California Advancing and Innovating Medi-Cal (CalAIM) Technical Assistance
Quantified Ventures is thrilled to be an approved vendor of DHCS-funded technical assistance to California providers, community-based organizations, counties, and others to establish the infrastructure needed to implement Enhanced Care Management (ECM) and Community Supports under CalAIM. This technical assistance is provided to community-based organizations for FREE by the state of California.
The chart below showcases a handful of services that qualify as community supports under CalAIM. Community Supports are direct services that can be provided that address health related social needs.
Medi-Cal Transformation: A Journey to a Healthier California for All
We worked with CalOptima Health and Consilience Group to craft a case study to help California-based nonprofits learn how to access Medicaid funding to support their social service delivery.
We highlight how two social service nonprofits in Orange County pursued and secured a service contract with CalOptima, the county-managed care plan, and in doing so, were able to extend their reach and effectively support the communities they serve.
Getting to the “Win3” – How Managed Care Plans Can Develop High-Value Partnerships
In a win3 model, a high-impact service:
Supports the patient/member;
Generates quantifiable value for the Managed Care Plan (MCP); and
Appropriately compensates the community-based organization (CBO) partner for its mission and work, with a funding mechanism that sustainably supports ongoing operations.
In the CalAIM framework, getting to the win3 requires a solution to create beneficial results for the member, CBO, and MCP (alone and often in coordination with other plans), while meeting the state’s rigorous requirements. And this in turn relies on aligned objectives, operations, and outcomes across all partners.
In a recent blog, Rebecca Gerr shares the core features of a win3 solution and the 4 criteria essential for win3 partnership success.
By designing a reimbursement model where the MCP pays the CBO for the value delivered by the service (often with pay-for-performance incentives) we help deliver better member health outcomes while achieving MCP and CBO financial goals.
The time is ripe for community-based service providers to expand their partnerships, programs, and impact through a focus on the value they create for the community and individuals as opposed to the cost associated with service provision.
Impatient for Systems Change to Adequately Fund Health Related Social Needs? Us Too.
At Quantified Ventures, we believe in the power and promise of community-based service providers to deliver better individual and community health outcomes – especially for people most affected by systemic racism and poverty. To meet high levels of demand and drive these outcomes most effectively, service providers need new sources of funding that are – in all respects – more: more reliable than philanthropy, more robust than fee-for-service healthcare reimbursement, and more flexible than government grant programs.
In this blog, Susan Donovan breaks down 3 encouraging health sector payment trends and and the related opportunities for community-based service providers to enhance their impact by diversifying and expanding revenue.
“Quantified Ventures has helped us navigate the challenges and opportunities associated with engaging local community providers and identifying pathways to help these community partners grow to drive greater health equity and deliver better health outcomes. One of the things I value most about our partnership is Quantified Ventures’ ability to be flexible and adapt to our evolving needs as the business environment and the health system at large shift to a more value-based and holistic approach.”
“The amount of need within communities we serve has been increasing year over year and became especially acute during the pandemic. We stretch every one of our dollars to meet the needs of the community and pay our staff a fair wage for the demanding, important work they do. One of the only ways to enhance services that meet increased community need is through value-based arrangements and the shared understanding that there is tremendous opportunity within the health system to provide for better outcomes and better cost solutions. But first we have to think differently about the system and the role of community-based organizations in the system. This only gets done with strong partners like Quantified Ventures, Humana, and Volunteers of America bringing their best skills and attributes to the table and working with one another to achieve the system transformation we seek. One of the things I appreciate most about our partnership with Quantified Ventures is our shared mission – at the end of the day we are focused on providing services to support healthy individuals and healthy communities.”
