MedicaidAdministrativeMedium impact
24-956m Improve Members' Experience with Care Coordination
Health Net·CA·Prior Authorization
We identified it
Jun 20, 2026
Summary
New policy provides best practices for care coordination to improve member experience, emphasizing timely information sharing between providers, prompt follow-up after hospitalizations, and comprehensive communication during referrals. Special attention is given to behavioral health coordination and obtaining proper authorization forms for information sharing.
Action Required
Immediately: Review current care coordination workflows and implement the following best practices: 1) Train front desk staff to ask patients about visits to other providers since last appointment and document in EMR, 2) Establish protocols for prompt follow-up within one week after patient hospitalizations, 3) Update referral processes to ensure comprehensive information sharing with receiving providers, 4) Create system to share assessment results with other providers within one week of member consent, 5) Maintain current authorization forms on file for behavioral health patients, especially those on psychotropic medications or with substance abuse disorders, 6) Consider case management referrals for complex patients seeing multiple providers.