Lack of access to reliable transportation remains one of the top barriers for members accessing care and other benefits. This year, CenCal Health extended transportation benefits to include picking up prescription medications and durable medical equipment, as well as accessing mental health services. Utilizing Ventura Transit System, scheduled rides are available Monday through Friday and greatly increase the chances that a member keeps appointments and decrease no-show rates – making this benefit popular with physicians too.

Also important in accessing care is ensuring that members access the right level of care for their needs. Dizziness after taking a new medication? Strange rash after gardening? Worst headache ever? Often, members are not sure if they should visit the emergency room, an urgent care, or wait and see their doctor in the following day or two. Sometimes it seems like illness and injury waits for a Friday night. That’s why CenCal Health implemented a 24-hour, toll-free Nurse Advice Line that gives members the ability to talk to a registered nurse to ask questions about medical concerns and conditions at their convenience.

There is growing awareness that the social conditions in which people are born, grow, live, work, and age may enhance or impede their ability to attain their desired level of health. These economic and social conditions, called “Social Determinants of Health,” include everything from cultural and language barriers, to isolation, homelessness and hunger. And increasingly, communities are looking to Medi-Cal health plans to help implement interventions outside of hospital walls and physician offices.

CenCal Health has long worked in collaboration with community-based organizations to find effective ways to address Social Determinants of Health, including supporting nutrition programs for Seniors and developing a program targeting preventable hospital re-admissions of homeless members. In 2018 alone, CenCal Health gave grants to Community Action Commission (serving Santa Barbara County) and Meals That Connect (serving San Luis Obispo County) that funded over 250,000 meals. See our video on "Local solutions to a national problem.”

In 2008, CenCal Health became responsible for Medi-Cal lives in San Luis Obispo County. Today, CenCal Health is the largest health insurer in San Luis Obispo County, covering roughly one in five residents - 19%, based on 2017 U.S. Census numbers. Thanks in large part to the excellent care afforded members by network physicians and other providers, the CenCal Health San Luis Obispo County plan’s quality ranking rated 10th out of 53 Medi-Cal health plans in the most recent HEDIS® scoring, moving up in the rankings.

In 2014, the Affordable Care Act expanded Medicaid to include, for the first time, working-poor, adult citizens without children. A quarter of all newly-insured people over the past four years are Californians, and roughly one-third are now in Medi-Cal, California’s version of Medicaid. For many of these newly-covered adults, it is their first time with health coverage. These individuals include those that are self-employed and those without employer-based coverage. These men and women hold jobs that our society depends upon every day such as hair stylists, waiters, landscapers, ride source drivers, housekeepers and others. Most encouraging, results from a recent survey reflect that disparities in health care coverage across race and ethnic subgroups have narrowed because of the ACA.* CenCal Health’s membership surged in the last four years due to this expansion effort, but has slightly declined this year due to some of these members earning slightly too much to qualify, often landing them, again, without health coverage. Coverage for these beneficiaries addresses two critical drivers in reducing healthcare costs: increasing primary care thus potentially diagnosing and treating disease earlier, and reducing unnecessary usage of emergency rooms for non-emergent situations.

*The California Health Interview Survey 2017 Data, UCLA Center for Health Policy Research

As a local health plan with deep roots in Santa Barbara and San Luis Obispo Counties, CenCal Health participates in dozens of community meetings each year. Geared toward creating partnerships that harness and amplify existing resources, CenCal Health’s Community Relations team collaborated with Community Action Commission, Mariposas Speech Camp, Community Action Partnership of San Luis Obispo and Meals That Connect, in 2018, just to name a few.

As the health plan with the largest membership in the counties, it is imperative that CenCal Health is visible...to our members, our stakeholders and the public at large, most of whom have no idea that CenCal Health is the best health plan they’ve never heard of. In 2018, CenCal Health had a presence at over 130 street fairs, charity events, local conferences, job fairs and community meetings. To support this tremendous task, this year the organization developed a staff Ambassador Program, consisting of enthusiastic employee volunteers who undergo training certification, in order to utilize the best – and proudest – emissaries of CenCal Health. In the program’s first two months, more than two dozen staff participated.

CenCal Health provides critical bridge funding to keep key speech therapy happening during summer break.

A unique collaboration aims to address where and how the homeless recover after emergency room care in order to improve health outcomes, break a costly cycle, and improve the lives of our most vulnerable neighbors.

A new resource available on cencalhealth.org makes evidence-based, easy-to-understand health education available to the community – not just members. Click here.

Thirty-five years ago, Medi-Cal beneficiaries in Santa Barbara County had to manage their own health care with the use of the Yellow Pages and a state Benefits Identification Card. In 1983, the Medi-Cal delivery system was changed for the better when the “Santa Barbara Regional Health Authority” (now known as CenCal Health) was authorized by the federal government and state law to assume responsibility for delivering benefits through the development of a local network. Initially, the network consisted of 2 hospitals, 81 Primary Care Physicians, 43 specialists, 36 pharmacies and 2 skilled nursing facilities (SNFs). Today, CenCal Health’s robust provider network consists of independent physicians, medical groups, hospitals, safety-net clinics, and ancillary providers. The provider network now includes 10 hospitals, 275 Primary Care Physicians, 1,250 specialists, 107 pharmacies, and 19 SNFs, and consists of Federally-Qualified Health Centers like Santa Barbara Neighborhood Clinics and Community Health Centers of the Central Coast; local integrated delivery systems like Sansum Clinic; distinguished local hospitals and systems like Cottage Health, Dignity Health, Tenet Healthcare and Lompoc Valley Medical Center; out-of-area tertiary care centers; and individual providers like long-time network physicians Dr. Peter Statti, Dr. Augusto Castaneda, Dr. Rene Bravo, and Dr. Sabrina Carter. Members like a good health plan. But they love a good doctor.

Being an exceptional health plan means having exceptional staff…staff like CenCal Health Provider Quality and Credentialing Manager, Sheila Thompson, RN, CPHQ. In November 2018, the National Association for Healthcare Quality (NAHQ) named Sheila as the recipient of the Luc R. Pelletier Healthcare Quality Award, an award given to one individual each year since 2008. This award recognizes an NAHQ member who develops a performance improvement program or initiative that directly impacts the quality of healthcare for a defined group of patients and improves organizational performance. Sheila, an 18-year employee of CenCal Health, and her team initiated a Performance Improvement Project by collaborating with providers at a local Federally Qualified Health Center (FQHC) to increase the rate of diabetic retinal eye exams. The FQHC experienced site level improvement of 30 percentage points over the previous year. This was achieved by implementing systemic efficiencies and developing a member outreach process to support telemedicine-based retinopathy screening, eliminating the need for specialist referrals. CenCal Health’s overall performance for the San Luis Obispo health plan improved by 11 percentage points, exceeding the national benchmark for this measure. Click here.

CenCal Health strives to be an employer of choice in Santa Barbara and San Luis Obispo Counties.

The call center manager explains why exceptional customer service is at the heart of CenCal Health.