This document discusses creating a functional population health program in Medi-Cal managed care. It provides background on the transition of Medi-Cal to managed care, including the inclusion of different eligibility groups over time. It then describes the typical delegated model used, with DHCS overseeing health plans that contract with IPAs and medical groups. It introduces SynerMed and DC3 Medical Group and their roles in serving Medi-Cal members. It outlines the goals and organization of DC3 Medical Group's Complex Care Center model for high-risk, high-cost members, including care coordination and improving outcomes. It concludes that new models of care can create value through better clinical and cost outcomes for at-risk populations.

1. Creating a Functional Population
Health Program in Medi-Cal
Managed Care
Peter Winston
Executive Vice President
SynerMed
CHCF Alumni Meeting
March 4, 2016

5. Medi-Cal Managed Care

6. Medi-Cal in Transition
• 1997 – Temporary Aid to Needy Families (TANF)
– Represents up to 50% of the CA Medi-Cal Population
– Aid to Families with Dependent Children (AFDC)
• 2011 – Seniors & Persons with Disabilities (SPD)
• 2014 – Targeted Low Income Children (TLIC)
– State Children’s Health Insurance Program (SCHIP)
– Formerly the Healthy Families Program
• 2014 – Medicaid Expansion
– Low Income Health Program
• LIHP – aid code L1
– Childless Adults up to 138% of the Federal Poverty Level
• aid code M1
• 2016 – SB75 – Undocumented Children

7. The Delegated Model
(Basic Design)
DHCS
Knox-Keene
Health Plan
IPA or Medical
Group
Hospital or Shared
Risk
Mental Health &
Substance Abuse
Programs
MLTSS & LTC
Shared
Risk

8. So how do you perform
population health in an
uncoordinated, bifurcated,
delegated and silo’d market?

10. 10

11. ● Largest Medicaid MSO in California
● ~1,000,000 members
● Serving Sacramento, Central Valley, Los
Angeles, Inland Empire, San Diego – and
Georgia
● All healthcare products: Medi-Cal, Medicare
and Commercial
● 10,000 CONNECT Users
● Scalable; Medicaid Expertise;
Demonstrated success
● California’s largest and most successful
Medicaid focused IPA
● ~500,000 members
● Serving Sacramento, Central Valley, Los
Angeles, Inland Empire – and Georgia
● Coordinated Care Plan of California
Restricted Knox-Keene
● 7,800 contracted providers
● Statewide; Scalable; proven capabilities
entering new markets; history of strong
outcomes
Company Overviews
11
• Community Hospital located in Chinatown near
downtown Los Angeles
• 230,000 Capitated At-Risk Members

13. Goals
• Develop and implement a Complex Care Center model of care
• Identification & Enrollment of High Risk, High Cost Members and those
predicted to be high risk from our 200,000 plus Dual risk members
• Improve Care Coordination & Transitions Leading to Better Outcomes
• Patient-Centered Member Care and Disease-Focused Approach
• Breaking Down Barriers to Health
• Assist PCP & Provide Resources to Manage Complex Cases
• Increase Member Self-Management Practices
• Decrease Total Cost of Care
• Encourage Development of Innovative and “Out of the Box” Solutions
• Changes the lives of our patient's for the better

14. Location
Close to Pacific Alliance Medical Center
Downtown Coordinated Care Center
711 W. College Street, #540
Los Angeles, CA 90012
Phone (213) 437-4216
Fax (213) 621-0430
Opened Doors on May 7th, 2012

15. Simplifying Care for Complex Needs

16. Organization
• In-House Clinical Team
• Physicians, Nurse Practitioners, Social Workers, Case Manager
• Quick access to specialists and ancillary providers located in the
MOB and nearby hospital
• Outside Street Teams
• HOMELESS Street Team
• HOMEBOUND Street Team
• Physicians, Nurse Practitioners, Social Workers
• Part Time Psychiatrist, Nurse and Psych NP
• 1 Mobile Van for Street Team Use, Equipment and Medications
• Single EMR for all Teams
• SynerMed Connects the Dots

17. Conclusion
• Create and execute new models of care for SPDs and
other "at-risk" populations
• New Model of Care creates “value”– better clinical
outcomes, lower costs and improved patient and caregiver
satisfaction

18. Our Websites
www.synermed.com
www.synermedconnect.com
www.californiamedicalchanges.com
www.dc3medical.com
www.youtube.com/synermed
www.ehsmd.com

19. Peter Winston
Executive Vice President