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CalAIM & Behavioral Health – An Update on California's Progressive Pursuit

Embracing Challenges & Celebrating Triumphs: How CalAIM is Transforming Behavioral Health in California


November 2, 2023 – A year and a half has passed since CalAIM began rolling out across California. While CalAIM encompasses various facets of health and social care, its approach to addressing behavioral health is particularly noteworthy. With rising concerns over mental health and the need for comprehensive care, understanding how CalAIM is navigating these challenges can serve as a roadmap for other states that might be struggling. 

Multiple CalAIM initiatives are changing how members with behavioral health conditions receive care, how providers deliver and are paid for care, and how county behavioral health agencies administer care. In this blog, we will explore these proactive measures to enhance the behavioral health landscape in California and examine how they are impacting consumers.

Understanding CalAIM

CalAIM, short for California Advancing and Innovating Medi-Cal, represents a multi-year initiative that reimagines the state’s Medi-Cal program. The goal is to transform the Medi-Cal program by offering whole-person care and addressing fragmentation of care. It’s a pivotal shift from the traditional models, emphasizing a holistic approach that acknowledges both the medical and non-medical determinants of health and integrates behavioral health.

At the heart of CalAIM’s philosophy is the intent to make value-based, person-centered, and high-quality care accessible to all. This initiative aims to address systemic challenges in healthcare by integrating physical health, behavioral health, and social services. By recognizing the connection between behavioral health and overall well-being, CalAIM seeks to ensure that individuals, especially those with complex needs, aren’t siloed into separate care pathways. The program strives to create a seamless continuum of care that addresses the unique circumstances and challenges that each person faces.

CalAIM's Approach to Behavioral Health

So, what is CalAIM doing to address behavioral health? Simply put, behavioral health is an often-overlooked area of care. Now, it is receiving renewed focus under CalAIM’s holistic vision. One in 25 adults in the state has a serious mental illness, and the proportion of adults with substance use disorders is also higher than the national average. Recognizing the intricate relationship between mental, behavioral, and physical health, CalAIM looks to use unique strategies to bolster California’s behavioral health framework.

One of CalAIM’s strategies in this area is Enhanced Care Management (ECM). ECM is particularly tailored for individuals with intricate health needs, encompassing those with severe behavioral health conditions or substance use disorder. The objective is to extend high-touch care coordination services through a single Lead Care Manager. This individual serves as a singular point of contact and ensures individuals get intensive management support, which is integral to their well-being. 

Another strategy is the implementation of Community Supports (CS). These are services that address the health-related social needs of members. These alternative services can serve as effective substitutes for traditional Medi-Cal services and consist of things such as support to secure and maintain housing, access to medically tailored meals, personal care and homemaker services, sobering centers are more. When you consider that many health-related social needs are linked to poor mental health, it becomes obvious why these are a focus of CalAIM’s attempt to address behavioral health. 

The CalAIM Behavioral Health Framework also emphasizes the significance of a standardized approach across the state. The vision is to create a unified behavioral health delivery system and to do this CalAIM is working to

  • Clarify the division of responsibility for mental health services between managed care plans and county mental health plans
  • Introduce a reimbursement system for behavioral health services based on the type of care provided, rather than the cost of the care
  • Streamline clinical documentation requirements for specialty mental health and substance use disorder treatment services, with the goal of reducing administrative burden 
  • Facilitate the integration of specialty mental health and substance use services at the county level into one behavioral health managed care program
  • Introduce new benefit — contingency management — for people with stimulant use disorder

One of the biggest issues with the Medi-Cal system is that it was highly fragmented. Through integrated and coordinated care that is bolstered by a focus on health-related social needs, CalAIM looks to flip the script and improve the health of members while reducing overall costs. 

And how have these strategies fared thus far? California is seeing positive results. Though only a year and a half into the rollout, early data for ECM and CS benefits has shown improved stabilization among enrollees. By weaving together innovative strategies and a focus on whole-person care, the initiative is set on the path to creating a cohesive and effective healthcare system that can successfully meet the needs of its members.

