pages)

Community Health Workers & Promotores in the Future of Medi-Cal
A project to enhance the capacity of Medi-Cal managed care plans and their partners to deploy community health worker and promotor programs that advance health equity. 

Deliverables

The Community Health Workers & Promotores in the Future of Medi-Cal resource packages, informed and reviewed by stakeholders, will provide actionable guidance for Medi-Cal managed care plans’ integration of CHW/Ps into population health, care management, and clinical care teams to deliver culturally specific care, with the ultimate goal of achieving health equity for 

their members. 

PROJECT DATES OF INTEREST 

• February 1, 2021 Draft Resource Package #2 on CHW/P training programs posted for public comment 
• February 1-9, 2021 Public comment period on Draft Resource Package #2 on CHW/P training programs 
• February 22, 2021 Release of Final Resource Package #1 on CHW/P roles 

Advisory Council

The Advisory Council is composed of representatives of California-based and national organizations and subject matter experts who have relevant knowledge or expertise in advancing the role of the CHW/P workforce in the Medicaid context. Members will share approaches and resources for effectively partnering with CHW/Ps and disseminate project deliverables within their organizations and constituencies

Mayra Alvarez (Children’s Partnership)
Heidi Behforouz (Los Angeles County Department of Health Services)
Tim Berthold (San Francisco City College)
America Bracho (Latino Health Access)
Amanda Clarke (California Association of Public Hospitals / California Health Care Safety Net Institute)
Alexander Fajardo (El Sol Neighborhood Educational Center)
Elia Gallardo (County Behavioral Health Directors Association of California)
Brian Hansen (California Department of Health Care Services)
Nancy Ibrahim (Esperanza Community Housing) 

Ashley Kokotaylo (Contra Costa Health Services)
Denys Lau (National Committee for Quality Assurance)
Maria Lemus (Visión y Compromiso)
Brianna Lierman (Local Health Plans of California)
Rishi Manchanda (Health Begins)
Andie Martinez (California Primary Care Association)
Amber Roth (Worker Education & Resource Center)
Carl Rush (Community Resources)
Kiran Savage (California Pan-Ethnic Health Network)
Holly Webb (WellSpace Health) 

Stakeholder Group

The Stakeholder Group is composed of organizational representatives and CHW/Ps who anticipate direct involvement in the CalAIM initiative implementation or who have historically engaged in California’s Whole Person Care pilots or Health Homes Program. The Stakeholder Group will guide and review each resource package before its release, ensuring the packages address the diverse needs and capabilities of organizations around California that plan to engage with the CHW/P workforce in Medi-Cal programs. Stakeholder Group members will distribute project deliverables within their organizations and constituencies.

Isabel Becerra (Coalition of Orange Community Clinics)
Joe Calderon (Transitions Care Network)
Cynthia Carmona (L.A. Care)
Martha Cervantes (Ventura County Whole Person Care)
Deiter Crawford (Desert Clinic Pain Institute)
Lakshmi Dhanvanthari (Health Plan of San Joaquin)
Valerie Edwards (Alameda County Whole Person Care)
Jessica Finney (Central California Alliance for Health)
Pamela Gomez (Contra Costa Health Plan) 

 Health Plan Council

The Health Plan Council is composed of a subset of the Medi-Cal managed care plan CEOs who anticipate direct involvement in CalAIM or who have historically engaged in California’s Whole Person Care pilots or Health Homes Program. These CEOs will support their organizational representative in the Stakeholder Group and share project deliverables within their organizations and among their networks.

John Baackes (L.A. Care)
Liz Gibboney (Partnership HealthPlan)
Sharron Mackey (Contra Costa Health Plan)
Jarrod McNaughton (Inland Empire Health Plan)

Michael Schrader (Health Plan of San Joaquin)
Stephanie Sonnenshine (Central California Alliance for Health) 

LEARN MORE

Sign Up For Project News

January 2021 News Letter

Funder: California Health Care Foundation

Author: Kathy Moses, Logan Kelly, and Audrey Nuamah, Center for Health Care Strategies

March 2021 | Toolkit

Many states, including California, are aiming to improve the quality of life and health outcomes for their residents, and one strategy is to better integrate community health workers and promotores (CHW/Ps) into health care delivery by health plans and providers. Health plans, federally qualified health centers, hospitals, or community-based organizations can partner to deploy effective, evidence-based CHW/P programs to advance health equity and improve overall outcomes. To do this successfully, it is important to have a common understanding of the various roles CHW/Ps can play in care delivery.

