Care Delivery Transformation in California: Aligning Opportunities With Capacity

Health care coverage issues are still front and center when the media talks about the Affordable Care Act. However, the delivery system reform elements of the law are quietly having a profound impact on today's health care landscape. California, as a leading state in implementing the law, has capitalized on the tremendous opportunities to better organize the delivery of both health care and long-term services and supports through several key provisions. We recently released a new report that highlights the breadth and depth of ACA-created care models that have been adopted or are being seriously explored in order to give Californians access to better, coordinated, and hence more person-centered care.

When the law first passed in 2010, California was facing serious budget shortfalls brought on by the nation's economic downturn. Rather than shying away from the law during this fiscally austere time, California chose to push forward, adopting several ACA opportunities that promote new programs and partnerships, which are transforming care for older adults and those with disabilities. New care models include Accountable Care Organizations, Community-Based Care Transitions, Fully Integrated Dual Eligible Special Needs Plans, and future Medi-Cal Health Homes - all of which are philosophically anchored in coordinated care through the eyes of the person and their individualized needs.

Why does all of this matter? Older adults with extensive health and daily living needs, along with their family caregivers, shouldn't have to hunt for ways to bring the pieces of their care delivery matrix together. As we move toward an era of paying providers for value instead of volume, health plans and delivery systems have a huge stake in mitigating the confusion that many older Californians experience when lost in the maze of getting their health care and daily living needs met. Now the challenge is to convert this care coordination philosophy into reality, which will require time and energy from consumer-focused stakeholders who are the champions of true person-centered care.

Testing these new models is truly uncharted territory and may be uncomfortable at times for all parties involved. It takes time to learn and evolve major systems of care in order to reach the goals of improved population health, better care, and lower costs. Currently, 35 counties are testing at least one, and in many cases several new care delivery models. With all these system changes, it can be confusing to know how people are really accessing the care they need and how consumer-focused stakeholders can engage effectively to advance person-centered care from ideal to reality.

The Foundation has believed that actively engaging local stakeholders championing the needs of their communities is critical in shaping the delivery system of the future. We are proud of the efforts of Regional Coalitions covering 95 percent of the state, but there is more work to be done. Therefore, we are releasing a Request for Proposals to further bolster California's Aging and Disability Coalitions. We know the value of experienced stakeholders working together in their communities to provide essential leadership that keeps the voice of older people and persons with disabilities in the midst of system planning, implementation, and quality improvement discussions.

California is moving full speed in transforming care delivery for those with the most pressing health care and daily living needs. Yet a great deal of work remains to institutionalize system change that offers value to individuals, providers, payers, and regulators. Elevating the voice of those needing services today through local stakeholder networks will maximize the likelihood of building the kind of system that we all want for our loved ones and ourselves.

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Bruce Chernof, M.D., is president and CEO of The SCAN Foundation, an independent, non-profit public charity devoted to advancing a coordinated and easily navigated system of high-quality services for older adults that preserve dignity and independence. Follow on Twitter @DrBruce_TSF.