In 2022, the California Department of Health Care Services (DHCS) will launch an ambitious and innovative program designed to address the complex physical, behavioral and social needs of Medi-Cal’s most vulnerable members. The California Advancing and Innovating Medi-Cal (CalAIM) program will build upon the plan-based Health Home Program and county-based Whole Person Care pilots that use whole-person care approaches to address underlying social determinants of health.
CalAIM envisions enhanced coordination, integration and information exchange among managed care plans (MCPs); physical, behavioral, community-based and social service providers; and county agencies by establishing new benefits and services, including Enhanced Care Management (ECM) and In Lieu of Services (ILOS).
Manatt Health and the California Health Care Foundation have partnered to create a new implementation roadmap—“CalAIM and Health Data Sharing: A Roadmap for Effective Implementation of Enhanced Care Management and In Lieu of Services”—that identifies data, data exchange and information system barriers to implementing ECM and ILOS program functions, and offers a set of recommendations and actions for policymakers, government agencies, MCPs and providers. The roadmap addresses three categories of data-sharing barriers and the steps necessary to mitigate them, including:
- Regulations and policies to facilitate safe and secure information sharing
- Technical infrastructure and standards to support the efficient collection, exchange and use of member information
- Financing, contracting and operations, where aligning incentives, contracting and tactics is crucial to institutionalizing the programs and ensuring their long-term success
Click here to read the full roadmap.