Five Questions For…
1: What is relatively unique about Medi-Cal managed care compared to Medicaid programs elsewhere in the country?
Brianna Lierman: California is the nation’s most populous state and has the nation’s highest poverty rate when considering the high cost of living, so it follows that we also have the largest Medicaid program (“Medi-Cal”) with nearly 14 million Californians enrolled. Over 80% are enrolled in the state’s organized managed care delivery system while the rest are in traditional fee-for-service, which is on par with other states.
But one truly unique aspect of California’s managed care program is the prominent role local health plans play in it:
- The vast majority – 70% – of the 10.6 million of the beneficiaries enrolled in Medi-Cal are covered by our state’s 16 local health plans, all of which are community-based, not-for-profits.
- With 7.6 million Medi-Cal beneficiaries covered, these 16 local plans are outpacing the scale of any other state’s entire Medicaid program – making California’s managed care model the largest publicly accountable, not-for-profit delivery system in the nation.
- Local plans outperform their commercial competitors on quality scores 85% of the time and more than 80% of beneficiaries select the local plan when given the choice, signaling that local plans are also serving the program tremendously well.
2: What advice would you give to someone just starting an administrative career in managed care?
Brianna Lierman: Take initiative, work hard, have a good attitude, and be resourceful. Managed care is very complicated – it’s regulatory, it’s statutory, it’s contractual, and it’s historical. There are innumerable acronyms, payment structures, benefit “carve-outs”, and exceptions to the rules. But there are also fantastic, free resources available to help you learn. Get a hold of them and learn. Ask questions of colleagues. Learn some more. Bright, hard-working people are always in demand.
3: What other California organization(s) involved with healthcare do you admire the most?
Brianna Lierman: There are so many wonderful organizations working in the various arenas of health care. The first organization to come to mind is the California Health Care Foundation (CHCF), which focuses deeply and productively on the challenges in and opportunities for improving the Medi-Cal program. They are incredibly collaborative and produce phenomenally thoughtful, high-quality papers and stakeholder discussion forums on key Medi-Cal policy issues. They dig deep into topics and ask questions we should all be thinking about.
4: What are some of the unique aspects of care delivered through Local Plans?
Brianna Lierman: Local plans were formed by their respective communities – counties and safety net providers – to ensure there would be a locally accountable, not-for-profit, and mission-driven health plan serving the community’s Medi-Cal population. Since they are public entities, all local initiative (LI) and County Organized Health System (COHS) local plans also operate with a high level of transparency under open meeting laws and the direction of public governing boards, which means that the care delivered by local health plans is indeed uniquely local and driven first by the community’s health care needs. And those aspects shouldn’t necessarily be considered unique; they capture how care delivery should look.
5: Are there any recent initiatives or developments at LHPC that you’re excited about and would like to share?
Brianna Lierman: The public nature, transparency and Medi-Cal mission-driven mindset – combined with the absence of competition between local health plans – lead to a tremendously collaborative approach to sharing information and solving problems. This high level of cooperation is not limited to the LHPC board. The collaboration has been occurring informally across all operational areas and staffing levels at the local health plans for years. With such a significant footprint in the market, local plans have incredible leverage to truly move the needle.
LHPC launched the LHPC Institute in 2017 to give more structure and resources to local plan collaboration. The Institute offers several courses each year. Each course is led by expert faculty on select managed care topics, providing ongoing and well-supported opportunities for local plans to learn, strengthen their community, and share best practices. We are very proud of the Institute. It is truly emblematic of local plans’ shared commitment to excellence in Medi-Cal managed care.