CalAIM: Population Health Management

Health Net’s Participation in Counties’ Community Health Assessments (CHAs) and Community Health Improvement Plans (CHIPs)

Health Net Counties

Health Net is contracted with DHCS to provide Medi-Cal services in the following California counties. Through meaningful collaboration with the Local Health Jurisdictions (LHJs), partnership with other Medi-Cal Manage Care Plan partners, and engagement with local CBOs and stakeholders, Health Net is actively participating in the Community Health Assessment (CHA) and Community Health Improvement Plan (CHIP) processes in all of the counties we serve. Health Net’s CHA/CHIP participation includes, but is not limited to, providing funding support, exchanging relevant data, joining local CHA/CHIP governance committees, and engaging/including Health Net members and providers in applicable CHA/CHIP events or activities.

The following are links to the CHA/CHIP information for counties in which Health Net is contracted and participating in the local process:

Los Angeles County, City of Long Beach and City of Pasadena

Population Health Management (PHM) Program

As part of the California Advancing and Innovating Medi-Cal (CalAIM) initiative and pursuant to state law, the Department of Health Care Services (DHCS) is implementing a Population Health Management (PHM) Program. The PHM Program seeks to establish a cohesive, statewide approach to all populations that brings together and expands upon many existing population health strategies. Population Health Management is a comprehensive, accountable plan of action for addressing Member needs and preferences, and building on their strengths and resiliencies across the continuum of care that:

• Builds trust and meaningfully engages with Members;
• Gathers, shares, and assesses timely and accurate data on Member preferences and needs to identify efficient and effective opportunities for intervention through processes such as data-driven risk stratification, predictive analytics, identification of gaps in care, and standardized assessment processes;
• Addresses upstream factors that link to public health and social services;
• Supports all Members staying healthy;
• Provides care management for Members at higher risk of poor outcomes;
• Provides transitional care services for Members transferring from one setting or level of care to another; and
• Identifies and mitigates social drivers of health to reduce disparities

The launch of the PHM Program is part of a broader arc of change to improve health outcomes that is further articulated in DHCS' Comprehensive Quality Strategy (CQS) (PDF), which emphasizes the long-lasting impact of coupling quality and health equity efforts with prevention. Under the PHM Program, Medi-Cal Managed Care Plans (MCPs) and their networks and partners are responsive to individual member needs within the communities they serve while working within a common framework and set of expectations. While the PHM Program is a statewide endeavor that interacts with other delivery systems and carved-out services and requires meaningful engagement and partnerships with members and other stakeholders, the requirements outlined in the PHM Policy Guide (PDF) apply specifically to MCPs.

Population Needs Assessment (PNA) and PHM Strategy

The Population Needs Assessment (PNA) is the mechanism that MCPs use to identify the priority needs of their local communities and members and to identify health disparities. Under the PHM Program, MCPs fulfill their PNA requirement by meaningfully participating in the Community Health Assessments (CHAs)/and Community Health Improvement Plans (CHIPs) conducted by Local Health Jurisdictions (LHJs). DHCS' vision is for the PNA process to evolve to help either initiate or strengthen engagement among MCPs, LHJs, and community stakeholders over time, fostering a deeper understanding of the health and social needs of members and the communities in which they live through cross-sector partnerships. This collaboration will ultimately enhance MCPs' ability to identify needs and strengths within members' communities so that MCPs and their community partners can reduce siloed approaches to Population Health Management and more effectively improve the lives of members.

Population Needs Assessment (PNA) Requirements
(Updated May 2024)

APL 23-021 (PDF), effective January 1, 2023, established that:

• MCPs must meaningfully participate in the current or next available cycle of each LHJ's CHA/CHIP in the service areas where the MCP operates.
• MCPs must submit to DHCS a new annual "DHCS PHM Strategy Deliverable" to update DHCS on the progress of this engagement and provide other updates on the PHM Program to inform DHCS' monitoring efforts.
• MCPs are no longer required to submit an annual PNA and PNA Action Plan under the requirements of APL 19-011 (PDF), which is retired.
• MCPs remain accountable for meeting cultural, linguistic and health education needs of members, as defined in state and federal regulations.

