Spotlight On: Supporting California’s Transformation of Medi-Cal

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California leads the nation in many domains. As the state with the largest health sector in the U.S., it provides critical healthcare coverage for the most underserved populations, reaching 1 in 3 Californians—or more than 12 million people total. And under its initiative, California Advancing and​ Innovating Medi-Cal (CalAIM), the state is poised to transform healthcare delivery, making Medi-Cal more equitable, coordinated, and person-centered for each person it covers. To address the root causes of health disparities, this large-scale transformation will take partners, voices, and solutions as diverse as the needs and challenges CalAIM will manage.

At Abt Global, we know that big or small, no matter the scale, a unique understanding of the people, partners and possibilities of every project must be front and center. We are honored to be a selected vendor for the ​Providing Access and Transforming Health (PATH) Technical Assistance (TA) Marketplace and a trusted partner in this unprecedented healthcare delivery journey. The PATH TA Marketplace aims to build capacity of on-the-ground partners to successfully implement CalAIM programs, including Enhanced Care Management and Community Supports. 

For almost 60 years, Abt has served as a trusted source of TA for clients in the U.S. and abroad. We’ve collaborated with federal, state, and local governments, rural jurisdictions, Tribal nations, community-based organizations, and philanthropies to improve the quality of life and economic well-being of people worldwide.

Browse by Domain:
Domain 1: Building Data Capacity: Data Collection, Management, Sharing and Use
Domain 2: Community Supports: Strengthening Services that Address the Social Drivers of Health
Domain 3: Engaging in CalAIM through Medi-Cal Managed Care
Domain 4: Enhanced Care Management (ECM): Strengthening Care for ECM “Populations of Focus”
Domain 5: Promoting Health Equity
Domain 6: Supporting Cross-Sector Partnerships
Domain 7: Workforce

Expertise
 

Our team of 500+ U.S.-based staff is dedicated to addressing pressing health and human services and equity challenges and bringing the following critical capacities essential to achieving the promise of CalAIM:

• Capacity building, health equity, and social drivers of health (SDoH) subject matter expertise and ready-to-deploy operating models
• Earned trust as a consensus builder and TA provider across SDoH domains and stakeholders
• Sophisticated-yet-adaptable digital solutions that link health and social platforms, including low-code/no-code tools that increase delivery velocity, improve flexibility, and elevate the user experience
• Harnessing data and analytics, including predictive models, to bridge the gap between policy and practice by identifying root causes
• Support in health policy and economics, epidemiology, long-term services and supports, food security, education, justice, chronic disease, and behavioral health.

We provide breadth, depth, and a proven approach to addressing SDoH needs and improving individual, child, and family well-being. Our team provides extensive program, data, policy, and digital expertise related to Medicaid, managed care, human services, housing, healthcare, climate, and public health. With communities and individuals with lived expertise, we co-create and implement a person-centered, data-driven approach infusing equity in all phases of our technical assistance project lifecycle. Our program and policy experts work with data scientists, engineers, and visualization experts to provide clients with multidisciplinary staff who ensure seamless, agile, and reliable support to meet their unique needs and goals.

We know that systemic inequities prevent people from accessing and benefiting from essential services. Understanding the sources of these inequities is a critical step in addressing them, and equity-centered data solutions and analysis are the foundation of Abt’s approach.

What do we mean by that? Data, algorithms, machine learning, and artificial intelligence (AI) reflect the biases in society. One of our critical functions as a digital TA provider is understanding bias embedded in data, as well as unrooting and preventing discrimination in our tools and analyses.

To advance health equity in states’ Medicaid programs, an equity- and user-centered digital approach means considering the pain points that all people who touch the system—beneficiaries, case managers, program and policy administrators, providers, managed care coordinators, and community-based organizations—experience when interacting with the systems and data that are intended to connect and serve beneficiaries.

          - Matt Gillingham, Vice President, Digital & Data Services

Domain 1: Building Data Capacity: Data Collection, Management, Sharing and Use

Data are useful if you can find the signal amid the noise. Working across different data systems and agencies is essential to comprehensively serve people covered by CalAIM.

At Abt, we do this everyday. To help modernize CMS’ data analytics, for example, our teams are applying a deep understanding of the agency’s digital transformation through the Enterprise Data Analytics Management and Maturing Execution (EDAMAME) project. By centralizing and leveraging data, CMS will be better able to make informed and timely decisions, reduce risk, eliminate manual analytical interventions, and optimize resources. We’re providing strategic and tactical support for data collection, exchange, management, and use.

