November 1, 2019 Edition

DHCS Releases CalAIM Proposal

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:

  1. Identify and manage member risk and need through Whole Person Care Approaches and addressing the Social Determinants of Health;
  2. Move Medi-Cal to a more consistent and seamless system by reducing complexity and increasing flexibility; and
  3. 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 Workgroups:

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.


PSPS Webinar and Resources

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 helpful guidance around the sharing of health information.


Upcoming Informational Hearing: Medi-Cal: Access to Care in the Regional Model and Children’s Preventive Health Services

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:


Medi-Cal Managed Care Studies – Regional Model and Geographic Managed Care

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.

The 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 providers. 

Both papers provide recommendations to state policymakers and program officials for improving care for Medi-Cal enrollees served by these managed care models.