A core element of all Medicaid Section 1115 “research and demonstration” waivers is an evaluation of the demonstration program and its efficacy in meeting the demonstration’s goals. Historically, however, Section 1115 waiver evaluations have been an afterthought for states and CMS, limiting their ability to inform future Medicaid policy and financing approaches.

Last year, Aurrera Health Group teamed up with the California Department of Health Care Services to provide early education and targeted technical assistance for providers on implementing Enhanced Care Management and Community Support services, two key parts of the CalAIM initiative. This experience revealed several promising practices for other states pursuing whole-person approaches to health care delivery.

By Trish Violett, Junior Policy Consultant and Megan Thomas, Director, Quality Initiatives

Over the past four years, the 52 hospitals and health systems participating in the California Public Hospital Redesign and Incentives in Medi-Cal (PRIME) program have been working to improve care delivery and maximize health care value through a “pay-for-performance” model. The PRIME hospitals are using evidence-based quality improvement methods to achieve designated goals and outcomes on select clinical projects and associated performance metrics.

By Lilly Clements, Junior Policy Consultant and Megan Thomas, Associate Director

Since 2014, the Cal MediConnect (CMC) program has coordinated care for some of the most vulnerable Californians. CMC was developed by the Department of Health Care Services (DHCS) and the Centers for Medicare & Medicaid Services (CMS) to better serve dual eligible beneficiaries – those enrolled in both Medicare and Medi-Cal (Medicaid in California).

A primary focus of CMC is to better coordinate behavioral health care service delivery for members. This week, DHCS released a report entitled “Improving Behavioral Health Integration and Coordination for Cal MediConnect (CMC) Members,” which details the complexities and nuances of CMC plans’ efforts to integrate behavioral health into the care delivery system for dual eligible beneficiaries.

By Jennifer Ryan, Vice President; Tanya Schwartz, Director, Medicaid Policy; and Molly Brassil, Director, Behavioral Health Policy

One would need to be completely “off the grid” to not be aware of the opioid crisis that has overtaken the country. Alarming and heart wrenching stories about the surprising range of victims of the substance use epidemic top the news headlines on a daily basis. The death rate due to drug overdoses has exceeded car accidents as the leading cause of death among adults under age 50 – since 2000, the rate of overdose deaths involving opioids (opioid pain relievers and heroin) has increased by 200%.