California health leaders discuss challenges with CalAIM implementation

By

Hannah Saunders

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CalAIM (California Advancing and Innovating Medi-Cal) is in its third year of implementation, and while it has precipitated many impactful changes for Medi-Cal enrollees, some challenges remain. Health leaders took the stage at the 2024 Northern California State of Reform Health Policy Conference to discuss the hurdles they’ve jumped over to improve the delivery of CalAIM. 

Selina Escobar, director of special programs at Anthem Blue Cross, said the health plan’s biggest roadblock is related to the several years it has spent on CalAIM implementation techniques and refining the process. 

“That, coupled with a lot of the changes we saw in January 2024, like implementing populations of focus for enhanced care management [ECM], ensuring that our community supports [CS] and our goal at Anthem—14 CS (programs) in every county we’re in—and ensuring those gaps were closed, or at least narrowed, as best as we could,” Escobar said.

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Al Rowlett, president and CEO of Turning Point—a mental health service facility in Rancho Cordova—said Medi-Cal members lack understanding on how to utilize ECM and CS. Turning Point staff educate members on ECM and CS, which enables them to earn patients’ trust.

“We engage people, but you can’t engage people when there’s an element of mistrust—especially if you are talking about behavioral health services and all the stigma associated with that,” Rowlett said. 

When Turning Point receives a file with member information in it, that information is frequently inaccurate, Rowlett said, leading to staff  pursuing information from that individual. If this administrative task is not built into a business plan, facilities will struggle, he said. Turning Point is currently working on a business plan that discusses the risks for every managed care plan, Rowlett added. 

Ruben Imperial, assistant executive officer of Stanislaus County, said another challenge is sustaining leadership and focusing on county organizations to continue to address roadblocks. The first two-and-a-half years of the CalAIM waiver created great opportunities through the Population Health Management initiative, which served as an opportunity for management to rethink and reorganize healthcare delivery systems, Imperial said. 

California’s Department of Health Care Services launched Population Health Management in 2023, which established a statewide approach to creating comprehensive and accountable action plans that tailor to the needs of Medi-Cal members. Plans across the continuum of care are required to engage meaningfully with members and build trust; focus on initiatives that connect public health and social services to support members in staying healthy; and provide care management, coordination, and transitions across healthcare delivery systems. 

Rowlett hopes to see a transition from a fee-for-service model to a value-based payment model through CalAIM. 

“Value-based payment is where I hope we are going, where we get paid for certain outcomes and not paid for taxonomies or other things,” Rowlett said. 

Rowlett said providers need to consider options to better support members with sustaining housing, manage healthcare benefits, and support people with managing behavioral health systems that may result in them having contact with the judicial system.

“Those are things we want to be paid for, and that’s where we are going. And certainly, we hope to engage plans in conversation that includes not only how we develop contracts that specifically call out value-based payment, but how we incentivize that as well,” Rowlett said. 

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