Anthem Blue Cross

Providers - California

California Advancing and Innovating Medi-Cal (CalAIM)


Anthem Blue Cross (Anthem) is working with the Department of Health Care Services and several county and local partners to implement the California Advancing and Innovating Medi-Cal (CalAIM) program. CalAIM is designed to improve the quality of life and health outcomes of our members by implementing a broad delivery system, program, and payment reform across the Medi-Cal Managed Care (Medi-Cal) program.

CalAIM leverages Medi-Cal as a tool to help address many of the complex challenges facing California’s most vulnerable residents, like homelessness and insufficient behavioral health care access. Meanwhile, it will focus on the increasing number of justice-involved individuals with significant clinical needs, individuals with complex medical conditions, and the growing aging population.

CalAIM has three primary goals:

  1. Identify and manage member risk and needs through whole-person care (WPC) approaches and addressing social determinants of health (SDoH).
  2. Reduce complexity and increase flexibility in the Medi-Cal program.
  3. Improve quality outcomes and drive delivery system transformation through value-based initiatives, modernization of systems, and payment reform.

This proposal will integrate:

  • Medi-Cal Managed Care   
  • Existing WPC pilots populations
  • Existing Health Home program populations
  • Drug Medi-Cal Organized Delivery System
  • Community-based adult services (CBAS)
  • Long-term care
  • SDoH-related services and more

Enhanced Care Management (ECM)

Intensive care coordination services will be provided at the community level to address physical health, behavioral health, and psycho-social needs.

Enhanced Care Management (ECM) is comprised of seven core services, including:

  1. Outreach and engagement.
  2. Comprehensive assessment and care management plan.
  3. Enhanced coordination of care.
  4. Health promotion.
  5. Comprehensive transitional care.
  6. Member and family supports.
  7. Coordination of and referral to community and social support services.

Enhanced Care Management is designed to assist the following populations of focus:

  • Homeless
  • High utilizers adults
  • Severe mental illness/ substance use disorder (SMI/SUD) risk adults
  • Nursing facility diversion
  • Nursing facility transition
  • Jail transition adults
  • Children and youth

For more information on the Enhanced Care Management Services program and core services, please review the CalAIM ECM flier.

In lieu of services (ILOS)

In lieu of services (ILOS) are a menu of services, which, at the option of a Managed Care Plan and a member, can substitute for covered Medi-Cal Managed Care services as cost-effective alternatives. ILOS providers are entities with experience and expertise providing one or more of the ILOS to individuals with complex physical, behavioral, developmental, and social needs.

DHCS has approved the following services:

  • Housing transition navigation services
  • Housing deposits
  • Housing tenancy and sustaining
  • Short-term post-hospitalization housing
  • Recuperative care (medical respite)
  • Respite services
  • Day habilitation programs
  • NF transition/diversion to assisted living facilities
  • Community transition services/NF transition to a home
  • Personal care and homemaker services
  • Environmental accessibility adaptations (home modifications)
  • Meals/medically tailored meals
  • Sobering centers
  • Asthma remediation

Please review the available in lieu of services overview.

Calling all providers

Interested providers for ECM and/or ILOS should complete a Letter of Interest form:

If you have questions regarding CalAIM, please contact us at CalAIM@anthem.com

Resources

Provider tools & resources

Interested in becoming a provider in the Anthem network?

We look forward to working with you to provide quality services to our members.