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CalAIM: Transforming Medi-Cal Coverage & Model of Care

California Advancing and Innovating Medi-Cal (CalAIM) is a multiyear waiver to transform California’s Medi-Cal program and enable it to work more seamlessly with other social services for the state’s most vulnerable populations.

CalAIM is a long-term commitment to transform Medi-Cal, making the program more equitable, coordinated, and person-centered to maximize outcomes & build sustainable infrastructure within the safety net.

Primary Goals

  1. Identify and manage member health and social needs through Whole Person Care Approaches and integrated models of care
  2. Move Medi-Cal to a more consistent and seamless system by reducing complexity and increasing flexibility
  3. Improve quality outcomes and drive delivery system transformation through value-based initiatives, modernization of systems and payment reform

Our Services

  1. CalAIM Strategic Alignment & Operational Readiness Assessment
    • In-depth assessment of infrastructure capabilities against CalAIM requirements
    • Align current business objectives & strategy to maximize CalAIM benefits and funding to achieve the greatest impact and ROI
    • CalAIM implementation roadmap to support provider transformation and care model redesign
  2. CalAIM Processes
    • Data capture, analytics, and reporting
    • Managed Care Plan contracting, billing and claims
    • Member identification, stratification and outreach
    • Documentation and workflows
    • Social Determinants of Health assessments & community partner engagement
    • Provider communication & engagement strategies
  3. Care Model Design
    • Care Model and Clinical Redesign tailored to populations of focus
    • Care Team Structure and Education/Training
    • SDOH and CBO Integration and Coordination
    • HEDIS Quality and SDOH Gap Closure
    • Patient Outreach and Engagement
  4. Data & Technology Infrastructure
    • Configuration of analytics and data models to meet CalAIM requirements and identify target populations
    • Risk stratification for high-risk member identification, outreach & enrollment
    • Platform & technology best practices to accelerate member engagement & improve clinical quality outcomes
  5. ECM/CS Provider Identification and Engagement
    • Asset mapping of providers within identified service areas
    • Strategic alignment & cross sector collaboration
    • Contract development & performance management
    • Operational workflows and care plans that can be shared across entities to support collaborative efforts
  6. Managed Care Contracting
    • Comprehensive financial modeling to support assessment of financial implications and operational requirements
    • Development of contracting terms & operational tools for quality and performance management
  7. Workforce Development
    • Development and implementation of customized competency based CalAIM training programs (e.g., analytics, care models, member engagement)
    • Development and implementation of hiring processes, employee engagement and training and performance management tools
    • Implementation of workforce pipeline & onboarding solutions

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