Preparing For CalAIM – Developing A Strategy For New & Innovative Service Line Development
California Advancing and Innovating Medi-Cal (CalAIM) is a long-term commitment to transform and strengthen CA Medicaid (Medi-Cal), offering 14M+ beneficiaries a more equitable, coordinated, and person-centered approach to maximizing their health. The CA Department of Health Care Services (DHCS) is transforming the Medi-Cal delivery system moving Medi-Cal towards a population health approach that prioritizes prevention and whole person care. CalAIM will offer Medi-Cal enrollees coordinated and equitable access to services that address physical, behavioral, developmental, dental, and long-term care needs. In the multi-year implementation, some provisions went live in 2022, including new managed care plan contracts with specialty provider organizations/CBOs to deliver Enhanced Care Management and Community Support services for adults with severe mental illness. Similar agreements will begin in 2023 for youth (SED), and the final provisions of CalAIM are projected to go live by 2027.
As CalAIM unfolds, the fundamentals of sustainability will change for most provider organizations – including the services delivered and reimbursement models. The question for executives of specialty care and primary care organizations is how to approach developing a sustainable strategy within the current climate of payment reform. Executive teams need to monitor service line(s) performance and financial strength – and create plans for adopting and developing new services for changing Medicaid, managed care, and health plans evolving service needs and expectations.
This session will cover:
- New service line opportunities for specialty provider organizations and primary care organizations
- Best practice approaches for service line development and integrated models of care
- Best practice strategies for sustainability in a changing Medicaid landscape
- Innovative service delivery of mental health services in whole person care environment