Module 1: Functions of a Hub
Section 1: Overview
Module 1 describes example Hub functions and spotlights existing Hubs in California to demonstrate how Hubs can facilitate connections between Medi-Cal Managed Care Plans (MCPs) and Providers.
After reviewing Module 1, Medi-Cal MCPs and Hubs will have a better understanding of:
- Organizations that may function as a Hub.
- Example functions offered by Hubs.
- Examples of Hubs currently operating in California.
Module 1 Key Takeaways
- Hubs are entities that centralize administrative functions for Medi-Cal Providers that address Health-Related Social Needs (HRSNs)
- Many kinds of organizations may function as a Hub.
- Functions offered by Hubs vary by organiztion and are ultimately determined through discussions between MCPs, providers, and the Hub.
Note: Hubs operate within the existing Medi-Cal Managed Care contracting structure and DHCS does not certify Hub organizations. See Module 2 for more information.
Section 2: Example Hub Organizations and Functions
Example Hub Organizations
Entities that may function as a Hub include, but are not limited to:
- Community-Based Organizations (CBOs)
- County health departments
- Administrative Services Organizations (ASOs)/Third Party Administrators (TPAs)/Management Services Organizations (MSOs)
- Independent Physician Associations (IPAs)
- Medical Groups
- Federally Qualified Health Center (FQHC) consortia
- Non-profit organizations
- For-profit organizations
Example Hub Functions
The functions offered by Hubs vary by organization and are ultimately determined through discussions between MCPs, Providers, and the Hub. While many Hubs hold direct contracts with MCPs, others provide centralized services to organizations downstream from service delivery. Some Hubs also offer direct services to Medi-Cal Members in addition to their administrative functions.
Table 1 below outlines examples of functions that Hubs provide. Beyond these functions, many Hubs offer additional services, including but not limited to, advanced operational standardization, technical capabilities such as integrated electronic health records (EHRs), Member engagement, and the provision of direct services to Medi-Cal Members.
Centralized Provider Contracting and Network Management
Supports centralized contracting and Network management such as to:
- Hold contracts with multiple Provider organizations.
- Provide readiness and onboarding support to Provider organizations.
- Engage, recruit, and manage the Network to ensure the quality of services delivered to Members across the Network, including engaging Providers through participatory governance structures.
- Build Provider capacity by providing training and technical assistance.
- Foster partnerships between the MCP, Providers, and CBOs to coordinate care delivery and advance health equity.
Streamlined Payment Operations for Medi-Cal Direct Service Providers
Supports efficient billing and payment process for contracted Providers, such as to:
- Support contracted Providers to submit compliant electronic claims.
- Streamline Provider billing and payment processes.
Data Infrastructure
Supports MCP data collection and reporting activities and requirements, such as to:
- Provide software/platforms to support referral management and service data collections.
- Centralize data management functions to support data compliance, analysis, and reporting.
- Facilitate data sharing between partner organizations to promote cross-sector collaboration.
Performance and Quality Management
Supports MCPs to conduct performance monitoring and improvement activities, such as to:
- Establish quality and performance metrics, a system for monitoring performance, and quality assurance tools and processes.
- Provide clinical support and training designed to improve quality and care.
- Facilitate peer learning opportunities to promote cross-sector collaboration.
Section 3: Hub Spotlight
Hubs operating in California currently offer an array of functions and add-on services. Figure 1 spotlights organizations serving as a Hub that have existing contracts or Business Associate Agreements (BAAs) with one or more MCPs and Providers to support the provision of Medi-Cal benefits. For more information about Hubs, including examples of Hubs currently operating in the state, please refer to the California Health Care Foundation (CHCF) publication Exploring Emerging Medi-Cal Community Care Hubs.
Figure 1: Hub Spotlight
Los Angeles County leverages existing county infrastructure, including a care management system and referral management processes, to administer ECM and Community Supports services to eligible Medi-Cal Members within the county system. The county is contracted with all six county MCPs to administer Community Supports, and with two county MCPs to administer ECM. This program initially relied on braiding and blending funds from initiatives like Measure H and the Whole Person Care pilot and is sustained by new investments through the Incentive Payment Program and Providing Access and Transforming Health Capacity and Infrastructure Transition, Expansion, and Development Initiative in addition to ongoing braided funding that includes Measure H/A and CalAIM Community Supports.
Integrated Health Partners of Southern California (IHP) is a clinically integrated Network of Federally Qualified Health Centers providing ECM services in Riverside and San Diego counties. IHP contracts with three of the local MCPs and centralizes contracting, referrals, claims, billing, and training for FQHCs in their Network. As a risk-bearing organization, IHP is focused on improving quality measures and Member outcomes.
Aliados Health is a non-profit regional consortium that supports community health centers across six Northern California counties. Operating as an Administrative Services Entity since 2023, Aliados Health has a BAA with an MCP and contracts with 13 organizations, including health centers, local government and community-based social service Providers, that provide ECM and/or Community Supports services, to support onboarding, training, documentation, invoicing, reporting, quality oversight, audits, and advocacy. Aliados is developing similar support services for the Medi-Cal CHW benefit.