ADVANCING THE QUADRUPLE AIM IN MEDI-CAL MANAGED CARE: PROVIDER AND HEALTH PLAN LEADER PERSPECTIVES REGARDING THE INCLUSION OF PARAPROFESSIONALS ON CARE TEAMS FOR DEVELOPMENTAL SCREENING AND CARE COORDINATION

Abstract

Problem Approximately 25% of Medi-Cal enrollees receive a developmental screening in the first three years of life, a rate below the 33% national benchmark (DHCS 2020). Medi-Cal providers cite limited time as a barrier to completing developmental screenings (First 5 LA 2017). Literature supports inclusion of unlicensed paraprofessionals on teams to increase developmental screening and service referral rates (Minkovitz 2003, Warmels 2017). An understanding of facilitators and barriers to adding paraprofessionals such as community health workers (CHWs) and care coordinators to teams can inform pediatric transformation initiatives. Research regarding workforce transformation strategies is pivotal as California advances a CHW Medi-Cal benefit in 2022 and prepares for a physician shortage (Chapman 2017, LAO 2021, Spetz 2017). Pediatric paraprofessionals could advance the “quadruple aim”- improving population health, enhancing patient experience, reducing per capita cost of health care, and improving clinician work life (Bodenheimer 2014). As the majority of Medi-Cal enrollees face health disparities, ensuring pediatric members with developmental concerns are routed to services could address the “quintuple aim,” which includes improving health equity (Nundy 2022).Methodology This mixed methods study analyzed 10 Medi-Cal providers’ and 10 Medi-Cal plan clinical leaders’ perceptions of facilitators and barriers impacting timely developmental screening and coordination to services and supports. The study then identified facilitators and barriers to shifting developmental screening and care coordination tasks to paraprofessionals. Results Medi-Cal provider and health plan informants were receptive to incorporating paraprofessionals on teams to perform select developmental screening and care coordination tasks. Facilitators included leaders committed to early identification and intervention (EII), a training and supervisory infrastructure, and software optimized for screenings and referrals. The major barrier was a perception of inadequate reimbursement. Few respondents perceived health plans as drivers of successful EII, suggesting an opportunity for California regulators to enforce screening and coordination requirements, fund pediatric workforce transformation, and route families to care coordination resources.Recommendations The research suggests major reimbursement needs to adequately support of developmental screening and care coordination tasks. Study findings can inform leaders pursuing pediatric workforce transformation initiatives in Medi-Cal. Additional qualitative research with paraprofessionals and families is warranted to refine workforce transformation approaches.Doctor of Public Healt