HPSM’s role in an historic Medi-Cal transformation
California Advancing and Innovating Medi-Cal (CalAIM) is a statewide, five-year, multi-system Medi-Cal transformation that the California Department of Health Care Services (DHCS) launched on January 1, 2022. CalAIM’s goal is to help high-risk, high-needs Medi-Cal members be as healthy as possible. This population accounts for less than 5% of all Medi-Cal members, but as much as half the program’s spending. CalAIM will improve this population’s health while reducing the cost of their care by:
- Unifying California’s health care and social services into a single seamless system of interconnected services to treat the whole person.
- Helping managed care plans like HPSM directly address the social drivers of health—such as food insecurity, lack of housing and the youth behavioral health crisis.
- Using personalized preventive care management to reduce unnecessary emergency room visits, hospitalizations and institutionalizations.
- Eliminating disparities in care based on race, ethnicity and gender to achieve health equity.
- Serving as a foundation and base for further improving the health care system over time so it better meets people's needs.
CalAIM includes a wide range of community support programs that health plans can choose to offer based on what will improve the health of their highest-need members and their community generally. CalAIM also offers Medi-Cal managed care plans the opportunity to earn incentive funds that they can use to support local projects that address the social drivers of health. This has enabled HPSM to take on a new role as a community investor in San Mateo County’s future health.
“The ultimate goal of CalAIM is to have managed care plans like HPSM deliver comprehensive, integrated services that address the full range of members’ health care needs—from medical, dental and behavioral to the social drivers of health.” – Amy Scribner, HPSM Chief Health Officer
HPSM’s CalAIM programs include:
- Enhanced Care Management (ECM), which helps coordinate and provide extra care coordination services to HPSM’s most at-risk Medi-Cal members – Learn more
- Community Supports (CS), which covers non-medical types of help that are designed to address life challenges that can affect Medi-Cal members’ health (such as food and housing insecurity) – Learn more
- Incentive programs that allocate DHCS funds to support our ECM and CS offerings as well as our efforts to address homelessness and youth behavioral health – Learn more
- The Population Health Management (PHM) Initiative, which ensures Medi-Cal members have access to a comprehensive program that leads to better
health and health equity – Learn more