Going Beyond Whole-Person Care with California's Medi-Cal Project CalAIM

CalAIM (California Advancing and Innovating Medi-Cal) promises to strengthen Medi-Cal, offering people a more person-centered approach to provide and receive care in all aspects of life. Based on two waivers, Medi-Cal 2020 Section 1115 demonstration and CalAIM Section 1915(b), along with several State Plan amendments, CalAIM initiatives will improve care coordination, access to services and the overall health of California’s 14 million Medi-Cal enrollees. It is broad-reaching reform, balancing partnerships with providers, managed care plans and community-based organizations, built upon previous pilots such as California’s Whole Person Care pilot and it impacts all aspects of care. There are three main goals that are overarching to the design:

1. Managing needs through the whole-person care approach and social drivers of health
2. Reducing health disparities and transforming the delivery system through value-based initiatives, modernization, and payment reform
3. Create an easier system to navigate therefore reducing complexity and increasing flexibility

How does CalAIM seek to transform healthcare for Californians? Below are just some of the ways they are revamping healthcare.

• Population health management—Care plans will implement a person-centered approach with assessments of the patient’s health while focusing on wellness and prevention
• Enhanced care management—Patients will have a single care manager who will coordinate care and services for that person, eliminating gaps of care because of this one person knows all approach
• Community supports—Meets social needs such as housing and food services that addresses social determinants of health (SDoH)
• New dental benefits—Makes dental services more affordable and accessible to those in the community
• Behavioral Health (BH) delivery transformation—Will help improve access to behavioral health services and promote integration between mental illness and substance use disorders treatment
• Services and supports for justice involved adults and youth—Helps people re-enter society from a correctional facility or prison, to ensure they get on the right track and have the resources they need
• Transition to statewide dual eligible special needs plans and managed long-term services and supports—Will specialize a care program for those eligible for both Medicare and Medi-Cal benefits
• Standard enrollment with consistent managed care benefits—People will have access to services regardless of location
• Delivery system transformation—Will develop a plan for foster children along with creating an integrated care plan for all aspect of healthcare

Enhanced Care Management (ECM) and Community Supports are foundational components of CalAIM to meet the social needs, including medically supportive foods or housing supports. Community supports are new services provided by Medi-Cal managed care plans as cost effective alternatives to traditional medical services or settings. 

Netsmart understands the complexity behind this comprehensive approach. We are working collaboratively with our clients to ensure you have the tools and education needed to meet these new requirements. We created a webinar series, kicking off with an overview of the goals and steps to complete the BHQIP, and continue with a monthly focus on the specific policies. This collaboration and sharing are critical as historically an EHR has been the instrument that many counties used to align their processes, services and data collection with the requests of the state. The depth and extent of CalAIM will require counties to grow beyond an EHR, to a comprehensive population health platform that has visibility into the whole person, beyond just healthcare to providing a catalyst that also advances equity and justice and we are honored to support the success of this exciting initiative.