ACT.md, a national provider of healthcare collaboration software, today announced a partnership with the San Joaquin Community Health Information Exchange in California to implement ACT.md’s care coordination platform for San Joaquin County’s Whole Person Care pilot program. Whole Person Care is a state of California cross-sector and multi-disciplinary strategy to coordinate the provision of health, behavioral health, and social services for Medicaid populations with complex health and social needs.
Whole Person Care is focused on a particularly vulnerable group of California Medicaid beneficiaries who have been identified as high utilizers of multiple systems in the county with poor health outcomes. The integrated Whole Person Care model is designed to address social determinants of health, which are the non-medical factors that affect health, such as housing instability, utility needs, food insecurity, interpersonal violence, and transportation, and which account for up to 60 percent of health outcomes. San Joaquin County’s WPC pilot is specifically focused on reducing homelessness, increasing initiation of alcohol and drug treatment, and decreasing emergency room visits and hospitalizations.
As the lead entity for the County’s WPC pilot, San Joaquin County Health Care Services Agency has convened a broad range of partners including public agencies, healthcare providers, community-based organizations, health plans, and technology services to coordinate care for program enrollees:
- Public agencies, including the county’s Behavioral Health Services, Housing Authority, Public Health Services, Substance Abuse Services, and Correctional Health Services at the San Joaquin County Jail.
- Healthcare providers, including San Joaquin General Hospital, Dignity Health St. Joseph’s Medical Center, Community Medical Centers, and San Joaquin County Clinics.
- Community partners, including Gospel Center Rescue Mission and Central Valley Low Income Housing Corporation.
- Managed care plans for Medi-Cal members, the Health Plan of San Joaquin and Health Net.
- San Joaquin County Health Information Exchange, and ACT.md.
“The population of San Joaquin County is one of the fastest growing in the state of California, and an increasing percentage of our Medicaid population stands to benefit from coordinated Whole Person Care,” said Mark Elson, PhD, Executive Director of San Joaquin Community Health Information Exchange. “As we test interventions and create a care management infrastructure between healthcare providers and community partners, ACT.md will help us coordinate resources and ultimately better serve individuals who are at high risk and are high utilizers of care.”
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Within ACT.md, case workers will assess clients and collect data on the most pressing reasons for high utilization, including lack of housing security or transportation. ACT.md’s community-based, social health information network will support intensive care management, referrals between healthcare and community organizations, and community-wide care planning and task sharing processes. ACT.md’s health collaboration hub captures data as care is delivered, enabling deep and unique analytics for public reporting, intervention evaluation, and performance management.
“California’s Whole Person Care initiative is a breakthrough in developing better pathways to services for all, across medical, behavioral, and social needs,” said Ted Quinn, ACT.md CEO and Co-founder. “We believe that housing is health care, and so we are honored to act together with the Whole Person Care teams and clients in the counties of San Joaquin, Marin and others in California to make health happen for people with complex health and social needs.”
Date: December 4, 2018