{"id":67083,"date":"2024-09-05T15:59:14","date_gmt":"2024-09-05T22:59:14","guid":{"rendered":"https:\/\/lapost.us\/?p=67083"},"modified":"2024-09-05T15:59:14","modified_gmt":"2024-09-05T22:59:14","slug":"years-into-historic-efforts-to-close-health-disparities-how-is-medi-cal-doing","status":"publish","type":"post","link":"https:\/\/lapost.us\/?p=67083","title":{"rendered":"Years Into Historic Efforts to Close Health Disparities, How is Medi-Cal Doing?"},"content":{"rendered":"
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By<\/span>Selen Ozturk<\/a><\/div>\n<\/div>\n<\/div>\n
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Palav Babaria from DHCS discusses health disparities in California, and how successfully the ongoing transformation of Medi-Cal is bridging them.<\/p>\n<\/div>\n<\/div>\n

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Over the last few years, Medi-Cal \u2014 California\u2019s version of Medicaid \u2014 has been on the national front lines of reducing health disparities impacting Californians of color.<\/p>\n

Palav Babaria, deputy director of quality and population health management at the Department of Health Care Services (DHCS), spoke with EMS about some of the state\u2019s more glaring health disparities, and how the historic transformation of Medi-Cal has helped bridge the gap.<\/p>\n

Reducing inequity<\/h2>\n

\u201cThere are two major ways we\u2019re approaching health equity,\u201d said Babaria. \u201cOne, we\u2019ve been tracking disparities, especially by race and ethnicity, for over a decade now, and setting bold, measurable goals to reduce them. But reporting on inequity is not enough to change it, so we\u2019ve also been expanding access through CalAIM.\u201d<\/p>\n

CalAIM, short for California Advancing and Innovating Medi-Cal, is a multi-year effort to reduce health disparities through new services like\u00a0street medicine<\/a>, home accessibility modifications,\u00a0medically tailored meals<\/a>, sobering centers and\u00a0housing support<\/a>\u00a0including rent aid, tenancy navigation, transitional housing and daily living skills training.<\/p>\n

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Palav Babaria, deputy director of quality and population health management at the Department of Health Care Services.<\/figcaption><\/figure>\n<\/div>\n

Medi-Cal is also providing\u00a0waivers<\/a>\u00a0for many of these services to Californians who may not otherwise qualify for them.<\/p>\n

To reduce maternal death and illness from conception through 12 months postpartum, Medi-Cal has developed a\u00a0Birthing Care Pathway<\/a>\u00a0coordinating services across various areas of members\u2019 lives; for instance, doula care, nutrition aid and mental health screening.<\/p>\n

\u201cWe\u2019ve been centering members themselves in how we design these programs,\u201d Babaria said. \u201cAs of 2024, all our medical plans in each county are required to have an Advisory Committee that includes community members and Medi-Cal members, and we kicked off a quarterly state-level Member Advisory Committee in 2023 \u2026 so the people experiencing health disparities can tell us how the system needs to change to better meet their needs.\u201d<\/p>\n

\u201cOur health care system is good when you\u2019re urgently sick and you show up to the emergency room or the hospital; people generally have their needs met. What our general health care system is really bad at is preventing people from getting sicker,\u201d said Babaria.<\/p>\n

\u201cMany people, for example, may not have a regular primary care provider screening them for diabetes and counseling them before they develop diabetes or have an amputation,\u201d she continued. \u201cThe purpose of our tracking is to identify who\u2019s at risk of getting sick before that happens to keep them well with preventive visits, and the purpose of these new programs is to address the social drivers of health, to improve the overall outcome of interrelated needs like diabetes, high blood pressure and depression.<\/p>\n

\u201cAltogether, that\u2019s called population health,\u201d said Babaria. \u201cThe concept has been a focus for Medicaid nationally for the last decade or so, but the data to be able to look at how we\u2019re doing at a statewide level has sometimes been lacking,\u201d said Babaria. \u201cNationally, we\u2019re definitely on the leading edge.\u201d<\/p>\n

Medi-Cal is tracking much of its progress through its\u00a050\u00d725 initiative<\/a>, a CalAIM campaign launched in 2022 to reduce disparities and improve care by 50% in three areas: children\u2019s preventive health, maternity care and behavioral health, which includes mental health and substance use disorder.<\/p>\n

Disparities in these areas vary between counties and races, but some goals like Asian and Hispanic or Latino youth preventive care visits and immunizations are already met, while other goals like maternity care for Black and Native American women are nearly met.<\/p>\n

The goals where disparities remain high include prenatal depression screening, which has a statewide rate of 10% against a goal of 15%, although some regions like southeastern and far northern California have rates as low as 3%, or are unreported altogether.<\/p>\n