The Center for Health Care Strategies, in partnership with the California Health Care Foundation as well as In-Sight Associates, Health Management Associates, and Schoen Consulting, is developing a series of resource packages that share best practices for supporting the integration of CHW/Ps into programs run by Medicaid managed care plans for members of Medi-Cal. This package, first in the series, includes considerations for health plans collaborating with partner organizations to better incorporate CHW/Ps into new and existing programs. It also outlines challenges and potential solutions to implementing these programs informed by insights from individuals with lived experience. The package includes curated, practical resources and tools including sample CHW/P job descriptions and CHW/P program design examples. While this resource is oriented to the California landscape, the lessons herein can be applied for plans in other states seeking to use CHW/Ps to improve health care delivery.

The series is a product of Community Health Workers & Promotores in the Future of Medi-Cal, a project by the California Health Care Foundation that aims to promote the role of CHW/Ps within the context of the California Advancing and Innovating Medi-Cal initiative. Look for future resources from the series, which will be published through 2021.

• Toolkit  Training Approaches for Community Health Workers and Promotores to Support Medi-Cal Members  APRIL 2021

 Community Health Workers & Promotores in the Future of Medi-Cal Resource Package #1: The Role of  Community Health Workers and  Promotores in Health Care 

 A Project of the California Health Care Foundation 

Prepared By: Kathy Moses, Logan Kelly, Audrey Nuamah 

 DRAFT Table of Contents 

Background and Context.....................................................................................................................4 

Introduction ..........................................................................................................................................4 Background ...........................................................................................................................................4 

Key Implementation Approaches........................................................................................................5 

Assess Community and Organizational Needs..................................................................................5 

Design the Scope of a CHW/P Program and Define CHW/P Roles..................................................6 

Develop CHW/P Position Structure and Supports ............................................................................7 

Develop CHW/P Supervisory Models:..................................................................................................7 

Identify CHW/P Case Loads:.................................................................................................................8 

Develop Position Supports:..................................................................................................................8 

Recruit CHW/Ps......................................................................................................................................9 Develop Job Descriptions:....................................................................................................................9 

Use Effective Recruiting Strategies: ....................................................................................................9 

Develop CHW/P Training.....................................................................................................................10 

Infrastructure Barriers and Solutions................................................................................................10 

Collaboration with Partner Organizations ........................................................................................11 

► Coordination with training organizations....................................................................................12 

► Coordination with hospital systems. .............................................................................................12 

► Coordination with community-based organizations ..................................................................12 

Insights from CHW/Ps ..........................................................................................................................12 

How would you describe CHW/P roles?.............................................................................................12 

What qualities and skills should CHWs have to be successful in their role?.................................13 

What is helpful for employers to know about the roles of CHW/P?...............................................13 

Lessons from Whole Person Care and Health Homes ....................................................................14 

Health Home Program ........................................................................................................................14 

Inland Empire Health Plan (IEHP)........................................................................................................14 

Whole Person Care................................................................................................................................14 

Los Angeles Department of Health Services (LA DHS).......................................................................14 

A Project of the California Health Care Foundation 3 Resources and Tools ..................................14 

Purpose of this section:..........................................................................................................................14 Toolkits.....................................................................................................................................................15 

Job Descriptions......................................................................................................................................15 

CHW/P Program Design ........................................................................................................................16 

Examples of CHW/P Programs and Roles from California................................................................16 

Examples of CHW/P Programs and Roles from Other States............................................................17 

READ REPORT

Resource Package #2  Training for CHW/Ps and Their Employers
Date: Posted for Public Comment February 1, 2021

Prepared By :  A Project of the California Health Care Foundation  Prepared By: Kathy Moses, Logan Kelly, Audrey Nuamah 

This resource package focuses on the elements of effective training programs to prepare CHW/Ps to work with Medi-Cal members and necessary steps to prepare managed care plans to employ or supervise CHW/Ps. 

Your feedback will be instrumental in making this resource package most useful to managed care plans integrating CHW/Ps into their programs.