MCPs were required to use 2023 as an initial planning year. In the fall of 2023, all Prime MCPs were required to meet with the LHJs in their service areas to begin planning how they will meaningfully participate in the CHA/CHIP on the next cycle and develop shared goal(s) and "SMART" objective(s) that are aligned with DHCS Bold Goals. MCPs were required to submit the inaugural DHCS PHM Strategy Deliverable (PDF) as an introductory step, showing that they had conducted this initial engagement. MCPs were also required to submit to DHCS the NCQA PHM Strategy they submitted to NCQA. MCPs must also continue to follow all applicable NCQA requirements.

In 2024 and beyond, MCPs are required to continue to work with LHJs on CHAs/CHIPs, following the guidance on specific aspects of that joint work as set out below. Given that a core strength of LHJs' CHAs/CHIPs is that they are driven by the unique needs of each community, the requirements outlined below provide overarching guidance but are not intended to be overly prescriptive. The intent is to continue to support these locally driven assessment processes, rather than to mandate a standardized process that all California communities must follow.

Timelines

DHCS and CDPH are collaborating to create a regulatory environment that supports effective and efficient joint work on CHAs/CHIPs between LHJs and MCPs. Thus, aligned with forthcoming CDPH guidance, the cycles for LHJs' CHA/CHIP development will become standardized across California starting in 2028.

• Between 2024 and 2027, LHJs' CHAs/CHIPs will largely remain on different cycles. MCPs will be required to work with each LHJ on its CHA/CHIP according to the guidance below. Some LHJs will be expected to complete a CHA, others a CHIP, and others a full CHA/CHIP cycle within this three-year window.
• Starting in 2028, all LHJs will be expected to be on the same three-year cycle with the LHJ CHA to be completed in December 2028 and the CHIP to be completed by June 30, 2029.

Collaboration Requirements in Jurisdictions with Differing MCP Contracting Arrangements

To initiate or advance meaningful collaboration between LHJs and MCPs at the local level, each Prime MCP must participate in the CHA/CHIP process led by each LHJ, including the three city LHJs, in their service area. Thus, a Prime MCP working in several LHJs must participate in multiple CHAs/CHIPs. Prime MCPs must ensure that any populations covered by a subcontracted MCP are included in their PNA process; that is, subcontracted MCPs do not have to complete a separate PNA process but must be included in the process their Prime MCP has with the LHJ.

When multiple Prime MCPs operate in the same service area, MCPs must collaborate with each other as well as with the LHJ to foster a unified planning process. MCPs must coordinate on what types of staffing/funding are provided and what data is to be shared, as well as communications with the LHJs.

Requirements for MCPs to Contribute Resources to Support CHA/CHIP Processes

As part of meaningful participation in LHJs' CHAs/CHIPs, MCPs are required to contribute resources to support LHJs' CHAs/CHIPs in the service areas where they operate, in the form of funding and/or in-kind staffing, starting on January 1, 2025. MCPs are strongly encouraged to contribute these resources in a manner that is at least commensurate with the number of Medi-Cal members served by the MCP within a given LHJ jurisdiction.

Effective January 1, 2024, MCPs are required to work with LHJs to determine what combination of funding and/or in-kind staffing the MCP will contribute to the LHJ CHA/CHIP process. See below for examples of types of funding and/or in-kind staffing that MCPs may contribute to LHJs' CHAs/CHIPs. Effective 2024, MCPs are required to describe their resource contribution decisions in their MCP-LHJ Collaboration Worksheet and report to DHCS on their contribution decisions via their annual DHCS PHM Strategy Deliverable submission, as described in the sections below and in a form and manner specified by DHCS.

