Executive Interview: CalOptima Strategy Starts With Mission, Partnership

"We cannot put the burden of the healthcare system's complexities on the member," says CalOptima Interim CEO Michael Hunn.

"I want to start with this," said says Michael Hunn, Interim CEO of the California Medicaid plan CalOptima.

The "this" was two-fold: the MCO's strategic plan, which Hunn held in hand throughout his recent interview with HealthLeaders, and the mission, vision, and partnership behind it. Joined by CalOptima COO Yunkyung Kim ("YK"), the two leaders detailed CalOptima's approach, new funding commitments, and the initiatives they will support—including those tied to the state's innovative new Medicaid demonstration.

As a Medicaid plan, CalOptima has a bird's-eye view into the social determinants of health (SDOH) that impact its more than 862,000 members. This includes individuals enrolled in Special Needs and Medicare-Medicaid Plans (SNP and MMP) as part of Medicare Advantage and PACE (Program of All-Inclusive Care for the Elderly).

Among the individuals with low incomes, disabilities, and special needs that CalOptima serves in Orange County are not only children, families, and seniors but those looking for a new life after incarceration. It is with these vulnerable populations that Hunn began.

Michael Hunn, Interim CEO of CalOptima. Photo courtesy of CalOptima.

Michael Hunn: I want to start with the mission and vision of CalOptima. It reflects the fact that our membership is multicultural, multilingual, and multigenerational. People who need services need to know where to get them and how to sign up. We cannot put the burden of the healthcare system's complexities on the member.

CalAIM is important here. It's about providing for clinical and the nonclinical needs. It's meant to help touch the individual, build equity in the community, and zero in on how we can better understand your needs and help you better.

(Editor's note: CalAIM is a five-year demonstration program authorized by CMS-approved 1115 waivers and State Plan Amendments. Its components include Enhanced Care Management to improve care integration and navigation, nonclinical community supports (e.g., housing, recovery and recuperation care), and technical and infrastructure support for the agencies that provide them. Plans will also be required to create and implement population health management plans and support data sharing.)

Hunn: We're already reaching out to hospitals, physician networks. I'm personally engaging with provider CEOs and executives to talk about what we can do together to be successful.

Yunkyung Kim: It's something we feel every single day. And CalAIM will help. It builds from a lot of other programs that were moving toward more integrative, whole-person care. The learnings from county pilots are allowing the state to expand these efforts.

CalOptima historically has led the way in raising our hands early and proactively to participate in statewide pilot programs such as the Coordinated Care Initiative, Whole Person Care Pilot, and Health Homes. We will use the same "early adopter" strategy when it comes to CalAIM, which will facilitate more diverse, collaborative partnerships and provide more funding.

Yunkyung Kim, COO of CalOptima. Photo courtesy of CalOptima.

HealthLeaders: Speaking of funding, can you also talk more about the additional $45 million investment in the community? I understand there are three main programs to combat homelessness, increase vaccine rates, and pay providers more for better care coordination.

Hunn: The money will help start some initiatives while also improving the existing delivery system infrastructure. We're funding free, multilingual vaccination clinics, which we locate based on county COVID-19 prevalence data. [The current vaccination rate for members aged five and older is 58%.] Members will receive gift cards. YK and I will both be at these clinics. If you're going to work with the community, you better be in the community.

Our homeless effort is another area receiving added funding. After leaving a facility, someone who is homeless is often not ready to go back to the street or a shelter. They need a place to recuperate outside the hospital.

(Editor's note: These efforts build on an existing CalOptima homelessness program that includes shelter-based services and roaming Clinical Field Teams. With CalAIM help, the program will link to housing vouchers and supports.)

Kim: Recuperative care for people who are homeless is another big example of the flexibility CalAIM will provide. Before, we could pay for hospital or SNF care but nothing in between.

Hunn: Housing navigation is also part of this. We had someone in need over the holiday who was authorized for a voucher. CalAIM will add to this, putting deposits down to help people get into housing.

HealthLeaders: Partnership is another thing that it sounds like CalAIM will amplify.

Hunn: I'm already socializing our strategic plan with other CalOptima executives and our board, then key stakeholders. We have a very supportive board.

We also need to figure out and start working on co-creating interagency strategic plans. We have a stellar relationship with Dr. [Clayton] Chau and Dr. [Veronica] Kelley.

(Editor's note: Chau is director of the Orange County Health Care Agency, where Kelley serves as chief of Mental Health and Recovery Services. Chau is also a CalOptima board member.)

We're thinking about things like, how can we co-locate staff so we have the synergy and the collaboration of a team? The same is true for the Community Health Needs Assessment: why can't we take common things and do it together instead of duplicating outreach? The health plan and the county are often not aligned but we are.

Noting his love for operations and strategy, Hunn concluded by adding: "I am blessed to be a leader, and I'm entitled to nothing. I am a CalOptima employee just like everyone else and serving the same mission. We're here for the member. I don't forget that. I’m standing on the shoulders of a lot of people who were at CalOptima before me."

Editor's note: This story was updated on January 18, 2022.