HEALTHmatters MD

In June 2024, HPSM’s Population Health Management (PHM) team completed our annual PNA to assess our members’ needs. The PNA process includes: 

1. Gathering data from a variety of sources—including claims, Healthcare Effectiveness Data and Information Set (HEDIS) results, language assistance services, utilization data, and results from member surveys.
2. Assessing member demographics and segmenting our member population based on factors such as age, gender, language preference, race/ethnicity, disability status and health conditions.
3. Analyzing findings to identify health disparities and evaluate member subgroups’ health status.
4. Developing an action plan with targeted Health Promotion, Population Health, Health Equity, and Culturally and Linguistic Appropriate Services (CLAS) program strategies.

Key demographic information highlighted in the PNA

• 92% of HPSM’s membership is covered under our Medi-Cal program, while 6% is covered by CareAdvantage.
• 34% of HPSM’s members are under the age of 21.
• 51% identify as Hispanic, 16% as Asian/Pacific Islander and 10% as Caucasian. 
• 91% choose English or Spanish as their preferred language. 

PHM priority areas

The PNA findings help to prioritize HPSM’s work in health equity, chronic disease management, health promotion and population health improvement. Below are the priority areas identified for our membership in 2024:

• Prenatal and postpartum care: HPSM has very high rates of timely prenatal and postpartum care. Building on that foundation, we are working to better understand indicators of mental health screening and follow up within our birthing population. 
• Well child visits: HPSM has identified disparities in well child visit utilization rates for young adults as well as Black and Caucasian identifying populations. We continue to partner with providers on multiple projects to increase well child visit utilization, especially for these demographics.  
• Cancer screenings: HPSM’s breast cancer screening rates have improved significantly over the past year. However, disparities in cervical cancer screening persist for people with disabilities. In December 2023, we sent cancer screening letters to remind members to get cervical, breast and/or colorectal cancer screenings. This year, we also launched two initiatives to increase breast and colorectal cancer screening rates for our CareAdvantage members. 
• Chronic condition management: A significant 35% of HPSM Medi-Cal members and 94% of CareAdvantage members live with at least one chronic condition. The most common chronic conditions include essential hypertension, lipid metabolism disorders and diabetes. Our Diabetes Prevention Program (DPP) is an example of how we address chronic conditions effectively.