Health Net, based in Woodland Hills, California, is making strides in improving healthcare management for its members. In 2023, they launched a new initiative that fosters collaboration between health plan managers, hospital clinicians, and medical group clinicians. This effort aims to enhance outcomes for Medicaid beneficiaries in California.
This innovative partnership involves Health Net, Dignity Health, and Vivant Health. Together, they have managed to reduce unnecessary hospital admissions significantly, making more resources available for emergency care. This collaboration has not only improved patient care but also created a more efficient healthcare system.
In just the first year, the partnership achieved remarkable results:
- They avoided over 400 unnecessary hospital stays.
- Patients who attended a follow-up appointment post-discharge rose from 76% to 96%.
- They saved an estimated $1.7 million in costs.
Anshul Dixit, M.D., the supervisory medical director at Health Net, explained that the program began with a contract signed in February 2023. It will run for three years. A key feature of the initiative is placing nurses from Vivant Health directly in the hospital. These nurses collaborate closely with Dignity Health’s care management, speeding up patient discharges while considering everyone’s perspectives in treatment.
CalAIM, California’s initiative aimed at improving Medi-Cal services, supports this effort. It focuses on comprehensive approaches to healthcare, including social services that address issues beyond traditional medical needs. This includes support for behavioral health and substance abuse, ensuring members receive well-rounded care.
The program also holds weekly meetings with a diverse team that includes physicians, nurses, case managers, and social workers. Together, they prioritize the best interventions for patients, avoiding unnecessary procedures and focusing on those that add real value.
Creating a respectful culture is another focus of the initiative. Team members are encouraged to voice their opinions, which helps shape patient care plans. Such collaboration is essential in avoiding unnecessary hospital stays and improving care transitions.
However, they faced challenges. Coordinating schedules and aligning efforts across busy clinical teams proved difficult at times. Yet, with creativity and commitment, they found solutions, ensuring that patients receive timely follow-up care after discharge.
The lessons from this initiative are clear: gathering the right people in a room can help dismantle barriers to care. With strong partnerships, Medicaid can provide better value-based care. This coordinated approach not only addresses physical health needs but also tackles the social issues affecting many beneficiaries.
Across the country, this model of care can inspire similar initiatives. Medicaid often leaves members underserved in traditional setups, making it crucial to find innovative ways to address their complex needs. With collaboration, there’s potential for a healthier future for many.
For more insights on California’s healthcare initiatives, visit the California Department of Health Care Services.
Check out this related article: New Law Enhances Youth Access to Behavioral and Complex Health Care Services
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