CalAIM

CalAIM Icon

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 our population by implementing broad delivery system, program and payment reform across the Medi-Cal program. The major components of CalAIM build upon the successful outcomes of various pilots (including but not limited to the Whole Person Care Pilots (WPC), Health Homes Program (HHP), and the Coordinated Care Initiative) from the previous federal waivers and will result in a better quality of life for Medi-Cal members as well as long-term cost savings/avoidance.

 

CalAIM has three primary goals:

  1. Identify and manage member risk and need through whole person care approaches and addressing Social Determinants of Health;
  2. Move Medi-Cal to a more consistent and seamless system by reducing complexity and increasing flexibility; and
  3. Improve quality outcomes, reduce health disparities, and drive delivery system transformation and innovation through value-based initiatives, modernization of systems, and payment reform.

 

How can I get a letter of support for the upcoming DHCS Medi-Cal Managed Care Plan RFP?

Applicants of the Department of Health Care Services (DHCS) Managed Health Care (MCP) procurement for the San Diego County Geographic Managed Care region that want to pursue the optional Letter of Support (LOS) from our Board of Supervisors shall commit to meeting the stipulations set forth in the guidelines below.

This list of requirements is based on Framework for the Future of San Diego County and County subject matter experts and program staff with intimate knowledge and experience serving unique populations that are the focus in the DHCS Medi-Cal procurement and 2022-2026 associated Medi-Cal waivers called California Advancing and Improving Medi-Cal (CalAIM).

Before the County LOS is finalized, it will be refined considering the final version of the DHCS procurement Request for Proposal as well as input from a local community advisory group assembled by the County Health and Human Services Agency (HHSA) Director.

The LOS template and all associated information will be posted in a dedicated section of the Health and Human Services Agency (HHSA) website https://www.sandiegocounty.gov/content/sdc/hhsa/programs/ssp/CalAIM.html and shared through Healthy San Diego and its various Committees and Subcommittees.

Framework for the Future for San Diego County

In 2021, the San Diego County Board of Supervisors committed to a core set of values as established by Framework for the Future, which prioritizes racial justice, health equity, economic opportunity, environmental protection, government transparency, and fundamental changes to County operations. These principles drive our policy approach and allocation of resources.

In order to bring our Framework for the Future vision to fruition, it is incumbent on us to form strong partnerships to collaborate and coordinate with a full spectrum of providers and payers in in our community that have a similar commitment to improve the health and wellness of our residents. The Board of Supervisors intends to be an active partner working with San Diego’s Medi-Cal Managed Care Plans (MCPs) to ensure quality services for our mutual clients, to address social determinants of health, and to mitigate, disparities and inequities as illustrated in the state procurement and CalAIM.  This represents our core values in the Framework for the Future.

Meaningful Coordination and Collaboration and Transparency

While the contracts for MCPs developed through this DHCS procurement will not begin until January 1, 2024, important components of CalAIM implementation are already in progress during 2021 to meet a January 1, 2022 start date. Of immediate interest to the County of San Diego is the transition of the Whole Person Wellness (WPW) Pilot and the Health Homes Program (HHP) to the new Enhanced Care Management (ECM) benefit and associated Community Services (CS), soon to be followed by the expansion of ECM/CS to other MCP members in the DHCS-specified Target Populations who meet eligibility criteria.

The County sees ECM/CS implementation as the essential foundation for further success of CalAIM. The initial focus populations for ECM per the state guidelines are individuals and families experiencing homelessness, high utilizers and adults with SMI/SUD. These are all populations in which County Departments have heavily invested and have delivered services to for many years.  Therefore, any MCP wishing to obtain a Letter of Support from the County of San Diego must meet and continue to demonstrate all of the following requirements from July 1, 2021 through CalAIM implementation:

