CalAIM (California Advancing and Innovating Medi-Cal) Initiative Goals

SOLUTION TRENDS

CalAIM is a multi-year initiative to improve the quality of care provided to Medi-Cal members by implementing a broad delivery system, program, and payment reform across the Medi-Cal program. We sat down with RamaOnHealthcare to discuss CalAIM goals and more with an excerpt below.

Why are all states staring closely at the CalAIM initiative right now?

It is essential to start by level setting and understanding the depth and breadth of the CalAIM initiative. CalAIM is a multi-year initiative to improve the quality of care provided to Medi-Cal members by implementing a broad delivery system, program, and payment reform across the Medi-Cal program. The major components of CalAIM are built upon the lessons learned from various pilots, such as Whole-Person Care, Health Homes Programs, and Coordinated Care Initiative.

Essentially, the goal of CalAIM is to align the elements of Medi-Cal into a system that is standardized, simplified, and focused on helping enrollees live healthier lives. The initiative is to move toward a population-health approach that will focus on prevention and whole-person care. It touches an enrollee from birth to the end of life.

California has the largest population of any state. With over 40 million people, it accounts for 12% of the total U.S.A. population. Approximately one-third of Californians rely on California’s Medicaid program, called Medi-Cal. As of 2021, Medi-Cal covered nearly 14 million people.

Along with the substantial financial investment and the commitment/participation of the network of health and community organizations, the initiative will work with other Department of Health Care Services (DHCS) initiatives, as well as items in the state budget. This is a collaborative initiative, and it requires all parties, especially servicing providers and plans, to track these items/initiatives alongside CalAIM to understand how each works separately and together. There are a lot of moving parts and many players. Success demands a high level of information sharing, silo destruction, and a lot of infrastructure work.

The initiative is about breaking down barriers that block access to quality and timely care, providing aid to the most vulnerable residents, and offering more equitable programs. This mission is similar in all states, as we recognize the overall impact of social determinants of health and health disparities. To achieve the best health outcomes possible, non-medical needs must be identified, addressed, and met. Healthcare cannot focus only on physical health. Behavioral health must also be addressed in whole-person, integrated care plans.

Knowing the complexity of the initiative and the anticipated positive outcome on individuals, families, communities, and the overall population, warrants other states, providers, payers, and servicing entities to keep an eye on what is working well and what initiatives they can adopt. Changes from the CalAIM initiative will span a multi-year period, with the first reforms already underway, effective as of January 1, 2022. Subsequent reforms will be phased in through 2027.

Allowing other states to scrutinize the progress of CalAIM — questioning what worked well, the initiative’s effectiveness, and if similar programs can be applied outside of California — we may find that California will define the road map for other states and drive widespread national policy change.

See the whole CalAIM interview with Karen Iapoce, Senior Director of Government Solutions at ZeOmega.