Dr. Clemens Hong, MD, MPH Talks About LA County’s Whole Person Care Waiver Program

Dr. Clemens Hong MD, MPH Director of Whole Person Care Los Angeles
Dr. Clemens Hong MD, MPH Director of Whole Person Care Los Angeles

At Eccovia we love to highlight the great work our clients and partners are doing to provide patient-centered care in their communities. The Los Angeles County Department of Health Services is building an integrated, county-wide health system that delivers coordinated wrap-around services to approximately 80,000 of the most vulnerable and high-risk individuals living in the county. On June 30, Dr. Clemens Hong, MD, MPH, Director of Whole Person Care and Medical Director of Community Health Improvement, joined Neal Howard from Health Professional Radio to discuss their innovative program. We are pleased to provide a segment of that conversation here.


Neal Howard: We’re here to talk about this new Whole-Person Care program. What is it and why was it created?

Dr. Hong: The Whole-Person care pilot program is part of the 1115 Medicaid waiver which is a contract that the state of California signed with the Centers for Medicare and Medicaid services to provide Medicaid services here in California. Part of this was a pilot program that they put into place to take care of some of the sickest and most vulnerable residents at the county level. The funds are provided to county departments to serve a subset of the highest risk individuals that we serve in our county (individuals who are homeless). In our case in Los Angeles, the individuals may be justice involved, suffer from serious medical illness, substance use disorder or significant medical illness. This group of individuals (through the Whole-Person Care pilot) have an opportunity for additional services that many would put in the sphere of care management or care coordination services.

Neal Howard: This is an extremely non-traditional outreach with these non-traditional types of patients. Do the same privacy guidelines apply when it comes to tracking these individuals, identifying them, and getting the care to them that they need? What type of a platform can you possibly use to put all of that non-traditional information together in a useful fashion?

Dr. Hong: This is where we have really done a lot of thinking and work with a partner of ours, which is Eccovia Solutions and their ClientTrack tool. It is a platform that we are trying to put on the ground here to really solve a lot of these, I would say, dis-integration issues in the way that information and health information is shared among different teams that are out there trying to provide coordinated care for these individuals. Like you alluded to, these are not the average clients that have any handful of issues that can be addressed predominantly in one or two settings. These are individuals that often have multiple case managers working across multiple settings.

This raises the need not only for information sharing but also a place where, perhaps, something such as a care plan—which is a place where we’re actively creating different activities and action steps that we are working with a client on—can be shared in views, so that multiple case managers and individuals involved in care can see what the status of any of the given application or set of services. For instance, if we wanted to refer someone to a food program like Snap, we could follow the status of that through one platform so we don’t have multiple case managers in three settings submitting applications.

This is made possible in our system through a series of IT platforms, but one really critical piece is that front-end platform that we contracted Eccovia for. It really allows us to keep that care plan in one place and—through a portal—make that care plan accessible to others. You alluded to some of the challenges in terms of data and sharing that data; we put together a robust consent process here, working with our county council, and this process will be managed with the support of this IT platform.

Eccovia applauds the continued efforts made by the Los Angeles County Department of Health Services to improve the health and overall well being of their highest risk constituents.

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