Program for Medi-Cal beneficiaries with complex health needs reduced emergency visits, hospitalizations
UCLA study finds Health Homes Program saved California more than $1,000 per beneficiary per year.
A California program for Medi-Cal beneficiaries with complex medical needs and chronic conditions reduced the number of emergency department visits and hospital stays among its enrollees, according to an evaluation published today by the UCLA Center for Health Policy Research. For those enrollees, the change lowered the annual cost of medical bills — which the state pays — by an average of $1,113 per person, the report found.
About 90,000 people in 12 California counties initially enrolled in the Health Homes Program, which ran from July 2018 to December 2021. The California Department of Health Care Services’ program was open to Medi-Cal beneficiaries who had chronic physical conditions, substance use disorders and/or serious mental illness. It was run by managed care plans that contracted with about 260 community-based care groups to provide comprehensive care management to coordinate physical health, behavioral health and community-based social services.
The largest portion of participants (48%) were between the ages of 50 and 64 years old, 59% were women and 47% were Latino. About 8% of those in the program were experiencing homelessness or were at risk of homelessness during the study period. And participants’ most common chronic conditions, prior to the start of the program, were depression (73%), hypertension (65%) and diabetes (49%).
UCLA researchers measured changes two years before and two years after enrollment and compared the results with data from Medi-Cal beneficiaries who were not enrolled in the program but had similar demographics and health conditions and comparable use of health services.
They found that over that period, visits to emergency departments declined for enrollees in the Health Homes Program, especially those with serious mental illnesses, and that program participants had fewer visits than the control group overall. The overall rate of hospitalizations was also lower for those in the program, with a significant decline among those with chronic health conditions or substance use disorders.
Those enrolled in the program were also more likely to have their high blood pressure under control than those who weren’t enrolled.
“The goal of the Health Homes Program was to address the critical needs of Medi-Cal beneficiaries with a very complex profile who were in need of extensive care management,” said Nadereh Pourat, the report’s lead author and the head of the Center for Health Policy Research’s Health Economics and Evaluation Research Program. “Our intensive assessment showed that the program effectively helped enrollees receive appropriate care in the right settings, keeping them healthier and saving the state thousands of dollars.”
The study also found that during the first six months of enrollment, those in the program tended to use primary and specialty care services more than they had previously and that their use of these services declined after that, indicating they were generally directed to appropriate professionals who could provide needed care.
Additionally, by the end of the study period, participants with mental health care needs used mental health and substance-use services less than those in the control group, suggesting that improvements in their mental health may have reduced the need for more frequent visits.
Overall, the researchers said, people in the Health Homes Program tended to use health care services less — with the exception of a slight increase in long-term care stays — than Medi-Cal beneficiaries who weren’t enrolled.
Faculty Referenced in this Article
Dr. Michelle S. Keller is a health services researcher whose research focuses on the use and prescribing of high-risk medications.
Nationally recognized health services researcher and sociomedical scientist with 25+ years' experience in effectiveness and implementation research.
Dr. Ron Andersen is the Wasserman Professor Emeritus in the UCLA Departments of Health Policy and Management.
Professor of Community Health Sciences & Health Policy and Management, and Associate Dean for Research
EMPH Academic Program Director with expertise in healthcare marketing, finance, and reproductive health policy, teaching in the EMPH, MPH, MHA program
