Strengthening a Medi-Cal Social Care Network
Client: CalOptima Health
Sector: All
Year: 2023 - 2025
Location: Orange County, California
Project Goals
Engage a network of non-profit service providers and build capacity to develop their value proposition to healthcare, identify and plan for earned revenue opportunities, and engage with the local Medicaid managed care plan in support of CalAIM
QV Health Solutions Role
In partnership with Consilience Group and Aguiar Professional Training, develop a core curriculum for CalOptima’s Non-Profit Healthcare Academy
Provide subject matter expertise on CalAIM and earned revenue planning
Prepare and deliver educational content for the on-site portion of the Academy
Provide 1-on-1 technical assistance training sessions with Academy participants to personalize the curriculum’s teachings for each organization
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The CalAIM initiative is a broad, multi-year effort to improve the quality of life and health of Medi-Cal members in the state of California. As part of CalAIM, Medicaid managed care plans (MCPs), such as CalOptima Health, can offer up to 14 Community Supports services that can be used in lieu of services traditionally covered by Medi-Cal.
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For community organizations that have a health focus this initiative represented a new path to fund aligned services for the community members they already serve. For CalOptima Health, it meant a significant push to find new providers to deliver both these Community Supports to members as well as outreach and engage with members who could benefit from these supports.
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To strengthen its ability to engage with community partners central to the success of its CalAIM efforts, CalOptima Health commissioned a cohort-based training and technical assistance program. The curriculum focused on:
Creating a foundational understanding of the healthcare system, trends, and opportunities
Clearly developing and communicating how participant organizations impact health of the clients they serve
Building financial acumen and capacity to pursue diversified revenue, including billing for CalAIM services
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Over 40 grassroots organizations developed essential knowledge and skills to engage with Managed Care Organizations and other healthcare stakeholders.
Over 40 grassroots organizations developed essential knowledge and skills to engage with Managed Care Organizations and other healthcare stakeholders.
The QV Health Solutions team has been phenomenal to work with! We have found them to be responsive and highly capable. They worked diligently to understand our agency so that their work would be well informed. We hope to do more things together with QV Health Solutions on this CalAIM journey and would highly recommend them to other agencies.
— MARY ELLEN STUART, CHAIRPERSON, BOARD OF DIRECTORS, THE JOHN HENRY FOUNDATION