  • Actively participate in Healthy San Diego or other committees formed by County Board of Supervisors or County HHSA pertaining to improving care of Medi-Cal -eligible individuals and Medi-Cal beneficiaries.
  • As soon as details become available on Providing Access and Transitions Health (PATH) funding from DHCS to Counties and incentive funding from DHCS to MCPs, collaborate with the County, community providers, and other San Diego MCPs in designing an approach for pooling and allocating these funds to support the community service infrastructure required by Community Supports (CS).
  • Agree to provide all 14 of the initially specified CS for all MCP beneficiaries in San Diego County who meet eligibility criteria.
  • Participate in a collaborative effort with the County of San Diego HHSA, other San Diego MCPs, and key community stakeholders to develop a joint Population Health Management Program for San Diego. (Section 2.1. of the CalAIM Proposal requires each MCP to develop its own Population Health Management Plan by January 1, 2023).
  • Partner with County Behavioral Health Services and providers to approve care and linkages for school children in order to ensure timely access to mental health services in the community.
  • Commit to joint strategies and coordination with County departments serving the following CalAIM specific populations, including, but not limited to, Foster Youth, Justice Involved, Aging, SMI/ODS, Homeless and housing, rural and trafficking and crime victims.

Person-Centered Care Coordination

  • Contract with County of San Diego Behavioral Health Services to provide ECM for the Seriously Mentally Ill/Substance Use Disorder/Serious Emotionally Disturbed populations.
  • Contract with County Public Health Services to provide ECM for complex patients for whom they serve as the clinical and/or social service experts (Including but not limited to Tuberculosis Control and Refugee Health Branch; California Children’s Services; and HIV, STD and Hepatitis Branch)
  • Transition all members enrolled in the Whole Person Wellness (WPW) and the Health Homes Program (HHP) as of 12/31/21 to Enhanced Care Management (ECM) and the relevant Community Supports (CS) as of 1/1/22, ensuring continuity of care for the case management component as well as the service providers and level of services for each new ECM enrollee.
  • Contract with the two community providers currently serving WPW enrollees and the CB-CMEs participating in the HHP at a sustainable rate, in order to ensure continuity of care.

Data Sharing/Information Technology (IT) Infrastructure

Key factors in the success of CalAIM will be the ability to characterize the population, collaborate in health management, and measure outcomes. Data sharing and IT infrastructure are essential elements recognized throughout the DHCS draft procurement and CalAIM.

This following are a continued list of requirements that MCP’s shall commit to:

  • Directly contract with, as well as contract with providers who are members of San Diego Health Connect, San Diego’s Health Information Exchange (HIE) to facilitate bi-directional information exchange with participating healthcare providers.
  • Be a member of 211 San Diego Community Information Exchange (211 SD-CIE) to facilitate bi-directional information exchange with participating community-based organizations.
  • Ensure that all case management platforms are inter-operable with the MCPs proprietary Case Management and billing systems.
  • Agree to the existing Data Use Agreement negotiated with the County (for WPW) as the foundation for any modifications/amendments needed to support the exchange of information on the Plan’s Medi-Cal members, including demographics, diagnoses, referrals and utilization, for purposes including risk stratification, predictive analytics for ECM/CS, and Continuous Quality Improvement to advance health equity.  

Instructions for Application and Approval Process

The County LOS is an optional component of an Interested Party’s Proposal Submission. If DHCS maintains its current timeline (otherwise will be adjusted to align with updated state notifications) for MCP procurement. Proposal Submission will occur in early 2022. The County of San Diego timeline, therefore, anticipates that any LOS would be provided no later than 15 days after the release of the State RFP using the following process:

Letter of Support Requests Submitted

Managed Care Plans interested in obtaining a LOS notify the County by submitting a Request no later than March 4th, 2022. The County will return the LOS by April 5th, 2022. The Request will include:

  • A completed Checklist documenting the LOS Requirements the MCP has met and commits to continuing to meet, signed by the Plan Chief Executive Officer
  • Any additional information the MCP wishes to include in support of its Request

County Consideration of Requests

  • The major factor in the County’s determination regarding provision of a LOS will be the Managed Care Plan’s active engagement in meeting the specified Requirements.

Decisions Communicated to MCPs

  • The County will individually notify each MCP that requested a LOS of the decision no later than 45 days after the MCP request.
  • The County will post all approved LOSs on its dedicated website.

For questions and feedback on Cal-SDAIM, please contact: SDAIM.HHSA@sdcounty.ca.gov