CalAIM Population Health Management Initiative
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In 2023, the Department of Health Care Services (DHCS) will launch Population Health Management (PHM), which is a cornerstone of
CalAIM.
PHM will establish a cohesive, statewide approach that ensures Medi-Cal members have access to a comprehensive program that leads to longer, healthier and happier lives, improved health outcomes, and health equity. Several of the key elements of PHM were already in place in the Medi-Cal program prior to CalAIM through both DHCS policies and Medi-Cal managed care plans' procedures and programs. Under PHM, plans and their networks and partners are responsive to individual member needs within the communities they serve, while also working within a common framework and set of expectations.
PHM will establish a comprehensive, accountable plan of action for addressing member needs and preferences across the continuum of care, which requires plans to:
- Build trust and meaningfully engage with members;
- Gather, share, and assess timely and accurate data on member preferences and needs to identify efficient and effective opportunities for intervention through data-driven risk stratification processes, predictive analytics, identification of gaps in care, and standardized assessment processes;
- Focus on upstream approaches that link to public health and social services and supports members staying healthy through wellness and prevention services;
- Provide care management, care coordination and care transitions across delivery systems, settings, and life circumstances; and
- Identify and mitigate social drivers of health to reduce disparities.
Beginning in 2023, all plans will be required to meet the National Committee for Quality Assurance's standards for Population Health Management as well as additional DHCS statewide PHM standards that are aligned with the requirements listed above.
CalAIM's PHM program is designed to proactively assess and address the care needs of beneficiaries with tailored interventions. By 2023, plans are expected to be responsible for the care of more than 90 percent of Medi-Cal beneficiaries. Establishing a unified, statewide approach to PHM ensures that all members — children, their parents, pregnant persons, elderly and other adults, and people with disabilities — have access to a whole-system, person-centered program that leads to longer, healthier lives, improved clinical outcomes and a reduction in disparities. The launch of PHM is part of a broader arc of change to improve health outcomes across the state that began with CalAIM, under which
Enhanced Care Management (ECM) and Community Supports are implemented. This change is also further articulated in DHCS'
Comprehensive Quality Strategy (CQS), as well as the
Medi-Cal's Strategy to Support Health and Opportunity for Children and Families.
While the PHM program rolls out, DHCS is building a statewide PHM Service designed to collect and integrate disparate information to support DHCS' vision for PHM. Most notably, the PHM Service will:
- Provide plans, providers, counties, Medi-Cal members and other authorized users access to more timely, accurate, and comprehensive data on members' health history and needs, to help improve care, and avoid duplicative processes.
- Support risk stratification and segmentation and risk tiering functions.
- Promote trusting relationships between members and their care team by making it easier for members to update their information and providing members with access to health education, their rights and applicable benefits, and information on how their data are being used, among other features.
- Improve DHCS' ability to understand population health trends and support oversight.
The PHM Service will be deployed in Q3 2023, and capabilities will be incrementally phased in. DHCS has been working with and will continue to work with stakeholders to identify the priorities, and capabilities that the PHM Service will support.
Download the factsheet about the CalAIM Population Health Management initiative.
Important Updates
Population Health Management Policy Guide and Readiness Deliverable Template
On September 2, 2022, DHCS released the
PHM Policy Guide and
Readiness Deliverable Template for Medi-Cal Managed Care Plans (MCPs). As a reminder, DHCS will launch the
PHM Program —a cornerstone of CalAIM—in January 2023. The PHM Program will establish a cohesive, statewide approach that ensures all Medi-Cal managed care members have access to a comprehensive program that leads to longer, healthier and happier lives, improved health outcomes, and health equity. The
PHM Policy Guide is one of the key DHCS guidance documents that sets forth comprehensive requirements applicable for MCPs for the implementation of PHM, beginning on January 1, 2023. The PHM Readiness Deliverable includes specific questions and attestations to which MCPs must respond and submit to DHCS by October 7, 2022 for review and approval. Both documents can be found on the
CalAIM Population Health Management website. For any questions, please email
PHMSection@dhcs.ca.gov.
