California Advancing and Innovating Medi-Cal (CalAIM) is a multi-year initiative, by the Department of Health Care Services (DHCS) to improve the quality of life and health outcomes of individuals on Medi-Cal by implementing broad delivery system, as well as program and payment reform across the Medi-Cal program. The CalAIM initiative utilizes the Medi-Cal program to help address the multifaceted challenges facing California's most vulnerable residents such as individuals experiencing homelessness, behavioral health care access, children with complex care needs, the growing number of justice-involved populations who have significant clinical needs and the growing aging population.
The three primary goals of CalAIM are:
- Identify and manage member risk and need through whole person care approaches and addressing Social Determinants of Health.
- Move Medi-Cal to a more consistent and seamless system by reducing complexity and increasing flexibility.
- Improve quality outcomes, reduce health disparities, and drive delivery system transformation and innovation through value-based initiatives, modernization of systems and payment reform.
To better recognize and manage PHC members' risk and needs for health and behavioral conditions, access to care as well as chronic diseases and disabilities, DHCS is organizing a whole system, person-centered approach that leads to a better quality of life for our PHC members, as well as long-term cost savings and avoidance. The elements of this enhanced whole system include:
- A statewide population health management strategy
- A statewide Enhanced Care Management (ECM) benefit
- Implementation of optional Community Supports (ILOS)
- Implementation of incentive payments for plans and providers
- Participation in the Serious Mental Illness (SMI)/Serious Emotional Disturbance (SED) demonstration
- Required screening and enrollment for Medi-Cal prior to release from county jail
- Pilot full integration of physical health, behavioral health and oral health under one contracted entity in a county
The key elements of the CalAIM initiative are built off the previous federal waiver programs success, which includes but are not limited to, Whole Person Care (WPC) and Health Homes Program (HHP). PHC was part of the WPC program but did not participate in the HHP. The WPC program was county based and the five PHC participating counties were Marin, Mendocino, Napa, Shasta, and Sonoma. Throughout this new DHCS initiative, services provided under programs such as WPC for PHC members will be transitioned under CalAIM and also made available to more of PHC's members.