CalAIM: Understanding the Physican Role ACCMA December 5, 2023
CALifornia Advancing and Innovating Medi-Cal
Vision for MediCal’s Future •
Equitable access to continuum of services and supports from birth to end of life for ALL MediCal members
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Align funding, data reporting, quality and infrastructure to mobilize and incentivize towards common goals
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Major focus on Social Drivers of Health (SDOH)
What is CalAIM? California Advancing and Innovating Medi-Cal (CalAIM) is a multi-year initiative and commitment led by the California Department of Health Care Services (DHCS) to improve the quality of life and health outcomes of Medi-Cal members and transform and strengthen Medi-Cal
Offering Californians, a more equitable, coordinated, and person-centered approach to maximizing their health and life trajectory through broad delivery system, program and payment reform across the Medi-Cal program. DHCS is innovating and transforming the Medi-Cal delivery system CalAIM is moving Medi-Cal towards a population health approach that prioritizes prevention and whole person care. Our goal is to extend supports and services beyond hospitals and health care settings directly into California communities
Why CalAIM? MediCAL provides coverage for: • One in three Californians
• 50% of California births & school aged children • 2/3 of long-term care patients
• 70% of foster youth • 80% of incarcerated people • 99% of MediCal beneficiaries are enrolled in managed care
Who will CalAIM help? • •
Many of the CalAIM reforms focus on improving care for people with the most complex needs. This group includes: • People with significant behavioral health needs, including people with mental illness, serious emotional disturbance, and/or substance use disorder • Seniors and people living with disabilities • People experiencing homelessness who also have complex physical or behavioral health needs • People transitioning from jail or prison back to the community who also have complex physical or behavioral health needs • Children with complex medical conditions, such as cancer, epilepsy, or congenital heart disease • Children and youth in foster care
CalAIM Components
Comprehensive Quality Strategy •
Increase focus on quality • Increased quality sanctions & rate impacts • AAH is increasing P4P
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Equity focus • Equity goals and equity incentive plan
Population Health Management
CalAIM Initiatives Behavioral Health Initiative
Community Supports
Dental Initiative
Enhanced Care Management
Incentive Payment Program
Integrated Care for Dual Eligible Members
Justice-Involved Initiative
Providing Access and Transforming Health (PATH)
Statewide Managed LongTerm Care
Supporting Health and Opportunity for Children and Families
CalAIM Components
Enhanced Care Management (ECM) •
Community based case management program • We welcome referrals from providers
CalAIM Components
Community Supports/In Lieu of Services •
14 cost-effective alternatives to traditional services • Housing bundle • Post-hospital housing
• Medical Respite • Medical food • Home Modification • Sobering Center
• Asthma remediation • Personal caregiver • Stay out/Get out LTC • Caregiver respite
• Day Habilitation
Long Term Care Carve-In •
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Under CalAIM, Medi-Cal managed care plans will cover and coordinate Medi-Cal institutional Long-Term Care (LTC) in all counties in 2023 in a phased approach by facility type Will provide all LTC residents with access to coordinated and integrated care within Medi-Cal managed care and make coverage consistent across California. Goal is to better integrate care across institutional and homeand community-based settings as well as to make the LTC delivery system consistent across all counties in California.
January 1, 2023 Transition: Skilled Nursing Facilities (SNF), both freestanding and hospital-based
January 1, 2024 Transition: Intermediate Care Facility for Developmentally Disabled (ICF-DD) Subacute Facility Pediatric Subacute Facility
Population Health Management
CalAIM Components
Re-Centering Primary Care •
Investing in primary care transformation
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report on % of spending on primary care
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alternative payment model arrangements • Private office & FQHC
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Leveraging $700M Health Equity and Practice Transformation payments
CalAIM Components
New MediCal Covered Services •
Dyadic Services
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Community Health Workers
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12-month Postpartum Eligibility
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Doulas
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Increased connection between county & MCP mental health services
CalAIM Components
Single Plan Counties MediCal/Medicare D-SNP •
AAH & CCHP will absorb Anthem volume 1/2024
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AAH & CCHP will develop D-SNP plans by 1/2026
Continuity of Care in 2024 Complex Case Management
Enhanced Care Management
Community Supports
• Transitioning members who are receiving care management services from Anthem will change to a new Care Manager on January 1, 2024, upon transitioning to CCHP
• DHCS expects that transitioning members actively receiving ECM will continue with their existing ECM provider • DHCS will require mandatory overlap of Anthem’s and CCHP’s ECM providers to the maximum extent possible • If plan is unable to bring an ECM provider into its network or establish a Continuity of Care agreement, the plan will transition the member to an in-network ECM provider for outreach activity and continuation of ECM
• DHCS is committed to ensuring that Medi-Cal members with authorizations to receive Community Supports do not experience disruptions to their Community Supports authorizations, provider relationships, or services due to the transition • If plan is unable to enter into a contract with a Community Supports provider or establish a Continuity of Care agreement, the plan will transition the member to an in-network Community Supports provider
CalAIM Components
Multiple Incentive Plans •
Incentive Payment Program (IPP) • Support growing ECM/CS infrastructure
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Providing Access & Transforming Health (PATH) • $1.8b for SDOH provider infrastructure
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Housing and Homelessness Incentive Program (HHIP) • Growing housing infrastructure and access
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Behavioral Health Continuum Infrastructure Program (BHCIP) • $2b to expand BH infrastructure
Physician/Provider Role •
Refer patients to ECM or other case management programs • Transitional Care, Complex CM, Care Coordination
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Refer patients to Community Supports
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Participation in EPT program
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Use new benefits
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Contract with AAH & CCHP
For More Information
CCHP:
AAH
•E-mail: cchpcalaim@cchealth.org •Website: https://cchealth.org/healthplan/providercalaim.php
•Website: https://alamedaalliance.org/providers/calaim/
DHCS: •Website: https://www.dhcs.ca.gov/CalAIM