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CalAIM (California Advancing and Innovating Medi-Cal) is a multi-year initiative by the California Department of Health Care Services (DHCS) to improve the health outcomes and quality of life for Medi-Cal members. The enhanced care management services of CalAIM are designed to provide more personalized, coordinated, and effective care to Medi-Cal beneficiaries with complex needs. The…
Many Medi-Cal managed care plans (MCPs) have introduced quality incentive programs (QIP) for Enhanced Care Management (ECM) providers. These QIP bonus payments are valuable incentives that encourage ECM providers to improve the quality of care they provide. By meeting specific quality metrics, ECM providers can earn a significant amount of money that can be used…
In the CalAIM ECM program, DHCS has provided standards for MCPs and ECM Providers to exchange information about members in the following types of exchanges: MCP Member Information File; ECM Provider Return Transmission File; ECM Provider Outreach Tracker File MCP MIF (Member Information File): MIF is a file containing information about the MCP's members. The MIF…