Linnea Koopmans recently took the reins as CEO of Local Health Plans of California, which represents the state’s 16 locally-based, non-profit health plans providing Medi-Cal services. Around 70% of California’s Medi-Cal population gets coverage through LHPC’s member plans. Formerly the senior policy analyst for the County Behavioral Health Directors Association, Koopmans has vast experience with California’s Medi-Cal system.
In this Q&A, Koopmans chats with State of Reform about how local health plans are preparing for the implementation of the Department of Health Care Services (DHCS)’s ambitious CalAIM initiative, the first portions of which are slated to begin in 2022. From enhanced care management to Medi-Cal Rx, Koopmans says “the work [of CalAIM] will be immediate, but the transformation will take time.”
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Eli Kirshbaum: In anticipation of CalAIM implementation, a good portion of which is set to take place next year, what is on the top of health plans’ minds as they prepare to meet the requirements set forth by DHCS?
Linnea Koopmans: “I think 2022 is really the start of what DHCS envisions as the major transformation of CalAIM. As we’ve heard them say a lot, [it’s about] focusing kind of beyond just physical health care and focusing on social determinants and social factors that impact health outcomes …
I want to emphasize [that this is a] longer-term transformation. In terms of preparing for it and what to expect in 2022, I think our priority is really focused on ensuring that Medi-Cal members who are getting services through whole-person care and the Health Homes program who will be transitioning to enhanced care management [ECM] have really minimal disruption in their services. So I think looking at January, or day one, that’s the initial goal, with that transformation being longer-term over time.”
EK: What are some challenges plans face in terms of implementing ECM services?
LK: “I think the challenge — and the opportunity — [is] taking something that is currently [delivered through] pilot programs through whole-person care and making it a standardized benefit that looks the same statewide … Part of the challenge — and this isn’t just the challenge of the plans, but of the counties and the providers who have been delivering services through whole-person care — is in standardizing what those services look like and making them a Medi-Cal managed care benefit, which is different, of course, than a pilot program … I think some of that will take time, in terms of what that transition will look like. So I think that’s one challenge.
In terms of what happens between now and the end of the year, we’re down to now less than 90 days before go-live, so I think a lot of the focus now is ensuring that we have the guidance that we need from DHCS, because there are still pieces that are outstanding there, and then that contracts are still in place with providers.
Lastly, [we’re focused on] ensuring that members are aware of what will and won’t change in January … There’s ‘noticing’ that goes along with all of these changes as well.”
EK: During DHCS’s public comment period for its draft Medi-Cal managed care procurement RFP earlier this year, what were some of the main concerns local health plans had with the draft?
LK: “The draft RFP review was really important for us because all of the plans, including the local plans, are held to the same contract. So looking at that draft contract they put out, the themes that we noticed and kind of what we commented on are that it requires a lot more intensive reporting [as well as] new managed care organizational and operational requirements.
So I don’t necessarily know that we think all those new requirements are a bad thing. They’re designed to provide better oversight, information, data, all of the things that we know are a priority of the department. But what’s critical is to ensure that there’s resources to support plans actually implementing a lot of those new requirements. Cumulatively, it’s a lot of new work that plans have not historically had to do. So I think one of our comments to the department is that [it] needs to be recognized in the resources provided to plans to actually accomplish those things.”
EK: What has communication with DHCS been like during the past year or so, while preparing for CalAIM? Are plans hopeful their feedback will be incorporated, do you wish there was stronger communication, etc.?
LK: “I think we have a collaborative relationship with the department. They’ve had many different public stakeholder forums for CalAIM and a lot of process for providing plans and others an opportunity to weigh in … I do think one area that we’ll be looking at over the coming years are what are the expectations and requirements, and how does DHCS work with plans to expand infrastructure and capacity for community supports? … Those are optional services to be provided by plans [that] will be scaled up over time. DHCS’s long-term goal is to have many of those be statewide benefits. So I think it’s going to be very important that there’s close communication and collaboration with plans on what that process actually looks like and how we get there.
One other thing … that I think is important and I want to touch on is putting this initial rollout of CalAIM into the broader picture of what will be happening on Jan. 1. So in January, there will be the initial rollout of enhanced care management, so that transition from whole-person care and Health Homes I was mentioning, and implementation of community supports.
But also, Medi-Cal Rx will be going live, which is a significant change to how members will receive their pharmacy benefits, which could result in a change in medication or pharmacies where members get their medications. All of this is happening at once, so I think there’s a concern that those transitions go smoothly. And while we are supportive of a smooth transition for Medi-Cal Rx, ultimately, that becomes a state responsibility and is out of our control. So we do have concerns about what that will look like on day one, and particularly for those members who are receiving enhanced care management because those are the higher-needs members.”
EK: Is there anything else I haven’t asked about that you feel is important to mention regarding CalAIM?
LK: “While there’s a lot happening at once, the actual outcomes and transformation will take time, in terms of having our system really address social determinants of health …
… One of the most important issues that we’ve been thinking about is that it’s sort of easy to talk about what the implementation of enhanced care management and community supports looks like, but I think [we] have to look at it in the greater context of everything that will be occurring over the next year, two years plus … All of these significant changes and proposals will be happening at the same time, the point being, the work will be immediate, but the transformation will take time.”
This interview was edited for clarity and length.