Disparity also persists for substance use disorder engagement and follow-up for an emergency department substance use disorder visit, with a statewide rate of 7% against a 14% goal for treatment and a 16% statewide rate against a 24% goal for follow-up.<\/p>\n

However, these metrics were last reported in 2021 and 2022. An update with more recent data measuring the progress of Medi-Cal since then is expected this August.<\/p>\n

Listening sessions<\/h2>\n

\u201cThere\u2019s a common saying in the healthcare world that every system is perfectly designed to get the results that it produces, and we know that our current system isn\u2019t working for some of our members,\u201d said Babaria.<\/p>\n

To hear directly from members experiencing this inequity, Medi-Cal also launched its three-phase, five-year\u00a0Health Equity Roadmap Initiative<\/a>.<\/p>\n

For the first phase, begun in November 2023 and now complete, DHCS staff held 11 listening sessions hosted by community-based organizations statewide, to listen to hundreds of Medi-Cal members about the challenges that prevent them from getting the health care they need \u2014 particularly for members from communities of color, those with disabilities, those in rural areas and those with behavioral health issues like substance abuse disorder.<\/p>\n

\u201cThe most resounding, consistent piece of feedback we got is that it\u2019s really hard to navigate and access all of the different Medi-Cal programs,\u201d she added. \u201cSometimes it\u2019s because there are weeks- or months-long wait times for appointments, or members haven\u2019t updated their contact information and we don\u2019t know how to reach them, or sometimes it\u2019s because we just have a very complicated health care system and our members don\u2019t know that dental, maternal or behavioral health services are even available.\u201d<\/p>\n

\u201cWe got a lot of requests for more behavioral health services, and that\u2019s a nationwide phenomenon,\u201d said Babaria. \u201cWe don\u2019t have as much capacity as the demand, especially after the pandemic, when we saw a lot more people having issues with mental health or substance use needs \u2026 and we experienced provider shortages, especially those who could speak members\u2019 native language, and often in rural areas and smaller counties.\u201d<\/p>\n

To expand information accessibility, Medi-Cal has set translation and interpretation\u00a0requirements<\/a>\u00a0in 18 threshold languages for health plans in all counties in California.<\/p>\n

Threshold languages \u2014 including Arabic, Chinese, Korean, Russian, Spanish, Tagalog and Vietnamese \u2014 are the primary language of 3,000 members or 5% of the member population in a county, whichever is lower.<\/p>\n

As of\u00a0March 2024<\/a>, non-enrolled Californians newly eligible for Medi-Cal spoke mostly English (197,469) and Spanish (125,722), with the next-highest being unreported (10,834) and Russian-speaking members (3,893).<\/p>\n

\u201cIn Phase 2, we\u2019re taking what we\u2019ve heard from members in the listening sessions and figuring out what solutions look like,\u201d said Babaria. \u201cOften, state health care policy is developed with providers and advocates, but members getting these services are not at the table. We want to do a co-design process where members themselves identify our biggest priorities,\u201d said Babaria. \u201cIn Phase 3, we\u2019ll turn those priorities into a timeline of goals we can measure.\u201d<\/p>\n

\u201cIf you want to close health disparities, you can\u2019t do that without the people most affected by it being at the table and having a voice in the process. We\u2019re at the beginning of that journey,\u201d she added. \u201cHaving these communities guiding our process at the local level is how we\u2019re going to make sure that we see measurable changes down the road.\u201d<\/p>\n<\/div>\n<\/div>\n","protected":false},"excerpt":{"rendered":"

BySelen Ozturk Sep 5, 2024 Palav...<\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"closed","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[6,16,9],"tags":[],"class_list":["post-67083","post","type-post","status-publish","format-standard","hentry","category-ca-local","category-health","category-opinion"],"_links":{"self":[{"href":"https:\/\/lapost.us\/index.php?rest_route=\/wp\/v2\/posts\/67083","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/lapost.us\/index.php?rest_route=\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/lapost.us\/index.php?rest_route=\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/lapost.us\/index.php?rest_route=\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/lapost.us\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=67083"}],"version-history":[{"count":1,"href":"https:\/\/lapost.us\/index.php?rest_route=\/wp\/v2\/posts\/67083\/revisions"}],"predecessor-version":[{"id":67084,"href":"https:\/\/lapost.us\/index.php?rest_route=\/wp\/v2\/posts\/67083\/revisions\/67084"}],"wp:attachment":[{"href":"https:\/\/lapost.us\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=67083"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/lapost.us\/index.php?rest_route=%2Fwp%2Fv2%2Fcategories&post=67083"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/lapost.us\/index.php?rest_route=%2Fwp%2Fv2%2Ftags&post=67083"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}