Preparing For CalAIM – Developing A Strategy For Sustainability & Success For Specialty Care & Primary Care In A Changing Medi-Cal Market

by

The California Advancing and Innovating Medi-Cal (CalAIM) initiative will implement broad reforms to California’s Medicaid delivery system, programs, and payment methodologies. The policy goals of CalAIM are to reduce system complexity, increase flexibility, improve quality of care, and drive system transformation through the use of value-based initiatives, payment reform, and integrated approaches for behavioral health, addiction treatment, and primary care for complex populations. In the multi-year implementation, some of the provisions go live on January 1, 2022 including new contracts with specialty provider organizations to deliver Enhanced Case Management and Community Supports (In Lieu of Services) for adult SMI populations. The final provisions are projected to go live by 2027.

One big question for executives of specialty care and primary care organizations is how to approach developing a sustainable strategy within the changing Medi-Cal market. As CalAIM unfolds, the fundamentals of sustainability will change for most organizations–including the services delivered, the contracting process, and reimbursement models. Executive teams need to monitor financial strength and service line portfolio performance–and create plans for developing new services for the changing market landscape and addressing issues of capital and scale needed for success.

The session will cover:

  • New service line opportunities for specialty provider organizations and primary care organizations under CalAIM
  • Best practice models for developing strategies for sustainability in a changing Medicaid landscape
  • A panel discussion of executives of specialty and primary care organizations on their strategic planning and service line development initiatives
  • A case study with Bayless Integrated Healthcare (Centene) – an integrated primary care and behavioral health organization based in Phoenix, Arizona, that provides comprehensive clinic-based and virtual care services for clients throughout the state. They provide a “whole person” approach to health and promote collaboration among a team of primary care providers and specialists. Their unique service integration of primary care, behavioral health, addiction medicine, and wellness has achieved better health outcomes for the clients they serve.