This document discusses how Medicaid waivers can expand whole-person care approaches. It provides examples of whole-person care pilots in California and Minnesota that integrate services across medical, behavioral health, and social services. These pilots aim to improve outcomes, patient experience, and lower costs. The document also discusses how care coordination platforms can help overcome challenges of data sharing, privacy, and interoperability across different provider types to better coordinate whole-person care.

1. HowdoMedicaid
WaiversExpand
thePossibilities
ofWhole-Person
Care?

2. Today's Healthcare Landscape
POOR HEALTH
OUTCOMES
INCREASED
PROVIDER COSTS
The healthcare landscape is
fragmented, with services split
among multiple programs and
providers
The silo-ed approach subjects
individuals to overlapping and
non-coordinated care plans,
leading to:

3. Medicaid Reform
• Medicaid reform is a hot
topic in political and
medical circles due to the
recent change in
administration
• State Medicaid programs
must find innovative ways
to improve patient
outcomes and reduce costs
due to the likelihood of
decreased federal funding

4. Why Medicaid Waivers?
The waiver system allows the Department of Health
and Human Services (HHS) to approve experimental,
pilot, or demonstration projects for states that
promote the objectives of the Medicaid system

5. Section 1115 Medicaid Waivers
• Section 1115 Medicaid Waivers empower
states to try experimental programs that:
-Provide additional services
-Reach targeted populations
-Introduce innovations in service delivery
• States maintain control at the local level over
programs that fit their unique needs – a key
theme in healthcare reform discussions

6. Medicaid Waivers
TYPES OF INNOVATIVE
MEDICAID PROGRAMS
INCLUDE:
• Expanding eligibility to individuals
who are not otherwise eligible
• Providing services not typically
covered by Medicaid
• Using innovative service delivery
systems that improve care,
increase efficiency, and reduce
costs
Health of a Population
Experience of Care Per Capita Cost
IHI TRIPLE AIM

7. Medicaid Waivers Drive Innovation
Medicaid Waivers are the functional vehicle that allows states to experiment
with programs that reduce overall costs, improve care, and maintain program
control at the state or regional level
Reduced Program
Costs for States
Increased Program
Control for States Improved
Patient Care

8. 1115 Whole-Person
Care Waivers

9. • Whole-person care is the rare
program that delivers desired
objectives to all stakeholders in the
healthcare ecosystem
• Whole person care treats the full
scope of patient needs jointly,
whether those needs are medical,
behavioral, socioeconomic, or other
needs
• Medical, behavioral health, and
community-based service providers
collaborate on patient care
What is a Whole-Person Care Waiver?
Whole Person Care
Coordination
Primary Care
Behavioral HealthCommunity-Based
Organizations

10. Whole Person Care
WHOLE-PERSON CARE HOLDS THE
POTENTIAL OF DELIVERING MULTIPLE,
DESIRABLE BENEFITS
Improve health outcomes by
addressing multiple conditions
simultaneously
Improve the patient
experience by eliminating
healthcare silos which lead
to redundancy and waste
Drive delivery
system and
payment reform
Avoid costlier, more
intensive care settings,
such as emergency or
institutional care
Lower overall
system cost

11. State Examples
CALIFORNIA

12. California
MEDI-CAL 2020
PROGRAMS
• Medi-Cal 2020 is a five year 1115 waiver
program that seeks to integrate the principles
of whole-person care with the state Medicaid
system
• The whole-person care pilot is not a single
standardized program, rather, multiple
programs will run concurrently within the state,
each with its own objectives and metrics

13. California
MEDI-CAL 2020
PROGRAMS
SOME OF THE DIFFERENT PROGRAMS
FOCUS ON:
Reducing resources consumed by
healthcare super-utilizers
Providing housing services for people
experiencing homelessness as a way
to improve health outcomes
Improving provider communication
across disparate systems

14. “The Whole Person Care Pilot
challenges county agencies, health
plans, and service providers to think
differently about how they work with
one another and most importantly, to
put patients at the center of that
redesign . . .these new ways of thinking
and collaborating have the power to
improve care in the safety net for all
patients.”
BRIANNA LIERMAN
Chief Executive Officer,
Local Health Plans of California

15. EXAMPLE:
San Francisco
Despite numerous
well-regarded programs to
provide care for San
Francisco’s homeless
population, many among
this group suffer poor
physical and mental health