 About the Project          

To address the challenges related to integrating CHW/Ps into systems of care serving Medi-Cal members, the California Health Care Foundation has partnered with In-Sight Associates (ISA), the Center for Health Care Strategies (CHCS), Health Management Associates (HMA), and Schoen Consulting to launch Community Health Workers & Promotores in the Future of Medi-Cal.  

Working within the context of the ​California Advancing and Innovating Medi-Cal (CalAIM) initiative, this 15-month project (October 2020 through December 2021) will generate a set of resource packages, informed and reviewed by stakeholders, that support the integration of CHW/Ps into Medi-Cal managed care programs. 

CHCF will gather these resource packages into a toolkit and publish it in the fall of 2021.

Sign up for the project’s email distribution list to receive project news!

READ REPORT

Table of Contents .....................................................................................................................................2  Introduction...............................................................................................................................................4 

About the Project and Resource Package .............................................................................................4 

 Key Concepts....................................................................................................................................................5 

Background on CHW/P Training.............................................................................................................5

The Landscape of CHW/P Training Programs in California. ...............................................................5 

Health Equity and CHW/P Training. .......................................................................................................6

Key Implementation Approaches...........................................................................................................7 Training for CHW/Ps.................................................................................................................................7

Learning Objectives and Topics.............................................................................................................7 

Engagement of CHW/Ps as Co-Designers and Trainers......................................................................8 

Training Structure....................................................................................................................................9 

Professional Development. ....................................................................................................................9

Training for Organizations and Supervisors ..................................................................................... 10

Learning Objectives and Topics........................................................................................................... 10 

Training Structure and Facilitation...................................................................................................... 11 

Training for CHW/P Supervisors.......................................................................................................... 11 

Collaboration with Partner Organizations.......................................................................................... 12  MCPs Provide Training......................................................................................................................... 12

MCPs Contract Out Training................................................................................................................ 12

Hybrid Approach.................................................................................................................................... 12 MCPs Partner Together. ....................................................................................................................... 12 State/County Provides Training........................................................................................................... 12 

Infrastructure Barriers and Potential Solutions ................................................................................ 13 Establishing CHW/P Training Programs............................................................................................. 13 Training Can Be Costly......................................................................................................................... 13 Making Training Accessible. ................................................................................................................ 13 

Staff Turnover........................................................................................................................................ 13

Training the Broader Team.  ................................................................................................................ 14 

A Project of the California Health Care Foundation 

Insights from CHW/Ps........................................................................................................................... 14

Insights from Joe Calderon................................................................................................................... 14 

Insights from Bianca Alvarez .............................................................................................................. 15 

58 Lessons from Whole Person Care and Health Homes................................................................. 15 

Examples in Action. .............................................................................................................................. 16 

Resources and Tools.............................................................................................................................. 16

Toolkits..................................................................................................................................................... 17

CHW/P Training Program Examples..................................................................................................... 16 

 DRAFT 

Health in All Policies (HiAP)

 The California Department of Public Health (CDPH) and the Public Health Institute developed the Five Key Elements of Health in All Policies as a guide and filter for identify opportunities for operationalizing this work:

1. Promote health, equity, and sustainability
2. Support intersectoral collaboration
3. Benefit multiple partners
4. Engage stakeholders
5. Create structural or procedural change

Executive Order S-04-10 in 2010 and brings together 22 departments, agencies, and offices from across State Government. Member departments, agencies, and offices include:

• Air Resources Board
• Office of the Attorney General
• Business, Consumer Services, and Housing Agency
• Dept. of Community Services and Development
• Dept. of Corrections and Rehabilitation
• Dept. of Education
• Environmental Protection Agency
• Dept. of Finance
• Dept. of Food and Agriculture
• Dept. of Forestry and Fire Protection
• Dept. of General Services
• Government Operations Agency
• Health and Human Services Agency
• Dept. of Housing and Community Development
• Labor and Workforce Development Agency
• Natural Resources Agency
• Dept. of Parks and Recreation
• Office of Planning and Research
• Dept. of Social Services
• Dept. of Transportation
• Office of Traffic Safety
• Transportation Agency

 It's important for us to get recognized and be somebody: Community health worker attributes, attitudes towards certification, and certification options in California  

By  Ashley Kissinger MPH, PhD

A dissertation submitted in partial satisfaction of the requirements for the degree of Doctor of Public Health in the Graduate Division of the University of California, Berkeley 

PDF ( 82 pages)

Summer 2020

 Community health workers (CHWs) are trusted members of the community who have an intimate understanding of the populations and communities they serve. They deliver culturally informed interventions to their communities and leverage their shared experiences and linguistic and cultural relationships to bridge their community to health care and social services. Historically successful in developing countries, CHWs promote chronic disease management, improve health outcomes, and reduce health care costs. 

