CalAIM is a new initiative from Medi-Cal, designed to offer Medi-Cal members (who are enrolled with managed care plans) more holistic, equitable, person-centered care. CalAIM includes 14 Community Supports – optional health-related services that are offered by Medicaid managed care plans (MCPs) to address social drivers of health.

Medically supportive food/meals/medically tailored meals (MTM) is one of those 14 services, that is supported by the evidence of reduced hospital stays and healthcare costs. As per DHCS guidance, MCPs should offer a range of food and nutrition services that helps members achieve their nutrition goals at critical times. The critical times include events such as when members leave the hospital or a skilled nursing facility. Members are most vulnerable to readmission at that time, and meals delivered to home can be very useful to prevent readmission. In addition, medically-tailored meals can be beneficial in addressing the unique dietary needs of members with chronic diseases.

Since Community Supports are optional, managed care plans have the flexibility to define the level of services, eligibility, cost, menu, providers, etc. This has led to a lot of confusion about eligibility criteria and understanding of what’s covered and what’s not. For example, in the same zip code, one member is eligible if they have CHF or diabetes, or COPD and another member is only covered if they have Type-2 diabetes with HbA1C of over 8 for at least 6 months, and they have agreed to complete a diet/lifestyle education course.

The benefits also vary by plan. Some include food vouchers and some don’t. Some include groceries and some only include frozen-meals delivery. Further, each MTM partner may have their own unique models (including dietician visits or not) which makes it harder for care management staff to understand what and whom to choose for their members.

At Sprite Health, we understand the importance of meal-related benefits in improving health outcomes and reducing acute care utilization. However if these benefits are not well understood by care staff or members, it can lead to a disjointed experience that significantly reduces the value of this great benefit.

We are trying to solve this issue by using technology to seamlessly integrate social supports with medicare care to ensure:

  1. Providers have a clear understanding of what benefit is offered by the member’s health plan.
  2. Providers and members understand what’s included and what’s not and the different options available through different vendors.
  3. Seamless coordination between providers and CBOs
  4. Tracking patient adherence to the meal plan
  5. Collecting data on the program’s outcomes and impact, and tracking patients’ progress.
  6. Scaling the program to serve a larger number of patients.

Connect with us to learn how our end-to-end unified solution can help you successfully implement and effectively manage your Community Supports and ECM initiatives.