CalAIM and health data sharing: a road map for effective implementation of enhanced care management and in lieu of services
- Collection:
- Health Policy and Services Research
- Author(s):
- Frohlich, Jonah, author McAvey, Kevin, author DiBello, Jonathan, author
- Contributor(s):
- California HealthCare Foundation, issuing body.
- Publication:
- [Oakland, CA] : California Health Care Foundation, May 2021
- Language(s):
- English
- Format:
- Text
- Subject(s):
- Information Dissemination Medicare -- organization & administration Patient Care Management California United States
- Genre(s):
- Technical Report
- Abstract:
- In 2022, the California Department of Health Care Services (DHCS) will launch an ambitious and innovative program designed to address the complex physical, behavioral, and social needs of Medi-Cal’s most vulnerable members. The California Advancing and Innovating Medi-Cal (CalAIM) program will build upon the plan-based Health Homes Program (HHP) and county-based Whole Person Care (WPC) pilots that use whole-person care approaches to address underlying social determinants of health (SDOH). CalAIM envisions enhanced coordination, integration, and information exchange among managed care plans (MCPs); physical, behavioral, community-based, and social service providers; and county agencies by establishing new benefits and services including: (1) Enhanced Care Management (ECM) benefit, which will provide intensive whole-person care management and coordination to address the clinical and nonclinical needs of Medi-Cal members with complex needs. MCPs will administer and oversee ECM benefits, identifying members in each of the ECM target populations and assigning them to “ECM providers” who will be responsible for conducting outreach and for coordinating and managing care across a broad spectrum of physical, behavioral, and social service providers. ECM services will be community-based, with high-touch, on-the-ground, face-to-face, and frequent interactions between members and ECM providers. (2) In Lieu of Services (ILOS), which are cost-effective, health-supporting services that may be substituted for existing State Plan–covered services to reduce hospitalization and institutionalization, reduce cost, and address underlying drivers of poor health. DHCS will allow 14 ILOS categories, including housing transition and navigation services, respite care, day habilitation programs, and nursing facility transition support to assisted living facilities or a home. MCPs may choose which ILOS to cover, in which counties, and to which members.
- Copyright:
- Reproduced with permission of the copyright holder. Further use of the material is subject to CC BY-NC-ND license. (More information)
- Extent:
- 1 online resource (1 PDF file (47 pages))
- Illustrations:
- Illustrations
- NLM Unique ID:
- 9918366388206676 (See catalog record)
- Permanent Link:
- http://resource.nlm.nih.gov/9918366388206676