Collaboration and Operational Support Key for CalAIM Community Supports Success
California is making progress six months in, but there is still work to be done to reach goals and achieve health equity
THE VBP Blog
August 30, 2022 – California Advancing and Innovating Medi-Cal (CalAIM) went live on January 1, 2022. There are several unique aspects of CalAIM, including the launch of Enhanced Care Management and Community Supports.
While Community Supports didn’t launch in every Californian county at the start of the year, the majority had at least one Community Support available in the area. Throughout this blog, we will take an initial look at how the launch of Community Supports has fared and best practices for maximizing the value of CalAIM Community Supports.
What Are Best Practices for Maximizing the Value of CalAIM Community Supports?
While there isn’t much quantitative data regarding the impact of CalAIM Community Supports thus far, there is qualitative data from MCPs and providers regarding the implementation. Their feedback thus far shows that while there is progress to be made, there are some best practices that should be incorporated into the Community Supports rollout.
According to recent briefs by the Center for Health Care Strategies (CHCS) and Health Net, there are several main considerations that are essential to the implementation of services. These are enhanced collaboration, partnerships between providers and community-based organizations, adequate operational support and funding, and streamlined data sharing and authorizations.
Collaboration and Partnerships Between Stakeholders are Crucial
Rolling out Community Supports, a link between MCPs, providers, and support service providers, requires collaboration. It is essential to create a seamless experience for providers and members. Throughout the process, providers and organizations struggled to navigate each plan’s administrative requirements, which can delay their ability to provide the necessary services. Others have struggled when contracting with multiple MCPs as each plan has unique tools and policies.
This is especially difficult for community-based organizations that might have limited staff and resources. One Community Supports provider stated, “I’ve lost a few staff already because they were spending more time figuring out the system than providing care.” It needs to be easy for providers to work with MCPs. That is why close collaboration is needed not just between MCPs and providers, but also amongst MCPs themselves. Without this collaboration and cooperation, consumers are not going to be able to access the quality care that they deserve.
Providers have warned MCPs that some organizations may not have the patience or willpower to obtain credentials and navigate vetting, claims submissions, authorization processes, and referral platforms. If plans in the same county standardize their workflows and requirements, this could make it easier for Community Supports providers and thus lead to better success. Some plans have already taken these steps. In Los Angeles, all MCPs issued a centralized questionnaire for those interested in contracting with plans. In other areas, plans have been working to align payment models and workflows. Through this close collaboration, CalAIM Community Supports will find more success and more consumers will be able to access services.
Establishing partnerships is also important, but these take time. Offering Community Supports has required MCPs to utilize nontraditional Medicaid providers that specialize in services like housing navigation. They also need to learn more about nontraditional Medicaid services like asthma remediation by establishing relationships with those that offer these services. Through these partnerships, a shared vocabulary needs to be built and complex processes and service components must be navigated. This takes time and cannot be rushed or there is a risk of creating a program that is too difficult for Medi-Cal enrollees to understand. Expanding these partnerships and scaling up Community Supports can also be difficult due to limited staffing and funds. In some counties, Community Supports providers do not even exist. Through the roll-out, the development of partnerships is essential, but cannot be rushed or the entire system may become too complicated to navigate for both providers and consumers.
Streamlined Data Sharing and Processes are Essential
Another best practice for the implementation of Community Supports is streamlined data sharing and authorizations. Accurate data collection and sharing facilitates better care coordination and enables consumers to access services quicker. Systems also need to be put into place to quickly and accurately share data between providers and community-based organizations delivering Community Supports. Streamlined authorizations also allow providers to deliver care and support faster.
hile it is important for Community Supports providers to understand each MCP’s authorization criteria, plans should also consider a shorter, simplified authorization period for certain Community Supports. Some plans have already created resources that delineate authorization criteria, which has minimized unnecessary delays for enrollees seeking access to services and care.
Providers Need Operational and Capacity-Building Support for Long-Term Success of CalAIM Community Supports
Operational support and capacity-building dollars are also a must when expanding Community Supports. Many Community Supports providers are new to MCPs and are not familiar with or utilize the systems that MCPs rely on. It is essential that Community Supports providers are set up for success and that means providing operational support and ensuring they have access to things like Electronic Health Records, Care Management Documentation Systems, billing systems, and closed loop referrals. With these systems and supports in place, providers and community-based organizations will be better able to provide quality services.
Financial support is also required for capacity building, putting compliance and oversight processes in place, technical assistance, and other essential tasks related to providing, billing, and reporting on services. Through the Incentive Payment Program (IPP), DHCS will reward plan $1.5 billion for meeting capacity-building milestones, but they will not direct how that money should be spent. Community Supports providers can also access funding and technical assistance through the Providing Access and Transforming Health (PATH) program. However, information about these programs and incentive payments is limited and there is some uncertainty surrounding them.
The confusion around the IPP and PATH programs can cause some providers and plans to move cautiously, thus slowing the rollout of Community Supports across the state. The hardest hit areas will be the low-income and rural counties that do not have providers already offering these services. As Community Supports roll out to more counties in higher numbers, adequate funding that is easily accessible is essential to ensure that quality services are being delivered. It is not enough to simply offer services in a county, they must be quality services that are easily accessible by consumers to ensure long-term success.
Advocates Perspective
While there isn’t much data on the impact that Community Supports have had on health outcomes yet, there is plenty of information on how to best roll out Community Supports across the state. While expanding access to all of the Community Supports across California is important, the method by which services are rolled out is also crucial. If the implementation is rushed, there is a risk that it will become too complex of a system that is difficult for members and providers to navigate. If that happens, the best-case scenario is that there is a delay in receiving care or services. The worst-case scenario is that Community Supports providers fizzle out due to the complexity of the system or members fail to seek services due to excessive hoops that they need to jump through or overall confusion of where to even turn for help. That is why it is essential to build strong partnerships through collaboration, streamline processes and systems wherever possible, and ensure that Community Supports providers have access to adequate operational support and capacity-building funds.
Onward!
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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.
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.