Healthcare leaders discussed the implementation of CalAIM, a multi-year plan to transform the state’s Medi-Cal program for a more seamless connection to additional social services, at the 2023 State of Reform Southern California Health Policy Conference.
Part of the CalAIM initiative engages community-based health organizations for better integration between clinical providers and health plans through integrated health and social supports. Jessica Rosenbaum, director of operations for Full Circle Health Network, said the collaboration with community-based organizations will broaden the scope of providers that offer services to Medi-Cal members.
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Rosenbaum said Full Circle Health Network is targeting organizations that have previously not been involved with Medi-Cal, and that there are plenty of administrative burdens with participants, including contracting with managed care plans, administrative services, data exchanges, and training.
“We need to be creative, and we need to be able to adjust to the new environment, and bridge that gap.”
Kimberly Lewis, managing attorney for the National Health Law Program of Los Angeles, said the state is trying to accomplish a one-size-fits-all framework, while also creating space for individualization.
“Some of the changes like with ECM [enhanced care management] and CS [community supports], there’s been much more prescriptive guidance than there has been in any other area in the past,” Lewis said.
While technical assistance vendors, such as Health Management Associates, have been of assistance with state guidance on CalAIM implementation, challenges with infrastructure remain. Lewis said it’s important to create a more integrated healthcare delivery system and that the state does not have the infrastructure to support all of these changes at once.
The CalAIM initiative brings data exchange requirements with it, and includes connecting numerous existing systems throughout the healthcare field to share information in real-time. Real-time health data sharing helps providers and health plans improve the delivery of care and member experience.
“In my opinion, if we really want to improve public health, and if we really want to change the data exchange environment for every CalAIM stakeholder, and most importantly—the people that we serve—the most important thing is focusing on these ADT notifications.”
— Mimi Hall, vice president of public health and innovation at Manifest Medex
ADTs (admission, discharge, and transfer) are core to what all health information organizations do, Hall said. ADTs are crucial for the Medi-Cal population, who are generally high utilizers of healthcare, and they allow for providers to connect with their patients during different care points.
Hall voiced concerns about how to fund ADTs so charges do not fall on patients or providers, and suggested a small statewide investment for accessible infrastructure for every CalAIM participant, provider, and to have a policy in place that requires all hospitals to send ADTs to one common system that is accessible to all. Hall said all hospitals need to participate in this transfer of data because if they don’t, the ADTs will only work in a select contribution ecosystem.
Under CalAIM, programs for children and youth are also expanding. Case management systems in place for adults and other populations must now be adapted for the unique needs and circumstances of children and youth. To do this, leaders must engage with new providers and community-based organizations.
Takashi Wada, MD, chief medical officer of Inland Empire Health Plan, said trust is a major factor in enhanced care management (ECM) for children and youth. ECM is one of the foundational parts of CalAIM, and allows individuals to access a single “lead care manager” who provides comprehensive care management while coordinating health and health-related care and services. ECM also focuses on connecting patients to quality care.
“As we were designing ECM with our initial county partners, we actually thought that because of the overlap, where you have a child in so many different county systems potentially … they could be seen already in multiple different programs just in the county,” Wada said.
Inland Empire Health Plan is developing a model with the county that is different than the adult ECM model. It is looking to add a nutritionist, which is not part of the adult model of care, Wada said. Inland Empire Health Plan is also looking at implementing an initial assessment and triage team so children and youth can go to one location, then be redirected to the appropriate ECM.
Minsun Meeker, assistant executive director of the Office of Child Protection in Los Angeles County, said the implementation of ECM for children and youth feels like flying a plane while building it. Meeker said it’s crucial to leverage which services and supports are already in place, and that providers should work with county department partners and managed-care plans to ensure community-based providers are not overburdened, especially since some children and youth may already be involved with other county programs.
Challenges with CalAIM as it pertains to children and youth include the differences in provider readiness and gaps in rural counties. Attendees suggested that providers who work with children should consider adding ECM, and that everyone needs to have a shared, clearly communicated vision of how ECM will improve outcomes for children, youth, and their families.