Equity in CalAIM: how to identify the patients who will benefit most
- Collection:
- Health Policy and Services Research
- Series Title(s):
- Perspectives from the field
- Author(s):
- Davis, Rachel, (Of Rachel Davis Consulting), author Hamblin, Allison, author Kelly, Logan, author
- Contributor(s):
- California HealthCare Foundation, issuing body.
- Publication:
- [Oakland, CA] : California Health Care Foundation, May 2023
- Language(s):
- English
- Format:
- Text
- Subject(s):
- Facilities and Services Utilization Health Equity Medicaid State Health Plans California
- Genre(s):
- Technical Report
- Abstract:
- California’s recently launched CalAIM (California Advancing and Innovating Medi-Cal) initiative is an ambitious effort to transform the state’s Medicaid program (Medi-Cal) with a focus on equity, quality, and whole-person care. With most enrollees now receiving benefits through managed care, the Department of Health Care Services (DHCS) enlisted managed care plans (MCPs) to carry out much of this work, including providing a range of care management and supportive services for people with complex needs. DHCS has developed initial eligibility guidelines for these programs and services; however, to ensure that these services and programs equitably reach those who would most benefit from them, MCPs and DHCS will likely need to innovate, refine, and adapt strategies throughout the course of CalAIM. This perspective explores the equity implications and unintended consequences of one commonly used approach for identifying people with high needs - relying on utilization and cost data from inpatient and emergency department (ED) visits. DHCS has included utilization in eligibility criteria for Enhanced Care Management (ECM) services in only a few instances and has given MCPs additional discretion to offer services to people based on criteria beyond those identified by DHCS. As MCPs refine their approaches for determining eligibility, it is helpful to look to the field for lessons on how to do so in equitable ways. To develop this brief, a team from the Center for Health Care Strategies spoke to national and local experts about their experiences pursuing high-need identification strategies, and reviewed the small amount of relevant published literature available. This paper highlights important considerations for DHCS and MCPs as they refine their eligibility criteria for new services, and offers insights for ensuring that these services are provided in a way that is both equitable and impactful.
- 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 (9 pages)).
- NLM Unique ID:
- 9918645684706676 (See catalog record)
- Permanent Link:
- http://resource.nlm.nih.gov/9918645684706676