VBP Blog Year in Review: CalAIM is Making Waves
As we wrap up 2022, let’s review the top five CalAIM blogs published this year
THE VBP Blog
December 22, 2022 – Throughout 2022 we have written numerous blogs on California’s shift from Medi-Cal to California Advancing and Innovating Medi-Cal (CalAIM). From looking at the unique aspects of the program and deep dives into what sets CalAIM apart to looking at how aspects of CalAIM can be replicated in other states, we’ve covered it all! Whether you missed a couple of blogs or simply want a refresher, keep reading for a recap of our top five CalAIM blogs of 2022!
In this blog, we took a deep dive into the move from Medi-Cal to CalAIM. The highlight of this blog was the new focus placed on whole-person care. Overall, the goals of CalAIM are to identify and managed comprehensive needs through whole-person care and SDoH, improve the quality outcomes while reforming payment models and reducing health disparities, and to make Medi-Cal a more consistent and seamless system for enrollees to navigate. We also briefly touched on the shared risk and shared savings aspect, which encourages provider buy in by providing the right incentives.
In this blog, we took a cursory look at two of the most pronounced aspects of CalAIM – Community Supports and Enhanced Care Management. Enhanced Care Management addresses both the clinical and non-clinical needs of the highest-need enrollees. Enrollees who meet certain criteria will have access to extensive coordination of health and health-related services to provide care no matter where an enrollee is. The other unique aspect of CalAIM, Community Supports, addresses social determinants of health. These statewide services will be provided by managed care plans and serve as cost-effective alternatives to traditional medical services.
In this blog, we examined one of the unique aspects of CalAIM – Community Supports in more detail. Community Supports, also know as In Lieu of Services (ILoS) are services designed to address social determinants of health (SDoH). Addressing non-medical needs like transportation, housing, and meals, is not a new concept. However, what’s unique about CalAIM is that these statewide services provided through managed care plans. In examining the early roll out of CalAIM Community Supports, it is clear that collaboration and partnerships between stakeholders, streamlined data sharing and processes, and operational and capacity-building support for providers is essential for long-term success of the initiative.
In this blog, we look at how CalAIM utilizes integrated care plans and how these can be incorporated in other states. First, what is an integrated care plan? Integrated care plans address the issue of siloed healthcare systems by combining physical, behavioral, and non-medical health needs under one plan. In the case of CalAIM, the state is testing the effectiveness of an approach the provides full integration of physical health, behavioral health, and oral health under one contracted entity. In other states, behavioral health, physical health, and oral health are all covered by different plans even though there are many studies showing that they are all linked. Under siloed care, there are gaps in care, disruptions in treatment, double testing, and overall frustration from consumers. Through an integrated care model, individuals get whole-person care through a system that is easy to navigate. This is something that CalAIM is doing that other states should take note of.
In this blog, we examined lessons learned from CalAIM and how some unique aspects can be applied in other states. In this instance, we looked at how shared savings and shared risk models can improve the quality of care and lower healthcare costs because they provide the right incentives. We know that delivering high-quality, low-cost care is the goal, but in order to reach that, payment models and incentives need to be structed in a way that gets providers to buy in. Throughout the blog, we look at evidence showing shared savings – shared risk provides benefits, as well as the keys to successful roll out so these payment models can be replicated in other states.
At XtraGlobex, we are advocates first. That is why we have covered CalAIM so closely, as it seems to be a good model for other states to consider. We also see a significant missing element in Provider Led Entities being designed in. While it is still in the early stages are more analysis will need to be done as the program progresses, the enhanced focus on providing whole-person care, addressing social determinants of health, assisting with care management, and properly incentivizing buy in with shared risk – shared savings models, CalAIM seems to be set up for success. We hope to see improvements in the integration of providers in the management of the program. Keep following us in 2023 as we continue to keep tabs on CalAIM to see if it is delivering on its lofty goals.
We want to thank you for following us during 2022 and wish you and yours the best in the year ahead. And as always…
Share This Blog!
Get even more insights on Linkedin & Twitter
Subscribe here to receive the blogs straight to your inbox
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.