Blue Shield of California is actively engaging with the California State Legislature and Governor Gavin Newsom’s Administration to promote health equity for commercial and Medi-Cal consumers. In particular, Blue Shield of California and Promise Health Plan are supporting the rollout of California Advancing and Innovating Medi-Cal (CalAIM) and advancing statewide health data exchange to further institutionalize programmatic and technical capabilities to meaningfully address the inequities in the health care system.
What is CalAIM? One in three Californians obtain health care coverage through the Medi-Cal Program. The State’s commitment to transforming and strengthening the Medi-Cal Program is represented by CalAIM, a long-term effort that went into effect on January 1, 2022, and is inclusive of multiple initiatives. CalAIM centers on a whole-person, equitable approach to delivering quality health care that accounts for the social drivers of health impacting our Promise members. Through this multi-year commitment, Blue Shield of California Promise Health Plan is tackling health disparities and further closing gaps amongst the populations served throughout Los Angeles and San Diego Counties.
Key CalAIM initiatives Blue Shield Promise is involved in elevating with the Legislature and Newsom Administration include:
- Community Health Workers Medi-Cal Benefit
- Doula Services Medi-Cal Benefit
- Population Health Management Initiative
Community Health Workers Medi-Cal Benefit. Beginning July 1, 2022, services provided by Community Health Workers will be covered as a Medi-Cal benefit. Blue Shield Promise understands the value of Community Health Workers, having already implemented its Health Advocates Program in 2019.
Doula Services Medi-Cal Benefit. Doula services will be carved in as a Medi-Cal benefit beginning 2023. This aligns with Blue Shield’s investment in maternal and infant health equity. In addition to funding maternal and infant health programs in Los Angeles and San Diego, Blue Shield recently launched its Maternal Child Health Equity Initiative. This initiative tackles disparities in maternal health and maternal mortality rates by providing comprehensive and integrated care to mothers, including the delivery of doula services to Promise members in target areas. Blue Shield Promise supported the Governor’s budget allocation advancing doula services last year, and this year and is actively engaged in the implementation of doula services as a Medi-Cal benefit by the Department of Health Care Services.
Population Health Management Benefit. Also launching in 2023, the CalAIM Population Health Management initiative will establish a unified statewide approach to delivering whole-system, person-centered care across all Medi-Cal Managed Care Plans. Expanding health care data exchange is a key priority for Blue Shield Promise and believes it is a central capability in Improving health outcomes for our members. The Population Health Management initiative will only be realized through access to comprehensive member health care data, which will be leveraged to drive data-driven approaches, wellness and prevention services, whole person care management, and by addressing the social drivers of health.
Advancing Health Equity through Data Exchange. Blue Shield believes that statewide data exchange is foundational to advancing health equity. Consistent data standards shared across the health care sector are critical for identifying and monitoring responses to health ecosystem inequities. Health Information Exchanges (HIE’s) are uniquely positioned to securely collect, link, and share individual’s data among health plans, providers, and public and private payers. Building on their existing connections and processes, HIEs can use the data they receive from participants to create centralized records for all members, allowing for tailored, whole person care that ensures the health care system is meeting the needs of all Californians and addressing inequalities the access and care.
Last year, Blue Shield advocated for, and helped pass, AB 133, which puts California on the path of creating its first statewide Health and Human Services Data Exchange Framework. The Framework is a single data sharing agreement and common set of policies and procedures that will govern the exchange of health information among health care entities and government agencies beginning in June 2024. This year, Blue Shield is a member of California Health and Human Services Agency’s Stakeholder Board, ensuring that the goals of AB 133 are met, and California develops a strong Framework that helps address inequalities in the health care system head on.