California D-SNP Market Entrance: 5 Key Success Factors for Risk Adjustment
As part of the California Advancing and Innovating Medi-Cal (CalAIM) initiative, a transformative effort to coordinate and expand health services for the most vulnerable populations in California, the Department of Health Care Services (DHCS) is directing Medi-Cal managed care plans to establish D-SNPs by 2026. Medi-Cal programs entering the Medicare Advantage market for the first […]
Key Considerations for the Final Round of California CITED Funding
Capacity and Infrastructure Transition, Expansion and Development (CITED) is an incentive payment model available to Enhanced Care Management (ECM) and Community Supports (CS) providers which includes Federally Qualified Health Centers (FQHC), county and social services agencies, community clinics, and other community-based entities. CITED is one component of the Providing Access and Transforming Health (PATH) Initiative […]
Driving Value with Analytics in CalAIM
As CalAIM continues through year three of implementation, Enhanced Care Management (ECM), Community Health Workers (CHWs) and Community Supports (CS) continue to scale. These services are increasing integration with primary care provider organizations, whether an in-house service, contracted or a referral partner, who are ultimately accountable to managed care plans (MCPs) and the State for […]
California Continues to Shape Payer & Provider Alignment to Address Social Drivers of Health & Health Equity
With the heaviest burdens of the pandemic falling disproportionately on Californians who are low-income Black and Latino and on frontline workers, the need to implement targeted solutions to address long-standing Social Drivers of Health (SDoH) and health equity is at an all-time high. This is reinforced by the principles and goals of California’s newest Medicaid […]
Medi-Cal Equity and Practice Transformation in California
Over the last couple of years, the COVID-19 Public Health Emergency (PHE) laid bare the disparities in health care in disadvantaged communities with preventive and routine care for chronic conditions was delayed in many cases. The California Department of Health Care Services (DHCS) has proposed a one-time investment for Equity and Practice Transformation of $700 […]
Medi-Cal Procurement Requirements Push the Managed Care Envelope: What Health Plans and Providers Need to Know
California is staking out bold new requirements for commercial health plans interested in providing managed care services for Medi-Cal, the state’s Medicaid health insurance program for low-income children, adults and seniors. Up for grabs are contracts to provide Medi-Cal coverage in 33 of 58 California counties and for 38% of the state’s Medicaid population. Roughly […]
Kaiser Permanente Mobilizes COPE Health Scholars to Fill Pandemic Staffing Shortages
An innovative workforce development and training partnership with COPE Health Solutions’ COPE Health Scholars enabled Kaiser Permanente to quickly fill critical staffing gaps at several medical centers during the pandemic. Kaiser Permanente Irvine Medical Center, Kaiser Permanente Anaheim Medical Center and Kaiser Permanente Orange County hospitals tapped this unique solution to supplement depleted staff in […]
Providence Hospitals Leverage COPE Health Scholars to Manage COVID-19 Vaccinations
Like hospitals everywhere, St. Joseph Hospital Orange and Mission Hospital faced the challenge of meeting the demand for COVID-19 immunizations while concurrently balancing the impacts of pandemic-related staffing shortages. The two Providence hospitals in Southern California turned to COPE Health Scholars, aspiring health professionals already on site as part of hands-on experiential education courses, to […]
Medi-Cal Pharmacy Carve-out: What You Need to Know and Should Do
The State of California is “carving out” the pharmacy benefit for Medi-Cal beneficiaries from managed-care plans and transitioning to a fee-for-service (FFS) program, moving 13 million Medi-Cal beneficiaries to a new pharmacy program by January 2021. Medi-Cal is taking responsibility from the managed care organizations (MCOs) for one of the key elements of care, the […]