November 1, 2019 Edition
On Monday, the Department of Health Care Services (DHCS)
released a multi-year initiative, California
Advancing and Innovating Medi-Cal (CalAIM). The Administration
identified three primary goals for CalAIM:
- Identify and manage member risk and need through
Whole Person Care Approaches and addressing the Social Determinants of Health;
- Move Medi-Cal to a more consistent and seamless
system by reducing complexity and increasing flexibility; and
- Improve quality outcomes and drive delivery
system transformation through value-based initiatives, modernization of
systems, and payment reform.
Key components of CalAIM are highlighted in the embedded presentation
from the October 29 Stakeholder Advisory Committee.
DHCS will solicit input on various aspects of the CalAIM proposal
through the Stakeholder
Advisory Committee (DHCS SAC), Behavioral
Health Stakeholder Advisory Committee, and the newly established CalAIM
CHEAC is a member of the DHCS SAC and two of the CalAIM
workgroups – Population Health Management Strategy and Plan Enrollment and Enhanced
Care Management and In Lieu of Services – and will provide regular updates as
discussions progress. For additional updates, please subscribe to the DHCS
stakeholder email service.
CSAC Webinar. Earlier this week, the California State
Association of Counties (CSAC) hosted a webinar on the Public Safety Power
Shutoffs (PSPS). Representatives of CSAC were joined by officials from the
Office of Emergency Services (OES) and discussed the appropriate use of the funding
provided to counties. For those unable to attend the webinar, a recording can
be viewed here.
State of Emergency. On Sunday, Governor Newsom declared a State
of Emergency due to the fires and extreme weather conditions. Included in the
proclamation is the reference to PSPS events impacting a multitude of residents
throughout the state. A copy of the declaration can be found here.
Website. The Administration launched a website to house
various PSPS event and fire response resources. The website, www.response.ca.gov, also includes
around the sharing of health information.
On Monday, November 4, the Senate and Assembly Health
Committees will convene a joint informational hearing on 1) access to care in
the Regional Model counties; and 2) children’s preventative services.
For access to care in the regional model, State Auditor
Elaine Howle will highlight the findings and recommendations of their audit report,
which was released in August 2019. The hearing will include responses from
California Department of Health Care Services (DHCS), Anthem Blue Cross and
California Health and Wellness and Partnership Health Plan representatives, and
Butte County Health Officer Andy Miller.
The children’s preventative health services portion of the
hearing will again include a report from State Auditor Elaine Howle on the
audit recommendations and six-month implementation progress report, followed by
responses from DHCS and representatives from Central California Alliance for
Health and Children Now.
Hearing Materials are linked below:
Last week, the California Health Care
Foundation released two new studies by the Blue Sky Consulting Group assessing
quality of care, access, and the provider’s experience under two models of
Medi-Cal managed care, the Regional and Geographic Managed Care (GMC) models.
Regional paper concludes that Medi-Cal enrollees in
Regional model counties have received somewhat poorer quality of care, have
greater difficulty accessing specialty care, and are less satisfied with their
health care compared to Medi-Cal enrollees living in other rural counties.
However, access to primary care was somewhat better in Regional model counties
compared to other rural counties, and overall quality was improving at a faster
rate in Regional model counties.
A key research question
for the GMC analysis was: Do multiple managed care plan choices for Medi-Cal
enrollees result in better outcomes? The paper concludes
that the added competition does not result in better quality, access, or
patient satisfaction in GMC counties when compared to similar urban counties
with different models of Medi-Cal managed care. Meanwhile, the multiplicity of
plans creates a confusing patchwork of networks, providers, benefits, and
services that often confuse enrollees and present many redundancies for
Both papers provide
recommendations to state policymakers and program officials for improving care
for Medi-Cal enrollees served by these managed care models.