Transforming Medicare in California: Pathways to Improvement

By 2030, nearly one in five Californians will be 65 or older, and the majority of them will be Medicare beneficiaries with complex health care needs. To address these evolving challenges, the California Quality Collaborative, The SCAN Foundation, Archstone Foundation, Gary and Mary West Foundation with partnership from the Department of Health Care Services Office of Medicare Innovation and Integration launched the California Medicare Collaborative (Collaborative) in March 2024. This year-long, multi-stakeholder effort was dedicated to improving care for residents insured solely by Medicare, including duals, non-duals and those in both traditional Medicare and Medicare Advantage programs.

Strategic Design and Implementation

The Collaborative’s approach was built on a foundation of multi-stakeholder engagement, drawing together state leaders, health care providers, health plans, advocacy groups and others. This collective effort focused on initiating change within the existing regulatory framework to quickly implement strategies that could have a short- to medium- term impact on the health care landscape. The initiative targeted four key areas:

• Chronic Illness Management and Care Coordination
• Access, Equity and Disparities in Care
• Beneficiary Choice in a Confusing Market
• Cognitive and Behavioral Health

Each area was carefully chosen to address the comprehensive needs of the senior population and to pioneer changes within California’s Medicare landscape.

Health Care Industry Recommendations

The Collaborative developed targeted recommendations to drive systemic improvements.

Strengthen Chronic Illness Management and Care Coordination

• Strengthen chronic care management via supportive funding streams and payment policy.
• Promote Advanced Primary Care (APC) by investing in supportive training, clinical care models and compensation models for Medicare patients.
• Increase support for and coordination with organizations that address patients’ health related social needs (HRSNs) via capacity building and innovative payment models.

Enhance Access and Equity

• Improve population health management by improving data on Medicare beneficiary HRSNs and evaluating programs that seek to meet those needs.
• Increase access to care for special populations—including low-income Medicare beneficiaries, Medicare beneficiaries with limited English proficiency, those receiving Medicare because they are on social security disability, and those that live in rural communities—via effective care delivery models.
• Strengthen the clinical workforce needed to serve Medicare beneficiaries in an equitable way through training for the current workforce, care team diversification and supports for trainees in shortage professions.

Improve Beneficiary Decision-Making

• Strengthen the clinical workforce needed to serve Medicare beneficiaries in an equitable way through training for the current workforce, care team diversification and supports for trainees in shortage professions.

Improve screening and supports for Cognitive and Behavioral Health

• Reduce stigma and normalize seeking cognitive and behavioral health services via culturally competent messaging and channels.
• Amplify and improve screening to promote earlier and wider detection of cognitive and behavioral health needs via spread of existing training resources and care models.
• Increase supports for patients with cognitive and behavioral health needs and their caregivers by expanding access to navigation and wrap-around services.

Conclusion and the Road Ahead

The Collaborative’s work represents a solid way forward in the state’s efforts to adapt its health care system to better meet the needs of its aging population. By focusing on strategic, actionable recommendations, The Collaborative aims to not only improve the quality of care but also ensure that all Medicare beneficiaries in California have access to the services they need to lead healthier, more fulfilled lives.

For a more comprehensive exploration of these strategies and detailed recommendations, access the full issue brief here.