In 1966, Medi-Cal was enacted as California’s Medicaid program to support the healthcare needs of California’s low-income population. About 1.3 million Californians enrolled in Medi-Cal that year.
As of August 2023, more than 15 million people are enrolled in Medi-Cal, including 40% of the state’s children. Since it was enacted, Medi-Cal has grown from a small program into an engine for change in California’s healthcare system.
In the last few years, the California Advancing and Innovating Medi-Cal (CalAIM) initiative was proposed to transform Medi-Cal and address many of the complex, evolving challenges facing California’s most vulnerable populations. CalAIM reworks Medicaid benefits to be structured around the unique needs of individual members while also simplifying its fragmented delivery system. It also recognizes the impact that non-clinical interventions have on health, and it prioritizes expanding access to those interventions, including access to services such as non-emergency medical transportation (NEMT).
Reliable access to transportation is a key driver of health, and SafeRide’s turn-key NEMT solutions for health plans can meet this need for members.
CalAIM was formally proposed in 2021 to further the large-scale early adoption of value-based care, a model rooted in health equity that rewards healthcare providers for the quality of care they provide to Medicaid recipients. In addition to value-based care, CalAIM applies a whole-person care approach, which focuses on empowering people, communities, and populations to improve and restore their health, build resilience, and prevent diseases across a lifespan. The program emphasizes identifying social determinants of health (SDoH) and addressing the conditions that impact access to care on both an individual and community level.
Since inception, CalAIM has set three primary goals: manage member risk through a whole-person care approach and address SDoH; reduce member complexity and flexibility to simplify enrollment and improve member experience; and improve member outcomes as well as drive delivery system transformation and modernization of payment systems through value-based initiatives. Driven by member-centric principles and industry-leading technology, SafeRide’s innovative approach to NEMT provides CalAIM a means to meet its progressive goals.
Customizing NEMT programs to match the needs of Medi-Cal members
CalAIM will require managed care plans to develop and maintain a data-driven population health strategy, which begins by gathering and analyzing key demographic and clinical data about patients. The population health model, a fixture in other state Medicaid programs such as Ohio’s Next Generation Managed Care Program, focuses on removing barriers to care by addressing members’ unmet social needs on an individual basis using data-driven risk stratification, predictive analytics, and standardized assessment processes.
For members who depend on Medi-Cal for healthcare services, transportation is a common SDoH that prevents reliable access to care, often due to location or cost. Nationally, unreliable transportation is a huge problem: one in five adults have recently reported forgoing healthcare because of transportation barriers, which disproportionately affects Black and Hispanic/Latinx adults and those with low incomes and disabilities. As of 2023, California is tied with Nevada as the most expensive state to own a car. Furthermore, as many as 34% of low-income residents do not own a vehicle.
Without transportation, patients are far less likely to access the healthcare they need, and this can often result in severe health consequences for them. To counter this, CalAIM has prioritized transportation by monitoring members with high appointment nonadherence and connecting them with transportation services directly.
Seamless access to care is a priority for CalAIM and a key feature of SafeRide’s customizable platform for health plans. SafeRide addresses patients’ unique transportation needs by meeting beneficiaries where they are based on their physical abilities, desired transportation usage, and communication styles. We enable health plans to deliver member-centric transportation benefits while moving more members to life-sustaining appointments and preventative care.
Enhancing member engagement and care coordination through streamlined services
In the past, the Medi-Cal enrollment process and service offerings have varied on a county and regional level. Such inconsistencies made it difficult for members and health plans to predict costs, identify eligible services, and improve health outcomes.
To advance consistency and improve member experience, CalAIM standardized the managed care enrollment process by requiring dual beneficiaries statewide to be enrolled in a managed care plan. This transition phase was completed in January 2023 and eliminated the confusing variation of enrollment practices across state populations and geographies. In addition, CalAIM standardized managed care benefits so that the same package is provided by all Medi-Cal managed care plans.
This consistency can go a long way toward creating more stability for members who need it most. For vulnerable populations, streamlining enrollment and improving Medi-Cal accessibility removes some of the barriers that prevent them from enrolling in Medicaid and better utilizing the services available to them. When such services are guarded by esoteric jargon and rigid criteria, health outcomes are put at risk. For some members, non-medical benefits such as transportation can substantially move the needle toward receiving life-sustaining care.
Jamie is a 56-year-old Medi-Cal member who recently suffered a stroke. Through CalAIM, Jamie is receiving the help she needs to make a complete recovery. She has been assigned to a care manager who oversees her case, helps her navigate her residual health complications, and connects her to the services she needs to advance her recovery. Thanks to her care manager, Jamie can spend the necessary time at a care center while her house is modified to adapt to her physical abilities. Once her physical health has improved, she will receive NEMT services back to her home. With ongoing support from her care manager, Jamie will continue her recovery by attending her necessary neurology appointments and adhering to her prescribed medication plan. Without the improvements to Medi-Cal through the CalAIM initiative, Jamie’s care journey may have looked very different. If her individual conditions weren’t identified and taken into consideration while her care plan was being developed, she could have run the risk of being advised to spend extended time in a care facility that was not fit for her long-term improvement.
To support CalAIM’s goals and enable more stories like Jamie’s, SafeRide works with health plans to streamline their NEMT benefits so that members can more seamlessly access care anytime, anywhere. Care providers, case managers, and others included in a member’s care journey are permitted to book and manage rides on behalf of members, providing an additional layer of flexibility and simplicity to meet the differing acuity needs of vulnerable members. Through a more optimized and elevated care experience, patients can feel more motivated to fulfill their essential medical needs and maintain their health.
Transforming member experience through technology and innovation
To improve care delivery, CalAIM seeks to increase value-based initiatives for providers, payment reform, and improved health systems. Many factors are involved in making these wide-ranging efforts successful. With whole-person care and value-based care at the center of its proposal, CalAIM intends to make Medi-Cal a more technology-driven, multidimensional solution that integrates services for beneficiaries across the state.
We know that the SDoH—where we live, learn, work, play, and age—occur outside of a hospital, clinic, or primary care office. When one or more of these factors contribute to deteriorating health and it’s time for us to receive care, intervention becomes more difficult if we can’t physically make it to our appointments. Technology-enabled NEMT is a vital piece of the whole-person care and value-based care puzzle, improving a beneficiary’s ability to access care and adhere to their care plan. From using real-time ride data and reporting to reduce frequent cancellations or no-shows to implementing customer service transformations like AI-supported call capabilities, SafeRide’s industry-leading technology and digitized NEMT network ensure that members get to their healthcare appointments so that their multidisciplinary care team can effectively address their physical and mental health conditions.
CalAIM has made significant headway in implementing a cohesive and streamlined infrastructure to better support members who have complex health needs and unmet social needs. Medi-Cal can identify the barriers to care faced by members through risk assessment and can use the data to develop the best value-based solution. Informed benefit plans could include NEMT, housing support, or even meal delivery. When more roadblocks to care are removed, members’ social needs stand a better chance of being met and better health outcomes can be realized.
Although there is still progress to be made, CalAIM has an ambitious vision to improve the quality of life for Medi-Cal members. By beginning an iterative system transformation and working to establish a more interconnected set of health and social services to address key SDoH, CalAIM is helping to ensure a bright future for Medi-Cal and its beneficiaries.
To learn more about SafeRide’s personalized approach to NEMT and how we can help Medicaid managed care health plans transform their transportation benefits, get in touch with us.