5 Things California: CalAIM’s future, Barger talks mental health, Community-centered care


Eli Kirshbaum


We have a really smart group of thoughtful minds here at State of Reform. I’m honored to get a chance to work with and mentor some of these folks. Eli Kirshbaum is one of those, who has put together so much of today’s newsletter. Emily Boerger is another one, who serves as our Managing Editor.

They help lead a team totaling seven reporters tracking health care, reform and policy, across states like California.

In the future, I’ll be taking more of a back seat on these newsletters. After a decade of writing and editing them, it’s time to give the keys over to other smart voices. I’ll still write a column from time to time. But, you can trust that your inbox is in good hands with folks like Eli, Emily, Patrick, Nicole, Aaron, Ethan and Soraya.

Thanks, as always, for reading our stuff!





With help from Eli Kirshbaum

1. Sup. Barger talks pandemic response and mental health

During the Morning Keynote at the 2021 Los Angeles State of Reform Health Policy Conference, LA County Sup. Kathryn Barger described the county’s cooperation with the state as being “phenomenal” during the pandemic, despite communication challenges early on. “When the governor would make an announcement, we would have a half an hour to basically pivot into what the state was mandating. Communication was lacking in the beginning, but towards the end we got better,” she said.

The Supervisor also spoke about the county and state’s work to support Los Angeles residents’ mental health, noting that the LA County Department of Mental Health’s 24/7 help line experienced a 50% increase in calls during the pandemic. She explained how the county partnered with Headspace to offer free mental health resources to all residents and said she hopes the county’s “highly successful” Mental Evaluation Team will continue to expand. You can watch Barger’s full keynote remarks here.


2. Lawmakers break down difficulties advancing bills in the legislature

At the State of Reform Conference, Sen. Monique Limón and Asm. Adrin Nazarian discussed the obstacles lawmakers confront in the policymaking process. Both agreed that being persistent is critical. Limón, whose multiple bills concerning Alzheimer’s disease have failed in past sessions, finally managed to advance this year’s attempt through both chambers. “You just don’t give up — you just keep going and going and going,” she said.

Nazarian — whose bill to prohibit health plans from imposing deductibles on insulin prescriptions was killed in the Senate Appropriations Committee this session — said fiscal consideration is important but that it can impede policymaking and often gets too political. When bills do succeed, they often differ considerably from their original form, Limón said. “They start off as one idea, and — almost one hundred percent of the time — that idea shifts through amendments,” she said.


3. The vision for CalAIM’s power acronyms

DHCS’s CalAIM initiative is set to be implemented Jan. 1, 2022, bringing with it a variety of transformational new programs including Community Supports (formerly In-Lieu of Services) and Enhanced Care Management (ECM). At our LA conference, a panel of health leaders discussed what the rolling out of these programs will look like and how it will change California’s health care delivery system.

“The implementation has required an unprecedented level of energy, cross-sector collaboration, regular and close communication, and even deeper levels of partnership between all the stakeholders,” said Martha Santana-Chin, Medi-Cal Director for Health Net. Beau Hennemann, Director of Special Programs at Anthem, spoke about how DHCS projects like LTSS and the Health Homes Program have helped pave the way for widescale delivery system transformation like CalAIM.


4. Experts discuss post-COVID health care payment reform

Carole Cusack, Director of Payer Client Engagement & Strategy at 3M, explained during last month’s conference how COVID-19 revealed an inadequate funding structure in US health care. She said the country has overinvested in its capacity to treat “low-value visits” and underinvested in crisis management — as evidenced by the shortage of space, staff, and emergency equipment during the pandemic — and primary care.

On the same panel, Adam Barde, Senior Director of Health Care Transformation Implementation at Blue Shield of California, broke down his organization’s Pay for Value Payment Model Strategy and how it rewards value rather than volume. “We know that providers are burnt out. We know that the current modeling almost requires unsustainable productivity in order to get reimbursed [the amount that] providers deserve to get reimbursed. So we’re switching that to value, with a focus on other metrics such as quality outcomes,” he said. See the full panel conversation here.


5. Health leaders offer ways to incorporate community into health care

Sonya Young-Aadam, CEO of the California Black Women’s Health Project, said “culture” and “racism” need to be seen as social determinants of health during last month’s conference. She said the state needs to acknowledge these two social determinants and make intentional investments in health initiatives developed by the Black community, such as Sisters Mentally MobilizedAnti-Violence Ventures, and Sistahs Aging with Grace and Elegance (SAGE).

Anuradha Rao, MD, another speaker on the panel and a pediatrician at the FQHC Omni Family Health, discussed her facility’s unique, SDOH-focused care model, explaining how she screens each patient’s family to identify any outside factors that may be affecting their overall health. They then use an online platform, Unite Us, to connect patients to needed community resources, including affordable housing, food, and transportation. This community-focused practice has proven successful, as 81% of the service connections offered to her patients through Unite Us between April and June of 2021 were accepted.