Final Population Health Management Strategy and Roadmap
On July 5, 2022, DHCS released the
Final Population Health Management Strategy and Roadmap, which incorporates stakeholder feedback on all components of the PHM Framework. DHCS appreciates thoughtful comments from stakeholders that have helped to improve the Department's vision for PHM. As a reminder, DHCS will launch the
PHM Program, a cornerstone of CalAIM, in January 2023. The PHM Program will establish a cohesive, statewide approach that ensures all Medi-Cal members have access to a comprehensive program that leads to longer, healthier and happier lives, improved health outcomes, and health equity. The Final Roadmap outlines key policy initiatives and accountability mechanisms, defines and describes PHM concepts and terminology, and details requirements for Medi-Cal managed care plans (MCMC Plans) for 2023 and 2024. The Final PHM Strategy and Roadmap is available at the DHCS
CalAIM Population Health Management webpage. For any questions, please email
CalAIM@dhcs.ca.gov
Key Documents
Informational Webinars
To support stakeholder planning and implementation, DHCS hosts informational webinars to provide Population Health Management Program updates; meeting materials will be made available here following each webinar.
PHM All Comer Webinar: Emerging Practices on the Implementation of Transitional Care Services
On January 19, 2023, DHCS held an all-comer webinar on PHM Transitional Care Services under the PHM Program, a cornerstone of CalAIM.
Transitional Care Services suppoer individuals undergoing a transition from one setting or level of care to another (e.g., discharge from hospital to home) to promote continuity of care and limit service disruptions. The webinar featured a panel discussion on emerging practcies for implementing Transitional Care Services for high-risk members in 2023, and an overview of the latest requirements, including the phased implementation timeline.
PHM Service All Comer Webinar
On May 23, 2022 DHCS held an All-Comer Webinar to discuss DHCS's Population Health Management (PHM) Service.
As described in DHCS's recently released
Draft Population Health Management Strategy and Roadmap , the PHM Service will support DHCS's vision for population heath management by: (1) collecting and integrating disparate information, (2) performing key population health management functions, and (3) providing authorized users with access to more timely, accurate, and comprehensive data on members' health history and needs. The webinar included a discussion of key planned functionalities of the PHM Service and time for Q&A.
Meeting and Materials
CalAIM Population Health Management Advisory Group
The PHM Advisory Group is comprised of cross-sector stakeholders who provide feedback and recommendations on many aspects of the CalAIM
PHM program and the PHM Service. Members include a diverse set of leaders from across the state with representation from health plans, providers, counties, state departments, consumer organizations, and other groups. Specific topics for discussion will vary by meeting and will include screening and assessments, risk stratification and tiering, basic population health management, including wellness and prevention, care management, and patient engagement. While the PHM Advisory Group will be open to the public, active participation will be limited to Advisory Group members. The group will meet periodically through 2022.
Questions about the PHM Advisory Group may be directed to
CalAIM@dhcs.ca.gov. To receive relevant updates on PHM Advisory Group meetings, sign up for
DHCS Stakeholder Announcements.
Population Health Management Advisory Group Meeting Information
Upcoming Meetings
The next Public PHM Advisory Group Meeting is on April 26th, 2023 from 12:30pm - 2:00pm PT. Members of the public may attend, and registration is required.
Past Meetings and Materials
- PHM Advisory Group Meeting # 8 - February 2023
- PHM Advisory Group Meeting # 7 - December 2022
- PHM Advisory Group Meeting # 6 - October 2022
- PHM Advisory Group Meeting # 5 -
September 2022
-
PHM Advisory Group Meeting #4 – July 2022
-
PHM Advisory Group Meeting #3 – May 2022
-
PHM Advisory Group Meeting
#2
– April 2022
-
Launch of PHM Advisory Group Meeting – March 2022
Additional Resources
Listed below are additional resources with key information about Population Health Management.
Questions and Comments
Contact DHCS with any questions or comments on the CalAIM Population Health Management initiatives at
CalAIM@dhcs.ca.gov.
