Sustainable Recuperative Care in California
CalAIM Playbook, Budget, and ROI Tools for Providers and Managed Care Plans
Recuperative care provides short-term services for individuals experiencing homelessness who are recovering from an acute medical condition.
QV Health Solutions, with financial support from the California Health Care Foundation, has produced a:
playbook for sustainable recuperative care in California;
budgeting tool for providers; and
return on investment (ROI) tool for Managed Care Plans.
CalAIM Playbook and Tools
This playbook equips providers with a framework for determining which services to bundle, how to align bundle design with MCP incentives, and how financial budgeting can inform the structure, pricing, and sustainability of those bundles. It also suggests how Alternative Payment Models could be used to fill persistent earned revenue gaps and strengthen partnerships with potential payers.
Recuperative care programs improve patient care, facilitate smoother care transitions, create stability, and support patients experiencing homelessness with connection to housing. Despite the value and cost-effectiveness of recuperative care, low Medi-Cal reimbursement rates can be a cause of concern for some organizations.
Organizations offering recuperative care often enhance their impact and sustainability by delivering a broader suite of aligned California Advancing and Innovating Medi-Cal’s (CalAIM) services, such as Community Supports related to housing transition, tenancy sustainment, medically tailored meals, and/or Enhanced Care Management (ECM). Reimbursement for these services could be used to fill persistent earned revenue gaps and strengthen partnerships with potential payers.
QV Health Solutions encourages organizations to assess the creation of bundled service packages that complement recuperative care, align with the needs of their population, address gaps in the local community, and offer clearer value to Managed Care Plans (MCPs) and other community partners. This approach can produce long-term outcomes, as well as support financial sustainability.
For Organizations + Providers:
CalAIM Budgeting Tool
This budgeting tool is designed for organizations that currently operate, or plan to operate, recuperative care, and are open to exploring the feasibility and potential benefits of CalAIM service bundling.
Spreadsheet includes video tutorial!
Using this playbook and budgeting tool, organizations will be able to:
Assess their current and potential CalAIM offerings for sustainability and impact
Understand service bundling impacts on client outcomes, operational efficiency, and value to current and prospective payers
Estimate costs and revenue potential of different recuperative care program models, and compare different bundling scenarios
Prepare to engage MCPs (or other payers) with data-driven program designs and value propositions
For Managed Care Plans:
CalAIM ROI Analysis Tool
This ROI tool is designed for MCPs that want to evaluate the business case for investing in recuperative care.
Using this playbook and ROI tool, MCPs will be able to:
Identify, measure, and interpret the costs and benefits of recuperative care from a direct financial perspective (e.g., reduced acute care utilization)
Consider the value of recuperative care from a broader systems perspective (e.g., improved housing stability, member engagement, and long-term cost avoidance)
Understand how alternative payment models can influence ROI trajectories over time, allowing for sustainable partnerships with community-based providers
Would you like help interpreting and using the models / playbook? Review them live with a QV Health Solutions team member!
By clicking submit you provide QVHS with your email and agree that QVHS can contact you to walk you through the model and assess what additional resources may be helpful to your organization.
You also can email us at calaim@qvhealthsolutions.com and a QVHS team member will assist you.
We thank the California Health Care Foundation (CHCF) for their funding and support of this important work.
