While California’s CalAIM initiative aims to reduce complexity in the provision of Medi-Cal health care and social services for seniors and people with disabilities (SPD) by transitioning them into new or consolidated health care delivery systems and programs, the transition process is expected to be complicated.
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Below are some of the CalAIM care delivery system transitions that could potentially impact SPDs.
A new issue brief published by the California Health Care Foundation (CHCF) identifies potential problem areas in the transition of SPDs into new services and delivery systems. The brief also includes recommendations to make the transitions as smooth and efficient as possible, as CHCF reports that there is currently significant variation across counties in the organization and delivery of services for SPDs. The brief says these recommendations also focus on health equity.
Some of the recommendations identified in the brief are detailed below. The recommendations are directed toward state agencies and Medi-Cal managed care plans.
- Notifications and enrollment materials for SPDs should be simplified, use clear language, and be written at an accessible reading comprehension level. This is especially important as the report notes that nearly a quarter of California adults lack English-language literacy skills.
- Different state agencies should work to keep information communicated to enrollees consistent and try to limit conflicting information.
- If an SPD enrollee receives a piece of communication too early or too late with regard to the timing of the program change, that piece of communication could be forgotten or unhelpful in anticipation of a deadline.
- Plans and providers should prioritize the sharing of the most important information to enrollees.
- Mailed and telephone communications sometimes don’t reach SPD Medi-Cal enrollees, as some of these enrollees may face housing insecurity and move around often, and some enrollees may have trouble paying for a telephone bill.
- Gaining feedback from SPD Medi-Cal enrollees and dually eligible enrollees to hear their opinions when planning for an important transition can be helpful in designing communication materials and choosing the best communication delivery methods.
- Test communication materials with a diverse group of consumers of different races/ethnicities, languages, ages, education levels, and disabilities, with special emphasis placed on the 13 most commonly spoken languages of Medi-Cal enrollees.
- Gain feedback from health literacy experts to ensure readability and comprehensibility of communication materials.
- Ask SPD enrollees about their preferred methods of communication and use them accordingly. State agencies and managed-care plans should also use phone communications and videos to relay important transition information and explain difficult concepts to these enrollees, as well as leverage partnerships with community-based organizations and Area Agencies on Aging.
- Allow SDP enrollees to provide feedback to state agencies and managed care plans in real-time, such as through an online centralized complaint form or the appointment of an ombudsman.
- State agencies should train managed care plan staff, enrollment brokers, and patient navigators in diversity, equity, and inclusion “… to recognize and attend to cultural differences that impact care preferences, communication methods, or both.”
- Ensure providers are aware of and educated about transitions to help them know what to expect and communicate accurate information to their patients, and communicate with them often.
- Engage many provider types, such as social care providers, care managers, and front office staff, to ensure they can provide enrollees accurate information about transitions, as SPDs often receive many types of health care and social services from many different types of providers.
- Develop collaboration and relationship-building opportunities for medical, long-term services and supports, behavioral health, and other types of providers to share information surrounding enrollee needs with each other.