Anthem Blue Cross

Providers - California

California Advancing and Innovating Medi-Cal (CalAIM)


Anthem Blue Cross (Anthem) is working with the California Department of Health Care Services (DHCS) and county and local partners to implement the California Advancing and Innovating Medi-Cal (CalAIM) program. CalAIM aims to transform Medi-Cal, making the program more equitable, coordinated, and person-centered to help Anthem members maximize their health and life trajectory. Under CalAIM, Anthem will integrate our Medi-Cal Managed Cared (Med-Cal) members’ care coordination and case management across physical health, behavioral health, and local social service providers. This model focuses on the need for integrated care for enrollees at various stages of risk and needs, while also providing care to enrollees with the highest risk through Enhanced Care Management (ECM) and Community Supports. CalAIM builds upon Anthem’s experience with the county-based Whole Person Care (WPC) pilots and the plan-based Health Home Program (HHP); both programs use whole-person care approaches to address underlying social drivers of health (SDOH). CalAIM envisions enhanced coordination, integration, and information exchange among managed care plans (MCPs), such as physical, behavioral, community-based, and social service providersalong with county agencies.

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.

ECM is designed to assist the following populations of focus:

  • Homeless
  • High utilizers adults
  • Serious 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 Flyer .

Community Supports

Community Supports (CS) are a menu of services, which, at the option of a managed care plan and a member, can substitute for covered Medi-Cal services as cost-effective alternatives. CS providers are entities with experience and expertise providing one or more of the CS 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
  • Nursing facility 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 CS overview:

Calling all providers

Interested providers for ECM and/or CS 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.