Partnership Health Plan Social Determinants of Health June 3rd, 2019 - - PDF document

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Partnership Health Plan Social Determinants of Health

June 3rd, 2019

What Exactly is Whole Person Care & Pathways?

Whole Person Care

Collaborative Leadership Target Populations Patient Centered Care Coordination

• f Services

Across Sectors Shared Data Financial Flexibility Financial Flexibility

• Pathways to Health + Home is the City of Sacramento’s Whole Person

Care (WPC) pilot program

• WPC is a pilot for high‐risk Medi‐Cal beneficiaries who are frequent

users of multiple care systems and still have poor health outcomes

• Provides flexible funding to achieve the “Triple Aim”:

Better Care, Improved Health, Lower Costs

• Pilots identify target populations, assess health and housing needs,

coordinate care in real‐time, and evaluate outcomes

• Promotes collaboration, coordination, and data sharing infrastructure

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Overarching Pathways Goals

Align with the City of Sacramento’s commitment to moving 2,000 individuals experiencing homelessness from the streets to housing by 2020

Align

Integrate the systems of care serving high‐risk, high‐utilizing homeless populations through care coordination and data‐sharing

Integrate

Achieve performance outcomes, including a reduction in avoidable hospitalizations and an increase in connection to housing services

Achieve

Improve the health and quality of life for individuals experiencing homelessness

Improve

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