CBO leader notes lack of “warm hand-off” between CalAIM and communities

The California Department of Health Care Services’ (DHCS) CalAIM initiative — of which a primary goal is to reduce health disparities — doesn’t have a clear plan for involving communities (CBOs) in its reform of Medi-Cal, according to a state CBO leader.

Maria Lemus is the executive director of Vision y Compromiso, a community-based organization that elevates the voices of community health workers. According to Lemus, the state is supposed to contract with CBOs through CalAIM, but the details of how it will do so are uncertain.

“What are the plans doing to resource the community?”

 

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Lemus explained how CBOs can provide day-to-day support to individuals after they leave the doctor’s office. There are no discussions about how a “warm hand-off” between health plans and the community will be achieved, she said.

Aside from the actual medical service delivery side of an individual’s health, there are also community-based factors that contribute to an individual’s overall health, like exercise, that, according to Lemus, have so far been unaccounted for in CalAIM planning.

“That community piece, we believe, is [that] warm hand-off. Partnering with community-based organizations to really provide that day-to-day support — whether it’s exercise programs, or it’s nutrition, or it’s wellness programs — that I think can turn the tide in wellness for our residents. And there hasn’t been a real clear road map for civilians.”

Lemus said while she has heard abundant discussion about the “technical” side of CalAIM implementation — metrics, funding, reimbursement — there are no conversations about intentionally integrating CBOs into the care process for Medi-Cal beneficiaries. This is despite herself and several other CBO representatives raising these concerns during DHCS’s County Advisory Committee meetings, she said.

She explained this aspect of CalAIM is important because community representatives, such as community health workers or “promotores,” serve as a bridge between technical medical care and community-based health supports, like wellness programs. There are numerous health factors that Medi-Cal-covered individuals wouldn’t necessarily tell their providers that CBOs can help with.

She noted that health plans are supposed to contract with CBOs through CalAIM, but it’s unclear which organizations DHCS will select. She has concerns about the state only choosing what she referred to as bigger “conglomerates” that didn’t have close enough ties to the communities they represent.

She’s concerned about health plans implementing their own form of community health workers.

“What I’ve seen some plans do is take the promotores, community health worker model and then adapt it in their own image as they think it should be. And that’s not necessarily the solution because then it becomes in their own image, which may or may not be a community-centered image.”

She has doubts about how effectively health plans will be able to accommodate regional differences among Medi-Cal populations.

“A native-born Latino is different than an immigrant Latino [which is] different than an indigenous Latino. So how is it that they can really focus on what the needs are for their particular area?”

Lemus also believes the state should be talking about reimbursing community health workers through Medi-Cal since they are an integral part of many individuals’ well-being. These community liaisons are 

“Those are the discussions that I don’t hear going on. And those are the things that I think are really important to really maximize both sides — both the community and the plans.”