- Community-based organizations
- Health plans
Over the last several months, Hospital Council regional vice presidents (RVPs) have attended collaborative meetings that focused on the implementation of California Innovating and Advancing Medi-Cal (CalAIM) in their designated communities. Through this work, the RVPs have learned about implementation plans, challenges, and partners in providing care outside the hospital walls. This work has allowed for open dialogue on key implementation areas in preparing for expended service offerings.
In the South Bay, community-based organizations (CBOs) are raising growing frustrations with the Department of Health Care Services — which administers the program —about the frequent administrative changes and low reimbursement rates offered to participant CBOs.
Health plans and hospitals in the South Bay have heard these partner challenges and are discussing their own concerns about the potential loss of providers or increasing number of providers opting not to participate. This could ultimately lead to gaps in care, higher emergency department census, and overall higher hospital utilization when preventive or alternate options may be better suited for patients.
Takeaway / Next Steps
Hospital Council will increase its work with local CBOs in the South Bay to better understand and identify strategies, if any, to support their ability to participate in CalAIM-Enhanced Managed Care.