新聞發布​​ 

加州醫療保險的轉型仍在繼續​​ 

新數據顯示更多縣正在實施增強的護理管理和社區支持，幫助更多加州人獲得他們需要的護理​​ 

SACRAMENTO — The Department of Health Care Services (DHCS) today released a quarterly update on the latest Enhanced Care Management (ECM) and Community Supports data. The data show an uptick in both the availability and use of Community Supports, showing significant growth in the number of counties offering these services.​​ 

ECM and Community Supports improve Medi-Cal members’ overall health and well-being by addressing both medical and social factors that can impact a person’s health, including housing assistance, medically tailored meals to support short-term recovery, homemakers, and personal services to create a high-touch, person-centered approach to care.​​ 

“Every day, more Medi-Cal members are benefitting from personalized care that goes beyond the traditional doctor’s office or hospital setting,” said DHCS Director Michelle Baass. “Enhanced Care Management and Community Supports are two key pillars of Medi-Cal transformation, and we’re seeing a great response. But there is still room to help even more people.”​​ 

“California Advancing and Innovating Medi-Cal (CalAIM) is a nation-leading effort that requires the support of all individuals, organizations, and health plans trusted with delivering care to members,” said State Medicaid Director Tyler Sadwith. “We are working closely with stakeholders, providers, and Medi-Cal managed care plans to ensure members and their caregivers know they can readily access these transformative services.”​​ 

WHAT THE DATA SHOW: As of January 2024, 23 counties offered all 14 Community Supports, and all counties offered at least seven Community Supports. This marks a significant increase from the end of 2022, when only three counties offered all 14 Community Supports. Overall, approximately 103,000 Californians (via Medi-Cal) used Community Supports in the first 21 months of the program, with more than 186,000 total services delivered. There is significant quarter-over-quarter growth in utilization; approximately 62,000 Californians (via Medi-Cal) utilized Community Supports in quarter (Q)3 2023 alone, up 170 percent from Q4 2022.​​ 

此外，每季接受 ECM 服務的加州 Medi-Cal 會員人數也在增加；在 2023 年第 3 季，約有 86,000 名會員接受 ECM 服務，較 2022 年第 4 季增加 28%。2023 年第三季總計包括 6,300 名 21 歲以下的會員，其中許多人在 2023 年 7 月新符合 ECM 資格。全州共有 160,000 多名 Medi-Cal 會員在 ECM 福利實施的前 21 個月內接受了 ECM。​​ 

WHY THIS MATTERS: This latest update shows a sustained increase in utilization as additional Populations of Focus (POF) become eligible for ECM and additional Community Supports services are offered in counties across the state.​​ 

DHCS expects to see more enrollment growth across ECM and Community Supports in the coming months and years. As California continues transforming Medi-Cal, ECM and Community Supports play a critical role in supporting whole-person care for Medi-Cal members with complex medical and health-related social needs. DHCS remains committed to supporting and sustaining this growth through program monitoring, design improvements, standardization, and direct technical assistance.​​ 

他們在說什麼​​ 

• “At Pacific Clinics, everything we do helps the people we serve to achieve their wellness goals and advance health equity. Medi-Cal transformation is essential to this work,” said Vice President of Emerging and Statewide Services Jacquelyn H. Torres. “Through Community Supports, we provide crucial pathways to affordable housing for individuals and families. Additionally, Enhanced Care Management ensures access to comprehensive services tailored to meet complex health needs with life-affirming services and care.”​​ 

• “Enhanced Care Management represents a critical new safety net service in California,” said Leticia Galyean, CEO of Seneca Family of Agencies. Seneca is a nonprofit provider of behavioral health services to young people and their families, and currently holds 10 ECM contracts with managed care plans across the state. “Seneca is integrating Enhanced Care Management services with our full continuum of prevention and intensive services for young people, promoting true whole-person care and cross-system integration and collaboration in ways we could not before.”​​ 

有關這些福利和服務的資訊：ECM 福利為有最複雜醫療和社會需求的 Medi-Cal 會員提供高接觸、以人為本的照護管理。接受 ECM 的會員有一位主要的護理經理，協助他們協調健康相關的護理和社會服務，使他們更容易在適當的時間、適當的環境（通常是他們所在的地方）獲得適當的護理。社區支援是 Medi-Cal 管理性護理計劃提供的 14 種服務，幫助會員解決與健康有關的社會需求，例如獲得安全的住屋或健康的膳食，以幫助他們從疾病中康復，避免更高和更昂貴的護理程度，並過更健康的生活。​​ 

TAKING ACTION: DHCS and its managed care plan partners are working to expand access and use of ECM and Community Supports in 2024 and beyond by:​​ 

• 擴大對 ECM 福利的訪問權限，從 2024 年 1 月 1 日起，其他 POF 符合 ECM 資格獲得 ECM，並增加州各縣的可用社區支持服務數量。​​ 
• 透過 ECM 和社區支援行動計劃（包括簡化授權和轉介程序、擴大服務提供者網絡以及改善資料交換），完善計劃運作和政策，以消除服務提供者簽約和使用服務的障礙。​​ 
• Providing grant funding and technical assistance to support providers in implementing and expanding capacity for ECM and Community Supports through Providing Access and Transforming Health (PATH), a $1.85 billion initiative.​​ 
• 定期舉辦聆聽會議，包括為全州提供者和社區成員舉辦的PATH 協作規劃和實施(CPI) 倡議工作組，歡迎來自全州提供者和社區成員的不同利益相關者團體對ECM 和社區支持實施情況的反饋。​​ 
• 鼓勵管理式醫療計劃透過激勵付款專案進一步提高 ECM 和社區支持的使用率。​​ 
• 根據託管護理計劃合同的要求擴展和利用各種方法，以識別可能受益於 ECM 和社區支持的會員。 這還包括主動確保合約提供者網絡了解 ECM 福利和社區支持服務以及資格標準，以及清楚提交轉介給受管理護理計劃的途徑。​​ 
• 確保管理式醫療計劃面向公眾的網站、會員手冊和提供者目錄包含有關所提供的 ECM 和社區支持以及如何獲取這些資訊的最新資訊。​​ 

BIGGER PICTURE: DHCS is transforming Medi-Cal to ensure Californians can get the care they need to live healthier lives. Medi-Cal members have access to new and improved services and receive comprehensive care that goes beyond the doctor’s office or hospital and addresses all of their physical and mental health needs. These changes will create a more coordinated, person-centered, and equitable health system that works for everyone, regardless of race, ethnicity, gender, sexual orientation, disability, immigration status, location, or health needs.​​ 

加州醫療補助健康保健計劃在為加州人提供建設更健康、更公平的州所需的護理方面處於領先地位。​​ 

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