California’s Medi-Cal delivery system is fragmented. In Medi-Cal, managed care plans are responsible for physical health care and some mental health services, while plans run by county behavioral health departments are responsible for specialty mental health services and most substance use disorder care. When individual Medi-Cal enrollees receive their health care from multiple systems, maintaining coordinated care is a challenge, which can affect their experience and outcomes.
To address some of these challenges, managed care plans (MCPs) and behavioral health plans across California are working to create closer connections and better care for their common members. This paper looks at efforts in San Mateo County to streamline operational functions between its managed care plan and behavioral health department with a goal of improving member care and better managing resources.
This issue brief is based on materials developed by Edward Ortiz, a founding partner of Cruz and Partners, a specialty consultancy focused on safety-net health care. Ortiz was a planning consultant on this project and was previously chief network officer for Health Plan of San Mateo.