16. EXAMPLE:
San Francisco
Under the Whole-Person
Care Pilot, San Francisco will
invest in technology
infrastructure to enable data
sharing across programs and
providers. The program’s
goals include:
Real-time data sharing across agencies
Universal assessment tool
Improved care coordination
A city-wide navigation system

17. State Examples
MINNESOTA

18. • Fragmented healthcare delivery system
• Super-utilizers consume a large share of healthcare
resources
• Unnecessary hospitalizations and emergency department
visits drive higher costs
• Lack of care coordination results in poor health outcomes
Minnesota
Problem

19. Minnesota has established multiple initiatives to
transition to whole-person care throughout the
healthcare delivery system, including:
• Establishing fully accountable communities of care
• Identifying those whose health may be at risk
because of nonmedical issues by supplementing
medical information with data from other
agencies, including:
-The corrections department
-Foster care system
-Housing providers
• Improving care coordination for individuals who
are eligible for Medicaid and Medicare
(dual-eligibles)
Minnesota
Hospital
Financial Care
Management
Behavioral
Health
Social Services
PharmacyTransportation
Housing
Food/Nutrition
Solution

20. Boosting Whole-Person
Care Through Technology

21. Technology
for Whole-Person
Care
The high level of
communication and
coordination among
providers that characterizes
whole-person care demands
a technology platform that
enables and enhances this
type of care coordination
Medical
Providers
Mental Health
Providers
Intellectual and Developmental
Disabilities Providers
Homeless Service
Providers
Care Coordination
& Reporting

22. Technology
for Whole-Person
Care
Regardless of the specific
delivery model, a
whole-person care system
inevitably involves:
Data sharing across systems,
programs, and departments
Numerous tracking metrics to
gauge the effectiveness of the
demonstration program
Collaboration among multiple
providers

23. Technology
Challenges
Legal and privacy concerns
over sharing patient data
Lack of a common data structure
across disparate systems
Interoperability across multiple
systems and disciplines, each
with unique data requirements

24. Legal and
Privacy Issues
• HIPAA standard security is required for all
systems
• Behavioral health providers require stricter
security for 42 CFR Part 2 regulations
• HIPAA allows sharing data for medical
reasons, such as coordination of care
• All providers should adhere to “minimum
necessary” standard for viewing patient data

25. Determining a
Standard Data
Structure
• Using standard tools simplifies data sharing.
Hennepin Health and the San Francisco
whole-person care pilot used standardized
assessment tools to standardize data
collection across providers
• Determining a data standard is a necessary
component of designing a large-scale system
for data sharing. For example:
-Some programs use a unique patient
identifier to identify an individual across
multiple systems and programs
-Other programs choose to use identification
algorithms to match patient records across
systems

26. • Patients have complex health needs and it is
next to impossible to deliver whole-person
care when providers have inaccurate data
• Interoperability is needed in order to share
data from one provider to another
• HL7 standards enable the transfer of clinical
and administrative data between multiple
providers
Achieving
Interoperability

27. Characteristics of a Modern
Care Coordination Platform

28. Characteristics
of a Care
Coordination
Platform
Full medical history, including care
provided by social services to
address the social determinants of
health
Patient Care Plans
Identify and qualify patients
automatically based on defined
program criteria
Program Eligibility Evaluation
Add patients to a waitlist for services
Waitlist

29. Characteristics
of a Care
Coordination
Platform
Interoperability
Able to share data across various medical health, behavioral
health, social service, HIE, and other required systems
Data Integrity Checking
The system runs checks to validate data and ensure accurate
data entry to prevent data error and redundancy
Online portal
Web-based portals simplify the process of data collection,
reporting, and collaboration between patients and providers

30. Characteristics
of a Care
Coordination
Platform
Flexible configuration
One size does not fit all.
Care coordination
platforms must adapt to
the unique needs of
individual programs and
providers
Reporting and analytics
Pilot programs, such as
1115 waivers, depend on
accurate data to analyze
program results. Powerful
reporting and analytics are
essential to program goals

31. Whole Person Care
Coordination
Primary Care
Behavioral HealthCommunity-Based
Organizations
Conclusion
• Change in healthcare is almost certain as we move foward
• Many states are using Section 1115 Waiver programs to enact
whole person care pilot programs
• Communication and collaboration across medical, behavioral
health, and community-based providers will be key to achieving
whole-person care
• Modern care coordination systems exist that simplify the
process of delivering whole-person care across disparate
providers and systems of care and enable innovation

32. Conclusion
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