Health Care Should Be More Than Just a Plastic Card in Your Wallet

by John Baackes, CEO, L.A. Care Health Plan

CalAIM to Improve Quality of Life and Health Outcomes

Living on the streets was going to kill Elizabeth. The 52-year-old woman suffered from diabetes, heart disease and mental health problems. She had managed to break her addiction to crack cocaine, but even though she had health coverage through Medi-Cal, Elizabeth found it difficult to deal with her other health issues since she spent so much time just trying to stay safe. That changed when she was referred to a case manager at L.A. Care Health Plan.

The case manager developed an individualized care plan for Elizabeth, which included bringing in social workers to help find her housing through L.A. County’s Housing for Health program, which L.A. Care supports through a $20 million commitment. As the CEO of L.A. Care, the largest publicly operated health plan in the country, I have always said that health coverage has to be more than a plastic card in your wallet. At any given time, we estimate that as many as 40,000 L.A. Care Medi-Cal members are experiencing homelessness. Even those who aren’t living on the streets, are often struggling to make ends meet. This despite the fact that many L.A. Care Medi-Cal members are working, the majority of those full-time. No one working full-time should have to worry about keeping a roof over their head or food on the table.

In 2000, L.A. Care’s Board of Governors established the Community Health Investment Fund (CHIF), which allows L.A. Care to support various projects that address social needs that impact health – things like housing assistance, food insecurity, and recuperative care. But thanks to California’s new approach to Medi-Cal, health plans can choose to offer these services, called community supports, through Medi-Cal starting this year.

The new program is called California Advancing and​ Innovating Medi-Cal, or CalAIM. It is a long-term commitment to transform and strengthen Medi-Cal, offering Californians a more equitable, coordinated​, and person-centered approach that will integrate social services with medical care, resulting in improved health outcomes and a better quality of life for Medi-Cal beneficiaries. In addition to letting health plans choose from a list of 14 community supports to offer, the program also includes Enhanced Care Management (ECM) for the highest-need Medi-Cal enrollees, individuals like Elizabeth. ECM, which is replacing the pilot mentioned earlier, will be provided primarily through in-person engagement, allowing care managers to get a complete picture of the members’ needs.

CalAIM is intended to help all Medi-Cal beneficiaries, but there is an emphasis on serving those with the most complex needs. For community supports, L.A. Care chose housing transition navigation, housing tenancy and sustaining services, recuperative care, and medically tailored meals. The health plan had already been offering some of these services through pilots and projects funded by CHIF, but now will be reimbursed through Medi-Cal, allowing for expansion of the existing programs.

CalAIM is recognition by the state that health coverage should be more than that plastic card, more than doctor’s visits and medications. The ultimate goal of CalAIM is to prevent repeated hospitalizations or trips to the emergency room, and to keep members living healthy lives in their homes, which ultimately lowers health care costs for everyone. A healthier population means a healthier and more productive workforce.

This sort of care works. Elizabeth, once off the streets in her own apartment, and receiving coordinated care with the help of her care manager, saw her health improve. She said it felt like a sack of bricks had been lifted off her back. And to top it off, her six children, who had been estranged, reentered her life. CalAIM will help produce more stories like that of Elizabeth.