Brooke Ehrenpreis and David Panush contributed to this post.
We are more than five months into the CalAIM Statewide Dementia Care Learning Collaborative – and we are making exciting progress.
Led by California Health Policy Strategies (CalHPS) with Archstone Foundation support, the collaborative is focused on helping people older than 65, living with dementia and eligible for the new services under the California Advancing and Innovating Medi-Cal (CalAIM) initiative. We estimate 128,000 people with dementia are at risk for institutionalization and eligible for CalAIM’s new enhanced care management and community supports benefits. CalAIM presents an opportunity to transform and strengthen Medi-Cal so many more Californians – especially those dually eligible for Medi-Cal and Medicare – receive more equitable, coordinated, person- and family-centered care.
The Foundation and CalHPS began laying the groundwork for the Learning Collaborative in July 2023, announcing the collaborative’s first meetings and publishing a blog post by David Panush of CalHPS. In it, he explained how the collaborative would facilitate relationship-building between community-based organizations and managed care plans in their counties, lift up the unique needs of older Californians with dementia, and identify common implementation challenges, policy advocacy efforts, best practices, and workforce development initiatives.
Establishing a Foundation
To lay a solid foundation for this effort, CalHPS developed a landscape analysis including estimates of the potential target population, utilization of existing programs, existing relationships with managed care plans, and opportunities for coordination with existing CalAIM initiatives. CalHPS also established a technical advisory committee of community organization leaders experienced in Medi-Cal managed care and CalAIM contracting. Other subject matter experts, state officials, and stakeholders were recruited to the committee to guide the project’s next phase. Their input was essential to understanding the demographics of (and health disparities among) older Californians and the benefits of CalAIM for the population the collaborative is seeking to help.
CalHPS also developed a list of the types of organizations to be invited into the collaborative including community-based adult services agencies, Area Agencies on Aging, state waiver programs, multipurpose senior services programs, and home health, assisted living and board and care facilities.
To garner additional support, CalHPS tapped its broad network of advocacy groups, trade associations, leaders in community-based dementia care, and state officials to host discussions about the collaborative’s goals and objectives.
To support participants in the collaborative, CalHPS wrote an overview and level-setting paper outlining a framework for understanding the new opportunities under CalAIM and the populations who could benefit. CalHPS shared the paper at the kick-off meeting and invited people from Local Health Plans of California and the California Association of Health Plans to share their perspectives on the new CalAIM benefits.
Additionally, the Foundation commissioned dementia experts at UCSF to write “How CalAIM Supports Best Practices in Dementia Care.” It details the services and supports that can reduce the cost of care and delay or prevent nursing home placement, then crosswalks these services and supports with CalAIM’s new benefits.
More than 40 community-based organizations from 19 counties have participated in the Learning Collaborative so far. In a survey to understand their knowledge of contracting with managed care providers, 56 percent of the 34 participants said they already have contracts to provide the new benefits – and 70 percent indicated interest in providing them. Asked what Learning Collaborative participants want most from the group, their answers centered on maintaining focus on the needs of older adults with dementia, developing partnerships and collaborating with other organizations, contracting with managed care plans, advocating for better state policies, and sharing challenges, opportunities, and best practices.
What We’ve Accomplished
In our monthly collaborative meetings and focused work groups, participants have discussed the challenges of CalAIM implementation, specifically providing the two new categories of benefits to older Californians with dementia. Among the questions:
- How do we identify those with dementia who are eligible for CalAIM?
- What are the best outreach and engagement strategies for these people?
- How will enhanced care management providers deliver services?
- How do community-based organizations best work with managed care plans?
- Where do those organizations obtain funding to build capacity to provide enhanced care management?
These questions have prompted CalHPS to invite guest speakers from managed care plans, lead discussions on the contracting process, and review CalAIM’s implementation framework.
After understanding the differing needs of Learning Collaborative participants, CalHPS developed subgroups of dementia-specific organizations and community-based organizations. Both are assisting participants at all stages of planning and implementing enhanced care management. And both are focused on the managed care contracting process, the referral processes, and making connections with managed care plans. To date, the collaborative is engaging with CalOptima Health, Health Net, and Partnership Health Plan to provide supplemental information on the plans’ role with CalAIM and working with community-based organizations to become enhanced care management providers.
Archstone Foundation has a CalAIM Statewide Dementia Care Learning Collaborative webpage with meeting recordings, slides, scheduled meeting dates and registration links – as well as links to CalAIM resources that help participants through this challenging yet worthwhile effort. The CalAIM Enhanced Care Management Policy Guide is a resource to help Medi-Cal managed care plans implement enhanced care management. And another CalHPS resource, Medi-Cal Managed Care Plans ECM Referral Forms, provides links (organized by county) to those forms and informational guides for each managed care plan.
Learn With Us
The importance of this effort is clear: It is essential to maximize the benefits of CalAIM to improve the care of, and resources for, people living with dementia. To join us, visit the Learning Collaborative webpage, register for upcoming meetings, review the available resources, and sign up for the collaborative mailing list.
Upcoming events:
Community-based Organizations Workgroup Meeting
Wednesday, February 21 at 12 PM
We will discuss a Community Care Hub approach for CalAIM participation.
Dementia-specific Workgroup Meeting
Thursday, February 22 at 2 PM
We will discuss a policy brief on In-Home Services and Supports (IHSS).
