Gold Coast Health Plan | Looking Back On 2019

When you engage new members in care management, you have an opportunity to address their needs before they escalate and land them in the emergency department. That’s what Gold Coast Health Plan (GCHP) concluded after two years of surveying the needs of new members and connecting them with care management services early. The survey, known as the Health Information Form (HIF), assesses the health care needs of new members and helps GCHP’s care management team identify those members who may need immediate care coordination or expedited services. Members who answer “yes” to any of the 10 questions receive a phone call from a care management coordinator to offer care management services. When a member accepts, they are connected with a registered nurse or licensed clinical social worker who assesses the level of attention their needs require. “We’re helping our members in a more comprehensive way,” said Rachel Lambert, GCHP’s director of care management. Addressing needs early GCHP’s approach to the HIF is unique. While other health plans also send surveys to their members, many Ventura County Medi-Cal Managed Care Commission Antonio Alatorre, Chair Clinicas del Camino Real, Inc. Jennifer Swenson, Vice Chair Adventist Health Simi Valley Fred Ashworth Los Robles Hospital Shawn Atin Ventura County Theresa Cho, MD Ventura County Health Care Agency Lanyard Dial, MD Ventura County Medical Association Laura Espinosa Consumer Representative Gagan Pawar, MD Clinicas del Camino Real, Inc. Dee Pupa Ventura County Health Care Agency John C. Zaragoza Ventura County Board of Supervisors Partnering with members Coordinating care Membership by age 189,436 Total members 24,628 members AGE: 0–5 56,830 members AGE: 6–17 90,929 members AGE: 18–64 AGE: 65+ 17,049 members of them focus on following up with members who answered “yes” to one or two specific questions. In 2019, GCHP received forms from 5,527 new members, 76% of whom went into care management. Connecting members to the resources they needed from the outset has resulted in a 26% decrease in visits to the emergency department compared to new members who were not engaged in care management. Because of the program’s success, in November 2019, GCHP’s Health Services leaders were invited to present the Plan’s multidisciplinary approach to care management at the American Case Management Association’s Leadership and Physician Advisor Conference in Miami. 4  |  Gold Coast Health Plan