Despite the evidence, CHWs are not widely utilized within the health care system. The National Academy of Medicine declares barriers to working with CHWs, such as inconsistent scope of practice, variable training and qualifications, and lack of professional recognition by other health care providers. States are investigating ways to standardize the CHW workforce, such as certification, to set workforce entry standards and integrate CHWs into health care systems. 

Currently, the CHW workforce faces a crossroads. One path leads to a standardized CHW workforce integrated into health care systems via formalized training and qualifications. The other path holds CHWs as part of the communities where they live and work, valuing their relationships and embodied knowledge. While both paths are options for the CHW workforce, CHWs and CHW stakeholders must determine if or how these two paths can coexist. California is the perfect case study because there is continued debate across CHW stakeholders about the stakes of certifying CHWs. California’s diverse CHW workforce represents varying CHW types with contrasting ideologies of care, such as clinical and community-based CHWs and promotores de salud, a subset of CHWs who primarily serve Latinx communities and are grounded in a social, rather than medical, model of care. California’s size and social characteristics pose implementation factors that are relevant for the diverse issues other states will have to address for their own CHW workforce. 

This dissertation identifies the unique contributions offered by CHWs to fill health system gaps and challenges differently than other health care providers. The research then describes feelings of opportunity and exclusion related to CHW certification in California. Finally, this dissertation presents strategic options for California stakeholders to develop an appropriate CHW certification model. 

State Strategies to Promote Team-Based Primary Care Through Medicaid Managed Care

Cassie Barrett, BSN, RN* and Matthew Ralls, MPH, Center for Health Care Strategies

April 1, 2021

Supporting team-based care is an important way for states to advance the delivery of high-quality, comprehensive, and equitable primary care. Team-based care improves health outcomes for patients by enabling primary care practices to offer care that better addresses patients’ unique combinations of medical, behavioral health, and social needs, among others. And a recent Health Affairs article found that care teams outperformed solo providers at managing care for patients with chronic conditions. By employing staff with diverse skillsets who can collaborate, communicate, and work at the top of their licenses (where applicable), practices are better equipped to provide high-quality and efficient patient-centered care. For example, approaches that use care team members who share similar life experiences as the patient, such as peer providers and community health workers (CHWs), are effective at improving outcomes, promoting health equity, and generating return on investment.

Strengthening Primary Care through Medicaid Managed Care

This blog post is part of learning series from the Center for Health Care Strategies, Strengthening Primary Care through Medicaid Managed Care. It will examine the tools and levers that states can use to advance comprehensive primary care strategies and equitably improve the health of Medicaid enrollees through webinars, resources, and blog posts. This series is made possible by The Commonwealth Fund.

1. Establish the Roles of Primary Care Providers and Managed Care Organizations

State Medicaid agencies seeking to encourage team-based care in a managed care program must determine the role that managed care organizations (MCOs) will play in supporting and promoting the model. This will depend on many factors, including: (1) the capacity and sophistication of provider organizations to manage team-based care efforts; (2) familiarity of both MCOs and providers with care delivery models such as patient-centered medical homes (PCMHs) or multi-disciplinary care management; and (3) the presence of other care coordination entities like accountable care organizations to manage the effort. Because MCOs or primary care practices can take ownership of common responsibilities, like care management, it is important that these responsibilities are clearly delineated between the entities to prevent duplication of duties or efforts.

2. Identify Whether to Use a Standardized or Flexible Approach

States promoting team-based care will have to consider how prescriptive to be in directing MCOs or provider organizations managing this work. States can take a prescriptive approach, requiring MCOs to use specific care models selected by the state, thus ensuring enrollees have access to related care and services. For example, a state may wish to connect enrollees with CHWs, and a prescriptive approach can require MCOs and providers to incorporate them into their respective care teams. Alternately, states can set general guidelines that allow MCOs the flexibility to choose and customize program models that may better reflect the needs of their providers and patient populations. Once a strategy is selected, states can use managed care contracts or the MCO procurement process to encourage, incent, or require MCOs or providers to contract with care team members to provide services. 

