Northern California Medi-Cal Onboarding: Upstream Engagement

Abstracts from the Kaiser Permanente2018 National Quality Conference


Sarita Mohanty, MD; Bryan K Lee, MD; Molly Drebes, MS;
Irene Alvarez-Zamzow, MPH

From Northern California

Background: The Affordable Care Act and Kaiser Permanente’s (KP’s) own efforts to enroll more Medi-Cal-eligible patients led to an influx of new members (85% increase from 2013-2017), challenging KP Northern California (KPNC) to meet the social, behavioral, and medical needs of this population. Medi-Cal members have a higher rate of avoidable, high-cost utilization; gaps in access to preventive care; and are more likely to face behavioral health and nonmedical social needs that impact their health, such as financial barriers and food insecurity.
Methods: New member onboarding (NMO) began in the Sacramento Valley Area in Fall 2015 and has since spread to the Napa-Solano Area and Greater Southern Alameda Area. NMO intervention has six key components: 1) family calls, 2) robust orientation, 3) resources and referrals, 4) scheduling, 5) medication concerns, and 6) documentation enhancements. Process and outcome measures are: Initial Health Assessment (IHA) completion rate (physical exam and questionnaire), Emergency Department visits, patient days, clinic visits, and total cost. NMO evaluation has three components: 1) monthly IHA performance monitoring, 2) observational/case control-matched evaluation (initial results complete), and 3) randomized control trial evaluation (results expected Q3 2018).
Results: Performance results indicate significantly higher IHA completion rate compared with KPNC for the 3 locations that have implemented NMO (Sacramento Valley, Napa-Solano, Greater Southern Alameda), (24.1% for the 3 locations compared to 4.5% for other KPNC locations). The observational/case control-matched evaluation conducted by KP Decision Support and Division of Research KPNC showed that overall, related to the matched control group, Sacramento Valley new Medi-Cal members (cases) showed higher nonpsychiatric patient days, higher Emergency Department visits, lower clinic visits, and lower cost. The subanalysis of Sacramento Valley Medi-Cal adults who completed the IHA (cases) showed lower nonpsych patient days (significant, 46% lower), lower Emergency Department visits (11% lower), higher clinic visits (significant, 23% higher), and higher cost (10% higher) than non-Sacramento Valley Medi-Cal adults (matched control) who did not complete the IHA.
Discussion: NMO is showing promising results. NMO is successful in increasing the IHA completion rate for the three locations that have implemented NMO (Sacramento Valley, Napa-Solano, Greater Southern Alameda), indicating early engagement with the member’s primary care physician. The initial evaluation indicates it is possible that the intervention had a favorable impact (lower avoidable high-cost services and higher rates of outpatient services) on members who completed the IHA. Next steps are to continue evaluation efforts, which will include the randomized evaluation (Q3 2018), quality outcomes, no-show rate, pharmacy script rate, patient satisfaction, and trending over time members that received NMO intervention.

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