Tsev Kev Sib Txuas Lus ntawm Medi-Cal Txog RSST​​ 

Hais txog RSST​​ 

Medi-Cal Connect​​ 

RSST yog dab tsi?​​ 

Qhov Risk Stratification, Segmentation, and Tiering (RSST) algorithm yog ib feem tseem ceeb ntawm Medi-Cal Connect. Nws muab txoj hauv kev zoo ib yam, thoob plaws xeev los txheeb xyuas qhov pheej hmoo ntawm Medi-Cal cov tswv cuab. RSST tau tsim los ua kom muaj kev pheej hmoo stratification ntau sib npaug thoob plaws California.​​ 

Tsis zoo li feem ntau cov qauv kwv yees kev pheej hmoo ib txwm muaj uas tsuas yog cim cov neeg uas kim heev lossis xav tau kev pab ntau xwb, RSST txheeb xyuas cov tswv cuab uas tsis siv cov kev pabcuam uas lawv xav tau - ib qho cim ntawm cov kev xav tau zais lossis tsis tau txais kev pab rau kev kho mob thiab kev pabcuam hauv zej zog. RSST qhov kev tsom mus rau qhov kev pheej hmoo thiab kev siv tsis txaus yog qhov tseem ceeb rau kev nrhiav pom qhov tsis txaus hauv kev saib xyuas uas tej zaum yuav tsis pom, txhawb nqa kev cuam tshuam ua ntej thiab ncaj ncees.​​ 

RSST groups members into low, medium-rising, or high-risk tiers based on their chances of facing future health, social, or behavioral challenges. This helps ensure care and support are focused where they’re needed most. The RSST method is open-source and ensures statewide consistency to help connect high-risk members to services.​​ 

RSST suav nrog cov qauv kwv yees rau peb pawg neeg: cov neeg laus (18+), menyuam yaus (4 lub hlis txog 17 xyoo); thiab cov tswv cuab yug menyuam. Cov neeg yug menyuam suav nrog cov poj niam uas yuav cev xeeb tub hnub nyoog 15-49 xyoo, suav nrog cov neeg uas muaj 12 lub hlis tom qab yug menyuam lossis tom qab cev xeeb tub poob, thiab cov menyuam mos txog 3 lub hlis.​​ 

Medi-Cal Connect's RSST yog tsim los txhawb—tsis yog hloov—cov cuab yeej npaj kev noj qab haus huv uas twb muaj lawm. Nws ntxiv ib txheej txheem ntawm cov ntaub ntawv txog kev pheej hmoo uas tuaj yeem txhim kho cov txheej txheem ua haujlwm tam sim no thiab kev txiav txim siab, pab kom ntseeg tau tias txhua tus neeg California muaj kev nkag mus rau cov kev pabcuam kev kho mob zoo dua.​​ 

Yuav siv RSST li cas?​​ 

Txij li Lub Ib Hlis 1, 2027, cov phiaj xwm kev saib xyuas Medi-Cal (MCP) yuav tsum siv DHCS cov txheej txheem kev pheej hmoo RSST los muab qhov tseem ceeb rau kev ncav cuag thiab kev koom tes, coj kev ntsuam xyuas zaus, qhia txog kev npaj saib xyuas tus kheej, thiab txuas cov tswv cuab rau cov kev pabcuam xav tau.​​ 

Thaum lub sijhawm siv txij lub Xya Hli 2025 mus txog rau Lub Ib Hlis 1, 2027, MCPs yuav tsum tsim kom muaj ib txoj kev npaj los siv DHCS txoj kev RSST tag nrho hauv txoj kev npaj Txoj Kev Tswj Xyuas Kev Noj Qab Haus Huv ntawm Cov Neeg (PHM) pib txij lub Ib Hlis 1, 2027. Txhua lub MCP yuav tsum xa daim phiaj xwm siv RSST (daim qauv yuav tsum tau muab faib) rau DHCS piav qhia txog yuav ua li cas nws yuav ua kom ntseeg tau tias cov khoom siv, cov peev txheej, thev naus laus zis, thiab cov txheej txheem ua haujlwm tau npaj txhij.​​ 

Saib Ntu D. Kev Nkag Siab Txog Kev Faib Qib thiab Kev Faib Kev Pheej Hmoo hauv Phau Ntawv Qhia Txoj Cai PHM Lub Xya Hli 2026 kom paub cov lus qhia ntxaws.​​  

Kawm ntxiv​​ 

DHCS tau luam tawm ntau cov ntaub ntawv los muab kev piav qhia meej rau pej xeem txog txoj hauv kev RSST tau tsim thiab nws ua haujlwm li cas:​​