Our team of policy experts is constantly monitoring the latest progress in care for people with serious illness. With special attention to advances in health equity, we recognize the transformative work occurring at the state level, such as with California’s Medicaid program (Medi-Cal). CMS has approved a waiver allowing for creation of the CalAIM program, which will transform care delivery for Medi-Cal recipients. Managed Medicaid plans in California are required by the state to deliver and administer a number of different programs and services for people with serious illness, including community-based palliative care and home and community-based services. However, they often lack the resources and infrastructure to ensure the people in the most need get assessed for and referred to services the fastest. The state’s new California Advancing and Innovating Medi-Cal (CalAIM) program may help solve this dilemma. Approved by CMS in December 2021, the program aims to prioritize population health and prevention by aligning care and increasing focus on social determinants of health.
CalAIM ensures that Managed Medicaid plans are building programs that their members can access and are focusing efforts on those most in need to address social determinants of health and advance health equity. C-TAC’s policy and advocacy efforts align with this sort of approach to transforming healthcare and California has continued to be a leader in this area. The CalAIM program presents a multitude of opportunities for the deployment of our Care Model Principles as health care delivery in the state adapts to the changes.
CalAIM has three primary goals:
- Identify and manage member risk and need through whole person care approaches and addressing social determinants of health;
- Move Medi-Cal to a more consistent and seamless system by reducing complexity and increasing flexibility; and
- Improve quality outcomes, reduce health disparities, and drive delivery system transformation and innovation through value-based initiatives, modernization of systems, and payment reform.
Clinical and analytics teams within California Managed Medicaid are preparing to comply with the measurement and quality reporting requirements being set forth in the CalAIM project. CalAIM is a multi-year initiative by the Department of Health Care Services (DHCS) to improve the quality of life and health outcomes of the CA population by implementing a broad delivery system, program, and payment reform across the Medi-Cal program. The major components of CalAIM build upon the successful outcomes of various pilots from the previous federal waivers and will result in a better quality of life for Medi-Cal members as well as long-term cost savings.
The first stage of the program launched January 1, 2022 and includes internal collaboration with clinical leadership and analytics teams to develop risk-scoring algorithms that can be applied to the plan’s membership to predict future healthcare needs and develop programs that address those needs. This can help the health plan understand who needs care the most, who is at the highest risk for going to the hospital, and who to ensure access to the right resources. For more information on the CalAim program, visit the DCHS webpage here.
Written by: Torrie Fields, C-TAC Strategic Advisor
