Are you ready for CalAIM?
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What is CalAIM?
CalAIM – California Advancing and Innovation Medi-cal, is a multi-year program by the Department of Health Care Services (DHCS) designed to enhance the quality of life and health impacts on the population. CalAIM was built on the successful results from prior pilots (such as Whole Person Care Pilots (WPC), Health Homes Program (HHP) and Coordinated Care Initiative) and was created to reform Medi-Cal by implementing broad delivery system, program and payment improvements across the program. 
- Using whole person care approaches to identify and manage member risk and need, as well as addressing Social Determinants of Health
- Reducing complexity and increasing flexibility by shifting Medi-cal to a more stable system
- Enhancing quality outcomes, reduce health disparities, and modify the delivery system by using value-based initiatives, updating systems, and payment reform
CalAIM Changes and Updates
- 2022: New Enhanced Care Management (ECM) benefit and In Lieu of Services (ILOS)
- 2022: Major Organ Transplant (MOT) benefit carved into Managed Care
- 2022: Update medical necessity criteria for specialty mental health services (SMHS) to improve access
- 2023: Long Term Care (LTC) benefits carved into Managed Care
- 2023: Dual Special Need Program (DSNP) Aligned Managed Care enrollment in CCI Counties
- 2025: Aligned Managed Care enrollment in non-CCI Counties
- 2023: Population Health Management (PHM) strategy
- 2026: NCQA accreditation for Medi-Cal MCPS and subcontractors
- 2027: Statewide Managed Long Term Services & Supports (MLTSS)
Two foundational pillars of CalAIM are Enhanced Care Management (ECM) and In Lieu of Services (ILOS). Both of these reforms are set to be implemented at the beginning of January, 2022. ECM refers to a whole-person approach to comprehensive care management that addresses clinical and non-clinical needs. ILOS are medically appropriate and cost-effective alternatives to state plan services. ILOS are optional services to provide for Medical Managed Care Plans (MCPs) and optional for managed care members. 
Case Management and Care at ARW
At ARW, we are eager and getting ready for the implementation of CalAIM. Our Case Management (CM) showcases how Cozeva works as a trusted channel of communication between your patients, providers and care team to proactively manage your patient population. CM focuses on the social needs of a person and questions how your organization is managing the patient individually – this relies on a whole-person, comprehensive approach to care.
2 Health Net presents CalAIM Coordinate Care Initiative (43:48) : https://www.youtube.com/watch?v=6-a6pKFHRhA