California Advancing and Innovating Medi-Cal (CalAIM) is a multi-year, care delivery and payment reform initiative led by the California Department of Health Care Services. CalAIM seeks to expand access to coordinated, whole-person care, and address health-related social needs. Launched in 2022 and rolling out over multiple years, two key components of CalAIM include: (1) Community Supports, 14 services that address social needs like food and housing insecurity; and (2) Enhanced Care Management (ECM) for individuals experiencing homelessness or serious mental illness, among other individuals with complex health and social needs.
CalAIM is a large, ambitious initiative requiring significant change management, partnership building, and investment. This webinar, made possible by the California Health Care Foundation (CHCF), explored innovative and early approaches on how to best implement and expand the new CalAIM initiative, featuring two health plans and one community-based organization. Lessons from this webinar can inform stakeholders in California and other states across the country seeking to improve health care services for people with complex needs.
I. Welcome and Introduction
Speakers: Diana Crumley, JD, MPAff, Senior Program Officer, CHCS and Melora Simon, MPH, Senior Strategist, CHCF
D. Crumley and M. Simon provided opening remarks.
II. Expanding Partnerships with Community-Based Organizations
Speakers: Kelly Bruno-Nelson, Executive Director, Medi-Cal/CalAIM, CalOptima and Milo Peinemann, MPL, CEO, American Family Housing
K. Bruno-Nelson discussed CalOptima’s efforts to expand access to Community Supports and ECM by expanding provider networks, increasing rates, incorporating community liaisons into staffing models, relaxing contracting requirements for community-based organizations, and automatically authorizing Community Supports. M. Peinemann described how these approaches impact American Family Housing, a community-based organization offering housing services.
III. Value-Based Payment Models For Enhanced Care Management
Speakers: Takashi Wada, MD, MPH, Chief Medical Officer, and Matthew Wray, Integration Process Manager, Inland Empire Health Plan (IEHP)
T. Wada and M. Wray discussed how IEHP’s ECM value-based payment model builds upon learnings from the Health Homes Program, and how the plan developed its value-based model to support ECM providers, considering upfront investment, staffing models, relevant outcome measures, and a separate fee-for-service component for outreach activities.
IV. Moderated Q&A
Moderator: D. Crumley, CHCS