For example, Minnesota’s MCO request for proposals asks potential MCOs to describe their plan to use “non-traditional health care services (such as doulas, community EMTs, community paramedics, community health workers, etc.) to provide culturally competent care and/or improve health outcomes.”  Michigan’s managed care contract is more prescriptive, requiring MCOs to support the design and implementation of CHW interventions.

While more directive policies and programs will create uniform standards, they may also require more state resources to design, implement, and oversee. Similarly, state-defined standards for PCMH programs, staff training, and certifications would also require more state involvement, rather than adopting existing external models or allowing MCOs flexibility to use their own approaches. States can also attempt to reduce administrative burden — on themselves and other stakeholders — by aligning team-based care models with other initiatives.

3. Determine How to Compensate Providers for Team-Based Care

New reimbursement pathways are critical for supporting the adoption of team-based primary care teams. Examples include increased reimbursement rates for practices recognized as PCMHs, as well as additional or enhanced per member per month (PMPM) payments for care coordination and other team-based care activities a state or MCO wants to prioritize. Oregon uses the latter approach, requiring its Coordinated Care Organizations to provide supplemental PMPM payments to the state’s Patient-Centered Primary Care Home clinics to support the development of infrastructure and operations.

States can also create billing codes for team-based care activities. For example, Washington State created new billing codes for primary care teams to use the collaborative care model to address the behavioral health needs of patients; while Minnesota’s medical assistance program uses billing codes that cover care coordination and patient education services provided by certified CHWs.

Additionally, states can consider providing MCOs with value-based payment (VBP) incentives to drive the adoption of team-based care among primary care practices through incentive or penalty arrangements. States that wish to be directive can require MCOs to meet targets or metrics related to team-based care initiatives, such as member enrollment in PCMHs or number of enrollees served by certain types of care team members. For example, New Mexico requires that at least three percent of enrollees are served by CHWs or Community Health Representatives. States can also incorporate team-based care elements into MCO care management requirements or within performance improvement projects, VBP initiatives, or Section 1115 demonstration projects or pilot programs.

Takeaways and An Opportunity to Learn More

States looking to promote team-based care can facilitate this effort in a way that not only achieves their goal of delivering optimal care for patients, but also supports MCOs, primary care practices, and care team members. To employ team-based care as an enhancement to primary care, states can explore what configuration and funding methods will enable and incentivize MCOs and providers to do so effectively and efficiently.

*Cassie Barrett is an intern at the Center for Health Care Strategies

visionycompromiso.org › workforce_report_web PDF 

Key Workforce Priorities for the Community Transformation Model

January 2017

Pages: 32

Authors: Visión y Compromiso

Funders: This work was made possible by the generous support of

The California Endowment, Kaiser Permanente Northern California Community Benefit

Program, Y&H Soda Foundation, and The Women’s Foundation of California.

TABLE OF CONTENTS 

From the Executive Director 2 

Executive Summary 3 

The Community Transformation Model 7 

Findings 13 

1. The Promotor Model is a Model for Community Transformation 

2. Training and Professional Development

 3. Core Competencies and Curricula 

4. Credentialing 19 5. Supervision 

6. Funding and Program Sustainability 2

Next Steps 24 

Endnotes 27 

Acknowledgements 28 

 ADVISORY GROUP (pg 28)

Alma Avila, City College San Francisco 

Gerry Balcazar, Visión y Compromiso 

Mayra Barcenas, El Sol Neighborhood Educational Center 

Norma Benitez, Esperanza Community Housing Corporation 

America Bracho, Latino Health Access 

Melinda Cordero-Bárzaga, Visión y Compromiso 

Alma Esquivel, Visión y Compromiso 

Alex Fajardo, El Sol Neighborhood Educational Center 

Gloria Giraldo, Latino Health Access

Lupe Gonzalez, Promotora 

Nancy Halpern Ibrahim, Esperanza Community Housing Corporation 

Miriam Hernandez, Providence Holy Cross Medical Center 

Ruben Imperial, Stanislaus County Behavioral Health And Recovery Services 

Maria Lemus, Visión y Compromiso 

Carlos Londoño, Tiburcio Vasquez Health Center 

Magaly Marques, Planned Parenthood Los Angeles 

Marie Mayen-Cho, Providence Holy Cross Medical Center 

Patricia Veliz-Macal, Planned Parenthood Los Angeles 

Contact:   Visión y Compromiso 

1000 N. Alameda Street Los Angeles, CA 90012 

(213) 613-0630 

info@visionycompromiso.org 

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 Taking Innovation to Scale: Community Health Workers, Promotores, and the Triple Aim A Statewide Assessment of the Roles and Contributions of California’s Community Health Workers Preliminary Findings, Observations, and Recommendations  

