Enhanced Care Management (ECM) & California Integrated Care Management
What is ECM and CICM?
California Advancing and Innovating Medi-Cal (CalAIM) is a new initiative by the Department of Health Care Services (DHCS). CalAIM works to improve the quality of life and health outcomes of Medi-Cal members by implementing a broad delivery system, program, and payment reform across the Medi-Cal program. CalAIM establishes the framework to address social determinants of health and improve health equity statewide.
Both Enhanced Care Management (ECM) and California Integrated Care Management (CICM) are whole-person, interdisciplinary approaches to care. ECM and CICM address the clinical and nonclinical needs of members with the most complex medical and social needs. Both approaches provide systematic coordination of services and comprehensive care management that is community-based, interdisciplinary, high-touch, and person-centered.
What are ECM and CICM Services?
The goal of both ECM and CICM is to coordinate all primary, acute, behavioral, developmental, oral, social needs, and long-term services and supports for members, including participating in the care planning process, regardless of setting. ECM and CICM are intended to be interdisciplinary, high-touch, person-centered, and provided primarily through in-person interactions with members where they live, seek care, and prefer to access services.
ECM eligible members will be assigned an ECM provider and a Care Manager who will assess a member’s needs to best support their health care and social needs.
CICM eligible members will be identified by the SFHP Care Plus Care Management team. Members receiving CICM will be paired with a CICM Care Manager at North East Medical Services (NEMS) who can assess their health and social needs.
See below to learn more about the core services offered through ECM and CICM.
Outreach and Engagement: Outreach and engagement includes active and progressive attempts to connect with and engage with members who are eligible, demonstrating a culturally and linguistically competent approach to build trust.
Comprehensive Assessment and Care Management Plan: Following successful engagement with the member, CICM Care Managers complete a comprehensive biopsychosocial assessment of member needs and engage the member in creation of a person-centered care plan that outlines the member’s strengths, risks, needs, and goals.
Enhanced Coordination of Care: Enhanced Coordination of Care includes the services necessary to implement the care plan, including ensuring care is continuous and integrated among all service providers. CICM Care Managers support coordination across the continuum of care, including primary care, physical and developmental health, mental health, SUD treatment, LTSS, oral health, palliative care, and necessary community-based and social services, including housing, as needed.
Health Promotion: Health promotion activities encourage and support members to make lifestyle choices based on healthy behavior, with the goal of motivating members to successfully monitor and manage their health. Examples include services like coaching, health education, teaching new skills, and connection to resources.
Transitional Care Services: Transitional care services are intended to support members as they transition between care settings or from one level of care to another, from the point of discharge planning until they are successfully connected to all needed services and supports. This can include discharges from hospitals, institutions, other acute care facilities, and SNFs to home or community-based settings, Community Supports, post-acute care facilities, or LTC settings.
Member and Family Supports: Member and Family Supports include activities that ensure the member and family/support are knowledgeable about the member’s conditions, with the overall goal of improving their adherence to treatment and medication management.
Coordination of and referral to Community and Social Support Services: Coordination of and referral to community and social support services involves determining appropriate services to meet the needs of members and ensure that any present or emerging social factors can be identified and properly addressed.
Who can receive ECM & CICM services?
DHCS has established specific criteria for ECM eligibility. To be able to enroll in ECM, individuals must meet criteria for at least one of the ECM Populations of Focus.
ECM is available for the following Populations of Focus:
- Adults, children/youth, and families experiencing homelessness
- Adults and children/youth with or at risk for avoidable ED and hospital utilization
- Adults and children/youth diagnosed with SMI or SUD
- Adults living in the community who are at risk for long-term care institutionalization
- Adult nursing facility residents transitioning to the community
- Adults and youth who are transitioning from incarceration
- Adults and youth who are pregnant or postpartum and subject to racial and ethnic disparities
CICM covers the same Populations of Focus listed above—but for adults only. Families and children/youth are not eligible for CICM.
Unique Populations of Focus
There are many overlaps between the Populations of Focus for ECM and CICM, but also distinct differences to be aware of.
These Populations of Focus are unique to ECM:
- Children/youth enrolled in California Children’s Services (CCS) or CCS Whole Child Model (WCM) with additional needs
- Children/youth involved in child welfare
- Adults and children/youth with intellectual and developmental disabilities who also qualify for another ECM Population of Focus
These Populations of Focus are unique to CICM:
- Adults who have a formal Alzheimer’s or dementia diagnosis
- Adults who have documented dementia care needs
Who can I contact for questions about ECM/CICM for Justice-Involved populations?
