How to Build Community Partnerships to Address SDOH & LTSS Needs


Pamela Mokler, MSG, President at Pamela Mokler & Associates, Inc. has over 17 years of experience as a managed healthcare executive consultant and as a healthcare innovation consultant.

In this webinar presentation, originally given in March 2020, Pamela discusses how community partnerships are essential for any health plan attempting to address the social needs of their members. Pamela shares experiences from her past clients as well as best practices for building relationships with community based organizations.

  • Get key takeaways from past models that integrate Medical & Social Services.
  • Learn more about recent changes in Medicare & Medicaid that address social needs - LTSS, HCBS, & SDOH
  • Hear Pamela share success stories and best practices live with an interactive Q&A session.

Meet the Speaker


Pamela Mokler, MSG
Pamela Mokler & Associates, Inc.

Pamela has been focused on integrating Long Term Services and Supports (LTSS) and the Social Determinants of Health (SDoH) into the medical and post-acute care continuum for the past 20 years.

In the late 1990s, she founded a senior housing business that provided contract Service Coordination for low-income elders and people with disabilities by creating service-enriched senior affordable housing communities to enable residents to continue to age in place and avoid unnecessary institutionalization. She served as Executive Director of the County of Orange Office on Aging (Area Agency on Aging) during 2000-2003; and has spent the past 17 years as a managed healthcare executive and health care innovation consultant.

As vice president of LTSS for Care1st Health Plan, now Blue Shield of California PROMISE Plan, she was responsible to integrate LTSS and long-term care (LTC) into the health plan in Los Angeles and San Diego counties as part of the California Coordinated Care Initiative and Cal MediConnect duals demonstration. She also led health care and social services integration Pilots, including an Integrated Care Management Pilot with the Area Agency on Aging (AAA) in Maricopa County, AZ (launched 2010), resulting in significant cost savings; and a Homeless & Disabled Pilot with the Independent Living Center (ILC) in San Diego county (launched 2013), which resulted in 45% of Pilot participants being housed. In 2015, Pam and her team launched a partnership with the Los Angeles County LTC Ombudsman program to safely transition institutionalized members to the community, and to ensure institutionalized members’ rights were protected. Through these and other interventions, she and her team helped significantly reduce LTC institutionalization.

She reopened her consulting business in 2017 and is continuing the important work of integrating our fragmented systems of care and improving the quality of life of our elders and people with disabilities, including the institutionalized and homeless. She is currently working with several start-ups and healthcare tech companies, facilitating contracts with managed health plans. She recently helped lease a Recuperative Care/Medical Respite facility to health plans in Los Angeles county, to give their members experiencing homelessness a place to recover following hospitalizations and nursing home stays.

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