California’s ambitious journey to reshape health care through the multiyear Medi-Cal reform effort known as California Advancing and Innovating Medi-Cal (CalAIM) represents a profound leap forward. The effort will introduce a variety of new programs and benefits over five years, aimed at improving care for the millions of Californians enrolled in Medi-Cal, the state’s safety-net health insurance program.
Two years into the program, there is anecdotal evidence that providers are already starting to see improvements in the patients they serve. However, providers are experiencing many challenges in adapting to the new whole-person and coordinated care approach, including resource capacity and redundant processes. The problem is compounded by the fast pace at which the state and health plans drive the program. Achieving successful implementation requires creative thinking and coordination of available resources.
As someone with more than 30 years of experience in health care information technology, and a member of a stakeholder advisory group for the California Health and Human Services Data Exchange Framework, here are the strategies I believe can make CalAIM a success.
- Seamless, purposeful data integration
CalAIM’s vision of more coordinated care across clinical, mental and social services, relies heavily on data integration and interoperability. This involves seamlessly sharing patient data among health care providers, payers and social service organizations. Achieving this level of data integration has been a formidable challenge. Health care organizations operate disparate data systems, each with their own workflow, formats, standards and protocols.
The Data Exchange Framework (DxF), which most of the state’s health care organizations are required to fully implement by January 2024, will support successful care coordination and sharing of patient information among stakeholders involved in CalAIM.
State-funded grants are available to help facilitate this transformation. The Center for Data Insights and Innovation has allocated up to $47 million for organizations that have signed an agreement to adopt the DxF and share data. In addition, the CalAIM Incentive Payment Program from the Department of Healthcare Services provides the funds dedicated specifically to helping CalAIM participants deploy the technology to meet key targets in their implementation and delivery of transformative programs and services.
- Build capacity to address skill gaps
Funds are also available for technical assistance. The state has appointed PATH TA Marketplace Vendors to allow providers, community-based organizations, counties and others to obtain assistance with implementing Enhanced Care Management (ECM) and Community Supports, two foundational initiatives of the CalAIM program. The program helps eligible organizations build data capacity, redesign workflow, strengthen services that address the social drivers of health, engage in CalAIM through Medi-Cal Managed Care plans, promote health equity, and enter cross-sector partnerships.
- Prepare the workforce for a data-driven future
Health care reform inevitably brings change. This requires comprehensive change management strategies that include communications, stakeholder engagement, and education and training for health care and social service professionals. The workforce will need to learn new technology and paradigms associated with CalAIM’s implementation. Future health and social service workers will require training on electronic health records, health information organization exchanges, and other health IT systems and how to use them effectively.
- Consider innovative solutions for care delivery challenges
The CalAIM transformation requires addressing workforce shortages, particularly in rural and underserved areas. Establishing comprehensive training programs and incentives for health care professionals in underserved regions can help address these shortages. Automating administrative tasks will reduce redundant processes and make resources available for patient care. Telehealth initiatives can also bridge gaps in access to care. In addition to IT training, cultural sensitivity training is critical to ensure the delivery of quality and compassionate care for our most vulnerable populations.
- Get involved to advocate, share and recognize efficiencies
At the recent State of Reform Southern California Policy event, community-based organization representatives shared that new processes and more resources are needed to effectively deliver Enhanced Care Management for children and young people. Sharing key challenges and potential solutions creates new opportunities for dialogue and cross-training and can influence future resource allocation and policy. This reduces excessive burdens on community-based organizations and the risk of duplicating services.
Considering that 50 percent of the state’s births are in Medi-Cal, it is critical to ensure the successful implementation of the CalAIM program for healthy and thriving communities across California. As with any transformational process, there are many factors involved in achieving successful implementation of CalAIM. These include ensuring frontline organizations responsible for delivering and coordinating care have enough resources, knowledge and preparation to move us closer to the vision of equitable health care for all Californians.
Ali Modaressi is CEO of the Los Angeles Network for Enhanced Services, a qualified health information organization in Los Angeles, and serves on the California Health and Human Services Data Exchange Framework Stakeholder Advisory Group.