How can you prevent "emerging risk" individuals from becoming high-cost for health plans and burdensome for providers, given that the fee-for-service model does not cover the additional 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.

Attendees will discover how to identify emerging risk populations before medical escalation occurs, and align a high-touch, wraparound care team—comprising community health workers, virtual behavioral health specialists, and RD/certified diabetes educators—to the distinct medical, social and behavioral barriers of the Medicaid population. Additionally, the session will outline how to design a sustainable prospective case-rate (PEPM) payment model and unify your network under a collaborative framework. Learn to align your payers, providers and community partners around the shared success metrics that matter most, from A1c and PHQ-9 to Patient Activation Measure (PAM) scores.

Learning Objectives:

• Describe a hybrid, human-centered care ecosystem  that utilizes a multi-stakeholder, wrap-around care model  that pairs community health workers (CHWs) with virtual specialists to address the social and behavioral needsof emerging-risk Medicaid members .
• Understand the rationale for payment reform and why traditional fee-for-service structurally fails complex populations and how transitioning to a prospective case-rate (PEPM) can financially sustain relationship-based, longitudinal care.
• Assess how this pilot utilizes a new actuarial ROI concept, focused on future cost avoidance, alongside NCQA-aligned measures (HEDIS Glycemic Status, Depression Remission, PAM) to validate the model's impact on health equity.