Early Key Takeaways from ITUP Listening Sessions on CalAIM Implementation
These statewide listening sessions are specifically focused on building partnerships between community-based organizations and the health care delivery system to make the goals of CalAIM meaningful for California communities. July listening sessions are being held now, register here.
The CalAIM initiative is a major step toward creating a health care delivery system that centers the needs of California communities served by the Medi-Cal program — and implementation is moving forward quickly across the state.
Below are some early key takeaways from the June listening sessions (Bay Area, Orange County, North Central, Central Coast, and Inland Empire):
- Clear, active communication channels between the county, plans, traditional health providers, and local CBOs is vital for the success of CalAIM. Local providers are generally on board with the overall vision of CalAIM, but are unclear about their role in it, implementation timelines for specific Community Supports, and the funds available to develop data infrastructure and enhance service capacity. To coordinate activities and disseminate accurate information, organizations are interested in attending DHCS meetings and county-wide workgroups to involve all partners in the transition process.
- Counties are entering into CalAIM from different positions and with varying relationships with local social service providers. Many counties with previous Whole Person Care (WPC) and/or Health Homes Programs (HHPs) experienced easier transitions to provide ECM and Community Support services by contracting with the same providers that they already have close relationships with. Although, even previous WPC counties cite struggles with contracting rates and making these partnerships from WPC work in CalAIM. For non-pilot counties, some are just beginning to prepare for July implementation whereas others are planning to start slowly with the Community Supports that are familiar and scale-up services over time.
- In general, organizations would benefit from detailed information and guidance on how to programmatically implement the new CalAIM programs. Health plans are encountering common challenges in providing ECM and Community Support services, including:
- Reimbursement rates are lower than the WPC & HHP initiatives, so plans are figuring out how to continue funding the same services that were available through these pilot programs.
- The referral and billing process for Community Supports are complex, with different requirements and payment structures for each service.
- ECM eligibility requirements are narrow, which makes it difficult to intervene early and support the well-being of high-need members.
- Traditional health providers and local CBOs are generally short-staffed, stretched thin, and experiencing burnout from the COVID-19 pandemic. These organizations are interested in getting involved with CalAIM, but it is very burdensome to implement data sharing across providers and develop new protocols, workflows, payment structures, and service capacity.