Just 18 months into a Medicaid transformation program in California, many implementers reported that they were already starting to see improvements for the people they serve, according to a recent report from the California Health Care Foundation.
The California Advancing and Innovating Medi-Cal (CalAIM) program launched Jan. 1, 2022. Its features are designed to create an easier pathway to support care for people outside of traditional healthcare settings and help address enrollees’ health-related social needs.
Among other things, CalAIM allows health plans to substitute social services for medical care. For instance, a patient who might be underhoused could have access to housing counseling.
The State of California is rolling out the CalAIM services gradually. In July 2022, the three targeted populations that went live were homelessness, high utilizers of emergency departments, and people with substance use disorder or severe mental illness. In January 2023, they added populations associated with people who are either in long-term care or on the verge of having to go into long-term care. In July 2023 the expansion included children and youth. In January 2024 it will be people who are transitioning from incarceration.
On behalf of the California Health Care Foundation, Goodwin Simon Strategic Research conducted qualitative and quantitative research in 2023 among CalAIM implementers to help understand how implementation is occurring on the ground. The research included an online survey and six online focus groups. This interviewed included staff and leaders of managed care plans, social service organizations, Federally Qualified Health Centers, and behavioral health organizations.
The report highlights both shared and differing perspectives from the staff and leaders of a broad range of health and social service providers. “Encouragingly, implementers share many successes in improved access and more comprehensive care for people with complex needs. At the same time, implementers also surface significant challenges and important improvements that must be made to increase CalAIM’s effectiveness in the coming years,” the report said.
Here are some key findings the report highlighted:
• There is a lot of room to increase familiarity with CalAIM — even among those who serve a high percentage of patients, clients, or members enrolled in Medi-Cal. Among those who report that more than 75 percent of their patients are enrolled in Medi-Cal, 16 percent say they are not at all familiar with CalAIM, and 14 percent say they are only a little familiar.
• A majority (52 percent) say that “overall access to services, including those that address health-related needs (e.g., housing navigation, medically supported food and nutrition services)” has gotten somewhat or much better as a result of CalAIM’s implementation.
• A majority of implementers are already able to cite some successes with the CalAIM program. Examples cited by implementers vary considerably, with each describing different aspects of the program and its implementation.
• Despite broad agreement with the goals behind CalAIM and some initial successes, satisfaction with implementation is not especially high — at least not at this point in the process. On a scale of zero to 10 where zero is “not at all satisfied” and 10 is “extremely satisfied,” the average rating for implementers falls just above the midpoint at 5.9. Although satisfaction varies by sector, region, and familiarity with CalAIM, there are very few who are either extremely satisfied or extremely dissatisfied. Implementers are largely clustered near the middle of the scale.
• When asked about how CalAIM has impacted their organization, a slight majority of implementers (51 percent) say that their ability to manage the comprehensive needs of people they serve has gotten better as a result of CalAIM, while 40 percent say that it has stayed about the same or that they are unsure.
• Almost half of implementers (48 percent) say that their ability to coordinate with other organizations serving the same people has gotten better as a result of CalAIM, while 44 percent say that it has stayed about the same or that they’re unsure.
Last year, Healthcare Innovation spoke to several providers starting to work on CalAIM implementations. For instance, Roseville, Calif.-based Adventist Health has a partnership with Emcara Health on Enhanced Care Management (ECM) services. We interviewed Monica Arrowsmith, Adventist Health’s executive director of CalAIM, and Emcara CEO Eric Galvin.
The three-year partnership combines Nashville-based Emcara Health’s advanced primary care model with Adventist Health’s clinical delivery resources to care for Medi-Cal members with the most complex care needs. As part of CalAIM’s Enhanced Care Management initiative, the partnership is intended to close care gaps for patients with the most complex care needs by addressing the social barriers, such as homelessness, that influence a patient’s health.
Emcara says its physician-led, in-home medical care solution increases access to timely and longitudinal treatment for a health plan’s most at-risk members. It uses predictive models to pinpoint members who are consistently high cost and can be positively impacted through additional home-based care and treatment. Emcara deploys integrated, multi-disciplinary in-home care teams that apply appropriate interventions and referrals based on a patient’s social, behavioral, and physical needs.
Emcara Health is deploying field-based care teams, consisting primarily of community health workers (CHWs), to meet patients on their terms, whether that’s at home, in a homeless encampment, or in the emergency department. Once engaged, CHWs conduct a social determinants of health assessment to understand the social impediments that may be impacting the patient’s health, such as access to food, stress, transportation and more. As part of the agreement, Emcara Health nurses and social workers are coordinating preventive care and clinical treatment through Adventist Health. Emcara is providing wrap-around support, including transitions of care, member and family assistance, and coordinating and referring patients to community and social support services.
Adventist has close to 20 hospitals and many clinics and skilled-nursing facilities across California. It has contracted with four Medicaid managed care organizations in the state and is working on contracts with several others.