SFHP’s Justice-Involved Liaisons are here to help with ECM provider assignment and to answer your questions about ECM services to support the Justice-Involved population. Contact a Justice-Involved Liaison:
Tina Yu – 1(415) 615-4203 or [email protected]
Shauntessa Aguon-Clark – 1(415) 530-6143 or [email protected]
Additional information about ECM eligibility criteria is available in the DHCS ECM Policy Guide. Visit ECM and Community Supports to learn more.
To contact SFHP Care Plus about CICM services for Justice-Involved populations, call the SFHP Care Plus Care Management Line at 1(415) 615-4545 or email [email protected].
How can I refer an SFHP member to ECM?
If you believe your patient would benefit from our services, either you or the patient can call our intake line at 1(415) 615-4501 weekdays from 8:00am to 5:00pm. Or email a completed ECM referral form to SFHP’s Care Management intake team at [email protected] to evaluate eligibility.
ECM referral forms are available here: Adult (21+ years of age) and Children and Youth (less than 21 years of age). For additional questions about ECM, please contact SFHP at [email protected].
How can I refer an SFHP Care Plus member to CICM?
To contact SFHP Care Plus about referring a member for CICM services, call the SFHP Care Plus Care Management Line at 1(415) 615-4545 weekdays from 8:30am to 5:00pm.
CICM referral forms are available here: Adult CICM referral. For additional questions about CICM, please contact SFHP Care Plus at [email protected].
Who provides ECM & CICM Services?
Please see the SFHP Medi-Cal Provider Directory to identify ECM providers currently contracted with SFHP.
SFHP will continue to collaborate with community providers to onboard additional ECM providers. Please contact SFHP’s Provider Relations Department at 1(415) 547-7818 ext. 7084 or email Provider Relations if you have any questions.
SFHP contracts with North East Medical Services (NEMS) to provide CICM services for SFHP Care Plus members. If an SFHP member is receiving ECM services before transitioning to SFHP Care Plus, we will ensure they continue to receive the same services with SFHP Care Plus.
Resources for ECM Providers
ECM Trainings
SFHP has offered a series of trainings for our ECM providers that describe best practices for delivering ECM services and working with the ECM populations of focus. Recordings of all trainings are included below. The ECM Bootcamp and Person-Centered Care Planning trainings are mandatory for all ECM providers. Any ECM providers serving nursing facility residents who could transition to the community and/or adults at risk for long-term care institutionalization should complete the January 2023 Populations of Focus training.
Outreach & Engagement
An overview of strategies to initiate successful outreach for ECM and to sustain member engagement throughout the benefit.
Transitions of Care (TOC)
An overview of strategies, techniques, and best practices to support member care during transitions between care settings, including discharges from hospitals and nursing facilities.
ECM Bootcamp
A 2-part training that overviews the ECM core services and how to work with the populations who are eligible for ECM.
January 2023 Populations of Focus
This training overviews best practices for working with the two populations of focus that went live in January 2023 – nursing facility residents who could transition to the community and adults at risk for long-term care institutionalization.
Best Practices for Case Management Training – March 2025
The Best Practices for Case Management training provides an overview of Person-Centered Planning (PCP) within the Enhanced Care Management (ECM) model. Participants will learn how to develop individualized care plans that prioritize member goals, strengths, and preferences while promoting equity and cultural humility. The session will cover key principles, required components, and best practices for effective person-centered care. Please share this training with Lead Care Managers and/or member facing staff from your organization.
Claims Submissions: Overview for SFHP Providers
This training is intended to support ECM and Community Supports providers with the claims submissions process to San Francisco Health Plan (SFHP). The training will cover key aspects of claims processing, including understanding denial reasons, corrected vs. replacement claims, and how to identify and track denied claims in the portal. Providers to submit claims directly to SFHP electronically using the SFHP Provider Portal or 837 file should attend this training.
Closed Loop Referral Training
SFHP is provided a live, virtual training for Enhanced Care Management and Community Supports providers to support the implementation of CLR requirements. This training was designed to help providers understand upcoming expectations and ensure readiness to comply with SFHP and the Department of Health Care Services’ (DHCS’) guidance.
Enhanced Care Management for Justice Involved Members
This training is designed to support Enhanced Care Management (ECM) providers and corrections department staff in implementing DHCS requirements to deliver ECM services to justice-involved individuals prior to their release. Participants will gain a clear understanding of the pre-release engagement process and explore strategies to build and sustain strong relationships between ECM teams and correctional facility partners. This training aims to ensure that justice-involved members receive timely, person-centered care and seamless transitions back into the community.