Health Net Shares Payer Best Practices for Bolstering Community Support

July 12, 2022 - Health Net, a subsidiary of Centene and a payer partner of California’s Medicaid program known as Medi-Cal, has released an issue brief outlining some best practices for providing community support.

California Advancing and Innovating Medi-Cal (CalAIM) is a Medi-Cal initiative in which Health Net participates. The initiative seeks to improve whole person care, value-based care, quality of care, and care navigation in California’s Medicaid program. CalAIM pursues these through various benefits, including community supports or “in lieu of services.” 

In the issue brief, Health Net found that developing strong community supports requires payers to collaborate with providers, offer providers funding and operational support, and achieve timely and complete data sharing.

“As one of the state’s most experienced Medi-Cal partners, Health Net works hand-in-hand with the state to transform and enhance Medi-Cal—and is a key partner in its implementation of CalAIM. At the six-month mark of CalAIM implementation, Health Net has identified early lessons learned and recommendations for the broader healthcare community,” the payer’s issue brief began.

The issue brief highlighted three best practices for payer-provider collaboration.

First, Health Net found that training providers who are new to the Medi-Cal health care system on community supports and CalAIM helped reinforce payer-provider partnership.

Second, the payer offered training and technical support to providers when the CalAIM initiative was launched. Health Net helped providers navigate referrals, authorizations, and other processes. The payer also committed to continuing in that support role even after the initiative’s launch.

Third, the payer spearheaded local roundtable events. The conversations at these roundtable events covered specific topics related to CalAIM’s launch but also, more broadly, allowed participants to share best practices and opportunities for community investments.

Health Net offered several suggestions for payers and healthcare stakeholders to incorporate into their operational support and funding for providers as well. 

Health Net shared its intentions to secure providers’ access to electronic health records and other health data exchange technologies, offer financial support for workforce expansion and training, and improve quality of care reporting. The payer has issued a request for applications to the contracted enhanced care management and community supports providers in California.

Finally, Health Net shared its goals for supporting providers’ data sharing. Before the initiative launched, the payer’s data analytics team assessed community support needs across California’s counties. Additionally, the payer enhanced its data-sharing technologies and aimed to include social determinants of health data in its data collection processes.

Moving forward, the payer announced that it was ready to start the next phase of the CalAIM initiative. The initiative will continue through 2027. Health Net warned that the payer had already faced some challenges in carrying out the program’s aims and that it expected challenges in the future as well.

“CalAIM Community Supports are a unique opportunity to address social drivers of health and help advance health equity,” Pooja Mittal, DO, Health Net’s chief health equity officer, said in the press release.

“We’ve collectively organized around the needs of our members to serve them more holistically and our early learnings are reflected in our company’s latest report. Still, we know more work lies ahead and we are committed to working proactively and collaboratively to ensure CalAIM’s success.”

Before this issue brief’s publication, Health Net’s work was featured—along with various other payers’ efforts—in a report on health equity from the Institute for Medicaid Innovation.

The push for greater social determinants of health support extends beyond California’s borders.

In the mid-Atlantic region, CareFirst BlueCross BlueShield worked with a healthcare analytics company to identify health equity needs and social risk factors.

In Texas, Humana worked with community-based organizations and a technology platform to address Medicare Advantage members’ social determinants of health needs.

And the movement to address social determinants of health continues to gain momentum on a national scale. The Association for Community Affiliated Plans (ACAP) launched a center to explore social determinants of health strategies and best practices. Humana has outlined steps that the industry as a whole can take to make progress on this issue.