Table of Contents
Since 2022, the California Advanced and Innovating in Medi-Cal (CalAIM) Initiative has been reforming California’s Medi-Cal to make it more “coordinated, person-centered and equitable” for their millions of members. One way in which they are doing this is with the use of the Enhanced Care Management (ECM) program. This is a program I’ve had the opportunity to work on ECM projects for several organizations.
This program evolved out of two other programs, the Whole Person Care (WPC) Pilot and Health Homes Program (HHP).
Enhanced Care Management is a new way of providing care and focuses on connecting individuals with the services they need, and has a special focus on the most vulnerable in our community including (among others) those who are unhoused, returning from incarceration, exiting long-term care, struggling with substance use or serious mental illness, and children.
What is Enhanced Care Management?
Enhanced Care Management or ECM is a benefit for Medi-Cal members that pairs you with an case manager to help provide you with comprehensive case management and ensure that you have a single point of contact for accessing care
How Does ECM Work?
The health plans provide providers with a MIF (Member Information File). Inside the MIF is a set of columns containing information on the members who are eligible. Providers then make outreaches to those members, and ask if they want to join. Those who say yes are then connected with their care manager and provided support.
All of this Enhanced Care Management data is stored inside Salesforce and is easily reportable to the health plans.
How does Salesforce help implement ECM?
Salesforce helps organizations implementing ECM by providing opportunities to automate the processing of the MIF, digitizing the data entry for the outreaches and the care that’s provided and simplifying the reporting back to the health plans.
Provisio has implemented ECM and a related service called Community Supports, for numerous organizations.
How do I learn more about Enhanced Care Management?
If you’re interested see Provisio’s website, where you can get in touch with our consultants to find out how Salesforce can transform your ECM experience.