DPH outlines $24M-a-year Whole Person Care Medi-Cal waiver program targeting high-use homeless patients

San Francisco's Department of Public Health detailed a multi-agency effort to use Medi-Cal's Whole Person Care waiver to coordinate care for people experiencing homelessness and high health-system utilization.

Maria Martinez, who directs the city's Whole Person Care initiative, told the commission the Department of Health Care Services designed the five-year waiver (through 2020) to encourage counties to integrate health, social and justice systems around a small group of very high users. San Francisco's award started in January 2017. Martinez said the city was awarded almost $24 million per year, half of which is matched by the City and County of San Francisco.

Martinez said DPH's data (from the Coordinated Care Management System) shows roughly 10,000 people experiencing homelessness touch the city's health system; about 13 percent of those who are high users account for roughly three-quarters of urgent and emergent care costs for that population. The department uses a stratification of severe, high and elevated risk based on service use and length of homelessness and tracks diagnoses across medical, psychiatric and substance-use categories. Martinez said the high-user, long-term homeless group has substantially higher mortality (about 7 percent within one year; 25 percent within five years in the cited data) and a high prevalence of co-occurring medical, psychiatric and addiction disorders.

Planned investments include low-barrier navigation centers, expanded medical-respite beds, certification and extended residential days for detox/drug-medicine services, and a shared data platform due in 2018 to allow privacy-appropriate information sharing and shared care plans across departments and community providers. Martinez emphasized the goal is to braid existing services and funding and to use the waiver to purchase targeted expansions rather than create a parallel system.

Commissioners asked about the geographic distribution of clients, performance measures and funding flows. Martinez said counties draw down funds under a complex structure and that many services are already in place but fragmented; some services will be expanded directly while others will be coordinated. Commissioners suggested further cluster analysis to locate service needs by neighborhood (for example Tenderloin, Bayview) and asked for a follow-up report by the end of the calendar year. Director Garcia and other staff said they envision semiannual reporting and additional operational detail once staffing and systems are in place.

Martinez noted negotiations were ongoing for an additional round of state funding and that a regional Whole Person Care discussion was planned to address cross-county coordination. She described the initial implementation team as small but experienced and stressed the work builds on more than a decade of local data integration in San Francisco.