A California county provides multiple support avenues for their citizens, including services that improve their health and wellness and help them become productive contributors to their community.
Enhanced Care Management (ECM) is a component of CalAIM that the county chose to implement because it addresses the clinical and non-clinical needs of the highest-need CalAIM enrollees. Beneficiaries will have a Care Manager who coordinates care and services and can meet enrollees wherever they are – on the street, a shelter, a medical facility, or home. You can read about this innovative program here.
About Enhanced Care Management
So how does the program work? Health plans send lists of CalAIM participants to social services organizations who can then reach out to these individuals, asking if they want to sign up for the ECM program. The program allows participants to receive much-needed access to housing, rehab, counseling, and other relevant services. Many organizations need a technology platform to help facilitate these efforts.
This particular county engaged with Provisio to set up ECM on the Salesforce platform. In Salesforce, they can add clients to the system, record outreach, and mark when an individual is ready to join the program. Provisio built all the forms they needed for billing inside of Salesforce, so they can export the forms and send them to the health plan for billing.
Opening New Revenue Opportunities
With previous programs, like Whole Person Care and the Health Home Program, organizations could not bill for the time spent reaching out to individuals; they could only bill when someone joined. The ECM program, on the other hand, allows them to bill for outreach efforts. Through Salesforce, organizations can log the time spent making contact. This not only allows them to help vulnerable community members but also opens up a new revenue stream.
Consider a Phased Approach to Implementation
If your organization is interested in offering ECM, you can do a phased approach. For example, your organization can get up and running on ECM in phase one, and in phase two Provisio can help automate the process of data moving from the health plans into Salesforce and reporting back to the health plans for billing. This allows staff to save anywhere from tens or hundreds of hours each month. If you are wondering whether you need to have an EHR to implement ECM, the answer is no. But if you DO have an EHR, we can integrate with it. Integrations with outside systems could be part of a phased approach as well.
Because Provisio has implemented ECM for many clients, our project timeline is shortened. We have worked with several health plans – with thousands of participants – so we have become very adept at meeting the specific requirements for each health plan.
The PATH Technical Assistance Marketplace
Agencies that want to adopt ECM can go to this marketplace and find a consultant to help them. The PATH Technical Assistance Marketplace initiative provides funding for providers, community-based organizations, counties, and others to obtain technical assistance resources to establish the infrastructure needed to implement ECM. You can apply to shop and receive services. And guess what? Provisio is one of the approved vendors on the marketplace.
If you are moving toward ECM, there should not be any obstacles in your way. An experienced consultancy like Provisio can help you with all the requirements, plus you can apply for funding to cover the costs. Sounds like a win win to us!
For more information, contact us here. We hope to work with many more organizations on the ECM and Community Supports initiatives.
Marjorie lives in Saint Louis, Missouri. She received her Master’s degree in English from Truman State University. Her responsibilities at Provisio Partners include content creation and technical writing.