Whether it’s managing a patient’s high blood pressure and heart disease or going upstream to prevent illness in the first place, Health Net is committed to the health, safety, and comfort of people in its operating regions.

So, when the California Department of Health Care Services (DHCS) introduced new recognition and reimbursement opportunities for community-based organizations (CBOs) and Community Health Workers (CHWs), Health Net was quick to get involved. They understand that barriers to health aren’t just medical; they’re social. That’s CHWs’ specialty.

“Community health workers play a vital role in bridging the gap between healthcare systems and our members, helping ensure they receive services related to perinatal care, preventive care, transportation, oral health, aging, and much more,” said Dorothy Seleski, Medi-Cal President at Health Net.

The community workforce already addresses members’ health-related social needs to improve overall health and well-being. Operationalizing the CHW benefit, however, is new for organizations, and doing it statewide, at scale, required overcoming key operational, workforce, and technology infrastructure hurdles. That’s why Health Net and Pear Suite teamed up. Health Net wanted a scalable solution to help community partners provide the benefit to their clients as a participant in the Medi-Cal program, and Pear Suite could deliver on that need.

Infrastructure and services for those who serve

Part of the challenge for CBOs and CHWs that want to provide the CHW benefit is that many have limited tools to track and manage members they’ve supported, document preventative services, submit compliant claims, and share data across the healthcare ecosystem. These activities are crucial to leveraging the CHW benefit and meeting health plan and state Medi-Cal requirements.

Health Net provided funds to Pear Suite as a pilot program, and Pear Suite used that investment to give CBOs access to our AI-powered care navigation platform and wraparound managed services from our Provider Network.

Pear Suite’s platform provides compliant documentation and billing, while boosting communication, improving care plan adherence, and closing care gaps, all while ensuring timely and accurate claims processing. For CHWs working in the field, Pear Suite’s mobile app allows member eligibility checks, simple activity documentation, referral monitoring, and claims submission on the go, doubling productivity and improving data accuracy. Many of these platform features would otherwise require 5 to 8 additional software systems. Pear Suite provides them in one.

By co-designing implementation with the Health Net team, Pear Suite has become more than a software provider. It quickly became apparent that the barriers for CBOs went far beyond technology. The Pear Suite Provider Network (a community care hub) was launched to provide comprehensive support and consulting services to help CBOs understand the CHW benefit policy and be successful with contracting, credentialing compliance, clinical review, and other programmatic requirements. Furthermore, Pear Suite’s customer success team provides hands-on guidance on platform utilization, real-time quality assurance feedback, and health plan reporting and audit-readiness coaching.

The Pear Suite Provider Network also benefits health plan partners. For Health Net, this means substantial network adequacy and insights into encounter data, attribution, and quality performance. The combination of a care platform and provider network cuts onboarding time by more than half—from over two months to under three weeks—helping CBOs provide compliant services and get compensated for their efforts faster.

Collecting community health data at scale

The result of this collaboration was the rapid utilization of the CHW benefit across 10 different counties. Within three years, more than 1,000 CHWs from 80+ CBOs were onboarded onto Pear Suite’s platform and joined the Pear Suite Provider Network, giving them accelerated access to the CHW benefit.

The CHWs logged more than 29,000 reimbursable activities in the system for support they provided to Health Net members, which, in many cases, were tied to quality improvement projects, such as cervical and breast cancer screening, tobacco cessation, maternal health, and menopause support programs. This means many of these activities directly improved HEDIS and other quality metrics, in addition to addressing basic health-related social needs, such as transportation, housing, and food access.

“Through our partnership, Pear Suite is able to empower members to take charge of their health, ultimately leading to improved health outcomes and reduced disparities,” said Seleski.

At a Glance: The Impact Metrics

The success from the program’s year one rollout led to expansion of the ongoing relationship. Health Net continues to champion the CHW by supporting Pear Suite as we onboard CBOs to our care navigation and billing platform and provide wraparound support. In the past 3 years, this partnership has produced rapid, measurable results and a strong ROI for Health Net’s investment in the community workforce.

Together, we’ve empowered CBOs and CHWs to capture and use more impact data and improve their sustainability by making the CHW benefit more accessible. Health Net has reduced access gaps, increased utilization, improved continuity of care, driven measurable quality improvements, and made tangible progress in closing care gaps that exist between our most vulnerable residents and the general population.

Ready to support community health work?

You too can be a part of empowering the community health workforce while improving the health of your members and exceeding your care delivery, quality, and experience metrics. Find out how by speaking with a member of Pear Suite’s growth team.
Schedule a consultation call.