Health Management Associates (HMA) was selected in May to serve as a technical assistance (TA) vendor for CalAIM (California Advancing and Innovating Medi-Cal) under California’s Department of Health Care Services’ funding initiative known as PATH (Providing Access and Transforming Health).
Under the state’s $1.85 billion, multi-year CalAIM initiative to improve the Medi-Cal program, California will continue to introduce new programs and alter existing ones. PATH will provide funding to strengthen the capacity and infrastructure of community-based organizations, public hospitals, and county agencies.
HMA received state approval to serve as a TA Vendor within the PATH TA marketplace. Margaret Tatar, a managing principal for HMA, spoke with State of Reform about the importance of this new partnership.
“PATH is a funding source—a grant funding source—to help build capacity, to help grow networks, to provide infrastructure for new providers and folks playing in the system so they have the appropriate data, IT systems, staff training, and resources to be appropriately and optimally participatory in these new critical networks.”
— Tatar
Tatar explained that CalAIM is the state’s most ambitious attempt to transform the Medi-Cal system that’s taken place during her tenure in the state. She said it aims to address disparities, improve the delivery of healthcare services, promote health equity, and address social drivers of health.
Foundational components of CalAIM include Community Supports (CS) and Enhanced Care Management (ECM), under which the health sector partners with community-based organizations to offer non-traditional health services. The purpose of ECM is to address clinical and non-clinical needs of the highest-need Medi-Cal enrollees, and includes supporting member treatment adherence. Medi-Cal beneficiaries may also be connected with CS, including housing transition navigation services, and sobering centers.
“The managed care plans are responsible for important new services and benefits. They will be delivered by new providers, meaning they are not the traditional healthcare providers like primary care doctors, hospitals, clinicians, specialists that managed care plans are used to contracting with. These are new providers. It will be important for the plans and the providers to understand how to work together.”
— Tatar
Different areas HMA will focus on include building data capacity through data collection, management, sharing and use; support with CS contracting and services; strategic planning and implementation; strengthening ECM; legal and technical assistance; and workforce.
HMA is distributing educational materials to health plan providers, like social workers, registered nurses, community health workers, and behavioral health workers, among others. The materials consist of software platform training and 90-minute learning sessions to create collaboration across the system.
One county in the central valley is working with HMA to prepare the county’s two health plans to become ECM and CS providers. HMA provided TA education to county staff on ECM and CS requirements, as well as contracting opportunities. HMA has also assisted that central valley county with developing a strategy to work with health plans and DHCS’ Incentive Payment Program and PATH, among others.
“Part of the technical assistance work will probably be … how [to] do business together, how do you enter into a contract to do these services, how do you understand the contract, what kind of reporting do you have to do under that contract, how do you have to coordinate care under that contract?” Tatar said.
HMA is working with Medi-Cal managed care plans with their implementation of CS services, including on the development of an online seminar series on topics such as assessment, care planning, outreach and engagement, complex clients, safety and de-escalation, housing readiness, and the medical needs of individuals experiencing homelessness.
In 2021, as part of CalAIM, Mom’s Meals partnered with Inland Empire Health Plan (IEHP) to launch a pilot program that provided over 28,000 meals to IEHP members in Riverside and San Bernardino counties and found reduced hospital visits for patients with congestive heart failure.
The annual total cost of care for pilot participants dropped from $7.2 million to $5.4 million, or a monthly savings of about $1,613 per member, which is attributed to decreased hospitalizations and associated costs. Rates of hospitalization dropped by 50 percent, or from 211 visits to 105 visits. Participants also experienced a cumulative weight loss total of 336 lbs., or an average weight loss of 5.8 lbs. per patient.
During the first phase of the pilot, which ran for 12 weeks, participants were given three prepared meals per day, while during the eight weeks of the second phase, the amount of provided meals dropped to two per day. Phase three lasted four weeks, during which participants received one prepared meal per day.
“In addition to the prepared meals, participants received one produce box every week for 12 weeks, and one pantry box every other week for 12 weeks with recipe cards to encourage healthy cooking.”
— Dr. Gabriel Uribe, lead of the pilot program for IEHP
Participants were able to select breakfast, lunch, and dinner options that were designed by a dietician. Some of their most popular menu items include homestyle meatloaf with potatoes and seasoned vegetables; salisbury steak with mushroom gravy, potatoes and seasoned vegetables; and Korean style BBQ meatballs with white rice and seasoned broccoli.
“This equated to 28,054 individual meals delivered—averaging 304 meals per participant,” Uribe said. “A total of 1,131 produce/day good boxes were delivered, equating to an average of 11 produce and six dry good boxes per participant.”
Mom’s Meals told State of Reform that they currently offer nutritious and fully prepared refrigerated meals to individuals who are within CalAIM’s CS program, and also provides nutrition education by registered dietitians, and produce boxes for individuals on certain health plans. The tailored menus support common health concerns including lower sodium, heart-friendly, diabetes-friendly, renal-friendly, cancer support, and pureed.
“We want to help keep Californians healthy and independent at home. Designed to provide easy access to daily nourishment, our high-quality meal choices satisfy individual tastes and preferences—fueling better health outcomes for individuals.”
— Teresa Roof, public relations manager for Mom’s Meals
As a TA Vendor, HMA may provide assistance for CS like these medically-tailored meals offered by Mom’s Meals, as well as housing-related services.
“Managed care has not traditionally contracted with housing services providers, so there is an opportunity for the managed care plans to work with new providers to provide access to CS and services that will help to address issues that are social drivers of health,” Tatar said.
“We are very proud that we were selected to be a technical assistance provider, so we are eager to provide support and assistance to any entity interested in being successful in CalAIM.”