Early Lessons from Utilizing CalAIM for Behavioral Health

As with any transformative initiative, the journey of integrating CalAIM to cater to behavioral health needs in California has been accompanied by insights and challenges. These early lessons are instrumental in refining the approach and setting the stage for more streamlined implementations in the future.

Holistic Integration is Challenging but Necessary: The effort to bring physical health, mental health, and substance use disorder services under one umbrella has been a substantial undertaking. The idea of offering comprehensive services is promising. However, achieving seamless integration has required extensive coordination, resources, and time. CalAIM isn’t fully there yet, but it will be time and money well spent as the benefits of such an integrated approach, in terms of care quality and efficiency, underscore its necessity.

Need for Stakeholder Engagement: CalAIM’s ambition is apparent, but its success relies heavily on consistent stakeholder engagement. There have been instances where beneficiaries, unaware of changes, found themselves navigating new systems without a lifeline. Continuous communication with service providers, patients, and advocacy groups is crucial to ensure the program’s aims are realized at the ground level.

Flexibility in Implementation: Every region in California has its unique challenges and demographics. A one-size-fits-all model has been proven to be less effective. What one county needs is not the same as another county. And the resources and capabilities vary across geography in the state as well. Tailoring strategies to local needs, while adhering to CalAIM’s overarching objectives, has emerged as a more successful approach.

Addressing Workforce Shortages: One of the prominent issues that resonated in the early phases was the workforce shortage, especially in behavioral health. While CalAIM presents a grand vision, the ground reality of a dearth of trained professionals can impede its success. Strategies for workforce expansion and training are imperative to cater to the increased demand.

Technology and Data Infrastructure: With the move to integrate services, the importance of a robust technological and data infrastructure has become crystal clear. Efficient data sharing, analytics, and electronic health records are foundational to CalAIM’s objectives, especially regarding care coordination. Initial hiccups in these areas highlighted the need for significant investments in health IT systems.

Beneficiary Education is Essential: Even the most well-intentioned initiatives can falter without proper beneficiary awareness. Early lessons underscored the importance of educating the beneficiaries about the changes, their rights, and the resources available to them under CalAIM. This makes it easier for them to navigate the system and get access to the quality care that they need and deserve. 

While the integration of CalAIM to address behavioral health is a step in the right direction, there have been significant learning curves. The good news is that these early lessons provide a roadmap, ensuring that the initiative not only addresses current challenges but also is equipped to handle future demands.

Advocates Perspective

California’s ambitious CalAIM initiative represents a bold step forward in the realm of behavioral health. It showcases the state’s commitment to ensuring holistic and quality care for its beneficiaries and there have been some positive results showing that success is achievable. The overarching lesson from the CalAIM experience thus far is that dynamic reforms, especially in healthcare, require consistent stakeholder engagement, flexibility, and a strong commitment to continuous improvement. As the state forges ahead, these early insights serve as a roadmap, guiding not only California, but also other states looking to address the growing behavioral health crisis.


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About the Author

Fady Sahhar brings over 30 years of senior management experience working with major multinational companies including Sara Lee, Mobil Oil, Tenneco Packaging, Pactiv, Progressive Insurance, Transitions Optical, PPG Industries and Essilor (France).

His corporate responsibilities included new product development, strategic planning, marketing management, and global sales. He has developed a number of global communications networks, launched products in over 45 countries, and managed a number of branded patented products.

mandy sahhar

About the Co-Author

Mandy Sahhar provides experience in digital marketing, event management, and business development. Her background has allowed her to get in on the ground floor of marketing efforts including website design, content marketing, and trade show planning. Through her modern approach, she focuses on bringing businesses into the new digital age of marketing through unique approaches and focused content creation. With a passion for communications, she can bring a fresh perspective to an ever-changing industry. Mandy has an MBA with a marketing concentration from Canisius College.