Supporting Medicaid Providers in CalAIM Implementation

Two initiatives have recently launched in California – Enhanced Care Management (ECM) and Community Supports – as part of the state's broader suite of Medicaid transformation efforts, known as California Advancing and Innovating Medi-Cal (CalAIM). CalAIM is a multi-year initiative led by the Department of Health Care Services (DHCS) that aims to improve the quality of life and health outcomes of beneficiaries, leveraging Medicaid to help address many of the complex challenges facing California’s most vulnerable residents. Together, they address the clinical and non-clinical concerns of the highest-need Medicaid enrollees through intensive coordination of physical and behavioral health services and social supports, like assistance with housing and addressing food insecurity.ECM and Community Supports build on several previous California initiatives – including the Whole Person Care Pilots and the Health Homes Program – to achieve a statewide approach for comprehensive care management. A number of states have pursued similar objectives in recent years. For example, Minnesota recently added housing stabilization services as a Medicaid benefit; New York is providing medically tailored meals through their “In Lieu of Services” program, and North Carolina is launching Healthy Opportunities Pilots to provide intensive case management and services related to housing, food, transportation, and interpersonal safety for high-need Medicaid enrollees.

New Types of Providers Call for Extra Support

Engaging new types of providers – like homeless services providers, meal delivery organizations, county agencies, and other community-based entities – will be critical to the success of the CalAIM initiative. These new organizations will play a vital role in delivering ECM services and Community Supports, including providing direct care, making referrals, and educating the community about the new benefits that are available. However, many lack experience with Medicaid and managed care delivery systems. In addition to learning how to bill Medi-Cal, participating in CalAIM presents challenges related to relationship building, administrative infrastructure development, technology, data sharing, and other processes. Ensuring adequate support around understanding program goals, adapting to new processes, and meeting state requirements is critical to success for initiatives that involve nontraditional providers. Early experience in California can offer valuable lessons for other states and their partners.In 2021, Aurrera Health Group assisted the California Department of Health Care Services (DHCS) by providing early education and targeted technical assistance to support providers in preparing for ECM and Community Supports implementation. This experience revealed several promising practices:

Gather provider questions and feedback early and often to inform ongoing support needs.

To ensure technical assistance is responsive to stakeholder needs, it is important to maintain close contact and track incoming questions and feedback throughout the course of engagement. Consistent stakeholder engagement helps ensure attention to new and evolving issues and can help identify common challenges across diverse stakeholders. In California, stakeholder engagement revealed managed care plans and new providers were facing challenges with assessing and demonstrating capacity to deliver the new services, which helped inform development of policy guidance, FAQs, webinars, and other assistance to clarify expectations and requirements. Stakeholder input also shed light on confusion related to roles and responsibilities for ECM and Community Supports and highlighted the need to better educate providers to foster a clearer understanding of how to participate and what would be required to do so.

Promote understanding of program goals, structure, and requirements – and provide connections to additional resources.

Educational webinars have been a key training and engagement strategy for California’s ECM and Community Supports initiatives. With support from Aurrera Health, DHCS hosted a series of targeted webinars with varying levels of detail to meet the needs of community providers who are interested in, or likely to participate in the initiatives. The first webinar focused on establishing a baseline understanding for providers that may have little or no experience with Medicaid or managed care. The webinar provided an overview of the Medicaid program, explained how managed care works, conveyed the vision, goals, and key components of CalAIM, and highlighted opportunities for providers to participate in ECM and Community Supports.The second webinar of the series expanded on areas of interest to new providers, including a deeper dive on health plan and provider roles and requirements, how plans and providers are paid, and key questions and considerations for discussion with managed care plans. The final webinar in the series explained and promoted the release of a comprehensive set of educational resources for providers. Importantly, each of the webinars was open to all providers and other stakeholders and offered links to additional resources, on theDHCS website.

Develop resources tailored to provider interests and needs.

Tailored support is critical to addressing unique provider interests and needs. In response to stakeholder requests, Aurrera Health designed and executed tailored trainings for individual provider associations and their members. The trainings provided additional information in areas identified by the associations and were responsive to their specific questions. Furthermore, Aurrera Health developed a comprehensive set of educational resources for providers interested in ECM and Community Supports. The resources use accessible language and actionable, easy to use formats allowing information to be understood and shared with an array of audiences. The resources include:

• ECM Provider Toolkit: Offers information about ECM and helps providers assess their readiness and prepare for ECM implementation. Topics include an overview of ECM, eligibility criteria, descriptions of core services, information about roles and provider requirements, and a section on becoming an ECM provider, including tips for engagement with managed care plans.

• Medi-Cal Community Supports Explainer: Provides a high-level overview of Community Supports, including service descriptions and key considerations for entities interested in becoming providers.

• ECM Outreach Toolkit: Delivers strategies and promising practices for ECM outreach staff to successfully engage and enroll eligible members.

• ECM Member Toolkit: Covers key information about ECM for members, including answers to Frequently Asked Questions.

CalAIM officially launched in January 2022, and there will undoubtedly be unforeseen bumps in the road along with important successes in supporting Medi-Cal beneficiaries at a new level than ever tested before. We expect the foundation established by DHCS to support managed care plans and community providers will smooth out those bumps and lead to many new productive relationships.

---

Authors

Brianna Nielson [Deputy Director]

Kate Johnson [Director]

Jill Donnelly [Managing Principal]