Reflections on CalAIM’s First Yr

As we kick off 2023, it’s exhausting to imagine solely a yr has handed for the reason that federal authorities permitted California’s formidable plan to remodel the Medi-Cal program. The initiative, CalAIM (California Advancing and Innovating Medi-Cal), is a multi-year effort to advance person-centered, holistic look after folks with complicated wants, whereas additionally pursuing inhabitants well being objectives to make care extra equitable for everybody in Medi-Cal.

CalAIM is so essential and far-reaching that it obliges all of us to work collectively in new methods to comprehend its promise. So, let’s assessment how a lot CalAIM has already undertaken and peer over the horizon at what remains to be to come back.

First, the accomplishments. Numerous folks throughout California’s Division of Well being Care Providers (DHCS), well being methods, supplier teams, well being plans, community-based organizations, and county well being departments got here collectively to make sure a clean transition for tens of 1000’s of Medi-Cal enrollees who have been supported by CalAIM’s precursor packages, referred to as Complete Individual Care and Well being Houses. This alone was an enormous elevate.

As well as, California achieved the next:

And that’s only a partial checklist.

The principle technique that CalAIM employs to maneuver a fragmented care system to a person-centered system, and to take action with sustainable funding, is managed care. Managed care shouldn’t be good, and it brings with it a further layer of administrative necessities. However given all of the trade-offs, it’s in all probability one of the best software we’ve got to make sure that the whole-person care Californians want may be delivered equitably.

You will need to keep in mind that CalAIM has inherently required everybody concerned to construct the bridge whereas crossing it. It entails numerous new partnerships, myriad new information sharing wants, unsure referral quantity, and cash-flow constraints launched by retrospective funds — all on the identical time. To get this far has been an infinite elevate throughout the whole Medi-Cal system. And all this transformation has taken place on the heels of a once-in-a century pandemic.

But we have to preserve our eyes on the mountaintop within the distance. CalAIM gives an unprecedented alternative to make Medi-Cal and different safety-net packages work higher for the Californians who rely upon them. It’s an opportunity to make care extra equitable and simpler to entry. Past that, it allows transformation of well being care supply to satisfy the wants of the entire particular person wherever folks  go for care. For instance, an individual who has a stroke wants their rapid well being disaster addressed however may want paid help at dwelling to totally recuperate. A lot of Californians’ final well-being hinges on components exterior the well being system, and lots of packages in CalAIM are designed to assist tackle these social wants, significantly for folks with complicated bodily and behavioral well being situations.

And for the tens of millions of individuals with well being wants which can be much less complicated, CalAIM raises the bar on high quality, entry, satisfaction, and fairness (PDF). DHCS is making variation in high quality metrics extra clear (PDF) and imposing fines on managed care plans falling brief on key measures.

What to Anticipate in 2023

CalAIM brings a raft of latest prospects and challenges in 2023. Throughout the state, folks will likely be engaged on instituting:

Once more, that is only a partial checklist. There’s additionally information to come back on extra waiver requests: the ​​​​​​California Behavioral Well being Group-Primarily based Continuum​ Demonstration​ waiver and “pre-release companies” for folks leaving jails and prisons.

What do all these programmatic modifications have in widespread? They help a deepening of engagement with individuals who for too lengthy haven’t been well-served — or not understood by — the system. The objectives of those modifications are to enhance well being fairness for all Californians. The modifications help a extra rational and constant supply of Medi-Cal companies to enrollees in each nook of the state. They usually help extra dependable funding streams for service suppliers.

From the affected person or client perspective, CalAIM ought to streamline the system to make it simpler for folks to get the care they want. Initially, it could not really feel like an enchancment to suppliers, well being plans, county well being departments, and different gamers within the well being care system. Certainly, the operational complexities of transferring from one established system to a brand new manner of doing enterprise shouldn’t be underestimated. And it takes time to domesticate cross-sector collaboration, belief, and relationships.

 Constructing the Infrastructure for Individuals-Centered Care

It will be practically inconceivable to implement CalAIM efficiently with out making different enhancements to the system. That’s why CalAIM makes key investments round information change, well being workforce, and the infrastructure to maintain new partnerships. Exchanging information amongst well being care methods and social companies businesses is de facto the one environment friendly manner for various suppliers to acquire a unified view of the affected person as an entire particular person with complicated and interconnected well being wants. The state has set a 2024 deadline for many well being care suppliers to have the ability to share well being care data. This yr’s state price range contains $250 million to help information change adoption.

A lot of CalAIM depends on managed care organizations, however their key on-the-ground companions — community-based organizations, hospitals, clinics, county businesses, tribes, and different suppliers — want to rent and practice workers and construct infrastructure if they’re to take part efficiently. After all, that every one takes cash. DHCS has allotted $1.85 billion in a brand new program referred to as Offering Entry and Remodeling Well being for these organizations to construct up their community-based workforce and methods to be efficient companions with managed care organizations in reaching individuals who too typically have been left behind. DHCS introduced in late December that it’s going to contract with 5 industrial well being plans in California. This transfer finalizes which well being plans will function in every county beginning in January 2024 in order that plans and suppliers can proceed working collectively to implement CalAIM packages.

CHCF is proud to associate with everybody throughout the state working to make the CalAIM imaginative and prescient successful. Momentous modifications like this take time. It’s value remembering different challenges that California has met. Ten years in the past, 22% of Californians have been uninsured. In the present day it’s lower than 6%, because of California’s enthusiastic embrace of the Inexpensive Care Act and extra Medi-Cal protection expansions. In 10 years’ time, we hope to see a statewide well being system that responds to all in a person-centered and equitable manner. If anywhere can do that, it’s California.