How do you stop "emerging risk" people from becoming high-cost for health plans and high burden for providers, when the fee-for-service model doesn’t pay for the extra engagement and support they need? Join Vayu Health, Partnership HealthPlan of California, and Open Door Community Health Centers to discover a scalable solution for uncontrolled diabetes in Medicaid. This session unveils a Hybrid Whole-Person Care model supported by a bold shift to Prospective Case-Rate (PEPM) payment. We will show how aligning payment reform with high-touch, community-based support drives improvements such as in HEDIS® Glycemic Status (2.1% mean A1c reduction) and reduction in PHQ-9 score which implies improvement in depression severity (80% improvement). Attendees will learn how to: Distinguish "emerging risk" populations before medical escalation occurs. Align a high-touch, wrap-around care team (CHW, Virtual Behavioral Health & RD/Certified Diabetes Educators) to the specific medical, social, and behavioral barriers of the Medicaid population. Design a Prospective Case-Rate (PEPM) payment model for sustainability. Unify the Partnership: A collaborative framework for aligning Payers, Providers, and Community Partners around shared success metrics (ie A1c, PHQ-9, PAM). Don't miss this blueprint for aligning accountability, access, and value-based care.