CalAIM experiences: Implementer views after 18 months of reforms

CalAIM, the multiyear effort to reform the state’s Medi-Cal system, is now in its second year. To gain a clearer picture of how implementation is occurring on the ground, CHCF commissioned an online survey, which was conducted July 21 to September 12, 2023, among 1,196 people working at managed care plans, behavioral health organizations, community-based organizations, social services organizations, and other types of people referred to collectively as “implementers” throughout this report.

Key findings of this report include:

• A majority (52%) say that “overall access to services, including those that address health-related needs (e.g., housing navigation)” has gotten somewhat or much better as a result of CalAIM’s implementation.
• Despite broad agreement with the goals behind CalAIM and some initial successes, satisfaction with implementation is not especially high — at least not at this point in the process. On a scale of zero to 10 where zero is “not at all satisfied” and 10 is “extremely satisfied,” the average rating is 5.9.
• When asked about how CalAIM has impacted their organization, a slight majority of implementers (51%) say that their ability to manage the comprehensive needs of people they serve has gotten better as a result of CalAIM, while 40% say that it has stayed about the same or that they are unsure.
• There is quite a bit of variation by sector when it comes to outlook on CalAIM — managed care plans (MCPs) tend to be much more positive about CalAIM implementation so far, while behavioral health providers are more likely than those in other sectors to say that things have not yet changed for the better.
• The most significant challenge reported is that payment rates are not covering the full cost of service (32% say “very challenging,” and 56% say “very or somewhat challenging”). However administrative burdens, too much time spent on documentation requirements, and ability to recruit and retain staff are also cited as major challenges.
• Social service organizations face a unique set of barriers, as they report having far less experience with contracting, data exchange, and closed-loop referrals than respondents who work in clinical settings or MCPs.