The California Advancing and Innovating Medi-Cal (CalAIM) initiative will implement broad reforms to California’s Medicaid delivery system, programs, and payment methodologies. The policy goals of CalAIM are to reduce system complexity, increase flexibility, improve quality of care, and drive system transformation through the use of value-based initiatives, payment reform, and integrated approaches for behavioral health, addiction treatment, and primary care for complex populations. In the multi-year implementation, some of the provisions go live on January 1, 2022 including new contracts with specialty provider organizations to deliver Enhanced Case Management and Community Supports (In Lieu of Services) for adult SMI populations. The final provisions are projected to go live by 2027.
The big question is how will CalAIM change the measures of success? What performance measures will get the focus of counties, health plans, and provider organizations? This session will provide an overview of the likely changes in performance measure in Medi-Cal – and how specialty provider organizations and primary care organizations can prepare for new measures of value and new value-based initiatives.
This session will cover:
- Likely changes in the measurement of ‘value’ under CalAIM with possible new value-based reimbursement models and their metrics of success
- How specialty provider organizations and primary care organizations can build a metrics-based management system and culture for CalAIM success
- Case Study: Discovery Behavioral Health will share their examples of value-based contracts with health plans, metrics management and performance measurement strategies to achieve aligned payer-provider success