Topic
California
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From HMOs to Homerooms: What Managed Care 101 Teaches Us About California’s Youth Behavioral Health Reform
HMO, PPO, EPO, capitation, value-based care — see how these managed care basics play out in real life through California’s CYBHI Fee Schedule program and its Evaluation Hub…
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Healthcare Costs and the New Population Needs Assessment
The new Population Needs Assessment requirements in California’s Population Health Management program aim to improve health outcomes while impacting healthcare costs. Initially, increased expenses from community engagement and…
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New California PNA Requirements: A Shift in Healthcare Strategy
As of 2024, California healthcare plans must submit a Population Needs Assessment every three years to enhance community engagement and address diverse health needs. This shift aims to…
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Academy · Administrative Work · Business · Calculators · California · California Advancing and Innovating Medi-Cal (CalAIM) · Care Coordination · Data Tools · Finance & HR · Funding · Health Equity · KPI · Managed Care · MCO · Medicaid · Modeling · Providers · Resource · Return on Investment Calculator · ToolkitsUnlock Financial Success with CalAIM: Budget Estimator Tool for CBOs
The CalAIM Budget Estimator Tool helps CBOs navigate the financial complexities of contracting under CalAIM. It offers an Excel-based template with built-in assumptions, cost input fields, revenue customization,…
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California · California Advancing and Innovating Medi-Cal (CalAIM) · Data Tools · Databank · Value Based Care · YouthUtilizing California State Data to Enhance Care for Foster Youth
The Continuum of Care for children in out-of-home settings can be enhanced by leveraging existing data sources. California’s CDSS, DDS, DHCS, and CDE provide crucial data on community…
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California · California Advancing and Innovating Medi-Cal (CalAIM) · Care Coordination · CHIP · CMS · Justice-Involved · Medicaid · Substance Use Disorders · Value Based Care · YouthMedicaid Coverage for Incarcerated Youth: California’s Initiative
What is the Justice-Involved Initiative? The Justice-Involved Initiative is a pioneering program under California’s Medicaid reforms, specifically designed to extend Medicaid coverage to incarcerated individuals. Historically, under the…
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Business · California · California Advancing and Innovating Medi-Cal (CalAIM) · Medicaid · Population Needs Assessment (PNA) · Quality Improvement · Resource · SDoHAddressing Critical Health Needs: Partnership HealthPlan of California Strategic Response to the 2024 Population Needs Assessment
Business Brief: Addressing Critical Needs in Population Health Partnership’s membership remained relatively stable in 2023. The member redetermination process, resulting from the winding down of the COVID-19 Public…
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Business · California · California Advancing and Innovating Medi-Cal (CalAIM) · Leadership · MedicaidStrategies for Success: Navigating California’s CalAIM Program
by Ali Modaressi, California Health Report California’s ambitious journey to reshape health care through the multiyear Medi-Cal reform effort known as California Advancing and Innovating Medi-Cal (CalAIM) represents…
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Dashboards: Breastfeeding Intention and Duration Indicators
The Breastfeeding Intention and Duration Indicators are key measures used to track breastfeeding practices and intentions among new mothers. These indicators include plans to breastfeed exclusively or in…
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California Primary Care Clinic Annual Utilization Data
California Primary Care Clinic Annual Utilization Data. Access the complete data set of annual utilization data reported by primary care clinics contains basic clinic identification information.
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Medi-Cal Managed Care Enrollment Report
This dataset contains the total number of Medi-Cal Managed Care enrollees based on the reported month, plan type, county, and health plan.
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Medi-Cal Managed Care Quality Improvement Reports (CA)
Various reports from the State of California regarding the quality of care provided by Medi-Cal managed care health plans. Plan-specific evaluation reports are also prepared for each individual…
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Payer Notice regarding the implementation of Senate Bill 855, Mental Health and Substance Use Disorder Coverage
Carenodes Health Enterprise Office of the Executive Dear Health Plan Representative, Please see attached Notice regarding the implementation of Senate Bill 855, Mental Health and Substance Use Disorder…
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Physical Therapy Referrals: Not Needed
Physical therapist services are generally covered as a basic benefit by all major health insurance companies. Ask your physical therapist to contact your insurance company to determine your…