Enhanced Care Management (ECM)

CalAIM’s Enhanced Care Management (ECM) aims to stabilize the health of the highest-need “Populations of Focus" who have multiple chronic conditions. The program addresses these Medi-Cal members' clinical and non-clinical needs not only at the doctor's office but wherever they need help: whether that's in their home, in a shelter or on the street. ECM makes it easier for them to get the care they need when they need it by coordinating between the medical, behavioral, dental, developmental and social services systems. This intensive coordination is led by a Lead Care Manager who:

  • Gets the member the specialized health care services they need (which can include finding doctors, scheduling appointments, and setting up rides to and from appointments)
  • Coordinates with the member’s care team (which can include their doctors, mental health providers, specialists, pharmacists, case managers, social services providers and others)
  • Helps the member better understand their medications, access community-based services and get follow-up care after they leave the hospital

This personalized level of support ensures members get the care, medications and referrals to resources they need. Members also get a customized care plan to help them better manage their symptoms and conditions in between visits. Anytime members have any issues, they can ask their Care Manager for support in getting the right kind of care. By going to the right doctor at the right time, they can avoid unnecessary emergency room visits—and the hospitalization or institutionalization that often results from lack of timely access to care.  

ECM currently serves those who:

  • Do not have stable housing 
  • Have health issues and have gone to the hospital or emergency department many times over the last six months
  • Struggle with a serious mental health condition or addiction
  • Are in a nursing home and want to transition back to the community
  • Are at risk for being placed in a nursing home

More populations will become eligible for ECM over the course of 2023, including:

  • Children and teens
  • Pregnant people
  • People within the justice system 

HPSM contracts with five agencies that provide ECM to our members: