This month marks a year since the launch of the CalAIM Statewide Dementia Care Learning Collaborative, a time to share progress and describe what’s in store.
With the consulting firm California Health Policy Strategies (CalHPS), Archstone Foundation created the collaborative to help organizations providing community-based dementia care and other services to benefit from CalAIM (California Advancing and Innovating Medi-Cal), the reinvention and expansion of the state’s Medicaid program. The effort is focused on helping the approximately 128,000 Californians with dementia who are at risk of institutionalization and therefore eligible for two new benefits under CalAIM, known as enhanced care management and community supports. The benefits provide access to coordinated, person- and family-centered care for people who require more intense services to continue to live in the community.
The collaborative aims to foster connections between community-based organizations and managed care plans to focus on the unique needs of older adults with dementia and their caregivers. Together, we work to identify common challenges, advocate for policy improvements, highlight best practices, and promote workforce development. Ultimately, we are striving for meaningful changes that improve access to services for those who need them.
Key Learning Over the Past Year
We've gained valuable insights since last October into the challenges and successes of integrating CalAIM services for those at risk of institutionalization because of their dementia.
One of the highest hurdles has been the difficulty in persuading people who qualify and their families to sign up for the enhanced care management and community supports benefits. Establishing trust with potential recipients takes time, and cold calls by providers often fail to translate into enrollment. Many also hold misconceptions about the new benefits — including believing they are scams – which creates a significant barrier to connecting people with the care they need.
Despite these challenges, we've seen promising pathways for increasing referrals to CalAIM services. Organizations including Area Agencies on Aging, Aging and Disability Resource Connection agencies, and Caregiver Resource Centers already refer older people and any possible caregivers to essential services and can now expand their reach by providing information about, and connections to, CalAIM.
This summer, the Foundation hosted a webinar with the California Department of Aging and Department of Health Care Services to explain how these referral networks can make CalAIM one of their offerings, which will be key to expanding the program’s reach.
Additionally, strong communication and partnerships between managed care plans and community-based organizations have proven central to success. Plans with large numbers of enrollees at risk of institutionalization typically have longstanding relationships with these service providers. Their partnerships, which involve frequent communication and training — especially about billing — help streamline enrollment for the new benefits so those eligible get the care they need.
Accomplishments to Date
In its first year, 57 community groups from 27 counties participated in the collaborative and 22 attended at least three meetings.
At the California Association of Health Plans meeting in August, I represented the collaborative during a presentation explaining how CalAIM’s new benefits align with best practices in dementia care. With Anna Chodos, MD, MPH, a professor of medicine at the University of California, San Francisco and the principal investigator of Dementia Care Aware, and Dustin Harper, MBA, the Institute on Aging’s chief strategy officer, we outlined opportunities for improving and expanding dementia care based on “How CalAIM Supports Best Practices in Dementia Care,” a report commissioned by Archstone Foundation. This was a valuable opportunity to engage with care plans and advocate for better support for individuals at risk of institutionalization.
The collaborative continues to share information about:
- PATH CITED, grants to help providers, local governments, community-based organizations and others build capacity and infrastructure to support CalAIM. The fourth round of funding will launch on January 6, 2025 and additional information is forthcoming.
- The Technical Assistance Marketplace, a one-stop-shop support website for all entities involved in CalAIM
- The Incentive Payment Program, which subsidizes managed care plan efforts to improve quality and access to care
- The Data Exchange Framework, a statewide system allowing health and social services providers to securely share patient information.
One concern raised at early collaborative meetings was the lack of a comprehensive database of community-based organizations contracted to provide enhanced care management. So we created an ECM provider list that is sortable by county, managed care plan, population of focus, city, and zip code. This tool can assist information and referral organizations, researchers, or policy analysts who want to understand service gaps.
We’ve also developed a report from current DHCS data on ECM enrollment data, stratified by county and managed care plan by populations of focus. This data can identify trends in ECM enrollment and coverage.
A recent survey of collaborative participants found that two organizations are currently pursuing contracts with managed care plans to provide the new benefits and four others are considering contracts. Support for community organizations is critical to CalAIM’s, and survey respondents said this is where they need the most help:
- Credentialing
- Contract review and negotiation
- Reporting requirements
- Claims submissions
- Funding for staff capacity-building
- Data sharing
- Identifying eligible beneficiaries from managed care plans
Looking Ahead
To better support the needs of the learning collaborative participants, the Foundation and CalHPS revised our work plan earlier this year. While we continue supporting community groups seeking contracts with managed care plans, we’re now focusing on targeted strategies for reaching lower-income Californians with dementia and building systematic approaches for their referral and enrollment.
To that end, we have launched ad hoc work groups of policy experts and stakeholders to advance specific action plans. Our survey revealed significant opportunities to provide more support for contracting and referrals, not only through collaborative meetings but also through technical assistance from CalHPS and the state’s Technical Assistance Marketplace. And so, the Foundation and CalHPS are committed to being connectors between providers and technical assistance resources.
The significance of this initiative is evident: Fully leveraging CalAIM’s benefits is crucial to enhancing care for those with dementia. We encourage you to get involved by visiting our webpage, exploring available resources, subscribing to our mailing list, and signing up for our meetings. These are the next two:
- Noon PST on Wednesday, Nov. 13, Review of the DHCS Enhanced Care Management for Long-Term Care Populations Spotlight
- Noon PST on Tuesday, Dec. 3, with a topic to be announced soon.
