California's 'Whole Person Care' Program Reduced Medicaid Costs for High-Risk Patients

A five-year pilot project launched by California's Medicaid program that addressed social determinants of health in high-risk, high-utilization patients reduced costs by almost $400 per member per year and cut down on ED visits and hospitalizations.

An innovative program designed to improve access to healthcare services for California's most at-risk Medicaid patients reduced per-patient costs by almost $400 per year during the five-year length of the program, according to a new study.

The Whole Person Care program, which ran from 2016 to 2021, enrolled 247,887 Medi-Cal members, according to a review by the UCLA Center for Health Policy Research. Run through 25 pilot projects covering 26 counties, the $3.6 billion program connected participants not only with primary care and mental health care providers, but more than 500 social service organizations, housing support groups and other resources aimed at addressing social determinants of health.

As a result, the program saw 45 fewer hospitalizations and 130 fewer Emergency Department visits per 1,000 beneficiaries (compared to a control group), and a reduction in Medi-Cal payments of $383 per person per year.

“The Whole Person Care program aimed to promote access to care for the most vulnerable Medi-Cal beneficiaries, and evidence suggests that the program was successful in developing needed infrastructure and delivering services needed to support effective care,” Nadereh Pourat​, associate director of the UCLA center, head of its Health Economics and Evaluation Research Program, and lead author of the report, said in a press release. “Patients received more care and had improved outcomes.”

The program is one of many that healthcare organizations across the country are launching to address health inequity by identifying non-clinical barriers to healthcare access, called social determinants of health. Advocates say that by addressing those barriers, providers can improve access and clinical outcomes while promoting long-term health and wellness.

In the Medi-Cal program, the California Department of Health Care Services (DHCS) used a Section 1115 Medicaid waiver called 'Medi-Cal 2020' and targeted high-risk enrollees with complex health concerns who often used emergency care services, including those with substance abuse issues, recently released prison inmates, people dealing with severe mental health issues, and homeless residents and those in danger of becoming homeless.

According to the UCLA report, the program accomplished three primary objectives. It:

• "Invested in promoting meaningful and diverse partner engagement and buy-in through consistent communication, consensus on strategic priorities, and/or financial incentives;
• Acquired and implemented innovative data sharing platforms needed to support cross-sector care coordination and facilitate data sharing with partners; and
• Were successful in developing appropriate infrastructure (e.g., staffing, standardized protocols) and processes (e.g., needs assessment, care plan, referrals) to support effective care coordination."

And while the program reduced ER visits and hospitalizations, it also saw an increase in the use of certain outpatient services, such as substance abuse treatment and specialty care, while also seeing a decrease in primary and mental health care services.

“The results show that such programs help complex patients in different ways, depending on their needs,” Pourat said in the press release. “Most importantly, our findings highlight the overall success of the Whole Person Care program and its potential for improving the lives of high-risk patients.”​

While the pilot program ended in 2021, state officials are working to expand its services throughout the state as part of a Medicaid overhaul called California Advancing and Innovating Medi-Cal (CalAIM).