Lessons and Opportunities: How First 5s can create meaningful partnerships with their Medi-Cal Managed Care plans

Brief  •  Apr 23, 2021

Brief

First 5s and Medi-Cal managed care plans can build powerful partnerships to improve individual and community-level health among young children and their families. Through a number of collaborations at the local level, First 5s have learned some important lessons about how to build these alliances with managed care. This brief highlights a few key lessons and points of intersection, provided by First 5 Alameda, First 5 LA, and First 5 Ventura through their work over the last several years and as part of the Pediatrics Supporting Parents project.

Table of Contents

County First 5 commissions are uniquely positioned to prioritize the needs of children ages 0 to 5 and their families. They seek input from the community and their locally-appointed commissioners to build strong, effective, and sustainable systems to serve young children in their communities.

First 5s and Medi-Cal managed care plans can build powerful partnerships to improve individual and community-level health among young children and their families. Through a number of collaborations at the local level, First 5s have learned some important lessons about how to build these alliances with managed care. This brief highlights a few key lessons and points of intersection, provided by First 5 Alameda, First 5 LA, and First 5 Ventura through their work over the last several years and as part of the Pediatrics Supporting Parents project.

The quotes below are from three webinars about Medi-Cal managed care and partnerships with First 5s: Demystifying Medi-Cal to Support Young Children and Families (October 27, 2020), Dyadic Care & the Medi-Cal Family Therapy Benefit (November 9, 2020) and Early Identification and Intervention in Medi-Cal (December 9, 2020).

Lessons Learned

1. Relationships Matter

To establish a partnership, it’s important to start with relationships. Develop mutually beneficial relationships with shared goals and consistent ways of communicating, like monthly convenings. Build relationships at multiple levels and across departments within plans so that you’re not dependent on one person; instead, cultivate working relationships with different kinds of staff who may be able to help with a joint project.

I had worked with Population Health and Health Education before, and now we’re pulling in people from Care Management, the Quality Improvement department, the Provider Network Operation department. I didn’t even know all those departments existed [but] it’s important for figuring out who needs to be at the table. Our success now, because we’ve done our homework, we’ve stayed the course, we kept coming back, we’ve been persistent … is that they’ll actually now reach out to us and ask, ‘how can we work together to [promote developmental screenings] … not only with our patients, our members, our families, but also with our providers who are out there doing the work? How can we help them? - Sharon Elmensdorp, First 5 Ventura

2. Joint External Communication Helps Build Commitment

Find opportunities to codify and solidify the commitment to partnership through joint papers or presentations. First 5s have found that working on concrete projects with work products, like white papers or slide decks, helps to make the relationship clear to all sides and the community.

3. Use Data to Advance Shared Priorities:

Identify common goals, like increased developmental screening rates or improved prenatal care for Black mothers. Build the case for your partnership on data, either public data about county outcomes, plan performance on child indicators, or data about programs that First 5s fund that address the shared goal. Where possible, create mechanisms for sharing data that helps both entities. This can be difficult and complex work, but valuable for systems building and long-standing relationships.

For information about how the health plans are doing on key child indicators in your county, see Children Now’s managed care plan county fact sheets.

[This work] represents a very big paradigm shift, for the plans to focus on the concept of prevention and early intervention as opposed to the traditional focus of containing costs for ‘high utilizers.’ We had to do a lot of level-setting work so the plans could see the connections to their responsibilities and goals.- Loren Farrar, First 5 Alameda

4. Start Early

Begin the partnership with managed care plans at the beginning of planning a new initiative, with long-term sustainability in mind. Building a working partnership takes time and buy-in.

At first a lot of our work was as a funder, funding initiatives that sat outside the core work of the plan. That evolved so that now we’re looking at where there are opportunities to be responsive to the shifts, decisions, and directions from the State. We want to work with health plans to ensure their success in meeting requirements, with a heavy focus on kids and pregnant people. We’re looking to a future that is more collaborative, where health plans are seeking us out … coming to us to identify projects to co-implement. - Tara Ficek, First 5 LA

Read about First 5 LA’s home visiting pilot with Blue Shield of CA Promise Health Plan and early identification and intervention pilot with L.A. Care Health Plan.

Points of Intersection

First 5s can build effective relationships with managed care plans by working on areas of joint concern, including:

  • Outreach to non-engaged members. Managed care plans are responsible for informing families about preventive screening and referrals services, including the benefits of preventive care; screenings, referrals and services available under EPSDT; and where and how to obtain these services. First 5s can work with partners on outreach to families with young children that First 5s are already connected to and have trusted relationships with.
  • Preventive services and care coordination for young children, including well-child visits, developmental screening, and ACEs screening. Managed care plans are responsible for tracking the rate of well-child visits and developmental screenings provided by their health care providers, which is reported to the State. They are also responsible for coordinating care for all medically necessary EPSDT services delivered both within and outside the health plan’s provider network. Through Help Me Grow, home visiting, and other local work, First 5s are uniquely equipped to partner with health plans to increase the rate of well-child visits, developmental screenings, and connections to critical services.
  • Referrals and care coordination for expectant parents. Expectant parents are a population of particular interest to health plans, as pregnancy is a window of time in which services are vital for the health of the baby and birthing parent. First 5s and their partners may be providing services to expectant parents even before the health plan is aware of the pregnancy, offering a powerful opportunity for partnership.
  • Enhanced Care Management for at-risk children. The State’s new CalAIM proposal includes a tier of “Enhanced Care Management” for populations with high levels of complex health care needs. ECM targets populations of children more likely to have complex health care needs, including foster care children, children in families experiencing homelessness, and children eligible for the California Children’s Services (CCS) program. Managed care plans may be interested in partnerships with entities that can provide high-touch, in-person care management. Some county Help Me Grows and related efforts may qualify to be an ECM provider.

For more information about Medi-Cal managed care, see the First 5 Center for Children’s Policy’s Medi-Cal Resources for First 5s.



Related Posts