By: Neil A. Solomon, MD, Co-Founder & CMO
Laurie Sprung, PHD, MPH, EVP, Product & Innovation
For years, there has been increasing awareness of how social determinants cause health disparities for the most vulnerable high-risk segments of our population. Those patients living with chronic health conditions and social barriers have historically been challenged with navigating complicated healthcare infrastructures, administrative hoops, and an overall lack of integration for access to services that address the complex realities of their lives. For many, this can feel like being trapped in a maze, between the stress of frequent hospital visits, the challenge of remembering all the directions provided by varying parties, and the hopelessness of not being able to access needed social services. It is little wonder that the costs of caring for vulnerable at-risk populations keep spiraling out of control. While many innovative solutions aim to close the health equity gap, the state of California has proposed comprehensive solutions in the upcoming CalAIM reform, specifically in the Enhanced Care Management (ECM) initiative, which intends to improve outcomes and make for a more seamless delivery system for high-risk high-cost patients.
The new ECM changes will soon go into effect for California health plans and managed care organizations’ high-risk members. Slated to begin in 2020 initially but pushed due to Covid-19, beneficiaries will soon start to see changes and what should be an improved patient experience that aims to seamlessly integrate a wide array of social services and medical care. Built on the foundation of Health Homes and Whole-Person Care programs, ECM is now in the planning stages, with implementation slated to go live in January 2022. While not losing sight of the sensitive nature of frail patients in current programs, health plans are scrambling to design transition plans that successfully roll out and migrate members to adhere to the new reforms. In addition, it is widely believed that the state has pinned provider groups as best suited to manage and execute the delivery of the new regulations, given the focus on integrated care. That said, most provider groups are not built to engage hard-to-reach members and coordinate the various vendors and range of services not commonly thought of as health-related. As a result, many provider groups and MCOs will struggle to manage the changes and will require strong partnerships to successfully deliver these complex services to beneficiaries.
MedZed, a complex care-focused, mobile medical practice exclusively serves high-risk patients facing health inequities by delivering social, physical, and behavioral care to vulnerable populations. We believe that interdisciplinary staffed provider groups could be uniquely positioned to facilitate the new ECM services. Health plans will need an innovation catalyst: nimble partners able to adapt, to transition, and to realize early impacts from the ECM roll out. MedZed was built for this, offering integrated care models to meet the realities of underserved populations. We are excited to support health plans and offer our experience integrating social and medical care in this transition to ECM. Our scalable model includes best-in-class engagement, complex clinical care, care coordination, and our experience as a community-based care management entity (CB-CME) make us an excellent resource for implementing ECM services.
The penultimate goal of CalAIM is to improve clinical care outcomes. This will be achieved by increasing access to needed services, and by better stitching together the separate parts of the health care delivery system that today are often operating in silos. While we realize all the proposed solutions in ECM may not live within one organization, we at MedZed are preparing by attending state meetings, reading DHCS documents, meeting with our health plan partners, and preparing our staff for the transition from Health Home and Whole-Person Care programs to ECM. We are already planning for the many programmatic transitions that our patients will need to go smoothly. We expect we will need to learn new In Lieu of Services providers in each geography we serve. We are also exploring how to optimize integration of ECM and medical services, both where we deliver primary care when it is needed, and supporting where it is provided by community clinics, provider groups or independent PCPs. We are embracing the coming changes, recognizing that this is a work in progress. We are excited to continue to serve some of the most challenged members of our state to live healthier and more successful lives.
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Neil A. Solomon, M.D., Co-Fouder and CMO
Neil is Co-Founder and Chief Strategist at MedZed, where he is responsible for developing our service programs, overseeing our CareForce, and establishing our clinical processes. He is a graduate of the Yale University School of Medicine and Board Certified in Internal Medicine.
Laurie Sprung, PhD, MPH, EVP, Product & Innovation
Laurie is responsible for program development, marketing, and client relations at MedZed. Laurie has over 20 years consulting health systems and physician groups around strategy, growth, and the overall transition to value. Laurie earned a Doctor of Philosophy and a Master of Arts in clinical psychology from Syracuse University.
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