Population Health Management (PHM) Initiative

The Population Health Management (PHM) Initiative is a cohesive plan of action for addressing needs for all enrollees across the continuum of care. Under CalAIM, managed care plans will be required to implement a whole-system, person-centered strategy that:

  • Focuses on wellness and prevention
  • Includes assessments of each enrollee’s health risks and health-related social needs
  • Provides care management and care transitions across delivery systems and settings

Under PHM, managed care plans are responsive to individual member needs within the communities they serve while also working within a common framework and set of expectations. Establishing a cohesive, statewide approach to population health management ensures that all members have access to a comprehensive program that leads to longer, heathier lives, improved clinical outcomes and a reduction in disparities. That includes everyone across the age span.

HPSM conducts an annual Population Needs Assessment (PNA) of our Medi-Cal population to identify member health needs and health disparities — read HPSM’s 2023 PNA.

CalAIM’s focus on population health will:

  • Improve care for Medi-Cal members by putting people in the center, with a focus on prevention, wellness and care coordination services for all enrollees through the Basic Population Health Management Program
  • Reduce health disparities through improved community partnerships, enrollee engagement and a broader focus on addressing unmet health and health-related social needs
  • Make meaningful advances in quality by establishing targets and benchmarks to measure quality, with a focus on preventive care and wellness

Several key elements of PHM were already in place in the Medi-Cal program prior to CalAIM through California Department of Health Care Services (DHCS) policies as well as managed care plans' procedures and programs. But PHM will enhance and add to those elements by establishing a comprehensive, accountable plan of action for addressing member needs and preferences across the continuum of care.