CalAIM is Underway!

California Advancing and Innovating Medi-Cal — more commonly known as CalAIM — is a far-reaching, multiyear plan to transform California’s Medi-Cal program and enable it to work more seamlessly with other social services. Led by the California Department of Health Care Services (DHCS), the goal of CalAIM is to improve outcomes for the millions of Californians covered by Medi-Cal, including those with the most complex needs.

CalAIM’s three primary goals create a massive shift in the way services are delivered, reviewed, and reimbursed by Ventura County Health Care Agency:

1. Identify and manage member risk and need through Whole Person Care Approaches and addressing 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.

Ventura County Health Care Agency’s vision is that people served by our programs should have longer, healthier, and happier lives. To do this, we must make the system changes necessary to close the gap in transitions between delivery systems, create opportunities for appropriate step-down care and mitigate social determinants of health.

A core set of guiding principles have been established to guide us through the CalAIM initiative:

• Improve the member experience
• Deliver person-centered care that meets the behavioral, developmental, physical, long-term services and supports, and oral health needs of all members
• Work to align funding, data reporting, quality, and infrastructure to mobilize and incentivize toward common goals
• Build a data-driven population health management strategy to achieve full system alignment
• Identify and mitigate social determinants of health and reduce disparities and inequities
• Drive system transformation that focuses on value and outcomes
• Eliminate or reduce variation across counties and plans, while recognizing the importance of local innovation
• Support community activation and engagement
• Improve the plan and provider experience by reducing administrative burden when possible
• Reduce the per-capita cost over time through iterative system transformation

Managed Care Plans:

Through CalAIM, Managed Care Plans that already provide medical coverage for low-income Californians, are now able to provide access to other necessary supports to improve the health and well-being of Medi-Cal members including Enhanced Care Management, and Community Support for help with social and other problems, such as housing and food.

In Ventura County, our local Managed Care Plan is the Gold Coast Health Plan (GCHP). Gold Coast Health Plan has contracted with Ventura County Health Care Agency to work together on the implementation, launch, and administration of these services.

For more information about Gold Coast Health Plan visit their website at: https://www.goldcoasthealthplan.org/for-providers/provider-resources/calaim-resources/
To learn more about Gold Coast Health Plan’s implementation of Enhanced Care Management and Community Support services, visit the GCHP CalAIM webpage at: https://www.goldcoasthealthplan.org/for-providers/provider-resources/calaim-resources/

Learn more

For more information on the CalAIM initiative and its vision to transform Medi-Cal, please visit the following links provided:

• CalAIM – CA Department of Health Care Services
• CalAIM Executive Summary and Summary of Changes

For more information about CalAIM or to speak with someone about Community Support or Enhanced Care Management services contact the Whole Person Care team by phone at 805-339-1122 or email wholepersoncare@ventura.org