CalOptima Health, a public health plan in Orange County, California, seeks to understand the health needs and challenges of its members to improve service delivery and health outcomes. 

CalOptima Health serves a diverse population in Orange County, including low-income children, families, seniors, and people with disabilities enrolled in Medi-Cal, California’s Medicaid program. These members face various health and social challenges influenced by their income, disability status, age, health, environment, and lived experiences.

To better support these members, CalOptima initiated a comprehensive Member and Population Health Needs Assessment (MPHNA) and Asset Mapping (AM) study. This study aims to identify whole-person health needs, gaps in care, identify community assets, and provide best practices for developing programs that serve all members effectively. The project addresses the intersecting barriers affecting members’ access to care, such as housing instability, food insecurity, transportation challenges, and economic opportunity. By understanding these barriers and leveraging community assets, CalOptima aims to improve health care access and outcomes for all members. 

NORC at the University of Chicago will conduct a mixed-methods study to assess health needs and community assets among CalOptima members.

NORC will implement a mixed-methods assessment of the health needs and community assets of CalOptima members. Our assessment includes:

• Study Design and Stakeholder Engagement: The study will begin with stakeholder identification and the formation of a steering committee. NORC will develop a detailed project plan and timeline, engaging CalOptima’s member and provider advisory committees to gather input on the study design and data collection protocols.
• Secondary Data Collection and Analysis: NORC will utilize existing data sources from CalOptima, county agencies, and state and federal databases to inform the assessment. The secondary data analysis will focus on demographic factors, health status, social determinants of health (SDOH), and clinical measures for CalOptima members.
• Primary Data Collection and Analysis: NORC will conduct member and provider surveys, focus groups, and in-depth interviews to gather insights from CalOptima members and providers. The member survey will be administered in eight threshold languages (English, Spanish, Vietnamese, Korean, Farsi, Mandarin, Arabic, and Russian). Focus groups and interviews will explore barriers and facilitators to accessing care and social supports, providing a comprehensive understanding of members’ experiences.
• Member and Population Health Needs Assessment Development: The findings from primary and secondary data collection will be synthesized into a comprehensive MPHNA report. This report will include actionable recommendations for improving health outcomes and addressing differences. An interactive dashboard will be developed to support strategic planning to improve the health and experience of CalOptima members.
• Asset Mapping: NORC will create digital mapping tools to visualize community assets in Orange County. The asset maps will highlight local resources, gaps, and barriers, providing clear and engaging visualizations to inform strategic planning and community investments. The final report will include an action plan with recommendations to advance health initiatives.