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Key Takeaways
- Delivering ECM is complex with challenges including varying requirements from managed care plans, and the different needs and challenges of so many populations of focus.
- Variation is common creating significant administrative burdens for providers who must adapt to different systems and requirements imposed by managed care plans.
- And yet, success is happening as ECM providers are effectively helping clients navigate systems and access needed services.
The Enhanced Care Management (ECM) program, launched in January 2022 as part of California’s CalAIM (California Advancing and Innovating Medi-Cal) initiative, represents a significant transformation in how Medi-Cal serves members with complex needs. This report, Perspectives from the Field: Up Close with ECM Providers, examines the early implementation experiences of ECM across different populations of focus (PDF).
During summer 2023, a UCSF Health Systems Leadership Pathway team interviewed 18 organizations providing ECM services across California. Their investigation revealed four critical insights:
- ECM Implementation Is Complex
- Organizations face challenges including variable provider capacity, inconsistent data quality from health plans, diverse needs across different populations, varying requirements between managed care plans, and limited established protocols in this new program.
- Variation Is the Norm
- The absence of standardized approaches to ECM delivery across California has created significant administrative burdens for providers, who must adapt to different systems and requirements.
- Success Is Being Achieved
- Despite obstacles, ECM providers are effectively helping patients navigate fragmented systems and access needed services, demonstrating the program’s potential value.
- Better Measurement Standards Are Needed
- Beyond enrollment and engagement metrics, ECM providers lack key performance indicators to target and measure program impact, making it difficult to demonstrate outcomes.
Program Evolution
ECM implementation has been phased, beginning in 2022 with three populations in 25 counties and expanding statewide six months later. Additional populations were added throughout 2023, with the final two — birth equity and people transitioning from incarceration — launching in January 2024.
This report offers valuable guidance for providers, Medi-Cal managed care plans, and California Department of Health Care Management administrators as they continue to develop ECM as a critical benefit for Californians with complex medical, behavioral, and social needs. The findings highlight both challenges and opportunities in this ambitious effort to transform care delivery for vulnerable populations.
About the Authors
A research team of UCSF medical residents and fellows worked with a team from California’s Department of Health Care Services to interview 18 ECM organizations. Providers describe their implementation efforts, impact of the program so far, and rollout challenges.
Claudia Boyd-Barrett is a longtime journalist based in Southern California. She writes regularly about health and social inequities.
From UCSF Health Services Leadership Pathway:
- Justin Zhang, MD, a third-year internal medicine resident
- Helen Pu, MD, a pediatric hospital medicine fellow
- Diana Funk, MD, a chief resident in internal medicine
- Reem Al-Atassi, MD, now completing a fellowship at the University of Pittsburgh Medical Center
- Edgar Pierluissi, MD, professor of clinical medicine at UCSF, and faculty adviser for the Health Systems Leadership group
Authors & Contributors
Claudia Boyd-Barrett
External Author
Claudia Boyd-Barrett is a longtime journalist based in Southern California. She writes regularly about health and social inequities. Her stories have appeared in the Los Angeles Times, San Francisco Chronicle, San Diego Union-Tribune, and California Health Report, among others.
Boyd-Barrett is a two-time USC Annenberg Center for Health Journalism fellow and a former Inter American Press Association fellow.
