Patients who rely on California’s public health care systems are often covered by Medi-Cal or remain uninsured. Many have low incomes and face complex health and social needs that require coordinated support from multiple organizations.
Meeting those needs requires close collaboration between systems and Medi-Cal managed care plans that are central to patients’ care. SNI’s member systems and managed care plans often serve the same patients and share a mission to improve their health and well-being, but their efforts are not always fully connected. When that happens, patients may experience gaps in care.
That is why closer system-plan partnerships matter: they create the conditions for both organizations to address patient needs together, helping reduce those gaps. By exchanging data and information, systems and plans can build a more complete picture of patients’ needs, align outreach, and better support them.
Where systems and plans have built strong partnerships, the quality of patient care has improved. More patients have completed colorectal cancer screenings, controlled their blood pressure, and received well-child visits.
At Riverside University Health System and Inland Empire Health Plan, closer collaboration helped drive progress, contributing to a 43% improvement in controlled blood pressure among shared patients.
How SNI helps member systems collaborate with their local Medi-Cal managed care plans
SNI helps member systems strengthen relationships with Medi-Cal managed care plans, share information more effectively, and develop joint strategies.
SNI works in partnership with the Local Health Plans of California Institute (LHPC), which represents the state’s local Medi-Cal managed care plans, to support stronger collaboration between systems and plans.
Together, SNI and the LHPC Institute gather dozens of leaders from systems and plans across the state for in-person convenings, virtual learning sessions, and monthly affinity group meetings. Topics have included strategies to improve quality and equity, shared vision and governance, and data sharing.
“When we [plans and systems] work together instead of in silos, we will see greater improvement in timely access to care and quality of care.”
Read the Q&A with SNI’s Executive Director Giovanna Giuliani and Koopmans
Areas of SNI support include helping systems:
Improve data exchange and data concordance with plan partners
Align quality improvement efforts around shared patient populations
Coordinate outreach for shared patients who are not yet established in care or are overdue for services
Strengthen transitions of care, including hospital discharge workflows and follow-up
Learn from promising system-plan partnerships across the state
Elevate challenges and opportunities affecting both systems and plans to the California Department of Health Care Services, including changes to quality measures and reporting requirements in statewide programs
“After our shared work [with Inland Empire Health Plan], we were able to increase blood pressure control to 67.4%, which is huge. Now there are that many more patients whose blood pressure is at goal and hopefully not having heart attacks and strokes.”
SNI and the LHPC Institute have developed resources and tools to help their members better understand each other’s goals and processes, and bolster their work together:
Q&A with SNI and the LHPC Institute leaders SNI Executive Director Giovanna Giuliani and the LHPC CEO Linnea Koopmans discuss why collaboration between public health care systems and Medi-Cal managed care plans is essential to improving care for their shared patients.
Reference guide Highlights promising practices and pilots of system-plan collaboration, along with external drivers that affect systems and plans and their overlapping quality measures.
For systems and plans beginning to tackle data exchange and alignment, SNI has developed two resources grounded in the experiences of four regional partnerships that have made progress:
Data alignment roadmap Outlines the process – and best practices – for systems and plans to compare and align their quality data.
Data alignment report Shares findings from the four regional collaborations, so systems and plans can learn from their challenges and successes.
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