Using Amazon Web Services and Tableau, Abt supports digital transformation at CMS by designing and launching dashboards and reporting systems that improve data flows, automation, and analytical processes—all essential capabilities to develop integrated SDoH protocols that support better health outcomes through improved quality of care and cost-effective services.

Relevant Projects

• Assess, Monitor, and Evaluate Home- and Community-Based Services Access | Client: Minnesota Department of Human Services
• Redesigning the Runaway and Homeless Youth Homeless Management Information System | Client: Family and Youth Services Bureau (FYSB), Department of Health and Human Services (HHS)
• Stella and Homelessness Data Exchange System | Client: Department of Housing and Urban Development (HUD)

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Domain 2: Community Supports: Strengthening Services that Address the Social Drivers of Health

More than 65 percent of Medi-Cal enrollees are from communities of color. Addressing social drivers of health is key to advancing health equity and helping people with high health care and social needs. (Source: CalAIM Community Supports for Social Drivers of Health)

Community supports are essential in addressing the complex and unmet needs that many Medi-Cal enrollees have. Abt has assisted Federal, State and local partners across the full spectrum of community supports, including discharge care planning and navigating housing programs, integrating evidence-based behavioral health, primary care and HIV services, assessing needs for home environmental modifications, and ensuring smooth transitions to nursing or assisted living facilities—to name just a few.

Relevant Projects

• California Homelessness Technical Assistance | Client: California Interagency Council on Homelessness
• Youth Homelessness Demonstration Program | Client: Housing and Urban Development (HUD); Continuums of Care for Los Angeles, Alameda County, San Diego
• Post-Acute Care Training II | Client: Econometrica/ Centers for Medicare & Medicaid Services

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Domain 3: Engaging in CalAIM through Medi-Cal Managed Care

Through our Federal TA and evaluation work, we have developed a unique understanding of how states with large managed care populations in urban and rural areas, and the associated payers and providers, implement health reforms, the common challenges they face, and related best practices. The project examples below illustrate our capabilities in:

• Monitoring and oversight, as well as implementing supports for adhering to program requirements
• Understanding implementation and sustainability of community supports, as well as TA for adhering to program requirements
• Designing and implementing surveys, interviews, and focus groups with Medicaid beneficiaries and health and community service providers
• Identifying potential areas where providers may need additional support to successfully participate in CalAIM initiatives.

Abt has supported many projects specifically aimed at integrating enhanced care management (ECM) and community supports. Our Accountable Health Communities (AHC) project with CMS focuses on how health care providers can address health-related social needs. While many needs are consistent across providers, different regions and populations have unique challenges and opportunities. Rural areas, for example, face challenges with provider access, beneficiary transportation, and access to social supports that are more available in urban areas. Understanding the wide variation between rural and urban communities, Abt provides customized TA to address the spectrum of challenges with contextual, community-informed solutions.

Much of Abt’s work includes rural communities. In West Virginia and Indiana, we are working to understand the successes and challenges of providing ECM for pregnant women with substance use disorder. In Minnesota, a state with significant rural and Tribal communities, we have been helping leaders gain an in-depth understanding of home and community-based services (HCBS) access to inform a strategic approach to building greater HCBS capacity statewide. We recognize that health reforms run the risk of focusing on more urban areas, where higher patient volume can make delivery system changes more predictable and more cost- effective. Abt is skilled at assisting both providers and managed care organizations to become aware of and address the risks and opportunities to successfully deliver rural health and social care.

Many community needs aren’t geographic. Justice-involved individuals have specific needs to successfully re-enter the community and reduce recidivism. Individuals released from jail and prisons are among those most vulnerable to homelessness. The challenges they face in securing housing upon re-entering community life are substantial. Our 2020 Center for Evidence-based Solutions to Homelessness Criminal Justice work included a literature review to understand best practices in serving people formerly incarcerated and preventing homelessness, finding that homelessness is a particular concern for many subpopulations such as people with substance use and mental health issues, chronic health conditions, and living in poverty—populations likely to be Medicaid-enrolled. We translate expertise at the intersection of health, homelessness, and justice system involvement into actionable TA plans to support eligible entities across the state of CA.

