Yesterday, CHA submitted recommendations to the Department of Health Care Services (DHCS) on its California Advancing and Innovating Medi-Cal (CalAIM) initiative proposal, the state’s multi-year initiative to redesign the Medi-Cal delivery system.
CHA’s comments — informed by the experience of California’s hospitals and post-acute care providers under the current system — are organized within two of CalAIM’s primary goals: 1) identify and manage member risk and need through whole person care approaches and address social determinants of health; and 2) move Medi-Cal to a more consistent and seamless system by reducing complexity and increasing flexibility.
In the letter, CHA provides recommendations for each of the CalAIM proposals, including requiring Medi-Cal managed care plans to submit local population health management plans; implementing a new statewide enhanced care management benefit and “in lieu of services” (e.g., housing navigation/supporting services, recuperative care, respite, sobering center, etc.); shared risk, shared savings, and incentive payments; behavioral health payment reform; and substance use disorder managed care program renewal and policy improvements.
CHA notes the following as critical to CalAIM’s success:
- Increased Oversight and Accountability: DHCS’ increased oversight and accountability of Medi-Cal managed care plan and county mental health plan performance is critical, as is the development of transparent mechanisms, to ensure the plans are held accountable for existing and new standards outlined within the proposal.
- Transparency: Transparency in all aspects of CalAIM implementation will help ensure that DHCS, managed care plans, mental health plans, providers, and community partners share accountability for the care provided to Medi-Cal members.
- Meaningful Stakeholder Engagement: CHA urges DHCS to implement CalAIM in a thoughtful manner, recognizing that if additional time is needed to refine a proposal, DHCS and stakeholders should do so in a way that ensures Medi-Cal members do not experience any unintended consequences.