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Whole Person Care (WPC) is a program of Monterey County Health Department and its community partners to provide comprehensive case management for our county’s most vulnerable Medi-Cal recipients who are high users of hospital and emergency department facilities. This focus population may also:
- be homeless/chronically homeless,
- have mental illness or substance use disorders or both,
- have multiple chronic disease
The WPC program Registered Nurse case managers assess WPC enrollees for health, housing, and social services needs, and then provide warm hand-offs to primary care clinics, mental health/substance abuse therapists, social services, housing supports and placement, and employment training. Case managers will also assist WPC enrollees will be assisted in their normal environments with benefit assessments, setting and keeping appointments, transportation, food and nutrition, peer support groups, and housing counseling and skill development training.
New strategies to be developed by WPC include cross-system data sharing systems between WPC case managers, four hospitals located within the county, Monterey County Clinic Services and community clinics, substance treatment providers, and homeless services providers. New facilities include an 8-bed sobering center for stays up to 24 hours, a 6-bed respite center for medically fragile WPC enrollees who need are discharged from a hospital but are unable to recover on their own.Approximately 600 individuals will be served between now and 2020. WPC enrollee health outcomes and delivery system improvements will be measured. We expect Emergency Department and hospital use to decrease for our WPC Population, and corresponding improvements in managed diseases such as diabetes and high blood pressure.
To be a referring partner, or refer a potential client to Whole Person Care, please contact us at 831-755-4630.
- Whole Person Care 1-Page Description
- Whole Person Care 1-Page Description - Spanish
- Monterey County Whole Person Care Pilot Program PowerPoint Presentation
- Monterey County Whole Person Care Agreement
- Whole Person Care Referral Form
- Cuidado de la persona entera Forma de Referencia
- WPC Field Resource Guide
- 2018 WPC Social Clinical Committee Meeting Schedule
- Whole Person Care Social Clinical Workgroup Contacts