Relevant Projects

• Strategic Medicaid and CHIP Managed Care Monitoring, Oversight, and Technical Assistance | Client: Centers for Medicare & Medicaid Services (CMS)
• Dissemination of Evidence-Informed Interventions to Improve Health Outcomes along HIV Continuum of Care-Dissemination and Evaluation Center | Client: Health Resources and Services Administration (HRSA)
• The Maternal Health Feasibility Study | Client: Department of Justice (DOJ)

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Domain 4: Enhanced Care Management (ECM): Strengthening Care for ECM “Populations of Focus” 

Abt’s multidisciplinary team understands the interlocking health and social needs that affect the diversity of people served by Medicaid programs and influence their health and wellbeing. CalAIM’s Enhanced Care Management (ECM) initiative makes explicit the components of a person-centered, interdisciplinary approach to coordination of physical health care, mental and behavioral health care, and social care to holistically address an individual and family's unique needs and circumstances. We stand ready to provide similar support to organizations working in partnership with California’s Medicaid managed care plans to deliver ECM to address the needs of children and adults.

Abt applies state-of-the art approaches to deliver high-quality, rigorous TA. We conduct research and assess the strength of evidence before making recommendations or delivering TA. We know one sizes does not fit all, and provide TA through a variety of mechanisms—ranging from conducting environmental scans and synthesizing best practices—to convening experts or facilitating focus groups, to performing complex data analyses to help inform and crystallize program options.

Relevant Projects

• MassHealth Crisis Intervention Training and Technical Assistance | Client: Massachusetts Executive Office of Health and Human Services
• Collaboration Technical Assistance to New York City (NYC) | Client: NYC Department of Health and Mental Hygiene and the Mayor’s Office for Economic Opportunity
• Assess, Monitor, and Evaluate Home and Community-Based Services Access | Client: Minnesota Department of Human Services (DHS)

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Domain 6: Supporting Cross-Sector Partnerships

Our approach to cross-sector TA centers around systems and design thinking. We believe these elements engage key stakeholders and earn their necessary support, bridging gaps across programs and organizations.

Systems Thinking. This method enables us to understand the many interrelated factors that contribute to specific health outcomes and to understand how these factors work in relationship to each other over time. For example, safe, stable, affordable housing in a neighborhood with minimal environmental hazards and access to transportation and healthy, affordable food promotes good health. A single adult who does not have stable or affordable housing may find they have to move frequently or face eviction, increasing their social isolation, and negatively impacting their mental health and credit score. These problems can potentially lead to moving into unsafe housing or no housing at all, as well as difficulties accessing other social services.

Design Thinking. While systems thinking provides an understanding that almost all systems that influence health are dynamic, design thinking provides the tools to positively impact these systems. At each stage, individuals who most directly interact with and are impacted by the system should be engaged. Design thinking can help understand the system from the perspective of those most impacted by it, and to test innovative solutions that improve health equity.

Relevant Projects

• Strategic Medicaid and CHIP Managed Care Monitoring, Oversight, and Technical Assistance | Client: CMS
• Youth Homelessness Demonstration Program | Client: Housing and Urban Development (HUD); Continuums of Care for Los Angeles, Alameda County, San Diego
• Section 811 Project Rental Assistance Program | Client: HUD
• Infant Mortality Collaborative Innovation and Improvement Network  | Client: HRSA Maternal and Child Health Bureau (MCHB)
• Accountable Care Organization (ACO) Investment Model  | Client: CMS

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Domain 7: Workforce

Abt has deep expertise in TA at the local, state, and national levels. Our staff apply learner-centered design and adult learning strategies for equitable access to a range of learning modalities. We are also adept in using quality improvement methods to collect feedback from target audiences in non-burdensome ways to strengthen our content and approaches.

Abt has been a long-time collaborator with the United States Department of Health and Human Services (HHS) in conducting impact studies of both the Pathways for Advancing Careers and Education (PACE) project and the Health Profession Opportunity Grants (HPOG) program. These two large-scale projects addressed education and training programs for Temporary Assistance for Needy Families (TANF) recipients and other low-income adults. The programs address a range of strategies within the career pathways framework to support getting people started and then advancing in careers. These analyses provided Abt with a deep understanding of both effective and less effective career pathways strategies to assist low-income individuals to secure credentials, gain employment, and increase earnings.

Relevant Projects

• Implementation and Management of the Payment Reform Technical Assistance Program | Client: Commonwealth of Massachusetts
• Paraprofessional Apprenticeship Technical Assistance (PATA) Program | Client: HRSA Bureau of Health Workforce (BHW)
• Developing the National Health Service Corps (NHSC) Pipeline Readiness Technical Assistance | Client: HRSA