Review of Whole Person Care Program Shows Significant Decrease in Overall Costs

13 Feb, 2023 F.J. Thomas

                               

Sarasota, FL (WorkersCompensation.com) – A recent program review released by the UCLA Center for Health Policy Research could potentially offer valuable insight for all sectors of the healthcare industry, especially when it comes to costs.  

While fee for service has been the industry standard for many years, in most recent years the healthcare industry has experimented with different alternative payment models or APMs as related to outcomes and costs.  In general, an APM is an alternative payment structure that requires providers meeting a specific outcome quality and costs goals. Although APMs are primarily seen with Medicare and Medicaid, some commercial plans have trialed APMs as well. 

Because overall outcomes and costs are monitored closely by the payers, one ancillary advantage for providers participating in an APM is the reporting that they share. Payers will usually provide in depth reporting to support their payment and distribution calculations. Providers can use that data in a multitude of ways to improve their patient care and business practices, and additionally build strategic relationships that can help in other areas of business. 

In 2016, California implemented the Whole Person Care program for their Medicaid program. Running until 2021, the program included 247,887 covered lives across 26 counties and 25 pilot projects. The cost of the program was $3.6 billion. Care of these patients took a holistic approach, which coordination of care across not only healthcare providers and specialists, but with behavioral health and social workers. 

As common with Medicaid programs, the covered population in the care program was high utilization and high risk. Severe mental health, substance abuse, and chronic conditions were common among patients. Thirty-seven percent had depression, 34 percent had anxiety, and 26 percent had schizophrenia and psychotic disorders. Thirty-two percent had substance abuse disorders, and 21 percent had alcohol use disorders. Over a third at 33 percent had chronic conditions such as hypertension. 

Additionally, there were patients that had recently been released from prison, were homeless, or were in danger of losing their home. The program allowed these patients to access not only usual medical care, but also mental health providers, social workers, housing resources, as well as transportation assistance. Overall, there were more than 500 social support organizations that patients had access to through the program. 

According to the UCLA program review, the program dropped costs by $383 per person per year. Additionally, the program resulted in  a reduction of 45 hospitalizations. Emergency department visits were decreased as well, with 130 less visits per 1,000 patients. 


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    About The Author

    • F.J. Thomas

      F.J. Thomas has worked in healthcare business for more than fifteen years in Tennessee. Her experience as a contract appeals analyst has given her an intimate grasp of the inner workings of both the provider and insurance world. Knowing first hand that the industry is constantly changing, she strives to find resources and information you can use.

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