Reflections on CalAIM’s First Year

As 2023 begins, it’s hard to believe it’s only been a year since the federal government approved California’s ambitious plan to transform its Medi-Cal program. This initiative, CalAIM (California Advancing and Improving Medi-Cal), is a multi-year effort to advance person-centered, holistic care for people with complex needs, as well as all Medicare It also pursues population health goals to achieve more equitable care for people.california

CalAIM is so important and far-reaching that it will require all of us working together in new ways to deliver on its promise. Let’s take a look at how CalAIM has fared so far and see what lies ahead.

Achievements first. Millions of people in the California Department of Health Services (DHCS), health systems, provider groups, health plans, community organizations and county health departments work together to support tens of thousands of Medi-Cal registrants We have made it possible to smoothly migrate by receiving Through CalAIM’s predecessor program known as Whole Person Care and Health Homes. This alone was a significant increase.

Additionally, California has achieved:

This is just a partial list.

A key strategy CalAIM is adopting to transform its fragmented care system into a people-centred system is managed care using sustainable funding. Managed care is not perfect and brings additional administrative requirements. But, given all the tradeoffs, it’s probably the best tool for equitable provision of the holistic care that Californians need.

It’s important to remember that CalAIM essentially requires building bridges as everyone involved crosses them. A myriad of new partnerships, a myriad of new data-sharing needs, uncertain referral volumes, and cash flow constraints from retroactive payments all occur at the same time. What we have achieved so far has had a significant impact on the entire Medi-Cal system. And all this change happened shortly after his 1-in-100 pandemic.

Still, you should keep your eyes on the distant peaks. CalAIM provides an unprecedented opportunity to help Medi-Cal and other safety net programs work more effectively for dependent Californians. An opportunity to make care more equitable and accessible. It also enables the transformation of healthcare delivery, meeting the needs of the whole person, wherever they receive care. For example, people who have had a stroke may have to deal with an immediate health crisis, but may need paid assistance at home to fully recover. Much of the ultimate well-being of Californians depends on factors other than the healthcare system. Many of CalAIM’s programs are designed to help address these social needs, especially for people with complex physical and behavioral health conditions.

And for millions of people with less complex health needs, CalAIM raises the bar for quality, access, satisfaction and equity (PDF). DHCS is making variability in quality metrics more transparent (PDF) and fines managed care plans for failing to take significant action.

What to expect in 2023

CalAIM brings many new possibilities and challenges in 2023. Across the state, people are working to establish the following institutions:

Again, this is just a partial list. There is also news about additional exemption requests. California Behavioral Health Community-Based Continuous Demonstration Waivers and “Pre-Release Services” for those in and out of prison.

What do all these programmatic changes have in common? They help us engage more with people who have been underserved or not understood by the system for too long The goal of these changes is to improve health equity for all Californians. This change will make Medi-Cal services more streamlined and consistent for subscribers across the state. It also supports a more reliable flow of funds for service providers.

From a patient or consumer perspective, CalAIM needs to streamline the system to make it easier for people to get the care they need. At first, it may not feel like an improvement to health care providers, health plans, county health departments, and other stakeholders in the health care system. In fact, established he should not underestimate the operational complexity in moving from one system to a new way of doing business. It also takes time to build collaboration, trust and relationships across sectors.

Building the infrastructure for people-centred care

Successfully implementing CalAIM without making other improvements to the system is nearly impossible. As such, CalAIM is making significant investments in data exchanges, healthcare workers, and infrastructure to sustain new partnerships. Exchanging data between health systems and social service institutions is the only efficiency for different providers to obtain a unified view of the patient as a whole with their complex and interrelated health needs. method. The state has set her 2024 deadline for most providers to be able to share medical information. This year’s state budget includes her $250 million to help adopt data exchange.

While much of CalAIM relies on managed care organizations, key field partners (community-based organizations, hospitals, clinics, county agencies, tribes, and other providers) hire and train staff as needed. and build the infrastructure. Participate safely. Of course, it all costs money. DHCS is committed to providing access and transforming health so that these organizations are effective partners with managed care organizations building community-based workforces and systems to reach those who are often left behind. He has allocated $1.85 billion for a new program called DHCS announced in late December that he will be contracting with five private health insurance companies in California. The move will finalize the medical plans that will operate in each county beginning in January 2024, allowing plans and providers to continue working together to enable him to implement the CalAIM program.

CHCF is proud to partner with everyone across the state who will work to make CalAIM’s vision a success. Big changes like this take time. It’s worth remembering other challenges California faced. Ten years ago, 22% of Californians were uninsured. Today, it’s less than 6% thanks to California’s eager acceptance of the Affordable Care Act and expanded Medi-Cal coverage. In 10 years, I hope our statewide healthcare system will be able to serve everyone in a people-centred and equitable way. If there’s anywhere you can do this, it’s California.