Date August 2013 

Pages 24 

Contact: For more information, please contact: Kevin Barnett, Dr.P.H., M.C.P., Senior Investigator,  Public Health Institute, and Co-Director, California Health Workforce Alliance (www.calhealthworkforce.org), at kevinpb@pacbell.net 

 PROJECT LEADERSHIP TEAM (pg 22)

Steve Barrow CEO and President AHEAD 

Juan Carlos Belliard, Ph.D. Assistant Vice President for Community Partnerships and Diversity Loma Linda University

America Bracho, MD Executive Director Latino Health Access 

Xochitl Castaneda Director Health Initiative of the Americas,

UC Berkeley, School of Public Health 

Cecilia Echeverría, MPP, MPH Director of Safety Net Partnerships Kaiser Permanente 

Catherine Dower, JD Associate Director Center for the Health Professions, University of California, San Francisco 

Pamela Ford-Keach, MS California Department of Public Health

Nancy Halpern Ibrahim, MPH Executive Director Esperanza Community Housing Corporation 

Maria Lemus Executive Director Vision y Compromiso

Laura Long, MBA Director of National Workforce Planning and Development, Kaiser Permanente

Jean Nudelman, MPH, Director of Community Benefit Programs, Kaiser Permanente

David Quackenbush, Vice President of Member Services, California Primary Care Association

Rea Pañares, MHS ;Senior Advisor, Prevention Institute

Beatriz Solis, Ph.D., MPH, Director of Healthy Communities, Strategies South Region, The California Endowment

Perfecto Munoz, Senior Policy Advisor on Consumer Health and the Workforce, UC Berkeley, School of Public Health

Tivo Rojas-Cheatham, MPH, Chief of the Community Participation and Education Section, CDPH

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COMMUNITY HEALTH WORKERS IN CALIFORNIA: Sharpening Our Focus on Strategies to Expand Engagement 

Date:  January 2015

Pages: 33 

http://www.phi.org/uploads/application/files/2rapr38zarzdgvycgqnizf7o8ftv03ie3mdnioede1ou6s1cv3.pdf

CONTENTS Acknowledgements..............................................................................................................................2 

Executive Summary..............................................................................................................................3 Introduction ..........................................................................................................................................6 Background ...........................................................................................................................................8 Discussion Themes Design Considerations in Team-Based Care..................................................17 

Skills, Recruitment, and Training of CHWs.......................................................................................20 

Organizational Capacity for Engagement .......................................................................................23 

Building Analytic Capacity .................................................................................................................25 

Taking the Engagement of CHWs to Scale: Recommendations....................................................30 

Appendix A..........................................................................................................................................33

RECOMMENDATIONS (Page 5)

R1: Establish a statewide clearinghouse to facilitate the rapid sharing of innovations, tools, best practice delivery models, and research support resources. 

R2: Develop a landscape analysis that outlines a scope of practice for CHWs that accommodates alternative team-based models and other team members and the full range of services and activities in clinical and community-based settings. 

R3: Conduct an independent assessment of employer-based, independent, and academic institution-based training programs that describes content scope and intensity, time frame, prerequisites, pedagogical models, geographic focus, and competencies. 

R4: Develop competency-based certification standards for new and existing training programs and for individuals who complete the appropriate training.  

R5: Identify regional sites to pilot the establishment of centralized data repositories that facilitate the integration of community-level data collection efforts and support the expanded use of collaborative data sharing tools for patient care management. 

R6: Provide targeted technical assistance to community health clinics to develop or adapt existing evaluation tools to monitor and disseminate program outcomes. 

R7: Partner with mobile health technology organizations to support mobile data collection, point of care decision support, and case management by CHWs and pilot those interventions with selected communities and organizations. 

R8: Develop standard metrics that effectively capture outcomes associated with services and activities undertaken by CHWs to address the social determinants of health. 

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