Through CalAIM, California’s Medicaid transformation effort, managed care plans (MCPs) are offering new care management services for people with complex needs. Determining eligibility for these types of services has traditionally relied on cost and utilization data from inpatient and emergency department visits. However, this approach can perpetuate inequities by disproportionately overlooking Black, Latino/x, American Indian and Alaska Native, and other members of underserved groups. It may also provide an incomplete picture of who has high needs, and who would benefit most from such services.
This webinar, made possible by the California Health Care Foundation (CHCF), explored how California’s MCPs and other stakeholders nationally can ensure that eligibility guidelines and identification strategies for care management services prioritize equity and maximize impact. Panelists representing MCPs, health care systems, and policymakers, shared their perspectives on identification strategies, approaches they have developed to prioritize equity in eligibility, insights from their experiences to date, and what is needed to support other MCPs in doing this work.
This 60-minute event is relevant to California-based MCPs, as well as health care systems, policymakers, patients, patient advocates, and other complex care stakeholders in California and nationally.
I. Welcome and Introduction
Speaker: Allison Hamblin, MSPH, President & CEO, Center for Health Care Strategies
A. Hamblin welcomed participants, reviewed the agenda and goals for the session, and introduced speakers.
II. Prioritizing Equity: The CalAIM Opportunity
Speaker: David Tian, MD, MPP, Medical Consultant, California Department of Health Care Services (DHCS)
D. Tian spoke to DHCS’ equity vision for CalAIM, and how equitably identifying eligible participants for services is central to its goals.
III. Perspectives from the Field: Key Takeaways
Speaker: Rachel Davis, MPA, Principal, Rachel Davis Consulting
R. Davis reviewed key takeaways from a CHCF brief exploring the equity implications of using cost and utilization data to determine eligibility for care management services. Drawing from both the literature and conversations with national and California-based experts, she shared insights about who traditional complex care eligibility approaches may overlook and promising practices for ensuring that eligibility criteria and identification approaches prioritize equity and impact.
IV. Panel: Identifying Candidates for Care Management with an Eye on Equity
R. Davis moderated a discussion with California-based and national practitioners in the field exploring their experiences in refining identification and eligibility guidelines for people with complex needs to promote equitable identification. D. Tian served as a reactor providing a state policy lens on the discussion.
- Chris Esguerra, MD, MPH, Chief Medical Officer, Health Plan of San Mateo
- Clemens Hong, MD, MPH, Director of Community Services, Los Angeles County Department of Health Services
- Jonathan Weedman, MA, Vice President of Population Health, CareOregon
V. Audience Q&A
The audience was invited to participate in a moderated question-and-answer session.