California Advancing and Innovating Medi-Cal (CalAIM) is a long-term commitment to transform and strengthen CA Medicaid (Medi-Cal), offering 14M+ beneficiaries a more equitable, coordinated, and person-centered approach to maximizing their health.
The CA Department of Health Care Services (DHCS) is transforming the Medi-Cal delivery system moving Medi-Cal towards a population health approach that prioritizes prevention and whole person care. CalAIM will offer Medi-Cal enrollees coordinated and equitable access to services that address physical, behavioral, developmental, dental, and long-term care needs. In the multi-year implementation, some of the provisions went live in 2022 including new managed care plan contracts with specialty provider organizations/CBOs to deliver Enhanced Care Management and Community Support services for adults with severe mental illness (SMI). Similar contracts began July 2023 for children and youth with serious emotional disturbance (SED) and the final provisions of CalAIM are projected to go live by 2027.
New population health management strategies have been implemented by managed care plans and the state of California is moving toward a seamless data exchange framework that will improve Californians health care experience, support whole person care system transformation and empower consumers with health data by 2024. One big question for specialty and primary care organizations executives is what technology enhancements will be required to have the right tech infrastructure to succeed under CalAIM in the future. The session will cover:
- Technology lessons learned to-date (2022-2023) in the implementation of Enhanced Care Management under CalAIM.
- Technology functionality required to provide coordinated care under new population health payer strategies.
- What technology will providers need to deliver services in a new data exchange framework.
- A panel discussion of executives of specialty and primary care organizations on their plans for technology investment under CalAIM