CalAIM: A Community Support’s Key Takeaways After Six Months

It has been six months since the launch of CalAIM (California Advancing Innovating Medical), a multi-year effort to improve health equity and quality of care for California Medicaid enrollees, allowing us to evaluate the successes and challenges the program has faced so far. CalAIM is a multifaceted approach to addressing health equity and quality of care for our underserved Southern California communities by engaging with Community Supports and Enhanced Care Management (ECM). ECM coordinates all health and health-related social services of Medi-Cal community members deemed “high need,” like our unhoused neighbors and returning citizens. Community Supports like the ones National Health Foundation provides are meant to bridge the gap in services to allow for continuity of care and access to resources.  

Since the launch we can see numerous ways in which the system can be improved for Community Supports so that we can continue providing the best care for our communities. One of which is the burden placed on Community Support providers with enrolling and billing a variety of providers and plans. We are eager to work with DHCS to find a way to streamline the processes and allow smaller Community Support providers to continue participating in the program. Another issue the program has revealed was difficulty obtaining authorizations from providers for Community Support recuperative care stays. Because of the delay in authorizations or coverage, the burden of the cost of the stay falls on hospitals and community members could experience gaps in care. Many of the initial hurdles faced in these last several months boil down to cost and unpredictable variation in processes.

“Presumptive authorizations, if a guest is eligible for a plan, was helpful because then hospitals did not have to wait to send us guests,” said Nicholas Correnti, National Health Foundation Account Manager. 

Looking back at the last six months we can identify the good, the burdensome, and the potential for improvement. To allow this program to thrive and serve as many of our community members as possible, systems and processes need to be streamlined and uniform across plans and providers. Another avenue to success is continuing to expand partnerships within the community-based organizations allowing us to reach everyone deemed “high need” who could benefit from access to services and resources. The potential for CalAIM to elevate the services and care of our communities is evident in these first six months and National Health Foundation will continue working with DHCS to make it a success. 

As we continue to restructure and reimagine equitable care for our most underserved communities, National Health Foundation is excited to continue serving Southern California communities.

Learn more about CalAIM.