California Advancing and Innovating Medi-Cal (CalAIM) is a long-term commitment to transform and strengthen Medi-Cal, offering 14M+ beneficiaries a more equitable, coordinated, and person-centered approach to maximizing their health. CalAIM’s mission to transform Medi-Cal will require the investment and sustained commitment of a broad network of health partners, payers, specialty providers, and community-based organizations.
The Department of Health Care Services (DHCS) is transforming the Medi-Cal delivery system moving Medi-Cal towards a population health approach that prioritizes prevention and whole person care. CalAIM will offer Medi-Cal enrollees coordinated and equitable access to services that address physical, behavioral, developmental, dental, and long-term care needs. In the multi-year implementation, some of the provisions went live in 2022 including new managed care plan contracts with specialty provider organizations/CBOs to deliver Enhanced Care Management and Community Support services for adults. Similar contracts will begin in 2023 for youth and the final provisions of CalAIM are projected to go live by 2027.
The big question is what are the new measures needed for success under CalAIM? Does your organization have a strategy for measuring key organizational and management performance outcomes for health plan contracts, access to care, service and consumer performance? This session will provide an overview of the likely changes in performance measures in Medi-Cal – and how specialty provider organizations, community-based organizations and primary care organizations can prepare to meet the new measures of performance and value initiatives.
This session will cover:
- An update on the CalAIM initiative 2022 – 2023.
- How specialty provider organizations, CBOs and primary care organizations can build a metrics-based management system and the new culture for success under CalAIM.
- Likely changes in the measurement of ‘value’ under CalAIM with possible new value-based reimbursement models and their metrics.
- Review of organizational management best practices and strategic initiatives providers will need to position, plan and implement services under evolving payer performance expectations.
- Case Study: Illumination Foundation – Pooja Bhalla, DNP, RN – Co-Chief Executive Officer
Illumination Foundation is a Southern California based, non-profit, fully integrated recuperative care organization providing, coordinated behavioral health, substance use disorders and primary care treatment services, as well as multiple levels of housing, for chronically homeless adults with complex behavioral health (SMI) and medical conditions.