• Funding: MCP funding to LHJs for CHA/CHIP-related activities may be for purposes including but not limited to:
  • Administrative support
  • Project management
  • Consultants who specialize in providing support on CHAs/CHIPs (e.g., data collection and analysis, stakeholder outreach and meeting facilitation, subject matter experts on topics such as the MAPP process, report writing)
  • Governance (convening support, etc.)
  • Data infrastructure (e.g., web-based data-visualization tools, technology to support data sharing and analysis, and consultants/training to analyze data)
  • Community engagement (e.g., incentives/food for community participation, funds for childcare, and gas cards)
  • Communications (e.g., funding for media/messaging about CHA, sharing success stories, and consultants)
  • Contracts with CBOs
  • Implementation strategies (specific to CHIP)
  • TA sessions for LHJs/MCPs.
• In-Kind Staffing: MCPs may contribute staffing or support for project management, data analysis, stakeholder engagement activities, or other administrative items. Staff or consultants contributing to these projects must have relevant public health background, and subject matter and technical expertise in the specific area where the LHJ seeks advice (e.g., if the LHJ would like expertise on understanding maternal health hospital utilization data, the MCP should provide a staff member with requisite expertise in maternal health and data analysis). MCP staff and/or consultants supporting these projects should ideally have experience in conducting health assessments.
• Intersection with Community Reinvestment Requirements: MCP funding and/or in-kind staffing contribution to the LHJ CHA/CHIP is a separate and distinct requirement from Community Reinvestment, which requires MCPs with positive net income to invest a portion of their net income into communities in which they operate. However, MCPs are prohibited from using Community Reinvestment funds on activities included in the MCP Contract or carved out of the MCP Contract but covered under Medi-Cal; therefore, these funds are not permissible for the CHA or CHIP development.

APL 25-004 (PDF) outlines MCP requirements for Community Reinvestment, including the specification that activities are informed by and aligned with the LHJs‘ CHAs and that LHJs are included in MCPs' Community Reinvestment planning and decision making processes. DHCS strongly encourages MCPs to allocate Community Reinvestment funding toward activities identified in the CHIP. As part of Community Reinvestment Plan submissions to DHCS, MCPs are required to submit attestations from Public Health Directors of each LHJ in the MCPs' service areas indicating the investment strategy is generally agreeable to the LHJ and aligns with community needs identified in the CHA/CHIP.

Stakeholder Engagement

As noted above, LHJs' CHAs/CHIPs generally involve a wide array of stakeholders. MCPs working on LHJ CHAs/CHIPs will benefit over time from cultivating stronger relationships not only with the LHJs, but also with other participating community stakeholders, which represent different racial/ethnic groups, CBOs, and various sectors— including: education, housing, and other health and social providers in the community.

Effective January 1, 2024, as part of meaningfully participating in the LHJ CHA/CHIP process, MCPs are expected to:

• Attend key CHA/CHIP meetings as requested by LHJs.
• Serve on the CHA/CHIP governance structure, including CHA/CHIP subcommittees, as requested by LHJs.

MCP staff serving as representatives at these meetings must have relevant public health background, relevant subject matter and technical expertise and appropriate decision making authority at the MCP to be able to make decisions quickly or get the necessary approvals for actions to be taken quickly.

Community Advisory Committees

In addition, effective January 1, 2024, MCPs are required to engage their Community Advisory Committees (CACs) as part of their participation in the LHJs' CHA/CHIP process. Specifically:

• MCPs must regularly report on their involvement in and finding from LHJs' CHAs/CHIPs to their CACs.
• MCPs must obtain input/advice from their CACs on how to use findings from the CHAs/CHIPs to influence MCPs strategies and workstreams related to the Bold Goals, wellness and prevention, health equity, health education, and cultural and linguistic needs.
• Over time, MCPs are encouraged to work with LHJs to rely on MCPs' CACs as a resource for stakeholder participation in LHJ CHAs/CHIPs (e.g., answer survey questions, and participate in focus groups, workgroups, and governance committees).